bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of facility volume on treatment guideline compliance and overall survival in oral tongue squamous cell carcinoma.
Authors: Tam Samantha , Du Xianglin L. , Lewis Carol M. , Yamal Jose-Miguel , Weber Randal S. 
Published: September 2018

17 Background: National treatment guidelines guide cancer care using the best available evidence and understanding the drivers of guideline compliance is essential to identifying modifiable factors to improve quality of care. This study aims to explore the impact of facility volume on the rate of guideline compliance in patients with oral tongue cancer and its effect on overall survival. Methods: Using National Cancer Database from 2004 to 2013, this retrospective cohort study investigated patients undergoing curative surgical treatment for oral tongue squamous cell carcinoma. Patients were divided into three tertiles according to mean annual case volume at their treatment facility. Guideline compliance was based on the National Comprehensive Cancer Network oral cavity cancer guidelines. Predictors of guideline compliance and overall survival were determined using multiple logistic regression and Cox Proportional Hazards models. Results: Guideline compliant care was delivered in 54.5% of the 35,810 eligible patients. Those treated at intermediate volume facilities had 1.75 times greater odds of receipt of guideline compliant care (95% CI = 1.57-1.96) and 2.14 times greater in high volume facilities (95% CI = 1.91-2.40) compared to low volume facilities. Guideline compliance (adjusted hazard ratio [HRadj] = 0.78, 95% CI = 0.72-0.84) and treatment at a high volume facility (HRadj= 0.88, 95% CI = 0.80-0.98) were independent predictors of overall survival. Conclusions: Facility volume independently predicted guideline compliance in oral tongue cancer. Guideline compliance and treatment at a high case volume facility were predictors of overall survival. Clinicians should apply guideline compliant care regardless of practice setting and treatment at higher volume centers should be considered.
Cancer patient (pt) attitudes and preferences towards smoking status assessment.
Authors: Eng Lawson , Liu Sophia , Zhang Qihuang , Farzanfar Delaram , Milne Robin , Yeung Sabrina , Brown M Catherine , Howell Doris , Xu Wei , Goldstein David Paul , Jones Jennifer M. , Selby Peter , Evans William K. , Giuliani Meredith Elana , Liu Geoffrey 
Published: September 2018

177 Background: Continued smoking after a cancer diagnosis is associated with poorer outcomes. Understanding pt attitudes towards smoking status assessment will help with integrating smoking cessation programs into survivorship care. Methods: Cancer pts were surveyed on their smoking history, assessment rates and attitudes/preferences towards smoking status assessment. Multivariate logistic regression models assessed for factors associated with screening preferences. Results: Among 501 pts, 115 smoked at diagnosis, 60% quit after; 53% had a tobacco related (lung/head and neck) cancer (TRC); 40% reported that their smoking status was assessed only on their first clinic visit, while 12% were assessed at all visits. Most felt smoking status should be assessed at the first visit (95%), while half (58%) felt it should be assessed each visit. Most felt comfortable with being assessed (96%), felt it was important for clinicians to be aware of tobacco use (98%) and that smoking cessation discussions should occur at the first visit (87%). Most preferred being assessed by their oncologist (88%); less preferred being asked by another healthcare provider (44%), on paper (29%) or e-surveys (32%). Compared to ex/never smokers, current smokers were assessed more often at most/every visit (36% vs 20%) and were less comfortable being assessed (88% vs 98%). Among current smokers, lung cancer pts were more agreeable being assessed each visit compared to head/neck (aOR 2.48 95% CI [0.9-6.5] P = 0.06) and non TRCs (aOR 2.63 [1.0-6.8] P = 0.05). Among all, pts who are older (aOR 1.03 [1.0-1.1]), curative (aOR 1.92 [1.1-3.2]) and smoked less (aOR 0.98 per pkyr [0.97-0.99]) were more agreeable to routine assessment. Most pts also felt oncologists should screen for second hand smoke exposure (92%), felt its assessment was important (93%) and should help others who smoke to quit (68%). Many felt that tobacco cessation programs for both pts (75%) and others who around them who smoke (65%) should be routine cancer care. Conclusions: Most cancer pts felt that assessment of smoking status was important, were comfortable being assessed and preferred direct assessment by their oncologist. Routine screening of those currently smoking is recommended to help with cessation.
Communication lapses and navigation needs for non-English-speaking patients: An MSK Patient and Family Advisory Council and Immigrant Health and Cancer Disparities initiative.
Authors: Niehaus Kate Southworth , Ramirez Julia , Gonzalez Javier , Licciardi Frank , Zimmer Alexander , Krug Elizabeth , Reidy Diane Lauren 
Published: September 2018

178 Background: In 2017, 5,939 outpatients (5%) and 1,065 inpatients (9%) treated at MSK were non-English-speaking. Given the new and varying treatment paradigms combined with the need to consider clinical trial enrollment, there are increasingly complex communication needs. We sought to address the needs of this vulnerable patient population. Methods: Patient Family Advisory Council in collaboration with the Immigrant Health & Cancer Disparities Service conducted focus groups to determine needs of non-English speaking patients treated at MSKCC. Mass emails were sent out to the MSK attendings and nurses to recommend appropriate patients to participate. A coordinator called all those patients and invited them to the focus groups. A trained bilingual moderator led each 120-minute group discussion using an interview guide. Results: Three focus groups were conducted : 2 in Spanish and 1 in Russian. Questions related to communication, patient experience and support services were asked to the patient volunteers. In total, 10 patients and 4 caregivers participated. Across all 3 focus groups, three major themes emerged: (1) inadequate communication, participants brought up examples of communication breakdowns (2) access to resources and information, participants expressed that there was a substantial need for accessible, competent, and social support/navigation services and (3) MSK patient experience, participants discussed interactions with doctors, nurses, and staff. Conclusions: Non-English-speaking patients and family members not only deal have to deal with the fear of a cancer diagnosis but also lack the ability to comfortably communicate their concerns. Programs to empower patients and their families to ask for help and advocate for themselves are desperately needed. Additionally, navigation services are needed to provide assistance in making the appropriate linkages for the services required. This qualitative research at MSK is ongoing.
Simple interventions to decrease use of chemotherapy in patients at the end of life.
Authors: Chiang Anne C. , Adelson Kerin B. , Kapo Jennifer , Severino Kimberly M , Lilenbaum Rogerio 
Published: September 2018

181 Background: Early palliative care referral has proven useful in reducing chemotherapy given to cancer patients in the last 30 days of life. We designed a program to help train primary oncologists in having goals of care (GOC) conversations with patients. We conducted this initiative across the Yale Cancer Center/Smilow Cancer Hospital Care Centers (SCHCCs). The aim was to determine whether simple tools could be used by general oncologists to improve patient care, as measured by chemotherapy utilization at the end of life. Methods: A multidisciplinary team completed process mapping and cause-and-effect barrier analysis regarding GOC discussion with patients. Five interventions (PDSA cycles) were chosen to improve physician skills with GOC conversations. SCHCC physicians (n = 21) utilized each tool on 5 patients per month from July to December 2017. Interventions included asking patients simple questions regarding GOC, using the phrase “allow natural death”, giving patients a “serious conversation starter kit”, and identifying patients with poor prognosis. A GOC survey was administered to physicians at baseline and after completion of the initiative. Data on chemotherapy and immunotherapy given during the last 30 days of life for SCHCC patients were measured. Results: SCHCC physicians who completed the baseline survey (n = 17) were 27% likely to discuss GOC repeatedly during the course of illness, compared to 70% post intervention (n = 10), while 88% felt comfortable discussing GOC at baseline compared to 100% after intervention. Chemotherapy within 30 days of death was administered to 30.3% patients (n = 109) in Q1 2017 and 23.3% in Q3 (n = 103) in the Care Centers. Of note, immunotherapy administered within 30 days of death was 6.4% in Q1 and 6.7% in Q3. Conclusions: A quality initiative focused on providing oncologists with simple tools to improve GOC conversations led to decrease from 30.3% to 23.3% of patients receiving chemotherapy within the last 30 days of life. Survey respondents felt more comfortable in discussing GOC and were more likely to do this throughout the course of illness. This pilot suggests that palliative care training of primary oncologists is feasible and may help to decrease unnecessary treatment at the end of life.
The influence of patient-reported adverse events on Health Utility Score (HUS) and Health-Related Quality of Life (HRQoL) in small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) patients.
Authors: Shakik Sharara , Vedadi Ali , Brown M. Catherine , Xu Wei , O'Kane Grainne M. , Liu Geoffrey , Shepherd Frances A. , Leighl Natasha B. , Bradbury Penelope Ann , Lok Benjamin H. , Sacher Adrian G. 
Published: September 2018

185 Background: The Patient Reported Outcome version of Common-Terminology-Criteria-for-Adverse-Events (PRO-CTCAE) and Edmonton Symptom Assessment System (ESAS) are validated tools that measure toxicities and symptoms in cancer patients. We compared the extent in which the presence and severity of toxicities and symptoms affected HUS in SCLC and NSCLC patients. Methods: Adult SCLC and NSCLC patients were recruited from the Princess Margaret Cancer Centre and surveyed cross-sectionally for clinico-demographic variables, EQ5D-5L, PRO-CTCAE and ESAS. HUS were estimated using EQ5D-5L. PRO-CTCAE toxicities include diarrhea, constipation, decreased appetite, nausea, vomiting, fatigue, neuropathy and rash. ESAS symptoms include pain, tiredness, drowsiness, appetite loss, nausea, shortness of breath, depression, anxiety and lack of well-being. These were combined to show frequency and average severity of toxicities/symptoms per patient. Univariable and multivariable linear regression analyses identified toxicity/symptom influencing HUS. Results: Of 75 SCLC and 150 NSCLC, 52% were male with median age of 65 years. The mean HUS was 0.76 (SCLC = 0.69; NSCLC = 0.79; p = 0.001). Compared to NSCLC, SCLC patients had a significantly higher number of toxicities (3.14 versus 1.33 using PRO-CTCAE, p < 0.0001); symptoms (6.75 vs 5.45 using ESAS, p = 0.0003) and severity of toxicities/symptoms (PRO-CTCAE 0-4: 0.95 versus 0.35, p < 0.0001; ESAS 0-10: 3.37 versus 2.04. p < 0.0001). There were significant correlations between the average severity of toxicities/symptoms and HUS (p < 0.0001) adjusted for age, histology, smoking pack years and performance status. For each increase in the average severity of toxicities, there was a corresponding mean drop of 0.03 in the HUS; for every increase in the average severity of symptoms, the drop was 0.04. These relationships were similar for both SCLC and NSCLC patients. Conclusions: Patient reported toxicities and symptoms have a significant impact on HUS in both SCLC and NSCLC patients. Early and aggressive management of such adverse events may be necessary to improve patients’ HRQoL.
Symptom Burden in Extensive Disease Small Cell Lung Cancer (ED-SCLC): A prospective, observational study in U.S. community practices.
Authors: Richards Donald A. , Hussein Maen A. , McCune Steven L. , Ulrich Brian Kent , Danese Mark D. , Gleeson Michelle L. , Lubeck Deborah P. , Abraham Pranav , Sanzari Jenine , Korytowsky Beata , Schwartzberg Lee Steven 
Published: September 2018

196 Background: There is a paucity of data describing the effect of treatment on symptom burden and health status for patients with ED-SCLC receiving care in US community oncology centers. This study explores ED-SCLC patient-reported outcomes independently for either first-line (1L), second-line (2L) or third-line (3L) therapy. Methods: CA209-118 is a prospective observational study of adult patients with lung cancer, including patients with ED-SCLC, in 70 US community practices enrolled between 2014-2017. Participants completed the Lung Cancer Symptom Scale (LCSS) and Euro-QoL 5-D (EQ-5D) utility index and visual analog scale (VAS) at the start of 1L, 2L, or 3L treatment and at follow-up visits. The LCSS is summarized in 3 scales: LCSS total scale which ranges from 0 – 100, average symptom burden scale (ASBI) ranging from 0 – 100, and a three-item global scale (3-IGI) ranging from 0 – 300 (lower scores reflect reduced burden). The EQ-5D scale is a preference based measure of health status with higher scores reflecting better quality and ranges from 0 to 1.0 (index) or 0 – 100 (VAS). LCSS and EQ-5D values at 60 days were predicted in a repeated measures model for patients having a score at baseline and at least 1 follow-up. Results: The mean LCSS and EQ-5D scores at the start of each line of therapy and predicted 60 day change are presented in the table . 60-day improvement was observed only for appetite and cough in 1L. A slight declining trend was seen in 2L and 3L. Conclusions: Patients with ED-SCLC treated in the community reported a high symptom burden at the start of each line of therapy which did not diminish throughout 60 days of treatment. [Table: see text]
Incorporating geriatric patient-reported outcomes into novel screening tool of distress and supportive care concerns.
Authors: Weldon Christine B. , Martin Joanna , Scheu Amy , Khosla Paramjeet , Roggenkamp Betty , Berardi Rosa , Chow Selina Lai-ming , Trosman Julia Rachel , Pasquinelli Mary , Feldman Lawrence Eric , Dale William , O'Mahony Sean , Gerhart James , Mumby Patricia B. , Gordon Ana , Wiebe Lauren Allison , Deamant Catherine 
Published: September 2018

198 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. The Supportive Oncology Collaborative, collaborative of 100+ clinicians funded by The Coleman Foundation, developed a patient-centric screening tool (CSOC-ST) adapted from ASCO Distress, NCCN Distress Problem List, IOM report and CoC standards, and other validated sub-tools (Weldon, ASCO-Q 2017). The Collaborative revised the CSOC-ST tool to align with ASCO geriatric guidelines. Methods: Literature and guidelines review of geriatric screening, added items to CSOC-ST, and piloted at 4 sites. Descriptive statistics and Fisher’s exact test used. Results: 473 patients screened with added geriatric relevant items to CSOC-ST: self-care concerns (PROMIS Instrumental Support), living alone (ASCO Distress 2014), and memory / cognition (PROMIS item bank). Treatment/care concern items were revised to identify health care power of attorney and advance directive interest. Geriatric related items endorsed by patients, see Table. PHQ4, Anxiety and Depression, average score 2.4 (mild > 3). Higher scores on the PHQ-4 were significantly associated with each of the following: self-care concerns, memory/cognition concerns and specific treatment/care concerns (p < .0001). Conclusions: Pilot results and comparison to ASCO geriatric guidelines identified important items to support geriatric patient reported outcomes screening. After pilot, added 3 items for falls/frailty. Eight sites implementing this CSOC-ST.[Table: see text]
Routine collection of EQ-5D-5L derived utility scores in a brain metastases clinic: Correlation with health-related quality of life (FACT-Br).
Authors: Chen Judy , Gao Yizhuo , Baek Justine , Chaudhry Maha , Hueniken Katrina , Liang Mindy , Brown M. Catherine , O'Kane Grainne M. , Eng Lawson , Xu Wei , Howell Doris , Shultz David Benjamin , Liu Geoffrey 
Published: September 2018

200 Background: Brain metastasis is a common occurrence in many cancers. However, with new therapies (stereotactic radiotherapy) and longer survival due to improved systemic therapies, more contemporary estimates of health utility scores (HUS) are required for this specialized cancer population. Further, recent efforts have tried to incorporate routine collection of such data, especially in an era when new radiation and new systemic therapies, especially targeted therapies require such data when undergoing health technology assessments. Methods: In a cross-sectional study design, patients in the specialized brain metastases clinic at Princess Margaret Cancer Centre were approached to complete the Health-related quality of life (HRQoL) tool, FACT-Br, and the EQ-5D-5L (to derived HUS using Canadian reference values) on iPad or paper. In addition, consent was obtained to collect clinico-demographic data from the patient and chart. In addition to descriptive analysis and participation rates, HUS were correlated to FACT-Br and its subscales. Results: Of 204 eligible patients, 134 were recruited (66% participation rate) from May 2017- Feb 2018. Of 105 patients in this preliminary analysis, the median age was 60 (range: 25-94) years; 73% were female; 64% were Caucasian; 20% were Asian; 49% had lung, 15% had breast, 37% had other primary cancer; 81% received some form of radiotherapy. Median time from first treatment of brain metastasis to survey was 12 (range 0.03-100) months. There were correlations with the following FACT-Br subscales: physical well-being (WB) (rho = 0.70), emotional WB (rho = 0.42), social WB (rho = 0.25), functional WB (rho = 0.59), and brain-specific subscale (rho = 0.67); overall FACT-Br (rho = 0.73); all correlations were p < 0.001. Conclusions: Patients with brain metastasis were generally willing to complete EQ-5D-5L, and patients had good HUS. HUS as measured indirectly by EQ-5D-5L were correlated to HRQoL as measured by FACT-Br or its subscales, with high correlation to the overall FACT-Br. EQ-5D-5L is a practical and useful tool to assess HUS routinely in brain metastases patients.
Electronic physician ratings and reviews process.
Authors: Denny, DBA Diane , Hizon Sarah , Caldarello Lauren , Hartman Scott , Markman Maurie 
Published: September 2018

209 Background: According to JAMA, Public Awareness, Perception, and Use of Online Physician Rating Sites; 35% of patients selected a physician based on good ratings, and 37% avoided one with bad ratings. Yet, there exists a stark difference between unstructured (i.e. Yelp) online reviews as compared to validated survey-generated data. A national network of hospitals that specializes in treating patients with complex cancer had been collecting patient satisfaction data using a validated tool administered by a 3rd party for some time. An electronic physician rating and review process was implemented as an adjunct to that survey process, providing a new mechanism for consumers visiting the networks’ website with accurate information about patients’ satisfaction with its oncologists. Methods: Physician ratings are obtained directly from patients who had an encounter using two specific questions regarding confidence and likelihood to recommend. Ratings are posted by physician and maintained on a 12-month rolling basis once a minimum of 30 ratings is achieved. Likert scale survey data are converted to a one-to-five star rating. De-identified verbatim comments are also posted. Criteria are in place to review comments prior to posting with limited exclusions, such as comments containing PHI or slanderous content. Physicians receive an email to review comments 15 days prior to posting, allowing a process for advance notice or appeal. Both positive and negative reviews are published. Results: Physician performance scores were 4.7 stars pre-launch compared to 4.8 stars post-launch. Additional performance statistics are provided below. Conclusions: Sharing information on the talent of physicians is an important component of transparency and arming patients with information to make informed treatment decisions. As a result, physicians have become more engaged with their data and utilizing reviews to identify improvement opportunities. This translates to a culture of accountability and deepened understanding of patients’ perceptions about care.[Table: see text]
Trust but verify: Patterns of obtaining health information and the role of physician trust in decision-making amongst patients with metastatic breast cancer.
Authors: Niranjan Soumya J. , Wallace Audrey S. , Williams Beverly R , Turkman Yasemin E. , Williams Courtney , Forero-Torres Andres , Bhatia Smita , Knight Sara J. , Rocque Gabrielle Betty 
Published: September 2018

218 Background: Increasing emphasis on patient-centered care has led to shared decision making, which better aligns medical decisions with patient preferences for care. In its 2004 report, Health Literacy: A Prescription to End Confusion, the US Institute of Medicine defines health literacy as the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions. However, little is known about the confluent role of patient health information seeking patterns and physician trust in the decision-making process. Therefore, we assessed perspectives of metastatic breast cancer (MBC) patients and health care professionals regarding how health information seeking and physician trust influence decision making. Methods: Qualitative interviews with 26 MBC patients and 6 community oncologists, as well as 3 separate focus groups involving lay navigators, nurses, and academic oncologists, were recorded and transcribed. Qualitative data analysis was conducted using a content analysis approach that included a constant comparative method to generate themes from the transcribed textual data. Results: Five prominent themes emerged from these responses. (1) Patients’ primary source of treatment information were physicians. (2) Patients differed in their approach to seeking further health information regarding the discussed treatment options (e.g. internet websites, family and friends, support groups). (3) Patients trusted their physician’s recommendations to achieve their goals of care. (4) Oncologists were cognizant of their fundamental role in facilitating informed decision making (5) Patient and physician discordant perspectives on shared decision making were apparent. Conclusions: Patient procurement of health information and their capacity to use it effectively to make informed decisions in conjunction with their trust in physicians, may play an important role in shared decision making.