bluuebunny/crossref_metadata_2025_split huggingface dataset:
Watson for Oncology applied to teaching and remote consulting model.
Authors: Fang Juemin , Guo Xianling , Zhu Zhongzheng , Wang Hui , Hu Fei , Chen Jianhua , Gao Song , Guo Liting , Zhao Yu , Yuan Min , Xu Qing 
Published: May 2019

6545 Background: IBM Watson for Oncology (WFO) is developed with artificial intelligence to assist the oncologists in treatment decision-making by providing evidence-based treatment recommendations with priority and personality. We have been exploring the value of applying WFO in teaching and remote consulting among members in the hospital union to improve medical quality and conformity. Methods: Four modes were followed to apply WFO to teaching and remote consulting. Firstly, a teaching hospital conducted instructional teaching for a primary hospital through WFO, or a primary hospital consulted with a teaching hospital on cancer treatment combined with WFO. Secondly, a teaching hospital conducted conference-based teaching and remote consulting for two or three primary hospitals through demonstrating WFO. Thirdly, we cooperated with other teaching hospitals to carry out interactive discussions on cases through WFO with several primary hospitals. Fourthly, we cooperated with other teaching hospitals to conduct WFO demonstration and discussion for several primary hospitals. Remote communication was performed by using third-party video conference software. A survey was conducted to collect feedback from 56 primary hospitals in our hospital union. Results: More than 80% of primary hospitals were willing to learn the standardized treatment and recent treatment progress of tumors by participating in WFO remote consulting in our hospital. The value of four modes to promote the standardized cancer treatment and improve the medical quality and conformity in primary hospitals were all recognized. WFO also contributed to academic exchanges and learning among high-level teaching hospitals, and facilitated the use of artificial intelligence in oncology therapy more rational and appropriate. Conclusions: Non-standardization in cancer care remains to be a big problem in primary hospitals in China. Although limitation of WFO exists in the complex cases of certain tumor types, the rational use of WFO in the teaching and remote consulting could help and promote the standardized cancer treatment in China.
Creation of a virtual cancer care network for remote oncology treatment.
Authors: Passero Vida Almario , Liman Andrew Dede , Allen Kaneen , Speerhas Lucy , Tan Jocelyn Lai , Harrold Laurie , Tokarsky Joyce , Veraldi Kristen , Couch Myra , Hotchkiss John , Gray Deborah L , Rai Hema , Green Jeanne , Shields Jenna 
Published: May 2019

6546 Background: The VA Pittsburgh Healthcare System (VAPHS) Virtual Cancer Care Network was launched in January 2018 after we had established an electronic consult service where 555 hematology electronic consults were completed at VAPHS in FY17. The clinical video telehealth (CVT) clinic allows veterans from central Pennsylvania to receive their anticancer therapy at the VA in Altoona, Pennsylvania where the oncology pharmacy, nursing, telehealth, and supportive oncology staff are on site. Patients follow regularly and remotely during treatment via CVT visits with their oncologist located 93 miles away at the VA in Pittsburgh. Methods: A chemotherapy pharmacy and nursing infusion clinic were created at the VA in Altoona. CVT visits started in January 2018. Data including treatment, adverse events defined through CTCAE v5.0, gender, age, zip code, and other details were examined retrospectively. Results: 279 CVT visits for 89 patients were completed January 2018 through Sept 2018. 87 were male, 2 were female. Average age was 70 (range 45-90). Most common primary disease sites were prostate (19.1%), colorectal (13.4%), and lung (9%). 61.8% of patients were on treatment. Non-treatment visits were for surveillance and survivorship. Treatment administered included platinum doublets, fluorouracil doublets, immunotherapy, and oral anticancer therapy. 5.4% of patients had Grade 3-4 events due to febrile neutropenia, increased liver enzymes, and hemolytic anemia. 41.7% had grade 1-2 events due to peripheral neuropathy, neutropenia, anemia, thrombocytopenia, and infusion-related reactions. Using an average commuting speed of 60 mph and a travel cost of $ 0.56 per mile, the total commute distance averted was 49,579 miles. Mean distance averted per patient was 557 miles. Total commute time saved for veterans was 826 hours. Total mileage costs saved for veterans was $27,764. Conclusions: The Virtual Cancer Care Network reduced the travel time and costs for veterans who previously would have travelled from central Pennsylvania to VAPHS for their oncology treatment. Adverse events were tolerable and managed by the VA in Altoona. Integration of CVT secures safe access to cancer care and maintains patients’ primary relationships with their oncologists.
Active search for toxicity reduces delay on chemotherapy.
Authors: Souza Juliana , Neves Daniele 
Published: May 2019

6548 Background: Interdisciplinary teamwork involves health care professionals working as a team with the purpose of discussing individual cases and recommending care plans. In october 2015, the breast cancer interdisciplinary team (BCIT) was implemented in our outpatient oncology clinic. This team includes oncology physician, pharmaceutist, psychologist, nutritionist and oncology nurse. Since 2018, the oncology nurse does active search for toxicity (AST) in order to solve early symptoms. Methods: We evaluated outcomes of breast cancer patients who finished neoadjuvant/adjuvant chemotherapy and received BCIT care at our oncology clinic from october 2015 to November 2018. Results: Of 200 pts who had finish treatment, 139 pts (69.5%) received adjuvant chemotherapy and 61 pts (30.5%) neoadjuvant schedule. Median age was 52,64 years (range:30.6-82.3y). At diagnosis, 50 pts (25%) were stage I, 101 pts (50.5%) were stage II, and 49 pts (24.5%) were stage III. When we compared before and after AST, there were no significant difference between mean age (54.13y vs 54.06y, p:0.97), colony stimulating factor use (p:0.10), cold-cap use (p:0.81), and timing of chemotherapy (p:0.13). There were 7 hospitalizations during chemotherapy, with no significant difference with AST (5pt vs 2pt, p: 0.82). However, patients in AST had significantly lower mean delay to complete chemotherapy (9.4 days vs 4.2 days p:0.003). After median follow up 17 months, there were 9 progression disease and 4 deaths. 1-year and 3-year overall survival rate was 99,2% and 95,1%, respectively. Conclusions: AST increased adherence to chemotherapy, with lower delay on chemotherapy treatment. There were no significant difference with colony stimulating factor use, cold-cap use, timing of chemotherapy, and hospitalization.
A blinded evaluation of a clinical decision-support system at a regional cancer care center.
Authors: Suwanvecho Suthida , Shortliffe Edward H , Suwanrusme Harit , Issarachai Surasit , Jirakulaporn Tanawat , Taechakraichana Nimit , Lungchukiet Palita , Thanakarn Nittaya , Decha Wimolrat , Boonpakdee Wisanu , Wongrattananon Pattanawadee , Preininger Anita , Kefayati Sarah , Dankwa-Mullan Irene , Esquivel Jaime , Patel Vimla L , Jackson Gretchen , Kiatikajornthada Narongsak 
Published: May 2019

6553 Background: Clinical decision-support systems (CDSS) such as Watson for Oncology (WFO) may reduce treatment variation in oncology, provided options offered by the system are at least as acceptable as expert, evidence-based options. Deviation from expert consensus in practice is not well documented. In this blinded study, WFO therapeutic options and treatment decisions made by individual oncologists at Bumrungrad International Hospital (BIH) were evaluated by expert panel. Methods: Treatments selected by BIH that were labeled as either “for consideration” or “not recommended” by WFO were evaluated by a panel of 3 oncologists in 2018. The panel evaluated WFO options and previous BIH treatments for prospective cases from 2016-2018, blinded to the source of treatment option. Consensus of panel rated treatment pairs as: identical; both acceptable and roughly equivalent; both acceptable, but one preferred; one is acceptable and the other, unacceptable; neither is acceptable. The results of 321 treatment choices for breast, lung, colon and rectal cancers were analyzed, and McNemar’s test, a modified pairwise chi-square, was applied to identify differences between BIH and WFO. Results: 71% of both BIH and WFO treatments across all 4 cancer types were considered acceptable or identical by the panel. In 18 cases (5.6%), WFO treatments were preferred; in 14 cases (4.4%), BIH cases were preferred. Unacceptable treatments by either BIH or WFO were identified in 15% and 23% of treatments, respectively. Statistical analysis of treatment pairs revealed no significant difference between BIH and WFO treatments for breast, colon and rectal cancer. Treatment for lung cancer differed significantly ( p = 0.004); in 6% of cases, WFO was unacceptable and BIH acceptable; in 1% of cases, BIH was unacceptable and WfO was acceptable. Conclusions: This study is one of the first to compare therapeutic options from CDSS to treatment decisions made in practice, evaluated in a blinded fashion by an expert panel. 71% of treatments suggested by WFO CDSS were as acceptable as those selected by clinicians at the point of care, and some were considered superior. Decisions made in practice were unacceptable to the panel in 15% of cases, suggesting a role for CDSS.
A framework for building a clinically relevant risk model.
Authors: Daly Robert Michael , Gorenshteyn Dmitriy , Gazit Lior , Sokolowski Stefania , Nicholas Kevin , Perry Claire , Adams Lynn , Baldwin Abigail , Holland Jessie C. , Zervoudakis Alice , Xiao Han , Salvaggio Rori , Chiu Yeneat O. , Katzen Lauren L. , Rozenshteyn Margarita , Reidy Diane Lauren , Simon Brett A , Perchick Wendy , Wagner Isaac 
Published: May 2019

6554 Background: Acute care accounts for half of cancer expenditures and is a measure of poor quality care. Identifying patients at high risk for emergency department (ED) visits enables institutions to target resources to those most likely to benefit. Risk stratification models developed to date have not been meaningfully employed in oncology, and there is a need for clinically relevant models to improve patient care. Methods: We established and applied a predictive framework for clinical use with attention to modeling technique, clinician feedback, and application metrics. The model employs electronic health record data from initial visit to first antineoplastic administration for patients at our institution from January 2014 to June 2017. The binary dependent variable is occurrence of an ED visit within the first 6 months of treatment. The final regularized multivariable logistic regression model was chosen based on clinical and statistical significance. In order to accommodate for the needs to the program, parameter selection and model calibration were optimized to suit the positive predictive value of the top 25% of observations as ranked by model-determined risk. Results: There are 5,752 antineoplastic administration starts in our training set, and 1,457 in our test set. The positive predictive value of this model for the top 25% riskiest new start antineoplastic patients is 0.53. From over 1,400 data features, the model was refined to include 400 clinically relevant ones spanning demographics, pathology, clinician notes, labs, medications, and psychosocial information. At the patient level, specific features determining risk are surfaced in a web application, RiskExplorer, to enable clinician review of individual patient risk. This physician facing application provides the individual risk score for the patient as well as their quartile of risk when compared to the population of new start antineoplastic patients. For the top quartile of patients, the risk for an ED visit within the first 6 months of treatment is greater than or equal to 49%. Conclusions: We have constructed a framework to build a clinically relevant risk model. We are now piloting it to identify those likely to benefit from a home-based, digital symptom management intervention.
Assessment of enrollment characteristics for Children’s Oncology Group (COG) upfront therapeutic clinical trials 2004-2015.
Authors: Faulk Kelly , Anderson-Mellies Amy , Cockburn Myles , Green Adam 
Published: May 2019

6564 Background: Improvements in pediatric cancer survival are attributed to cooperative clinical trials. Under representation of specific demographic groups has been described in adult and pediatric cancer and poses a threat to the generalizability of trial results. A comprehensive evaluation of data provided by the Children’s Oncology Group (COG) of upfront trial enrollment for US patients 0 to 29 years old between 2004 and 2015 was performed to assess for disparities in participation. Methods: Estimates of cancer cases were calculated using the Surveillance, Epidemiology, and End Results registry and the US Census and compared to observed COG cases. Percent enrollment and Standardized Ratios of enrollment were calculated across various demographic, disease, and socioeconomic groups. The COG website was utilized to quantify available upfront trials during the study period and assess age eligibility criteria. Results: 21.3% of estimated US cancer patients age 0 to 19 years enrolled on COG trials. Younger patients were consistently more represented across disease types and race/ethnicities. Patients with hematologic malignancies were more represented compared to solid and central nervous system (CNS) tumors. Conclusions: COG clinical trial enrollment rates are declining, which may be due to challenges in pediatric drug development, difficulty designing feasible trials for highly curable diseases, and issues in ensuring trial availability for the heterogeneous group of solid and CNS tumors. Though racial/ethnic groups and county-level socioeconomic factors were proportionally represented, under representation of the adolescent/young adult (AYA) population and younger patients with solid and CNS tumors remain significant concerns. Targeted enrollment efforts should focus on the identified subgroups and further research should evaluate AYA enrollment across all available trials to provide continued treatment advances for all patients.
Forecasting the global need for high-dose methotrexate to prevent and mitigate shortages.
Authors: Howard Scott C. , Ilbawi Andre Michel , Lewis Brian , Lam Catherine 
Published: May 2019

6571 Background: Causes of drug shortages in low-income and middle-income countries are numerous and often more than one cause contributes. Shortages are especially problematic when they involve drugs like high-dose methotrexate (HDMTX), which is required for several highly curable cancers and has no good substitute. Morocco is currently experiencing a national shortage of high-dose methotrexate that has so far lasted several months and has impacted the care of all patients whose protocol includes HDMTX. In this case, a single supplier left the market due to government-imposed pricing that made continued sales increasingly unprofitable. Practicing hematologist/oncologists in Myanmar, the Philippines, Vietnam, and Cambodia also reported shortages that reached patients during 2018. Methods: We created a forecasting model to identify the total annual national need for HDMTX and number of patients based on incidence by age, age distribution, and numbers of doses in typical protocols for osteosarcoma, primary CNS lymphoma, pediatric B-cell NHL, and ALL, curable cancers for which HDMTX is essential. Results: More than 200,000 patients per year need HDMTX (approximately 950,000 doses, see Table). 86% of these live in low- and middle-income countries, where access to inexpensive generic drugs is especially important. Conclusions: This forecasting tool will facilitate national purchasing and negotiating to assure continuous supply of HDMTX. It can be adapted for other drugs, and is especially relevant for low-cost generic drugs, which are disproportionately affected by shortages. [Table: see text]
Investigation of HBOC germline mutations in women diagnosed with breast cancer in Trinidad and Tobago.
Authors: Parkinson Gerneiva , Chagpar Anees B. , Alleyne-Mike Kellie , Nunez-Smith Marcella , Zhou Alicia , Servais Lily , Hofstatter Erin Wysong 
Published: May 2019

6574 Background: Trinidad and Tobago (T&T) is the southern-most Caribbean island, and according to the WHO/PAHO, it has the 2nd highest breast cancer mortality rate in the region. Notably, a large proportion of breast cancer cases in T&T occur at a young age; with nearly 36% of them being diagnosed under the age of 50. There is a known association between a younger age at diagnosis and Hereditary Breast and Ovarian Cancer syndrome (HBOC). Yet, the prevalence of HBOC mutations remains unknown in T&T, as genetic counseling and testing services are extremely limited in the region. Therefore, we sought to determine the prevalence and spectrum of HBOC mutations in T&T. Methods: At the National Radiotherapy Center, T&T’s main oncology unit, female breast cancer patients, who met NCCN criteria for further genetic counseling and testing were recruited through chart reviews. After pre-test counseling, enrolled subjects had a detailed interview about their personal breast cancer diagnosis and family history. A saliva sample was collected using an Oragene kit, and analyzed by Color Genomics Inc. for 30 genes associated with hereditary cancers. Finalized results were returned to patients by genetic counselors from Color Genomics. Results: A total of 118 female patients who met NCCN guidelines for HBOC testing received genetic testing. A majority were 50 years of age or younger (69/118, 59%). The cohort was ethnically diverse: 34% African, 15% Asian, 48% multiple ethnicity, and 3% other/unknown. A pathogenic or likely pathogenic variant (positive result) was identified in 21.2% of the cohort (25/118) - most commonly identified in the BRCA1 gene (13/25, 52%), followed by BRCA2 (5/25, 20%), PTEN (2/25, 8%), BRIP1 (1/25, 4%), CHEK2 (1/25, 4%), MSH6 (1/25, 4%), PALB2 (1/25, 4%), and RAD51C (1/25, 4%). Conclusions: We found a strikingly high HBOC germline mutation prevalence rate of 21.2% among a cohort of female breast cancer patients meeting NCCN criteria for HBOC testing in T&T. Given the growing implications of germline HBOC mutations for breast cancer treatment and prevention, our results demonstrate an urgent need for funding, as well as the development of robust genetic counseling and testing services in T&T.
Emergency department visits for prescription and synthetic opioid overdoses among patients with cancer.
Authors: Jairam Vikram , Yang Daniel X. , Yu James B. , Park Henry S. 
Published: May 2019

6579 Background: Patients with cancer may be at high risk of opioid dependence due to physical and psychosocial factors, although little data exists to inform providers and policymakers. Our aim is to examine overdoses from prescription and synthetic opiates leading to emergency department (ED) visits among patients with cancer in the United States. Methods: The Healthcare Cost and Utilization Project Nationwide Emergency Department Sample (HCUP-NEDS) was queried for all patient visits with a primary diagnosis of prescription or synthetic opioid overdose between 2006 and 2015. Baseline differences between patients with and without cancer were assessed using chi-square and ANOVA testing. Overdose rates by primary cancer site were normalized using prevalence data from the Surveillance, Epidemiology, and End Results (SEER) Program. Weighted frequencies were used to create national estimates for all data analyses. Results: There were 682,820 weighted ED visits for synthetic opioid overdose, among which 34,547 (5.1%) visits were also associated with a diagnosis of cancer. During this timeframe, ED visits for opioid overdose among patients with cancer increased 2.5-fold, compared to 1.7-fold among those without cancer. 16.5% of patients with cancer had metastatic disease. Patients with cancer presenting for opioid overdose had higher risk of hospital admission (74.8% vs 49.6%), respiratory intubation (13.2% vs 12.2%), mortality (2.1% vs 1.1%), and cost-of-hospital-stay ($32,665 vs $31,824) compared to their non-cancer counterparts (all P < 0.05). Primary cancers with the highest normalized overdose rates (ED visits per 10,000 patients) were esophagus (134), liver & intrahepatic bile duct (124), and cervical cancer (124). Other common cancers had the following normalized overdose rates: lung (105), head and neck (70), and breast (26). Conclusions: Approximately 5% of all ED visits due to prescription and synthetic opioid overdose are among patients with cancer. The rate of increase in ED visits due to opioid overdose from cancer patients was nearly 50% higher than that from non-cancer patients over the 10-year study period. Patients with esophageal, liver, and cervical cancer may be at highest risk.
Is immunotherapy toxicity associated with improved overall survival among older adults with advanced cancer?
Authors: Johns Andrew , Grogan Madison , Hoyd Rebecca , Bridges John F.P , Wei Lai , Patel Sandipkumar , Li Mingjia , Husain Marium , Kendra Kari Lynn , Otterson Gregory Alan , Burkart Jarred Thomas , Rosko Ashley Elizabeth , Andersen Barbara L. , Carbone David Paul , Owen Dwight Hall , Spakowicz Daniel , Presley Carolyn J 
Published: May 2019

6580 Background: There is growing evidence that checkpoint inhibitor immunotherapy (IO) toxicity is associated with improved treatment response. There is a paucity of evidence examining the relationship between toxicity and overall survival (OS) in older adults. Methods: We performed a single institution retrospective cohort study of adults who received IO for advanced cancer from 2011-2017. Baseline clinical characteristics were abstracted from the electronic health record. Immune-related toxicities were graded by physicians based on Common Terminology for Adverse Events criteria, v4.0. Bivariate analysis with chi-squared statistics was used to describe baseline characteristics of patients ≥70 years (y) vs. <70y. Survival outcomes were estimated by the Kaplan-Meier method (time zero = start of first-line IO) and compared using the log-rank test. The association of age and ≥ grade 3 toxicity with OS was tested with a Cox proportional hazards model. Results: Among 676 patients treated with IO, 238 (35.4%) were ≥70y. There was no difference in baseline characteristics of each age group except cancer type (P<0.01). The incidence of ≥ grade 3 toxicity did not differ by age (<70y: 14.5% vs. ≥70y: 13.5%, P=0.71). Median OS was significantly longer for adults <70y (16.4 vs. 13.2 months, P<0.01) or those with ≥ grade 3 toxicity (18.3 vs. 14.7 months, P<0.01). When stratified by age and toxicity, patients <70y with ≥ grade 3 toxicity had longer OS vs. those without ≥ grade 3 toxicity (P<0.01). However, there was no OS difference among adults ≥70y with vs. without ≥ grade 3 toxicity (P=0.78). Adjusted hazard ratios with an interaction term are below. Conclusions: Though the incidence of ≥ grade 3 toxicity did not significantly differ by age, there was no significant OS advantage for older adults with ≥ grade 3 toxicity as compared to younger adults. Caution should be used in considering a toxicity-survival relationship in older adults.[Table: see text]