bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of follow-up appointments and admission unit on readmissions in patient with cancer on chemotherapy: A tertiary center experience.
Authors: Abdel Rahman Zaid , Philip Joyce , Mohtadi Omar , Kahlon Pushpinderdeep Singh , Donthireddy Vijaya 
Published: September 2018

e18239 Background: Readmissions are a huge burden on patients and organizations, especially in light of the newly emerging bundled payment systems. Many interventions have been proposed to reduce readmissions, including admitting patients to a cancer-specific unit (CSU) and scheduling follow-up appointments after discharge. Methods: We conducted a retrospective cohort study to identify the effect of admission unit and follow-up appointments on readmissions within 30 days among cancer patients receiving outpatient chemotherapy. We included unplanned admissions between July and October 2016 at Henry Ford Hospital. Results: There were 232 inpatient admissions. Of those, 73 (31%) were readmitted. The number of admissions to the CSU was 100 (43%) compared to 132 admissions (57%) to other general practice units (GPUs). Mean length of stay was 5.8 (1-29) days and 3.8 (1-30) days, respectively. Most common malignancies were hematological (27% and 22%) and gastrointestinal (26% and 19%). The most common reasons for admissions were infections (29% and 28%) and pain management (19% and 12%). Of patients who were admitted to the CSU, 24 (24%) were readmitted compared to 49 (37%) for other GPUs, OR 0.53 (95% CI:0.3-0.95, p = 0.033). Readmission rates were also calculated based on the type of appointment scheduled within 30 days of discharge (Primary care (PCP) and oncology, PCP only, Oncology only and neither). Odds ratios of readmission were calculated for the last three categories in comparison to having both appointments. Of admissions that had both appointments, 15 (23%) had a readmission within 30 days. Of admissions that had oncology only appointments, 39 (33%) had a readmission; OR 1.6 (95% CI: 0.8 to 3.3, p = 0.15). Of admissions that had a PCP only appointment, 6 (42%) had a readmission; OR 2.5 (95% CI: 0.7 to 8.3, p = 0.13) and of admissions that had neither appointments, 12 (57%) had a readmission; OR 4.4 (95% CI 1.6 to 12.6, p = 0.0049). Conclusions: Care for cancer patients is challenging as they carry a high risk of readmission, admitting cancer patients to cancer-specific units significantly reduces that risk. Having no follow-up appointments carries a high risk of readmission.
Cardiotoxicity of tyrosine kinase inhibitors among veterans diagnosed with renal cell carcinoma.
Authors: Lynch Kristine E. , Lynch Julie Ann , Efimova Olga , Chang Jiwon , Berse Brygida , Rivera Donna , Becker Daniel Jacob , DuVall Scott L. , Filipski Kelly Kristin 
Published: September 2018

e18248 Background: Renal cell carcinoma (RCC) accounts for 3% of cancers diagnosed in the Department of Veterans Affairs (VA). Each year, 15% of the 1,600 veterans diagnosed with RCC have advanced disease. Until a decade ago, there were few non-surgical treatments for advanced RCC. Approval of multi-targeted tyrosine kinase inhibitors (TKIs), sorafenib, sunitinib, and pazopanib significantly improved outcomes for patients. However, several studies demonstrated increased risk of congestive heart failure, stroke, and thromboembolic events in patients treated with TKIs. We sought to understand whether veterans, who have a high prevalence of comorbidities, have increased risk of cardiac events following TKI treatment. Methods: This was a retrospective study of patients diagnosed with advanced RCC from 2006 to 2015. The outcome variable was whether the patient had congestive heart failure, cardiomyopathy, acute myocardial infarction, stroke, or cardiovascular related death after initiation of at least one TKI. Clinical, demographic, and pharmacy data came from the VA Central Cancer Registry and Corporate Data Warehouse. Patient characteristics across treatments were evaluated using chi square tests, t-tests and ANOVAs, as appropriate. We used multivariate logistic regression to determine the likelihood of cardiac event in patients treated with TKIs. Results: We identified 3,510 patients eligible for treatment who did not have a prior cardiac event. Overall, 1,840 patients were treated with at least one TKI prior to any cardiac event: 953 (27.1%) were treated with only sunitinib, 179 (5.1%) with sorafinib, 289 (8.2%) with pazopanib, and 419 (11.9%) treated with a combination. There were 909 who had a cardiac event (25.9% of all patients). Only 259 (28.49%) were treated with a TKI. On multivariate analysis, statistically significant predictors of a cardiac event were having diagnoses of dyslipidemia (Odds ratio [OR] 2.1, 95% confidence interval [CI] 1.7-2.5) or diabetes (OR 1.5, 95% CI 1.3-1.8). Patients treated with TKIs had a lower likelihood of a cardiac event (OR 0.3, CI 0.2-0.3). Conclusions: Among veterans, treatment with TKIs do not pose as great a risk for cardiac events as underlying comorbid diagnoses.
Pulmonary embolism prophylaxis in solid tumors: Exploring a paradigm shift.
Authors: Hakim Nausheen Naila , Marconcini Luiz Antonio Liarte , Vazquez Martinez Mariola A. , Rivas Doris Maria , Trotta Christina , Carter Jordan Spencer , Perimbeti Stuthi , Lee William May , Niphadkar Seema , Nandi Neilanjan , Ward Kristine Marie , Jain Maneesh Rajiv , Styler Michael 
Published: September 2018

e18252 Background: Studies have found higher risk of development of pulmonary embolism (PE) in those with metastatic disease within the first year of diagnosis, predominantly in pancreatic cancer. Therapeutic anticoagulation is consequently recommended in pancreatic cancer. We thus hypothesized that the rate of PE would be highest in pancreatic cancer compared to other solid tumors. Methods: We queried the Nationwide Inpatient Sample between 1999-2014 using the ICD-9 codes for PE in association with the following solid tumor types: esophageal, colorectal, lung, stomach, breast, pancreatic, liver and small intestine. The primary diagnosis was the type of solid tumor and the secondary diagnosis was PE. Chi-square analysis was used to to analyze for the independence of two variables. Results: From 1999-2014 there was a total of 16,473 cases of PE in solid tumors. 1.9% of the pancreatic cancer admissions developed a PE, followed by 1.7%, 0.9% and 0.8% for lung, liver, and colorectal, respectively (p > 0.05). Overall mortality rate for PE in pancreatic, lung, and colorectal cancers decreased from 32% in 1999 to 15% in 2014. Conclusions: Earlier detection due to improved diagnostic modalities may have contributed to the decrease in overall mortality rate observed in lung, liver, and colorectal cancers diagnosed with PE from 1999-2014. The highest rate of admissions associated with PE was seen in pancreatic cancer: however the differences between the four cancers were not statistically significant. Future studies should focus on observational prospective data monitoring solid malignancies for PE. If the prevalence of PE is indeed similar in different types of cancers, we should consider the addition of therapeutic anticoagulation to the current recommendations.
Implementation of the IOM 13 point care plan by Oncology Care Model (OCM) practices.
Authors: Fargnoli Brenton , Jaffe Natasha , Bauer-Levey Nick , Cowing Keith , Schneider Joanne , Parulkar Rohit , Lee DJ , Harary Ovadia , Holleran Ryan , Zhang Sen , Revol Cindy , Tran Dan , Shah Robin , Abernethy Amy Pickar , Kolodziej Michael A. 
Published: September 2018

e18279 Background: The completion of the IOM 13 point care plan is mandatory for all patients enrolled in the OCM. We built an integrated care plan into the electronic medical record, with 9 points being auto-populated by data documented elsewhere in the EMR and 4 points requiring completion by the caregiver. We report on preliminary experience with care plan completion. Methods: Of the 190 practices selected by CMMI for the OCM, 32 practices utilized the embedded care plan. Patient eligibility for the OCM was determined by identification of a qualifying episode by an electronic algorithm. Initiation of a care plan was determined by physician completion of any field in the care plan field. Completion of the care plan was defined by the act of printing and distributing the care plan to the patient. Correlations between number of eligible patients and completion rates were calculated using Pearson’s product moment correlation coefficient (r). P-values were calculated using a t-distribution and null hypothesis of 0. Results: Over the first 6 months, 15,705 patients were identified as eligible for the OCM. At these practices, 69% (10,851) of patients had care plans initiated (range 0-100%) and 34% (5,290) had a care plan printed (range 0-100%). Within the care plans initiated, 53% (5,711) had the advance directive field completed (range 0-87%). There was no correlation between percent of care plans initiated or percent of care plans printed and number of eligible patients in the practice (r = -0.16, p = 0.51 and r = -0.13, p = 0.44); likewise, advance directive field completion percent was not correlated with the number of eligible patients (r = -0.16, p = 0.37). Conclusions: Completion of the IOM care plan has proven challenging for practices in the OCM irrespective of practice size. This suggests technological solutions represent only one component needed for success in this component of the OCM.
Neutropenia related hospitalization risk in lung cancer patients with chemotherapy.
Authors: Ma Qinli , Agiro Abiy , Acheson Anupama Kurup , Wu Sze-Jung , Patt Debra A. , Barron John , Rosenberg Alan , Schilsky Richard L. , Lyman Gary H. 
Published: September 2018

e18290 Background: We sought to describe outcomes following granulocyte-colony stimulating factor (G-CSF) prophylaxis in patients with lung cancer receiving chemotherapy regimens with low to intermediate risk for inducing neutropenia related hospitalization. Methods: We identified 11,233 lung cancer (all histologies) patients ≥ 18 years from 14 commercial US health plans. All patients received first cycle chemotherapy during 2008–2013. 5,423 patients received one of the 3 regimens: carboplatin and paclitaxel, cisplatin and etoposide, carboplatin and etoposide. Primary prophylaxis (PP) was defined as G-CSF administration within 5 days of chemotherapy. Outcome was neutropenia, fever, or infection-related hospitalization within 21 days. Regression and number-needed-to-treat (NNT) analyses were used. Results: A total of 11,233 patients received any chemotherapy (21.2% PP), were older (median years 64 PP; 64 no PP) and had at least 1 non-cancer comorbidity (79.8% PP; 77.9% no PP). About 2,776 patients received Carbo/Paclitaxel (13.9% PP), 1,356 patients received Cisp/Etop (23% PP) and 1,291 patients received Carbo/Etop (45.8% PP) regimens. PP was associated with lower risk of neutropenia related hospitalization for any chemotherapy (4.7% PP; 7.5% no PP; odds ratio [OR] 0.61; 95% CI 0.49 – 0.74), for Cisp/Etop (5.1% PP; 8.8% no PP; OR 0.56; 95% CI 0.32 – 0.97) and Carbo/Etop (5.6% PP; 11% no PP; OR 0.48; 95% CI 0.31 – 0.73), but not Carbo/Paclitaxel (5.7% PP; 6.7% no PP; OR 0.84; 95% CI 0.53 – 1.32) regimens. Based on NNT, the total cost of PP for 36 patients with any chemotherapy regimen to avoid one hospitalization would be $128,952 (mean hospitalization cost = $11,900, Standard Deviation [SD] = $9,541). For 28 patients with Cisp/Etop, it would be $101,920 (mean hospitalization cost = $16,957, SD = $16,135). For 19 patients with Carbo/Etop, it would be $63,270 (mean hospitalization cost = $11,356, SD = $6,949). Conclusions: Primary G-CSF prophylaxis was associated with some benefit in lowering neutropenia-related hospitalization in patients with lung cancer receiving Cisp/Etop and Carbo/Etop regimens, although the cost to treat patients remains high. Future studies need to examine the value of continued G-CSF use in subsequent cycles.
Strategies to minimize wastage of expensive drugs in expensive times: Cabazitaxel, a single center experience.
Authors: Fallah-Rad Nazanin , Lee Roy , Ng Pamela , Smith Alan D. , Hansen Aaron Richard , Joshua Anthony M. , Sridhar Srikala S. 
Published: September 2018

e18297 Background: Although approved for metastatic castrate-resistant prostate cancer (mCRPC), the use of cabazitaxel has been limited due to concerns over drug wastage. In Canada, Cabazitaxel costs $96.7/mg and comes prepackaged in 60 mg single-dose vials, a quantity higher than the average prescribed and provincially reimbursed dose based on body size. Despite a discount offered by Sanofi to help cover the costs of drug wastage, many centers still cannot afford to administer it. We investigated whether aggressively batching patients (pts) on the same day, and allowing for excess drug to be used for subsequent pts can result in cost-savings. Methods: Between 09/2015 and 09/2016, all mCRPC pts receiving cabazitaxel at Princess Margaret Cancer Center were only treated on Mondays. Left over drug in opened vials was used for subsequent pts treated on the same day. Pts were dosed according to clinical parameters and BSA, at a dose of 20mg/m2 every 3 weeks. We calculated the total number of vials used daily and the amount of drug (mg) wasted. We then compared costs of the new batching system to the standard practice of opening one vial per treatment session. Results: During the trial period, 28 patients, mean age 72.3 (range 45-91) received cabazitaxel as 2nd line (23 pts) or 3rd line (5pts) therapy until disease progression or toxicity. In total, they required 117 individual treatment sessions, administered on 53 treatment days. With the batching system, 91 cabazitaxel vials were used, in comparison to 117 vials required with standard practice. As a result, 26 vials were unopened, $149,760 CAD were saved, equating to a 22.2% cost reduction over a year. In terms of wastage, $121,154 CAD of Cabazitaxel was wasted compared to $251,808 CAD wasted without batching, a difference of $130,656 CAD. Conclusions: Batching of mCRPC pts receiving cabazitaxel on the same day was feasible at a single center and significantly reduced drug wastage. This approach could be applied to centers with adequate patient volumes to save costs and reduce a key barrier to the use of cabazitaxel. A similar strategy can also be applied to other drugs across the field of oncology and has similar implications for cost-savings.
Impact of value of research analyses on SWOG’s clinical trial capsule scoring.
Authors: Carlson Josh John , Kim David , Guzauskas Gregory F. , Bennette Caroline Savage , Hershman Dawn L. , Baker Laurence H. , Hendrix Nathaniel , Basu Anirban , Veenstra David Leroy , Ramsey Scott 
Published: September 2018

e18311 Background: The Institute of Medicine has called for approaches to help maximize the return on research investments in cancer clinical trials. Value of Research (VOR) analysis is a health economics technique that estimates the clinical and economic returns for research investments and can inform research prioritization. Our objective was to evaluate the impact of VOR estimates on SWOG executive committee’s (EC) clinical trial proposal review scores. Methods: We used a previously developed minimal modeling approach to calculate per-patient and population-level (based on US cancer incidence) VOR estimates for 9 phase II and III SWOG research proposals between February 2015 and December 2016. VOR estimates were presented to EC members who determine which studies to submit to the National Cancer Institute (NCI) for funding approval. EC members scored proposals on scientific merit and potential impact before and after receiving VOR estimates. Scores ranged from 1 (best) to 5. We used the Wilcoxon signed rank test to evaluate the change in pre-post scores. Results: Study characteristics, VOR estimates, and pre-post scores are below. EC scores changed after receiving VOR estimates for 8 of 9 proposals. There was no association between VOR estimates and the magnitude of the change in proposal scores (all p > 0.2). Proposals with larger planned annual enrollment had larger changes in scores (0.3 more points [95% CI: 0.2, 0.56] per 100 patient increase; p = 0.04). Conclusions: Presenting VOR estimates influenced EC scores for SWOG trial proposals. VOR may add important data to inform reviews of trial proposals within NCI Cooperative Clinical Trials group settings. [Table: see text]
Comparison of treatment characteristics between patients diagnosed with immune thrombocytopenia (ITP) and treated with thrombopoietin receptor agonists (TPO-RA).
Authors: Lokhandwala Tasneem , Bhor Menaka , Stafkey-Mailey Dana , Chen Herman , Elliott Brian Marc 
Published: September 2018

e18314 Background: There is limited real-world information on the utilization of TPO-RAs, eltrombopag (ELT) and romiplostim (ROM), for the treatment of ITP. Methods: The study employed a retrospective, longitudinal cohort design using integrated healthcare claims data from July 2008-June 2015. Adults diagnosed with ITP initiating TPO-RA therapy from Jan 2009-July 2014 were included. Patients not continuously enrolled in benefits for 6-months prior and 12-months post the index date (first TPO-RA claim date) were excluded. Index TPO-RA discontinuation rates, concomitant therapy, restarts, subsequent therapy, and treatment free periods were assessed. Results: Of the 1,067 patients included, 26.5% (283) received ELT and 73.4% (784) ROM. Age (58.8 vs 59.3; P= 0.705) and gender (males: 45.9% vs 46.6%; P= 0.858) were similar between cohorts. Among ELT and ROM patients 35.7% and 27.6% continued therapy (no gap of ≥30 days) for ≥1 year ( P= 0.010). The average duration of continuous therapy (up to gap ≥30 days) was 131 and 108 days, respectively ( P= 0.001). During continuous course of index TPO-RA treatment 52.7% ELT and 47.2% ROM patients received concomitant ITP-related treatment ( P= 0.115). Following discontinuation, 42.9% of ELT patients restarted ELT, 22.0% did not initiate any subsequent ITP treatments, and 35.2% started a new ITP treatment. Among patients who discontinued ROM, 38.4% restarted, 26.9% did not receive any subsequent therapy, and 34.7% initiated a new treatment. Treatment free periods (≥30 days with no ITP treatment) were experienced by 52.7% of ELT patients and 61.6% ROM patients ( P= 0.009). Mean duration of treatment free period was 109 and 137 days ( P< 0.001), respectively. Conclusions: ITP patients receiving ELT had a longer duration of treatment and shorter treatment free periods compared to patients receiving ROM. Further research is needed to compare clinical outcomes (e.g., platelet counts, bleeding symptoms and remissions) among ITP patients receiving ELT and ROM, in the real-world setting.
The value of cancer treatments: Patient and clinician perspectives.
Authors: Briggs Andrew , Baba Camilla , Kaltenboeck Anna , Lipitz Snyderman Allison Nicole , McIntosh Emma , Bach Peter 
Published: September 2018

e18320 Background: A number of frameworks for assessing the value of cancer treatments such as the National Comprehensive Cancer Network’s evidence blocks, Memorial Sloan Kettering Cancer Center’s Drug Abacus and ASCO’s value framework have been developed to help address the rising cost of cancer treatments. Yet the methodological basis for the inclusion of differing attributes, how to incorporate other contextual considerations and understand stakeholder trade-offs is unclear. This qualitative study aimed to identify contextual factors prioritized by stakeholders for inclusion in oncology value frameworks. Methods: A scoping review identified attributes currently included in value frameworks. Nominal group technique methods were then used in 3 focus groups representing cancer patients, oncology nurses, and physicians across a range of cancer specialties. Each group was tasked with ‘identifying important treatment features’ based on their own experience. Following discussions, participants ranked attributes in order of importance and group consensus identified the ‘top 6’ factors. Results: Twenty-one attributes were identified by the patient (n = 9), nurse (n = 10) and physician (n = 6) focus groups. All identified efficacy and safety/toxicity. Long-term adverse effects, alternative treatment options, quality of evidence and reputation of the treating oncologist/center were prioritized by patients. Nurse preferences centered on mode of administration, quality of life, communication and treatment innovation. Physicians focused on the burden and inconvenience of treatments to patients, functional outcomes, financial toxicity to patients, and societal costs. Conclusions: Although efficacy and safety/toxicity were prioritized in all groups, the prioritization of contextual factors across stakeholders highlights the need to further understand the relative value of possible ‘other’ attributes currently not reflected in frameworks thus, possibly failing to reflect the preferences of stakeholders.
Predictors of advanced imaging use during breast cancer surveillance.
Authors: Miles Randy C. , Lee Christoph I. , Sun Qin , Bansal Aasthaa , Fedorenko Catherine R. , Specht Jennifer M. , Ramsey Scott David , Lyman Gary H. , Lee Janie M. 
Published: September 2018

e18337 Background: Our objectives were to determine advanced imaging use (whole body imaging with bone scan, CT, or PET-CT and breast MRI) during breast cancer surveillance, and to identify drivers of potential imaging overuse as outlined by ASCO’s Choosing Wisely initiative. Methods: Cancer registry records for 2923 women diagnosed with primary breast cancer in Washington State from January 1, 2007 to December 31, 2014 were linked with claims data from two regional commercial insurance plans. Inclusion criteria included women with AJCC stage 0-3 disease treated with curative intent. Women without continuous insurance enrollment from 3 months prior to diagnosis until 14 months after diagnosis were excluded. Surveillance began 4 months after the end of primary therapy and lasted for 15 months or until restart of treatment. Women’s (age, race, family history) and tumor (grade, receptor status, stage) characteristics were collected. Evaluation and management codes from claims data were used to determine mammography, advanced imaging, and tumor biomarker use during the peri-diagnostic and surveillance periods. Multivariate logistic regression models were used to identify factors associated with advanced imaging use during surveillance. Results: Of eligible women, 80.0% (2332/2923) received mammography, 16.5% (483/2932) received whole body imaging, and 21.5% (670/2932) received breast MRI during the surveillance period. Whole body imaging was significantly associated with increasing stage of disease (stage 3: OR = 3.39, 95% CI: 2.30-5.02), peri-diagnostic whole body imaging (OR = 1.80, 95% CI: 1.36-2.38), and surveillance tumor biomarker use (OR = 1.83, 95% CI: 1.46-2.31). Significant predictors of surveillance breast MRI included young age ( < 45 years: OR = 2.40, 95% CI:1.78- 3.25), family history (OR = 1.58, 95% CI:1.26-1.98), peri-diagnostic breast MRI (OR = 2.01, 95% CI: 1.56-2.59), and surveillance tumor biomarker use (OR = 1.74, 95% CI:1.41-2.17). Conclusions: Peri-diagnostic use of advanced imaging and surveillance use of tumor biomarkers are associated with advanced imaging use during surveillance, and may represent targets for interventions to increase adherence to Choosing Wisely clinical guidelines.