bluuebunny/crossref_metadata_2025_split huggingface dataset:
Artificial intelligence-based clinical decision-support system improves cancer treatment and patient satisfaction.
Authors: Wang Zuochao , Yu Zhonghe , Zhang Xuejing 
Published: May 2019

e18303 Background: Traditional diagnostic model for cancer heavily relies on physicians and their teams’ knowledge. However, under this diagnostic model, patients’ source of information is quite limited. Cancer patients usually fill with negative emotion. Lack of knowledge to the disease and treatment options further leads to less confidence to their treatment outcome. Methods: In order to improve their faith in getting proper treatment and the hope for surviving the deadly disease, we has introduced an artificial intelligence based clinical decision-support system, the Watson for Oncology (WFO), since May-2018. WFO is developed by IBM, it assesses information from a patient’s medical record, evaluates medical evidence, and displays potential treatment options. Our oncologist can then apply their own expertise to identify the most appropriate treatment options. We have generated a new 7-step consultation system with the help of WFO. That include 1: introduce the WFO to patients, 2: patients express their demands and expectations, 3: the oncologist presents patient’s medical condition, 4: discussion with other members in the consultation team, 5: input patients’ information into WFO system and review treatment options, 6: discuss and finalize treatment options with patients, 7: feedbacks form patients after consultation. 70 patients who were hospitalized from May-2018 to Dec-2018 were divided into two groups, 50 patients volunteered to be assigned to the new 7-step consultation system and 20 patients stayed with the traditional diagnostic method to find them treatment options. All patients were followed up by questionnaire. Results: The results showed that patients in the 7-step consultation group presented significantly higher satisfaction rate towards treatment options, confidence level to their health care workers, and willingness to follow the treatment option when compared to patients in the traditional diagnostic group. Conclusions: The WFO assisted 7-step consultation system not only provides a more efficient way to find treatment options, but also improves patients’ understanding to their disease and possible side effects towards the treatment. Most importantly, patients build stronger confidence with their health care team and are willing to believe they will benefit from the treatment plans.
Patient satisfaction with oncology clinical decision support in South Korea.
Authors: Lee Kyounga , Lee Seon Heui , Preininger Anita , Shim JungHo , Jackson Gretchen 
Published: May 2019

e18329 Background: Watson For Oncology (WFO) is an artificial intelligence (AI) tool that presents therapeutic options to oncologists and patients at 9 hospitals in Korea. The earliest user is Gachon University Gil Medical Center (GMC), where the tumor board (MDT) is fully integrated with WfO (MDT-WfO). GMC patients and oncologists may select one of the treatment choices presented by MDT-WfO or choose to follow recommendations of one or more oncologists at GMC augmented by WfO (non-MDT-WfO). This study is aimed at determining the satisfaction of patients who pursue shared decision-making through the MDT-WfO approach. Methods: Cancer patients enrolled in this IRB-approved study and treated at GMC between March and September of 2018 were surveyed. All patients rated satisfaction levels from 1-10 after treatment decision-making was completed, with 1 indicating the lowest level of satisfaction and 10 the highest. For each question, the average satisfaction score for patients in the MDT-WfO group was compared to the mean for patients in the non-MDT-WfO group, with a t-test for significance. Results: There were 9 cancer types treated at GMC from March through September of 2018. Of the of 290 patients enrolled in this study, 130 (44.8%) selected MDT-WfO and 160 (55.2%) did not. Overall, patients that interacted with MDT-WfO viewed GMT more positively (86.9%) after treatment decisions had been made than patients in the non-MDT-WfO group (71.3%).Although patients did not report significantly differing levels of satisfaction for most survey questions, there was a significant difference in terms of satisfaction with the explanation they received from the medical staff. Satisfaction level for this item was 9.52 with MDT-WfO and 9.22 points without ( p = 0.029). Conclusions: Patients reported greater satisfaction in the explanations they received in the MDT-WfO group, consistent with their more positive impression of GMT after treatment decisions were made. More studies are needed to determine if the increase in the level of satisfaction for this item is due to explanations from MDT unrelated or related to WfO. More studies on how WfO is used differently by the tumor board and individual oncologists may provide a unique perspective on how WfO is integrated into the MDT.
The ability of isolated fine needle aspiration of lymph nodes to provide complete diagnostic information without necessitating additional diagnostic procedures: A retrospective cohort study.
Authors: Tidwell Nathan , Barnett Taylor Leslie , Thrun Connor H , Graham Brendan C , Graham Lindsey Jean 
Published: May 2019

e18341 Background: Diagnostic fine needle aspiration (FNA) of pathologically enlarged lymph nodes is a relatively safe, quick, and well-tolerated procedure that can be quickly analyzed to identify the presence of malignant cells. Though proven very useful to assess for the presence or absence of malignancy for staging purposes, the procedure’s ability to provide adequate tissue to appropriately diagnose a new malignancy and perform all necessary predictive and prognostic studies has not been explored. Methods: We retrospectively reviewed clinical records of patients who underwent FNA of a pathologically enlarged lymph node for the purpose of obtaining a tissue diagnosis at our institution between January 2010 and December 2015. We then assessed the percentage of patients that required a second diagnostic procedure independent of the FNA result. Procedures done for therapeutic purposes (such as resection) were not counted as a second procedure. We also collected data on the type of procedure used to obtain FNA, patient history of malignancy, and whether the diagnosis was benign or malignant. Results: We identified 594 FNA procedures that fit the study criteria. Of these, 277 (46.6%) required an additional diagnostic procedure. Among the 277 that required a second procedure, 237 (85.6%) were benign and 40 (14.4%) were malignant on primary FNA (P < 0.0001). Of the 237 benign FNAs that required a second procedure, 84 (35.5%) had the diagnosis changed to malignant after the second procedure (P < 0.001). There was no difference between procedure used to obtain the FNA (bronchoscopy, endoscopy, percutaneous) or patient age in the need for a second procedure. Conclusions: Though fine needle aspiration is a useful procedure for establishing the presence or absence of metastatic disease, our analysis suggests that the ability of the procedure to reliably diagnose or provide sufficient tissue for ancillary testing is limited. Nearly half of the patients in this study were subjected to the risks, cost, and diagnostic delay associated with a second procedure.
Perspectives and practices of oncology providers in addressing financial toxicity.
Authors: Ragavan Meera Vimala , Parikh Divya Ahuja , Patel Manali I. 
Published: May 2019

e18342 Background: Few studies have evaluated the perspectives and clinical practices of oncology providers in regards to assisting patients with financial toxicity. Our study sought to assess providers’ attitudes regarding their role in addressing patients’ financial concerns, understand practice patterns in discussing cost of care, and obtain feedback on potential interventions to help address existing barriers. Methods: We developed an 18-question electronic, anonymous survey informed by an extensive literature search and piloted with three physicians with health services research experience. We emailed the survey to 75 attending physicians in Medical Oncology, Hematology, and Radiation Oncology, 117 advance practice practitioners (APPs) and 46 trainees. Responses during the study period 12/12/2018-1/31/2019 were analyzed. Results: A total of 71 (response rate of 30%) participants completed the survey, including 31 attending physicians, 28 APPs, and 12 trainees. Sixty-two percent of participants agreed that oncology providers should openly discuss cost of care with patients. There was wide variation in opinion around whether providers should offer the same treatment recommendations to all patients regardless of cost, with one third stating they agreed, one third stating they disagreed, and one third stating they were neutral. Sixty-one percent of participants did not use any cost-effectiveness tools in decision making. Sixty-three percent of respondents stated that a gap in knowledge of out of pocket costs was the number one barrier to helping patients avoid financial toxicity. The highest ranked intervention of those listed was a guide on available resources for patients with financial needs, voted for by 70% of respondents. Conclusions: Providers identified many barriers at our institution to discussing cost of care, including lack of transparency of out of pocket costs and lack of awareness of available resources. Providers were overwhelmingly interested in incorporating institutional resources and cost-effectiveness tools into their clinical practices. These findings can inform provider-level interventions to better address the financial burden patients face with their cancer care.
Efficacy of a stepped collaborative care intervention for comorbid cancer and depression: Health care utilization and costs.
Authors: Richards Geena , Steel Jennifer Lynne , Geller David A. , Billiar Timothy , Procopio Judith , Kucinski Barbara , Murphy Emily , Tsung Allan , Marsh Wallis , Antoni Michael , Vodovotz Yoram , Spring Michael , Pathak Ritambhara , Cheng Hannah , Sidleck Blake 
Published: May 2019

e18348 Background: The aims of this study were to test the efficacy of a stepped collaborative care intervention for comorbid cancer and depression on outcomes including complication rates, health care utilization and costs. Methods: Patients diagnosed with cancer were enrolled in a randomized controlled trial testing the efficacy of a stepped collaborative care intervention. Patients were administered a battery of questionnaires prior to randomization. Rates and severity of surgical complications, health care utilization and costs were collected for a one-year period after randomization. Descriptive statistics, Chi-square analyses, and Ordered Restricted Inference analyses were performed. Results: Of the 100 patients, the mean age was 64.0 (SD = 10.3), the majority of the patients were male (51%), Caucasian (89%), diagnosed with hepatocellular or cholangiocarcinoma (47%) and stage III and IV (60%). For patients less than 75 years, patients randomized to the collaborative care intervention had lower rates of complications after surgery [Χ2= 5.45, P = 0.02]. We observed that 16% of patients randomized to the collaborative care intervention had complications versus 66.7% of the patients in the screening and referral arm. For patients who survived 6 months or less, those who were randomized to the collaborative care intervention had lower rates of 90-day readmissions than patients randomized to the screening and referral arm [Χ2= 4.0, P = 0.046]. The patients randomized to the collaborative care intervention did not have any readmissions while 2 patients in the screening and referral arm were readmitted. Patients randomized to the collaborative care intervention arm had lower median costs associated with the loss of workforce productivity ($2340 versus $3001; P = 0.07), hospital costs ($13,008 versus $21,109, P = 0.09), and cost per hospital registration ($1158 versus $2219, P = 0.07) when compared to the screening and referral arm. Conclusions: The stepped collaborative care intervention not only reduced depressive symptoms, but patients randomized to this intervention had lower complication rates, health care utilization, loss of work productivity, and hospital related costs. Clinical trial information: NCT02939755.
Social values and cancer funding priorities: Empirical evidence for cancer policy.
Authors: Denburg Avram 
Published: May 2019

e18352 Background: Achieving value in health care requires knowledge of public values and priorities. To better understand public values for resource allocation on cancer care, we conducted a population-based stated preference survey with a nested randomized controlled moral reasoning intervention. Our objective was to generate evidence to inform economic evaluation and policymaking on cancer care priority-setting and payment reform in developed health systems. Methods: We conducted a population-based stated preference survey of societal views on the prioritization of health resources between children and adults, administered to a nationally representative sample (n = 1,556) of Canadian adults. Allocative preferences were elicited across a range of hypothetical treatment scenarios and scored on a visual analogue scale. Participants were randomized to a moral reasoning intervention (n = 773) or a control group (n = 783). Those randomized to the intervention group were exposed to a moral reasoning exercise prior to each choice task. The exercise presented participants with a list of ethical principles relevant to health care resource allocation and tasked them to select the top principles guiding their choice. The main outcomes were the difference in mean preference scores by group, scenario, and participant demographics. Results: Multiple regression analyses demonstrated a consistent aggregate preference by participants to allocate scarce health system resources to children. Exposure to the moral reasoning exercise weakened but did not eliminate allocative preference for children, as compared to control (difference 0.72, SE 0.14, p < 0.0001). Younger respondent age (-0.71, SE 0.14, p < 0.0001) and parenthood (-0.40, SE 0.11, p < 0.0002) were associated with greater preference for children. The top three principles guiding participants’ allocative decisions were treat equally (54.3-63.9%), relieve suffering (39.6-66.1%), and rescue those at risk of dying (37-40.8%). Conclusions: Our results demonstrate a significant preference by participants to allocate health care resources to children, but one attenuated by exposure to a range of ethical principles to guide decision-making. It also evinced strong support for humanitarian principles to guide health care resource allocation. Definitions of value in health care based primarily on the magnitude of clinical benefit and cost-effectiveness may exclude moral considerations that the public values.
Impact of solid tumor brain metastases on end-of-life healthcare utilization.
Authors: Ray Emily Miller , Dunham Lisette , Reeder-Hayes Katherine Elizabeth , Sanoff Hanna Kelly 
Published: May 2019

e18373 Background: Patients with brain metastases (BMets) represent a subset of cancer patients who may experience high costs and frequent healthcare utilization. This study aims to assess whether patients with BMets have higher likelihood of low-value healthcare utilization at the end of life compared to other patients with metastatic cancer. Methods: Using the Cancer Information and Population Health Resource, linking North Carolina Medicare and Medicaid and cancer registry data, we conducted an observational cohort study of decedents with metastatic cancer with or without BMets. The cohorts included adults with melanoma, renal cell carcinoma, breast cancer, or lung cancer, diagnosed 2003 to 2014. Multivariate logistic regression, adjusting for demographics, cancer type, systemic treatment, comorbidity, frailty, and hospice use, was used to examine the impact of BMets on emergency department (ED) use, hospitalization, and intensive care (ICU) in the 30 days prior to death. Results: Relative to patients without BMets, patients with BMets were more likely to experience a hospitalization (12.9% vs 9%, p < 0.001), but experience no difference in ED or ICU use. In adjusted analyses, BMets patients receiving systemic treatment were particularly high risk for hospitalization (OR 1.823, CI 1.504, 2.209). Black race; receipt of systemic therapy near the end of life; and Charlson comorbidity score of 3+ confers increased risk of ED use, hospitalization, and ICU use (Table). Utilization did not vary by cancer type. Conclusions: Patients with BMets are high risk for hospitalization at the end of life. Further study is needed to determine if targeted health system interventions can decrease hospitalizations in this patient group. [Table: see text]
Health-related quality of life (HRQoL) in patients with advanced melanoma receiving immunotherapies across real-world clinical practice settings.
Authors: Joseph Richard Wayne , Liu Frank Xiaoqing , Shillington Alicia C. , Macahilig Cynthia , Diede Scott J. , Dave Vaidehi , Harshaw Qing , Saretsky Todd L , Pickard Alan S 
Published: May 2019

e21004 Background: Pembrolizumab (PEMBRO) and combination ipilimumab + nivolumab (IPI+NIVO) are FDA-approved immunotherapies for advanced melanoma (AM). HRQoL was better maintained with PEMBRO vs IPI in KEYNOTE-006. CheckMate-067 reported no clinically meaningful HRQoL differences with IPI+NIVO vs IPI. As randomized trial data are lacking, we compared HRQoL outcomes in AM between PEMBRO and IPI+NIVO in real-world clinical settings. Methods: A prospective, observational study was conducted with sponsor blinded to sites, and sites blinded to sponsor; nine oncologists from 9 US academic centers and affiliated satellite clinics enrolled AM patients (pts) age ≥18 years initiating first-line PEMBRO or IPI+NIVO between June 2017 – March 2018. The European Organization for the Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ C30) and EQ-5D-5L were administered at baseline and weeks 6, 12, 18, and 24 following therapy. Least squared (LS) mean changes in HRQoL scores from baseline were compared using mixed-effects models for repeated measures, adjusting for baseline covariates. Results: A total of 225 PEMBRO and 187 IPI+NIVO pts were enrolled, with > 95% questionnaire completion rates through week 24. At baseline, PEMBRO pts were more likely > age 65 (49% vs 37%, p = .011), stage IV disease (92% vs 85%; p = .002), and higher comorbidity index (1.0 vs 0.6; p < .001) compared with IPI+NIVO pts. Adjusted EORTC global health status/quality of life (GHS) LS mean changes from baseline showed greater improvement with PEMBRO vs. IPI+NIVO at 12, 18 and 24 weeks. At week 24, PEMBRO pts achieved a 3.3-point improvement (95% CI = 0.8, 5.7) and IPI+NIVO pts had no significant change (1.0, 95% CI = -1.6, 3.5), with a LS mean difference of 2.3 points (p = .037; 95% CI = 0.14, 4.51). At week 24, the EQ-5D visual analogue scale increased 1.0 (95% CI, -1.2, 3.2) for PEMBRO vs IPI+NIVO which decreased 0.9 (95% CI = -3.2, 1.3), with a statistically significant LS mean difference of 2.0 (95% CI = 0.4, 3.9; p = .045). Conclusions: Results from 2 measures suggest HRQoL was maintained vs. baseline in both PEMBRO and IPI+NIVO pts, with a significant between-group difference favoring PEMBRO in GHS over 24 weeks.
Safety and interim results from a phase II, single-arm study of atezolizumab and bevacizumab in Merkel cell carcinoma (MCC).
Authors: Ferrarotto Renata , Mata Javier , Mott Frank , Bhosale Priya , Rubin M. Laura , Altan Mehmet , Dervin Shannon , Yun Cindy , Yao James C. , Halperin Daniel M. 
Published: May 2019

e21006 Background: MCC is an aggressive neuroendocrine carcinoma of the skin. Avelumab (anti-PD-L1) was FDA approved for the treatment of metastatic MCC based on an overall response rate (ORR) of 32% in chemotherapy-refractory pts. In first line, responses to PD1/PD-L1 have been reported in 56-62% of pts. Atezolizumab (Atezo) targets PD-L1 and bevacizumab (bev) inhibits VEGF. Pre-clinical data suggests atezo + bev improves antigen-specific T-cell migration, and encouraging clinical activity of this regimen has been reported in renal cell and hepatocellular carcinoma. Here we report safety and interim results of atezo + bev in MCC. Methods: In this phase II single-arm study the efficacy and safety of atezo + bev was evaluated in pts with recurrent/metastatic PD-1/PD-L1-inhibitor naive MCC. Patients were treated with atezo 1200 mg + bev 15 mg/kg IV Q3W. Primary endpoint was ORR (RECIST 1.1) by blinded independent radiologist. Secondary endpoints included ORR by iRECIST, PFS, DOR, DCR, OS, and safety. Results: 11 pts enrolled. Median age was 70 (range:57-84), (7) 63% were male, and 7 (63%) had been treated with curative intent. Five (45%) pts had received platinum/etoposide (2 in the neo-adjuvant setting and 3 in first-line). Median follow-up is 9.7 months (range:2.8-15.9). Adverse events (AEs) that occurred in > 1 pt: hypertension (7), proteinuria (3), fatigue (2), peripheral edema (2), epistaxis (2), and transaminitis (2). Grade 3 AEs: hypertension (2), proteinuria (1), and auto-immune hepatitis (1); all manageable. Only 1 subject discontinued treatment due to toxicity (auto-immune hepatitis). There were no grade > 3 AEs. Objective response occurred in 7 (64%) pts, including 3 (27%) complete responses (CR). One partial response was unconfirmed (patient discontinued treatment after 1 dose of atezo/bev due to grade 3 hepatitis). 4 pts remain on treatment (1 pt with CR withdrew consent for further therapy and has not recurred). Median PFS is 6.3 months (95% CI:4.5-NA). Conclusions: Atezo + bev was well tolerated in MCC pts. Safety was consistent with that of the individual agents. Activity is encouraging with 64% ORR (27% CR rate) and mPFS of 6.3 months. Clinical trial information: NCT03074513.