bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cancer and non-cancer pain opioid utilization in Medicare and Medicaid populations.
Authors: Datto Catherine J. , Hu Yiqun , Wittbrodt Eric , Fine Perry G. 
Published: May 2018

139 Background: Limited data exist comparing opioid use patterns in Medicare and Medicaid patients with cancer-related (CP) and non-cancer-related pain (NCP). Methods: A retrospective analysis of Medicare and Medicaid claims data (MarketScan Research Databases) investigated opioid use patterns in patients with CP and NCP. Adults (age ≥18 yr) with ≥1 pharmacy claim for an opioid (index date), continuous plan eligibility for 6 months pre- and 12 months post-index date, and duration of opioid use of ≥4 weeks were identified. CP patients were identified by medical claim for a cancer diagnosis within 30 days before index date. Results: A total of 4,009 Medicare and 551 Medicaid patients with CP and 98,631 Medicare and 25,163 Medicaid patients with NCP were analyzed. The most common cancer diagnoses were breast, lung, prostate, and colorectal. Medicare patients with CP and NCP had similar mean age; in the Medicaid cohort, patients with CP were older than those with NCP. In the Medicare cohort, NCP patients were more likely to be women; sex distribution was similar among Medicaid patients. Higher rates of comorbidity in the CP cohorts were observed in both datasets. Median index and post-index opioid doses were consistent between the CP and NCP cohorts. The post-index pattern of change in opioid dose was consistent between CP and NCP in both Medicare and Medicaid patients. The most common pattern observed was up to a doubling of index dose. Conclusions: Similar opioid utilization patterns in Medicare and Medicaid populations, including dose escalation, were observed regardless of pain etiology (cancer or non-cancer). [Table: see text]
Material and behavioral financial hardship as predictors of health-related quality of life in a diverse cohort of cancer survivors.
Authors: Hastert Theresa A. , Harper Felicity W. K. , Beebe-Dimmer Jennifer Lynn , Baird Tara , Schwartz Ann G. 
Published: May 2018

145 Background: Financial hardship is common among cancer survivors, but its association with health-related quality of life (HRQOL) unknown. Methods: We utilized data from 570 black participants the Detroit Research on Cancer Survivors (ROCS) cohort study diagnosed with breast, colorectal, lung or prostate cancer since 1/1/13 and diagnosed or treated at the Karmanos Cancer Institute, and 402 white survivors meeting the same criteria. HRQOL was measured using the functional assessment of cancer therapy-general (FACT-G) and its subscales of physical, social, emotional and functional wellbeing, and site-specific measures. We fit linear regressions to estimate associations between material (debt, borrowing, selling assets, reduced income) and behavioral (skipping medication, not seeing a doctor, refusing treatment due to cost) financial hardship (MFH and BFH, respectively) and HRQOL. Adjusted models include demographic, socioeconomic, and treatment-related factors. Results: Overall, 50.3% of participants experienced material and 17.6% experienced behavioral financial hardship. In unadjusted models, HRQOL scores were 0.39 (95% CI 0.27, 0.51) standard deviations (SD) lower in those reporting any MFH. MFH was associated with significantly lower physical, emotional, and functional wellbeing scores, and with lower scores on breast-, colorectal-, and prostate-specific HRQOL measures. Total HRQOL was 0.68 SD (95% CI 0.52, 0.84) lower for participants who reported BFH than those who did not, and BFH was inversely associated with each subscale and each cancer-specific measure. In adjusted models, HRQOL scores were 0.15 (95% CI 0.03, 0.27) SD lower among participants reporting MFH and remained inversely associated with physical and functional wellbeing. BFH was associated with 0.42 (95% CI 0.27, 0.57) SD lower HRQOL scores and remained inversely associated with physical, social, emotional, and functional wellbeing; and with breast- and prostate-specific measures. Conclusions: MFH and BFH are associated with lower HRQOL among diverse cancer survivors. Addressing BFH in particular may improve HRQOL among survivors, particularly those with breast and prostate cancer.
Seeking a no-regrets decision: Women's rationale for choosing contralateral prophylactic mastectomy (CPM).
Authors: Bloom Diane , Wheeler Stephanie B. , McGuire Kandace P , Lee Clara , Weinfurt Kevin , Rosenstein Donald , Plichta Jennifer K , Hwang Eun-Sil Shelley 
Published: May 2018

152 Background: More women with early-stage unilateral breast cancer and low genetic risk are opting for CPM, despite their low risk of developing cancer in their healthy breast and evidence to demonstrate that CPM improves neither survival nor quality of life, while increasing the risk of surgical complications. Little is known about the factors that motivate this irreversible decision. Methods: We conducted comprehensive qualitative interviews with 42 women at low risk for contralateral breast cancer (CBC) who had CPM in the last 10 years. We recorded and transcribed the interviews and analyzed them using a grounded theory approach. Results: Contrary to hypotheses that newly diagnosed women overestimate their CBC risk, study patients knew of the low risk of cancer in their healthy breast, but still chose CPM. Statistics were unpersuasive; given healthy lifestyles and lack of risk factors, they felt unlucky to get breast cancer and feared they would be unlucky again. They believed CPM would give them more peace of mind and the fewest regrets should cancer return. Avoiding mammograms was important, given the potential for callbacks, biopsies, and more bad news. Avoiding radiation and wanting matching breasts were cited less often. Most were mainly focused on reducing their cancer risk and could not recall having critical information about CPM’s potential harms. A few knew of likely harms but misjudged their impact. When told of CPM’s higher risk of complications, most dismissed this as a disclaimer, believing they would get through surgery well. Despite experiencing negative effects of CPM, 38 of 42 stated they would make the same decision again. Conclusions: When choosing CPM, most women felt confident in making their decision, although many had incomplete knowledge of potential long-term impacts. Nevertheless the majority of women who chose CPM did not regret their decision, suggesting that women who elect CPM are selecting a treatment option that is consistent with their long-term personal values and preferences. While important to ensure women know potential long-term harms, our findings suggest they may not necessarily be dissuaded from CPM by more data, though they may be better prepared for it’s aftermath.
The hidden burden of anxiety and depression in ovarian cancer: A prospective study from diagnosis.
Authors: Webb Penelope M , Beesley Vanessa , deFazio Anna , Obermair Andreas , Grant Peter T. , Nagle Christina , Friedlander Michael ,   The OPAL Study Group
Published: May 2018

155 Background: Women with ovarian cancer (OC) report high rates of anxiety (A) and depression (D), but most studies have used a cross-sectional design at a single time-point, not considered prior history and not included affected women who are symptom-free due to medication. Our goals were to quantify (i) the total burden of A and D among women with newly diagnosed OC; the proportions who (ii) experience symptoms only after their OC diagnosis and (iii) with persistent symptoms; and (iv) use of appropriate medication/services by those affected. Methods: The OPAL (Ovarian Cancer Prognosis & Lifestyle) Study is a prospective study of Australian women diagnosed with OC from 2012-15 who agreed to complete questionnaires at baseline, 3, 6, 9, 12, 24, 36 & 48 months after diagnosis. At baseline, they were asked if they had ever been diagnosed with A or D and if they took medication for this in the year before their OC diagnosis. At follow-up they completed the Hospital Anxiety and Depression Scale (HADS) and were asked about current medication use. Results: Of 893 women with data for ≥1 time point, 216 (24%) reported clinical levels (HADS > 10) of anxiety (18%) and/or depression (15%) on at least one occasion during the first 3 years after diagnosis, with another 157 (18%) reporting use of anxiolytic or antidepressant medications. A further 167 (19%) reported subclinical (HADS 8-10) A or D. Of those with clinical levels of A/D and/or taking medication, 225 (60%) reported this at ≥3 time-points, 216 (58%) reported no prior history of A or D, and 271 (73%) reported no use of anxiolytic/antidepressant medication in the year before diagnosis. When women reported clinical levels of A or D, only 45% reported taking medication (37%) and/or seeing a psychiatrist or psychologist (19%). Conclusions: More than 40% of women with OC experienced clinical levels of A or D during treatment or the first 3 years of follow-up, for 25% this persisted. For 24% this was their first experience of distress and > 50% of those affected did not receive appropriate medication or psychological support. The hidden burden of anxiety and depression in this population is much greater than previously reported but is amenable to effective intervention if recognized.
Family medicine providers' perceptions of their ability to provide evidence-based survivorship care.
Authors: Rodriguez Maria Alma , Palos Guadalupe R. , Gilmore Katherine Ramsey , Lewis-Patterson Paula A. , Foxhall Lewis E. , Shay Laura Aubree 
Published: May 2018

16 Background: Opportunities for medical students and primary care providers to learn about evidence-based cancer survivorship care remains limited. To fill this void, we created an innovative curriculum using ECHO, a tele-mentoring approach, to teach faculty and residents in family medicine programs about the core principles and skills of survivorship care. Our objective was to explore participants' perceptions about their self-efficacy to deliver high quality care to survivors. Methods: Subjects were recruited from 3 academic centers with medical residency programs collaborating with our cancer center in a state-funded education grant to develop a tele-mentoring training program. The survey, which was developed by the research team, measured self-efficacy and satisfaction. Subjects were asked to rate their confidence in their abilities to offer evidence-based care after completing the program. Descriptive statistics were used to report results. REDCap, a web-based application, was used to manage the development and distribution of the survey. Results: A total of 116 surveys were sent out electronically with 59 returned (50.9%). Table 1 indicates most participants reported the ECHO program increased their knowledge, clinical skills, and expertise to provide comprehensive survivorship care. Conclusions: Overall, the participants’ perceptions of their expertise to offer optimal survivorship care were positive. There is room for improvement to maximize the learning experience for all participants.[Table: see text]
When will I feel normal again? Quality of life trajectories after first-line chemotherapy for ovarian cancer.
Authors: Webb Penelope M , Beesley Vanessa , Nagle Christina , Grant Peter T. , deFazio Anna , Obermair Andreas , Friedlander Michael ,   OPAL Study Group
Published: May 2018

172 Background: Patients often ask if/when they will feel normal again following treatment for ovarian cancer (OC). There is a paucity of data on the trajectories of quality of life (QoL), physical (PWB), social (SWB), emotional (EWB) and functional (FWB) wellbeing over time following chemotherapy and especially regarding those who have persistent problems. Our aim was to quantify the proportion of women with significantly lower QoL/wellbeing than the general population at the end of treatment and determine if/when they return to normal. Methods: The OPAL (Ovarian cancer Prognosis & Lifestyle) Study is a prospective study of Australian women diagnosed with invasive OC from 2012-15 who agreed to complete regular questionnaires after diagnosis. 580 participants who received ≥3 cycles of platinum-based chemotherapy as primary treatment and completed a questionnaire while on or < 6 weeks after completing chemotherapy (baseline) were included. FACT-G data came from questionnaires at baseline and ~3, 6, 9 & 18 months post-baseline. Group-based trajectory models were used to identify groups with distinct patterns of QoL/wellbeing over time. Results: Overall, 44% (254) of women had QoL scores significantly lower than the general population at baseline; 35% (88) returned to normal by 3 months after treatment, 73% by 6 months and 27% (69) had not returned to normal by 18 months. The Table shows the comparable figures for the wellbeing subscales. Conclusions: While > 50% of women with OC can expect similar QoL, FWB and EWB to the general population at the end of chemotherapy, PWB was compromised in 3 of 4 women. For most, wellbeing recovered within 6 months but a substantial proportion reported ongoing deficits. A particularly prolonged impact was seen for those with poor EWB at baseline, warranting early intervention in this subset. [Table: see text]
Lung screening in head and neck cancer survivors.
Authors: East Avigayil , Swider Susan 
Published: May 2018

179 Background: Lung screening is a relatively new screening method to detect early lung cancers among current or former smokers (American Cancer Society, 2016). One quarter of head and neck cancer survivors succumb to second malignancies with lung cancer representing 53% of second cancers (Baxi et al, 2014). At one ambulatory cancer center rates of screening within the head and neck cancer population were low at 15% (Local Tumor Registry, "Head and Neck Cases,” 2016). Furthermore, smoking documentation, which is required for determining appropriateness of lung screening, was incomplete within 39% of audited head and neck cancer patient charts (Local Tumor Registry, "Head and Neck Cases,” 2016). The objective of this project was to identify the effect of education on prescribers’ intention to screen and on smoking documentation within the electronic medical record. Methods: An educational session addressing barriers to screening prescription was presented to prescribers (N = 12) and clinical staff nurses (N = 18). Using an evidence-based approach, a question/answer period plus an electronic health record demonstration were included within the session (The Community Guide, 2017). The study design used pre- and posttest methodology to evaluate the session’s impact on screening rates, with pretest represented by extant data. Posttest survey and chart audits were used to measure outcomes of education including intention to screen and rates of completed smoking documentation. Results: Rates of completed smoking documentation increased from 61% to 78% after the educational intervention. On prescriber surveys 88% of respondents (N = 8) indicated that as a result of the educational session they were more likely to order lung screening. Other findings from survey showed there might have been a high level of knowledge about lung screening prior to the session. Conclusions: Multicomponent educational sessions served as a useful reminder resulting in high rates of intention to screen. Providing background information about lung screening may be useful for clinical nursing staff in improving smoking documentation. Next steps include a 6-month post hoc analysis of lung screening rates as well as nursing remediation to further increase smoking documentation.
Leveraging survivorship care to identify recurrent melanoma.
Authors: Ward Andrew Joseph , McLoughlin James M. , Lewis James M. 
Published: May 2018

181 Background: The University of Tennessee Medical Center in Knoxville, Tennessee is the regions only academic medical center. This includes the Cancer Institute, where in 2013 a division dedicated to melanoma and soft tissue tumors (MASTT) was created. Since 2013, the number of melanoma cases treated at UTMCK treated has increased in excess of 300%. One critical aspect of the MASTT service was to provide survivorship care to all patients treated. This has given MASTT a unique opportunity to determine how survivorship care has impacted detection of recurrence in melanoma. Methods: Tumor registry data was retrospectively reviewed from a prospectively maintained database. All melanoma patients treated from 2011 to 2015 were identified. This cohort was selected because all of these patients would have been eligible for survivorship care. These patients were then stratified into stage and sub-stage, recurrence status, stage at recurrence, and whether alive or dead. Median and range of time to recurrence were calculated as well. Results: A total of 758 patients were treated for melanoma between 2011 and 2015 at UTMCK by the MASTT service. From this overall sample, a total of 37 patients demonstrated recurrence (4.88% overall). Local recurrence was noted in 9 cases (1.2%), regional recurrence in 4 cases (0.53%) and distant in 15 cases (2.0%). Seven of the recurrent cases were not specified. Median time to recurrence was 12 months (6-40 months). Overall mortality rate for patients with recurrent melanoma was 18/37 (48.6%). Nationally, local recurrence rates are reported between 3 – 5%. Conclusions: A retrospective analysis of tumor registry data for melanoma patients treated at UTMCK CI by the MASTT service line shows that offering survivorship care to this population is beneficial in detecting recurrence. This is key in getting patients evaluated and established for immunotherapy and/or other treatment options at the earliest time of recurrence, which can potentially improve their response to treatment by.
The occurrence of human papilloma virus (HPV)-related cancers in human immunodeficiency virus (HIV)-infected women compliant with highly active antiretroviral therapy (HAART).
Authors: Hennebery Ruth B. , Robinson William R. 
Published: May 2018

185 Background: HAART has been demonstrated effective at maintaining immunocompetence (as measured in part by CD4 levels) and reducing the occurrence and severity of cervical cancer in HIV-infected women. Conversely, rapid disease progression, poor treatment response and the development of multiple cancers has been associate with suboptimal HIV therapy and low CD4 counts. Methods: 17 HIV-infected women presenting to an inner-city, academic medical center from 1996-2016 were diagnosed with cervical cancer and at least one other HPV-associated cancer. Data recorded include: year of diagnosis and treatment for cervical cancer; the type, year of diagnosis and treatment of subsequent HPV-associated cancers; compliance with HAART and CD4 counts at diagnosis and death (if applicable). Results: 15/17 (88.2%) used HAART and had CD4 counts > 200 at cervical cancer diagnosis. The time from diagnosis of cervical cancer to a second HPV-associated cancer was 0-19 years, with 52.9% developing a second cancer within 3 years. Second cancer diagnoses included vulvar(9), vaginal(2), anal(3), oropharyngeal(1), urethral(1), and bladder/urethral(1). Seven patients developed third cancers: anal(3), oropharyngeal(3), vaginal(1). Conclusions: Despite the effective use of HAART, HIV-infected women appear to be at risk for the development of multiple cancers following a diagnosis of cervical cancer, even years to decades later. Screening for HPV-associated cancers (including oropharyngeal) should therefore be maintained and emphasized, even in highly compliant subjects with adequate CD4 levels.
Educating primary care providers about cancer survivorship.
Authors: Chaput Genevieve , Courteau Catherine , Williams Tristan , D'Souza Vinita , Fortier-McGill Blythe 
Published: May 2018

20 Background: Nearly 50% of cancer survivors (CS) experience psychosocial and physical treatment-related effects. CS are often afflicted with greater medical conditions than non-cancer patients: survivorship care is thus imperative. In addition to follow-up by specialists, 75% of CS also visit their primary care provider (PCP) during and after treatments. Despite their role in survivorship, insufficient knowledge and low confidence have been reported by PCPs, supporting the need to educate them. This study aimed to evaluate the educational benefit of a survivorship workshop (SW) targeting PCPs in Montreal, Canada. Methods: An accredited 60-minute SW based on common survivorship issues and recommended guidelines by recognized entities was developed and delivered to 167 PCPs at 6 sites. The same MD presented each SW. Brief matched pre, post and 3 month delayed post surveys were designed (Likert-scale and short-answer questions), and completed on a voluntary basis. Outcome measures targeted 3 levels of Kirkpatrick’s learning model: satisfaction, knowledge, and behavior. Data were analyzed with parametric (paired t-tests) and non-parametric (Wilcoxon Signed rank tests) comparisons as appropriate. Results: The pre and post survey response rate was 65.3% and the 3-month delayed post survey response rate was 56.9%. Immediately following the SW, participants were significantly more likely to be able to list standards of survivorship, t(108) = 10.50, p < .001, and to name late-effects of cancer treatment, t(108) = 5.52 , p < .001. High relevance and satisfaction of SW was reported (95%), and 99% expressed intent to incorporate survivorship information into practice. At 3 months post-SW, confidence remained significantly higher than pre-intervention levels for both knowledge of “late physical effects” ( Z = 6.08, p < .001, n = 60) and “adverse psychosocial outcomes” of cancer and treatments (Z = 4.26, p < .001, n = 62). Conclusions: Much literature has focused on determining PCP barriers to survivorship care, including limited topic proficiency, yet further initiatives are warranted to optimize PCP survivorship expertise. Our SW increased PCP survivorship knowledge, and confidence levels remained greater at 3 months post, indicating its educational merit.