bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of bilateral mastectomy with or without immediate reconstruction on time to subsequent therapy in breast cancer in a community oncology clinic.
Authors: Chakraborty Rajshekhar , Regal Ronald , Johnson Brian , Benedict Jennifer , Friday Bret Edward Buckley 
Published: September 2018

e18154 Background: Due to an increase in the elective decision to pursue contralateral prophylactic mastectomy (CPM), the incidence of bilateral mastectomy (BM) with/without postmastectomy reconstruction (R) [BM+/-R] has increased in the last decade. While prior studies at academic centers have investigated concerns regarding its impact on subsequent cancer therapy, we hypothesized that BM+/-R is associated with a delay in initiation of adjuvant therapy (AT) in a community oncology clinic. Methods: This study involved chart review of all patients who underwent mastectomy as definitive surgery for stage I-III breast cancer between 2007 and 2012 and were subsequently followed at Essentia Health Cancer Center. The primary endpoint of the study was the proportion of patients receiving subsequent AT within 6 weeks of surgery (TST6) when compared between different surgical groups. Results: A total of 478 patients were included in the study, with a median age of 63 years. Patients were divided into 4 groups, BM-R (n = 133), BM+R (n = 73), unilateral mastectomy (UM) –R (n = 244) and UM+R (n = 28). Significant demographic differences were identified between the groups including age ( p< 0.001), medical comorbidities ( p< 0.001), and BMI ( p< 0.001). The incidence of any major post-operative complication (including flap/implant failure, infection and wound necrosis/dehiscence) or additional surgeries within 6 weeks of surgery was higher in patients undergoing reconstruction, [BM+R (19%) and UM+R (18%)] compared to those who did not [BM-R (6%) and UM-R (4%)] ( p< 0.001). Patients having major complications or needing additional surgeries within 6 weeks had a lower adjusted likelihood of achieving TST6 compared to those who did not (OR = 0.35; p= 0.009). However, there was no significant difference in TST6 between the surgical groups ( p= 0.31). Conclusions: Immediate post-mastectomy reconstruction is associated with a significantly increased risk of postoperative complications or need for additional surgeries within 6 weeks. In an appropriately selected patient population, CPM and reconstruction do not significantly delay subsequent AT in a community oncology clinic.
Payers, patients, and physicians understanding of quality of life, functional status, and their importance relative to survival in triple-negative breast cancer.
Authors: White Richard Edward , Floyd Jennifer , Lankford Maria L. , Kaufman Stewart , Mahtani Reshma L. 
Published: September 2018

e18156 Background: Value has taken center stage in US oncology treatment as evidenced by the growth of value frameworks and value-based pricing/contracting. These efforts include assessment of quality of life (QoL), survival, and functional status (FS), but the perspectives of payers, patients, and physicians are relatively unknown. We explored the relationships between QoL, FS, and survival in triple negative breast cancer (TNBC) and their importance relative to each other among the 3 key interviewed groups. Methods: Hour-long phone interviews with 6 individuals with TNBC and web-assisted phone interviews with 6 payers and 6 medical oncologists in the US were conducted. Respondents were asked how they differentiate QoL and FS, and how, relative to survival, each impacts their view of TNBC treatment. Results: For payers, QoL and FS are commonly confused and viewed as both supplementary and less important than survival metrics; however, they do desire to understand how each predicts survival. Oncologists prioritized survival, other clinical endpoints, and safety, but believed QoL and FS were very important. Moreover, they assess QoL by the adverse events experienced while on treatment, and view FS as being more objective. For patients, QoL and FS are intermingled, falling under a broad category of QoL. FS was poorly understood, and survival was viewed as critical to meaningful QoL. The threshold at which QoL overrides survival was the point at which patients consider themselves a burden to others. Conclusions: The definitions of QoL and FS used by health services researchers who define “value” is out of sync with patients, payers, and sometimes physicians, making communication of this important information to the individuals interviewed difficult. While the perceived value of QoL and FS varies, and considering the limited treatment options available for TNBC, survival supersedes both measures such that QoL and FS are nearly disregarded. [Table: see text]
The validity of algorithms using health administrative data in identifying cancer-related events in adolescents and young adults: A population-based study using the IMPACT cohort.
Authors: Pole Jason D , Nathan Paul C. , Baxter Nancy N. , Lau Cindy , Daly Corinne , Cullen Aileen , Gupta Sumit 
Published: September 2018

e18168 Background: Despite the importance of estimating population level cancer outcomes, most registries do not collect critical events such as relapse and progression. Attempts to use health administrative data to identify these events have focused on older adults and have been mostly unsuccessful. We developed and tested administrative data-based algorithms in a population-based cohort of adolescents and young adults (AYA) with cancer. Methods: We identified all Ontario AYA 15-21 years of age diagnosed with leukemia, lymphoma, sarcoma, or testicular cancer between 1992 and 2012. Chart abstraction was used to determine the end of initial treatment (EOIT) date and subsequent cancer-related events (progression, relapse, second cancer). Linkage to population-based administrative databases identified fee and procedure codes indicating cancer treatment or palliative care. Algorithms that determined EOIT based a time interval free of treatment-associated codes, and new cancer-related events based on billing codes, were compared to chart abstracted data. Results: The cohort comprised 1,404 patients. Time periods free of treatment-associated codes did not validly identify EOIT dates; using subsequent codes to identify new cancer events was thus associated with low sensitivity (56.2%). However, using administrative data codes that occurred after the EOIT date based on chart abstraction, the first cancer-related event was identified with excellent validity (sensitivity 87.0%, specificity 93.3%, PPV 81.5%, negative predictive value 95.5%). Conclusions: While administrative data alone did not validly identify cancer-related events, using administrative data in combination with chart collected EOIT dates was associated with excellent validity. The collection of EOIT dates by cancer registries would significantly expand the potential of administrative data linkage to assess cancer outcomes.
Feasibility of a geriatric chemotherapy toxicity prediction tool in adults with advanced cancer: A pilot study at the University of Pittsburgh Medical Center (UPMC).
Authors: Garcia Christine Ann , Ormond Ellen , Van Londen G J. , Chu Edward , Burgess Melissa Amber 
Published: September 2018

e18179 Background: Adults with advanced cancer vary considerably in health status and functional reserve. Given the substantial risk of toxicity from systemic therapy, the challenge for medical oncologists is to objectively evaluate the risk of treatment complications prior to starting treatment. The Hurria Prediction Tool for Chemotherapy Toxicity in older adults was developed to aid medical oncologists in predicting which patients are at the highest risk of toxicity. This validated tool stratified geriatric patients with advanced cancer into low, medium, and high risk for toxicity from chemotherapy. In line with UPMC’s mission to “ensure that every patient gets the right care, in the right way, at the right time, every time,” we investigated the feasibility and usefulness of the tool to predict toxicity in adults with advanced cancer, and assist in shared decision making when undergoing treatment decisions. Methods: Adults ≥ 18 years old with advanced cancer whom were being considered for systemic therapy were identified. Patients completed a brief health assessment form prior to their physician visit. Lab values and treatment characteristics were combined with the patient’s subjective health assessment to calculate a toxicity score. Karnofsky and ECOG performance statuses, toxicities, treatment details, hospitalizations, and length of stay were collected. This project was approved by UPMC’s Quality Improvement Committee. Results: Initial pilot testing in sarcoma and genitourinary cancer clinics demonstrated that the implementation of a toxicity prediction tool is feasible in busy academic oncology clinics. We will present results of staff surveys related to the ease of use and utility of this tool. Conclusions: Preliminary results suggest the use of this chemotherapy toxicity tool, previously validated in the geriatric population, to be feasible and useful in adults with advanced cancer. Further data analysis and studies are planned to expand this validated tool in other oncology clinic settings, and evaluate how well predicted toxicity correlates with actual toxicity for patients of all ages and treatment types.
Implementation of a multidisciplinary quality improvement initiative to improve molecular testing rates in advanced non-squamous non-small cell lung cancer.
Authors: Otaibi Zachary , Rao Rohit , Bartock Matthew , Gaddam Mamatha , Martin Samantha A , Finley Gene Grant 
Published: September 2018

e18181 Background: EGFR mutations and ALK rearrangements are key therapeutic targets in nonsquamous nonsmall cell lung carcinoma (nsNSCLC). Treatment with targeted therapy has been shown to improve progression-free survival and overall survival in many cases. Current guidelines recommend testing all advanced (Stage IIIB and IV) nsNSCLC patients for these genetic aberrations. Our previous work revealed that we were not evaluating a large percentage of eligible patients. In order to improve testing rates, we conducted a series of multidisciplinary meetings aimed at direct physician education and process enhancement. Methods: Utilizing the Association of Community Cancer Centers (ACCC) molecular testing framework in conjunction with support from Pfizer, we launched a lean six sigma initiative aimed at improving our molecular profiling rates. A series of multidisciplinary meetings were conducted addressing action items outlined by the ACCC. A total of 158 advanced nsNSCLC patients were identified from our tumor registry during or shortly after the start of this initiative (2014-2015). Testing rates for EGFR and ALK were determined by individual chart review and compared to our previously published testing rates (2011-2013). Results: We found 77.9% (123/158) and 60.8% (96/158) of patients were tested for EGFR mutations and ALK rearrangements, respectively. We utilized a chi-square test of homogeneity to determine whether there was an increased EGFR and ALK testing rate post-intervention . Our EGFR testing rate increased 80.3%, from 43.2% (2011-2013) to 77.9% (2014-2015), p < 0.00001, and our ALK testing rate increased 155.5%, from 23.8% (2011-2013) to 60.8% (2014-2015), p < 0.00001. Conclusions: Multidisciplinary educational and process enhancement meetings improve molecular testing rates in nsNSCLC.
Beyond the guidelines: Clinical investigators' (CI) self-reported use of genomic assays (GA) to assist in decision-making regarding use of neoadjuvant (NA) and adjuvant chemotherapy for patients (pts) with ER-positive/HER2-negative (ER+/HER2-) early breast cancer (BC).
Authors: Love Neil , Burstein Harold J. , King Tari A. , Kelly Gloria , Miller Kirsten , Moss Jonathan , Paley Douglas , Ziel Kathryn 
Published: September 2018

e18187 Background: GA, specifically the 21-gene Recurrence Score (RS), have been widely used to help inform decisions regarding use of adjuvant chemotherapy in ER+/HER2- node-negative BC. Although substantial anecdotal evidence exists that clinicians, particularly BC-focused CI, are employing these tests in other situations (node-positive disease, the NA setting), ASCO guidelines do not endorse these practices. Here we aimed to quantify self-reported CI use of GA across a spectrum of hypothetical BC presentations. Methods: In December 2016, a 225-item survey was sent to 97 US-based surgical (S) and medical oncology (MO) CI from a proprietary database. A modest honorarium was provided. Results: 51 CI (26 S and 25 MO) completed the survey. CI generally recommend GA for node-negative tumors but less so for older pts with smaller lesions. 75% of CI reported that they would recommend GA for pts with 1 involved node and 55% would do so for those with 2 to 3 nodes. 31% of CI use GA to guide NA chemotherapy decisions, and 53% who do not use GA in NA decision-making altered their treatment approach when a GA result was available. Conclusions: CI prefer GA when the benefit of chemotherapy is uncertain based on tumor stage and pt age. CI are comfortable using GA in node-negative and node-positive hypothetical cases, and some do so to aid in decisions regarding NA therapy. Quantitative assessment of self-reported CI practice patterns can serve as a complement to established guidelines and provide physicians, pts and third-party payers additional viewpoints on possible appropriate management strategies. [Table: see text]
Impact of room pooling and electronic health record on patient (pt) wait time, clinic work flow, and pts’/providers’ satisfaction.
Authors: Vadhan-Raj Saroj , Zhou Xiao , Narayanan Meyyammai , Janarthanan Shawn J , Daniel Mary , Jernigan Colleen , Patel Shreyaskumar 
Published: September 2018

e18191 Background: Excessive pt wait time can have negative effect on clinic work flow and on pts/ providers satisfaction. Increasing pt volume and limited clinic capacity can lead to long wait times for pts. The purpose of this two-part study was to evaluate the impact of Room Pooling Model (RPM) instead of Room Allocation Model (Part 1) and Electronic Health Record (EHR) on pt wait times in clinic and pts’/providers’ satisfaction (Part 2). Methods: The time studies and pts’/providers’ wait time satisfaction surveys were carried out over 2 weeks before (baseline) and 8 weeks after the implementation of RPM (Part 1), prior to the new EHR system, and 6 months after the implementation of EHR (part 2). All times of when pts, mid-level providers (MLP), and doctors (MDs) entered and exited the exam rooms were collected for 887 pts seen during the clinic. Data was analyzed using JMP and SAS. Results: As described earlier (ASCO 2016, abst 6595), the RPM was associated with increase in the proportion of pts seen by MDs within 30 min from the time roomed in the exam room and improvement in pts’/provider’s satisfaction. Post EHR, there were delays with decrease in the proportion of pts seen within 30 min from the time roomed in. Although the pt satisfaction did not change significantly, the number of times MDs had to wait for an open exam room increased from 8% (5/65) to 24% (14/59, p=0.01). The impact of RPM and EHR on pt times are shown below. The delays to see MDs after EHR were associated with longer time spent with the nurse (from median 4 to 7 min) and delays in seeing MLPs (from 11 to 18 min). Conclusions: These findings indicate that RPM can improve pt wait times. During initial stages of EHR implementation, the increase in pt wait time and reduced clinical efficiencies can be related to learning, and adapting to the new system. These data can be useful to design interventions that can target the areas of delays such as training and redesigning workflow to improve the clinical efficiency. [Table: see text]
What oncologists, patients, and families want from published clinical trials and office visits.
Authors: Hoffman Kenneth Robert 
Published: September 2018

e18192 Background: When oncology-related professionals & patients are reading their publications such words as: "may, possibly, might, could, hopefully & perhaps" are used to describe potential improvements in treatment & outcome. Similarly the terms "significant inprovement" & "approval" have different meanings to professionals & their patients & toxicity issues are often not clearly defined. This often leads to misunderstandings about treatment. Methods: To better understand these issues, 4 round table discussions with 16 community oncologists & 4 discussions with 26 patients or family member were held. The basic question was "what's missing" to help make a better treatment decison? Results: From physicians: a lack of clarity on the order of treatment, especially dealing with non-chemotherapy agents was seen. Issues of how & when to judge response to therapy & whether treatment should continue, stop or be changed were clear. There was much confusion as to when & what to order to evaluate diagnostic, prognostic& therapeutic options. Questions on proper randomization based on solid tumor load & location (quality & quantity of disease) and the aggressiveness of supportive care for patients on study vs "standard of care" led to questions on the comparability of reported results & their own clinical practice. Discussing "statistical" vs "clinical" significance & FDA drug "approval" was confusing in discussions with patients. The cost & reimbursement of drugs, whether oral or IV was problematic. From patients & their families, similar concerns were raised. Their frustration was seen by unknown "out of pocket" financial costs & the "hidden costs" of treatment, like supportive care issues, transportation & psychosocial support to the family. However, what the patients and their families wanted more than anything else was for them to be respected: appointments kept on time, empathy & honesty in their discussions with & from caregivers. Conclusions: Clinical articles should have a summary section with information on how to treat today's patients & when possible, treatment costs should be included to help with these discussions. Patients need to be seen as a person with a disease rather than as a disease attached to a person.
Safety and feasibility of a quality of life intervention in a randomized controlled trial on patients with colorectal cancer.
Authors: Klinkhammer-Schalke Monika , Lindberg Patricia , Steinger Brunhilde , Koller Michael 
Published: September 2018

e18200 Background: The analysis of drug safety is a mandatory part of pharmaceutical studies. For quality of life (QoL) interventions equal standards are missing. We performed a safety analysis for a QoL intervention in a randomized controlled trial (RCT) on colorectal cancer (CRC) patients. Methods: A clinical pathway with QoL diagnosis and therapy was developed in a complex intervention. In a 2-arm RCT N = 220 primary CRC patients have been recruited in 4 certified colorectal cancer centres. In the intervention group (IG) QoL of patients is measured at 0, 3, 6, 12, 18 months postoperative (EORTC QLQ-C30, QLQ-CR29). The coordinating practitioner (CP: physician, responsible for outpatient treatment) is informed about the results of QoL measurement (QoL profile) and receives recommendations for QoL therapy (expert report). Control group (CG) patients` QoL is also measured but CPs neither receive QoL profile nor expert report (routine follow-up care). Safety analysis was performed after data for the first 50% of patients were available. The following safety parameters were investigated: (1) exclusion of patients from RCT due to detrimental effects of study participation; (2) drop-outs of patients; (3) physician workload related to RCT; (4) physician benefit related to RCT. Descriptive statistics and chi square tests or Fisher`s exact tests were used to analyze frequencies. Results: Mean age of the 110 patients was 66.2 years (SD = 9.7) with 64% being male (n = 70). Tumor stages were UICC III (n = 40), II (n = 33), I (n = 24), and IV (n = 13). Only 1 out of 110 patients was excluded from the study by the physician due to patient`s psychological burden. Four more patients dropped out of the study due to either lack of motivation, comorbidity, or positive health situation. Workload regarding RCT was rated low by most physicians (33/35 CPs with IG-patients vs. 24/27 CPs with CG-patients; p = .65). In contrast, many physicians reported benefits connected with RCT participation (19/33 CPs with IG-patients vs. 8/27 CPs with CG-patients; p = .03). Conclusions: Data showed that the study is feasible and safe. Thus, the RCT will be continued to the end according to trial protocol.Clinical trial information: NCT02321813 Clinical trial information: NCT02321813.
Quality indicators at a breast cancer (BC) unit in a Uruguayan university hospital according to the requirements of European Society of Breast Cancer specialists.
Authors: Camejo Natalia , Castillo Cecilia , Richter Lucia , Artagaveytia Nora , Hernandez Ana laura , Delgado Lucia Beatriz 
Published: September 2018

e18209 Background: Although clear guidelines for BC management have been developed and widespread, there are many variations between centers, with impact in clinical outcomes. Quality indicators to assess care allows comparison with standards and monitoring changes post intervention. The objective is to evaluate quality indicators in BC care at our Breast Unit. Methods: Retrospective analysis of women diagnosed and treated for BC from June 2014 through June 2016 .The European Society of Mastology (EUSOMA) guidelines for quality assurance in BC and diagnosis (published in 2010 and up dated in 2013 ) were used in order to asses quality of care Results: 103 patients treated for BC were included in the study. Median age was 54 years old, ductal carcinoma: 76,5 %, histological grade I-II: 74 %; stage 0-II: 72%, axillary metastasis: 39 %, progesterone receptor/estrogen receptors+ (RE/RP+): 64 %, HER2+: 27 %. Quality criteria associated to preoperative diagnosis, pathology analysis, surgical treatment, radiotherapy and oncologic treatment were met. Conclusions: Quality indicators allows BC evaluation from established standards, giving objective and reproducible information, helpful to plan process optimization. Care received by patients seen at the Hospital de Clinicas BC Unit during the referred period met all indicators suggested by the European Society of Mastology. [Table: see text]