bluuebunny/crossref_metadata_2025_split huggingface dataset:
Referral rates and supportive care metrics for a first-year community oncology AYA program.
Authors: Cull Elizabeth H. , Mcalhany John , Taylor Sarah B , Bowers Heather , Susko Kerri , Saha Aniket 
Published: September 2018

63 Background: Adolescent and young adult (AYA) oncology patients have a unique set of needs compared to younger and older patients that are often not addressed by primary providers in a busy clinical setting. Genetic counseling, fertility preservation, clinical trial enrollment and psychosocial support are a few of the key needs to address in this group. The AYA Cancer Program was created to specifically address these issues and mitigate the disparity in care and outcomes often seen in the AYA cohort. This study examines the number of patients referred to the AYA Cancer Program in its first year and evaluates the role of the program in addressing the supportive care needs of AYA patients. Methods: The study assessed patients actively under treatment between ages 15-39 from September 1, 2016 to September 1, 2017. The number of referrals to the AYA program, participation in the AYA program, and met supportive care needs (fertility, genetics, clinical trial participation) were examined. Results: During the first year of the clinic, 63 (22%) of the 288 AYA patients seen throughout the whole institution were seen in the AYA clinic. An additional 34 (12%) patients were referred but did not come to the appointment. 192 (69%) patients were not referred. Compared to non-referred patients, AYA clinic patients were more likely to be enrolled on a clinical trial (54% vs. 18%), have a documented fertility counseling discussion (94% vs. 16%) and receive a genetics referral (69% vs. 43%). Patients that were referred to the clinic but did not come were slightly more likely than non-referred patients to be offered the above services as well but still trailed the group of patients seen in the AYA clinic. Conclusions: Patients that were seen in the AYA program were more likely to receive fertility referrals, genetic referrals and had increased clinical trial participation compared to patients that were not referred. This highlights the essential role of the AYA clinic in meeting these under addressed needs in the AYA population. [Table: see text]
Implementation of a fellow-initiated financial toxicity screening tool in medical oncology clinics.
Authors: Brondfield Samuel Craig , Borno Hala , Mulvey Claire , Huang Li-Wen , Cinar Pelin 
Published: September 2018

64 Background: Financial toxicity is an increasingly recognized problem for patients receiving cancer treatment, particularly in the high-cost precision medicine era. Financial toxicity is linked to asset depletion, debt, and bankruptcy. To address this imminent concern, we designed, implemented, and evaluated a fellow-initiated financial toxicity screening tool for use in medical oncology clinics. Methods: An interprofessional team of University of California San Francisco (UCSF) social workers and physicians selected three highly rated items from the COST measure, a published financial toxicity tool with validity evidence. We oriented all UCSF hematology/oncology fellows to the tool and the concept of financial toxicity. We instructed fellows to screen all patients other than second-opinion visits and to offer a social work referral to high-scoring patients. Implementation was from August 2017 to March 2018. While screening was initially documented in the progress note, in October 2017 we built a navigator into the electronic medical record to facilitate screening. We randomly selected one half-day per week for each fellow and reviewed charts for screening scores. The cumulative goal was to screen 30% of eligible patients during implementation. Results: Fellows (n = 8) rotated in five disease-specific medical oncology clinics. Prior to implementation, fellows did not document financial toxicity (0%). At the mid-point of implementation, fellows had screened 32% of patients. By the end, the cumulative screening rate decreased to 18%. The screening tool will be presented. Qualitative fellow feedback identified lack of provider familiarity with financial toxicity, packed clinic visits, and difficulty remembering to screen as barriers. Fellows suggested that screening performed by clinic staff prior to the encounter might better inform the visit. Conclusions: Fellow-initiated financial toxicity screening was initially successful but decreased over time. Future iterations could include screening prior to the encounter, augmenting provider financial toxicity training, and continual reminders. Future work is needed to improve screening and mitigate the impact of financial toxicity.
A focus on culturally sensitive communication to transform institutional awareness of health care disparities.
Authors: Maples William James , Argenio Sandra L , Scaz Linda , Krippner Jennifer 
Published: September 2018

69 Background: Healthcare organizations can cultivate the strength of a diverse workforce in creating a culture of excellence. Enabling the team to understand how personal and cultural beliefs affect our decision making and how we interact with patients and colleagues is integral. Gaps in care exist in cancer diagnoses and treatment in many minority groups. A need for education in the nature of assumptions, unconscious biases, and awareness around the existence of healthcare disparities, was identified through culture transformation work within multiple healthcare institutions. Methods: An experiential course was designed for multi-disciplinary groups of providers. Designed to meet the evolving demographics in the country and help participants recognize how their own cultural beliefs and values affect their decision making. Topics include cultural awareness, assumptions and unconscious bias, effective use of interpreters, and skills to recognize when cultural differences may be playing a role and how to successfully navigate these situations. Raising awareness of healthcare disparities is highlighted, including disparities in cancer care diagnosis, treatment and outcomes for different ethnicities and socioeconomic groups. Examples include disparities in diagnosis, treatment and outcomes of lung cancer, colon cancer and breast cancer in minorities. Results: Participants engage in skills-based work. Participants develop a plan how they can take this information and education back to help create an awareness of disparities and skills to successfully navigate these situations. After this program, participants will be cognizant of the nature of assumptions and unconscious bias and understand the strength of diversity as an asset rather than a hindrance. Conclusions: Healthcare disparities can have a significant impact on patient experience, quality and outcomes. Specific inequities in cancer diagnosis and treatment in minorities is highlighted. Participants are provided with information and skills that can be introduced to their home institutions to have all caregivers recognize and successfully navigate culturally sensitive situations.
Reducing the impact of distance on hematopoietic cell therapy patients.
Authors: Burns Diane , Simanovski Vicky , Hagens Victoria Karuna , Matheson Garth 
Published: September 2018

74 Background: Hematopoietic Cell Therapy (HCT) patients experience unique travel challenges and high out-of-pocket costs due to the highly specialized care required. We conducted a mixed methods study to understand current patient support programs in Ontario and other jurisdictions and a cost analysis to inform the development of recommendations to reduce the impact of remoteness on HCT patients and caregivers. Methods: Qualitative information on patient transportation and accommodation supports was gathered through informal and structured input from fourteen Ontario Regional Cancer Program Directors, Hematologists, Patient and Family Advisory Council and Aboriginal Navigators. An environmental scan of medical travel assistance programs within Ontario and in other jurisdictions was performed. A scoping literature review was conducted of published studies focused on inequities in receipt of cancer care in countries with Universal Health care. HCT patient travel patterns to each of the transplant facilities in Ontario were obtained from analysis of Cancer Care Ontario data holdings. Results: We concluded that travel assistance for cancer patients in Ontario varies considerably across the province, and that Ontario lags behind other jurisdictions in Canada and internationally. The scoping literature review revealed that patients who live far from specialist centres, for some diseases, have later stage at diagnosis, less timely access to specialist care, poorer outcomes, lower patient experience scores, and make treatment decisions based on distance. From the analysis of travel patterns for HCT patients, provincially 4 – 79% of patients travel for HCT based on their location (see table below). Conclusions: This study highlights the need to better support HCT patients in Ontario. As a result, a proposal to support accommodations for HCT patients was developed and approved by the Ontario government for implementation in 2018/19.[Table: see text]
Comparing quality of care for Medicaid and commercially insured patients with cancer in Washington State.
Authors: Fedorenko Catherine R. , Panattoni Laura Elizabeth , Walker Julia Rose , Li Li , Kreizenbeck Karma L. , Ramsey Scott David 
Published: September 2018

75 Background: Uniformity in receipt of high quality cancer care is imperative to reduce health care disparities. In order to help prioritize efforts aimed at reducing disparities in care, we compared several quality metrics for Washington State cancer patients enrolled in Medicaid and commercial insurance plans. Methods: We linked 2014-2016 Washington state cancer registry records for cancer patients under the age of 65 with enrollment and claims records for the two largest commercial insurers in the state and Medicaid. We then generated thirteen nationally recognized quality measures. Outcome measures were adjusted for age, sex, comorbidity score, stage, cancer site, and treatment factors where appropriate. Process measures were not adjusted. Results: 6,868 commercially insured and 2,379 Medicaid patients are represented in the reported quality measures. Conclusions: Care of Washington state cancer patients enrolled in Medicaid is comparable or superior to commercially insured patients, except for significantly higher ED use during chemotherapy. Further research is needed to understand why Medicaid-enrolled cancer patients utilize the ED at more than double the rate of commercially insured patients.[Table: see text]
Financial toxicity of cancer treatment at a diverse county hospital.
Authors: Ahuja Parikh Divya , Ragavan Meera Vimala , Maitra Debeshi , Aggarwal Sangeeta , Patel Manali I. 
Published: September 2018

76 Background: The rising costs of cancer care increasingly results in financial distress for patients and their families. Low-income patients face a greater burden of financial toxicity, but few studies have characterized what factors contribute to this, and what interventions can relieve toxicity. Methods: From October 2017 to December 2017, we used a validated COST survey tool to understand the extent of financial burden that patients with cancer experience. We surveyed patients who receive their oncology care in a medical system that serves predominantly minority and low-income patients in Santa Clara County. We collected demographic information including sex, education level, ethnicity, income, insurance status, monthly out of pocket costs (OOPC) and employment status prior to diagnosis. We used a multivariable linear regression to study the association between the patient factors and financial burden as demonstrated by the COST score. All data were analyzed using Stata 14. Results: Demographic information is presented in Table 1. A total of 152 patients completed all 11 items of the COST survey. In the multivariate model, there was no significant difference in COST score by sex, education level, or ethnicity. However, income ≤$25,000 was associated with higher COST scores (p = 0.019), as was higher monthly OOPC (p = 0.003). Medicare patients and patients who were employed prior to diagnosis tended to have higher COST scores although not quite statistically significant (p = 0.057, p = 0.083). Conclusions: Patient-reported financial toxicity is an unmet concern among patients in this single institution study with a high proportion of underinsured patients. Higher OOPC and low income was associated with a higher financial burden. These findings suggest that patients would benefit from targeted interventions to mediate out of pocket costs of cancer care.[Table: see text]
Assessment of language needs and resource use among Canadian immigrant patients with cancer.
Authors: Liu Sophia , Smith Elliot Charles , McCartney Alexandra , Basgaran Amedra , Balaratnam Karmugi , Brown M Catherine , Howell Doris , Jones Jennifer M. , Giuliani Meredith Elana , Xu Wei , Liu Geoffrey , Eng Lawson 
Published: September 2018

77 Background: Canada's foreign-born population is estimated to reach up to 30% by 2036. Immigrants diagnosed with cancer can face poorer cancer outcomes compared to non-immigrants due to language barriers affecting physician-patient communication and non-equivalent interpretation by untrained translators. Reducing this disparity is a growing challenge due to continued high immigration rates. As Canadian data is lacking, we explored the language needs and resource utilization of Canadian cancer patients. Methods: Adult cancer survivors from Princess Margaret Cancer Centre were surveyed in English on their socio-demographics, perceived communication difficulties, and interpreter use. Results: Of 470 patients, 45% were foreign-born; 37% self-identified as immigrants; 78% spoke mostly English at home. Among self-identified immigrants, median age at diagnosis was 60 years, 46% were female, and 59% completed post-secondary education. Top three countries of origin were China (23%), India (10%), and Italy (9%). Although 73% of immigrants reported English as their most comfortable language in which to receive healthcare information, 18% reported difficulties communicating with the doctor in English at a few visits or more, 14% indicated some discomfort communicating with their oncologist in English, and 4% of immigrants felt their cancer care was affected by a language barrier. Twenty-six percent of immigrants required interpretation, with 91% employing family, 7% utilizing professional interpreters, and only 19% have ever used the institutional language services. Conclusions: Although most immigrants identify English as their most comfortable language for healthcare delivery, some still experience communication difficulties with their oncologist during at least a few visits. However, most patients felt comfortable communicating with their oncologists and do not feel their cancer care is affected. Most relied on family members to interpret, while local hospital language resources were largely underutilized. Strategies for promoting professional translation service use may help improve immigrants’ experience, caregivers’ burden, and enhance physicians’ ability to counsel patients directly.
Safety of delivering chemotherapy by community nursing staff supervised by telemedicine in remote New South Wales (NSW).
Authors: Honeyball Florian 
Published: September 2018

82 Background: Outcomes for cancer patients living in rural and remote areas are worse than for their metropolitan peers. Disparity in access to treatment is one of the causes for this difference. Using non-oncology, community based nurses with basic training in safe handling of chemotherapy to administer cancer treatments under the supervision of a medical oncologist and senior oncology nurse via telemedicine has been successful in remote Queensland. This is the pilot study analysing Remote Video Assisted Chemotherapy (RVAC) in NSW. Methods: Demographic data, regimens, and toxicity profiles of patients at the trial site in Coonabarabran was extracted from the electronic medical record. Similar data was extracted from all patients receiving the same treatment regimens in Dubbo, the referral hospital for Western NSW, 160km to the south. Data was analysed using a two-sample proportions z-test. Results: Data was collected in the 7 months after opening the trial site. This is summarised in the table below. There is no evidence to suggest differences in toxicity between the hub site and the trial site. Of those with grade 3 or 4 toxicity, 6 at the main site (40% of those on chemotherapy) and 2 at the trial site (50%) received chemotherapy. A higher proportion of patients receiving chemotherapy at the trial site may explain this difference. Although there was a significantly increased number of delayed doses at the trial site, the majority were due to logistic issues in the first two months. Conclusions: Using this model to deliver chemotherapy is safe. Toxicity numbers are low in this cohort, given the high number of patients receiving low risk anticancer drugs including endocrine and monoclonal antibody therapy.[Table: see text]
Real-world comparison of biosimilar filgrastim and reference filgrastim in cancer patients receiving chemotherapy.
Authors: Chen Xiaoxue , Barron John , Agiro Abiy , Debono David Joseph , Fisch Michael Jordan 
Published: September 2018

85 Background: The approval pathway for biosimilars was established in 2010 to facilitate drug competition and generate cost savings. Biosimilar filgrastim products (filgrastim-sndz or tbo-filgrastim) were the first approved biosimilars in the US. This study examined study outcomes (incidence of febrile neutropenia (FN), growth factor related adverse events (AE) and filgrastim treatment cost) between users of biosimilar and reference filgrastim drugs among the commercially-insured US population. Methods: A retrospective observational design was used to analyze administrative claims data on adults with cancer treated with chemotherapy between 09/01/2012 - 4/30/2017. The population was grouped into biosimilar filgrastim users (B) and filgrastim users (F) according to the earliest filgrastim use (index date). FN risk factors were assessed within 6 months prior to the index date. Study outcomes were assessed within 21 days post index date using multivariable regression modelling. Results: Among 1,694 biosimilar users and 10,460 filgrastim users, no meaningful differences in baseline FN risk factors were observed. In adjusted results, no difference in incidence of FN was observed between the two groups (B: 13.3%; F: 11.0%; odds ratio [OR]: 1.17; 95% confidence intervals [CI] 0.99-1.38; p = 0.06). Rates of AE were similar between the two groups (B: 6.9%; F: 6.4%; OR: 1.04; 95% CI: 0.84-1.29, p = 0.72). The mean number of filgrastim doses administered was 3.4 in both groups (Relative difference: 0.01; 95% CI: -0.02-0.04; p = 0.53). The mean filgrastim drug costs were similar between the two groups (B: $2,491; F: $2,510, Cost Ratio [CR]: 0.96; 95% CI: 0.91-1.01; p = 0.12). However, the mean filgrastim drug cost was 6.7% less for filgrastim-sndz when compared to reference filgrastim (sndz: $2,342; CR: 0.91; 95% CI: 0.84-0.99; p = 0.04); but not for tbo ($2,549; CR: 0.97; 95% CI: 0.91-1.04; p = 0.40). Conclusions: Biosimilar filgrastim is similar to the reference filgrastim in drug safety and effectiveness. The early adoption and saving impact of biosimilar filgrastim has been modest, which highlights the structural and regulatory challenges to biosimilar uptake.
The impact of financial toxicity on quality of life in older patients with cancer: Baseline data from the University of Rochester NCI Community Oncology Research Program (NCORP).
Authors: Arastu Asad , Ciminelli Joseph , Culakova Eva , Lei Lianlian , Xu Huiwen , Dougherty David W. , Mohamed Mostafa Refaat , Wells Megan , Duberstein Paul , Flannery Marie Anne , Morrow Gary R. , Kamen Charles Stewart , Pandya Chintan , Berenberg Jeffrey L. , Aarne Valerie , Mohile Supriya Gupta 
Published: September 2018

87 Background: Financial toxicity (FT), or the stress and strain patients (pts) experience as a result of paying for cancer care, can have profound negative impacts on pts’ overall quality of life (QoL). This study examined associations of FT with anxiety, depression, and QoL in older pts with advanced cancer. Methods: This is a secondary analysis of baseline data from a Geriatric Assessment intervention study conducted by UR NCORP across 31 practice sites (PI: Mohile). Pts were categorized as experiencing FT if they reported any one of the following: delaying medications due to cost, insufficient income in a typical month for food and housing, or insufficient income in a typical month for other basic needs. Pts also completed the Generalized Anxiety Disorder-7 (GAD7, score 0-21) to evaluate anxiety, the Geriatric Depression Scale (GDS, score 0-15) to assess depression, and the Functional Assessment of Cancer Therapy- Generation (FACT-G, score 0-108), to measure overall QoL. Associations of FT with anxiety, depression, and QoL were assessed in separate multivariate linear regression models controlling for covariates at p < 0.1. Results: Among 542 pts (mean age 77; range 70-96, 49% female), 18% (98 pts) experienced FT. In separate regression analysis, FT was significantly associated with all 3 outcome measures. On average, pts experiencing FT scored 1.76 higher (p < 0.01) on the GAD7 (indicating greater anxiety severity), 0.76 points higher (p = 0.02) on the GDS (indicating greater depression severity), and 5.16 points lower (p < 0.01) on the FACT-G (indicating lower QoL). Conclusions: Older pts with advanced cancer who experience income and cost-related barriers to quality cancer care reported worse anxiety, depression, and QoL than those without FT. Given the association between FT and these outcomes, these 3 FT questions may help identify vulnerable older pts and allow providers to intervene sooner and thereby enhance the quality of care pts receive.
Understanding epidermal growth factor receptor mutation (EGFRm) testing in patients (pts) with non-small cell lung cancer (NSCLC) in a large community oncology network.
Authors: Nadler Eric , Fernandes Ancilla , Pavilack Melissa , Amirian Susan , Clark Jamyia , Frytak Jennifer R. 
Published: September 2018

9 Background: EGFR TKI therapy improves outcomes in pts with EGFRm+ NSCLC. NCCN guidelines recommend EGFRm testing for pts with NSCLC. Testing patterns and predictors of documented EGFRm testing were studied in a real-world setting. Methods: Adult pts with stage IV NSCLC treated from 1/1/2012 to 8/31/2017, identified from the iKnowMed (US Oncology Network) EHR were analyzed. Rates of documented EGFRm testing were calculated. Multivariable stepwise logistic regression analysis was conducted to identify characteristics associated with documented EGFRm testing. Results: Of 14,461 pts, 59.8% had adenocarcinoma and 17.5% had squamous cell carcinoma. Median age of pts was 69.3 years, 52.3% were male, and 14.6% were non-smokers. Testing rates were ~36% overall, an increase in rates was seen over time: ~30% in 2012 to 41% in 2016 (p < .001). Histology, practice size, and several characteristics were associated with documented EGFRm testing (Table). Conclusions: Testing rates steadily increased over time, but were still low, implying suboptimal/under-documented testing. This analysis presents practice site characteristics to target educational programs to improve testing and/or documentation in community settings. [Table: see text]