bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the Effect of Right-Censored End Point Transformation for Radiomic Feature Selection of Data From Patients With Oropharyngeal Cancer
Authors: Zdilar Luka , Vock David M. , Marai G. Elisabeta , Fuller Clifton D. , Mohamed Abdallah S.R. , Elhalawani Hesham , Elgohari Baher Ahmed , Tiras Carly , Miller Austin , Canahuate Guadalupe 
Published: November 2018

Purpose To evaluate the effect of transforming a right-censored outcome into binary, continuous, and censored-aware representations on radiomics feature selection and subsequent prediction of overall survival (OS) and relapse-free survival (RFS) of patients with oropharyngeal cancer. Methods and Materials Different feature selection techniques were applied using a binary outcome indicating event occurrence before median follow-up time, a continuous outcome using the Martingale residuals from a proportional hazards model, and the raw right-censored time-to-event outcome. Radiomic signatures combined with clinical variables were used for risk prediction. Three metrics for accuracy and calibration were used to evaluate eight feature selectors and six predictive models. Results Feature selection across 529 patients on more than 3,800 radiomic features resulted in increases ranging from 0.01 to 0.11 in C-index and area under the curve (AUC) scores compared with clinical features alone. The ensemble model yielded the best scores for AUC and C-index (often > 0.7) and calibration (Nam-D’Agostino test statistic often < 15.5 with 8 df). The random forest feature selectors achieved the best performance considering all metrics. Random regression forest performed the best in OS prediction with the ensemble model (AUC, 0.75; C-index, 0.76; calibration, 8.7). Random survival forest performed the best in RFS prediction with the ensemble model (AUC, 0.71; C-index, 0.68; calibration, 19.1). Conclusion Including a radiomic signature results in better prediction than using only clinical data. Signatures generated randomly or without considering the outcome result in poor calibration scores. The random forest feature selectors for each of the three transformations typically selected the greatest number of features and produced the best predictions at acceptable calibration levels. In particular, random regression forest and random survival forest performed best for OS and RFS, respectively.
Cancer patients’ and healthcare providers’ perceptions about supportive and integrative oncology services.
Authors: Jiang Cherry , Larbi Olivia , Feyes Denise , Momotaz Hasina , Li Ming , Daunov Kate , Daly Barbara J. , Mazanec Susan Rose , Rodgers-Melnick Samuel , Rolfe Sarah , Tamburro Nancy , Lee Richard T. 
Published: November 2018

100 Background: Supportive and integrative oncology services help to improve quality of life for cancer patients. This study characterizes and compares the perceptions of these services among cancer patients and healthcare providers. Methods: A cross-sectional survey was administered to Seidman Cancer Center (SCC) providers online in Spring 2018 and to SCC patients in waiting rooms March - July 2018. The survey asked about familiarity, perceived importance, frequency of use, accessibility and barriers of 19 supportive and integrative oncology services using a 5 point Likert scale. Data analysis included the Chi-square test and Spearman’s rank correlation. Results: A total of 585 surveys were obtained (421 patients and 164 healthcare providers). Patients were generally > 60 (58.2%), female (57.4%), Caucasian (64.2%) with most at > 1 year from starting treatment (59.9%). Healthcare providers were physicians (38.7%), RN partners (38.1%), and advanced practice providers (APPs) (23.2%). Most were female (74.3%), Caucasian (80%) and worked at SCC for > 5 years (56.4%). When compared with providers, many patients were not familiar with and did not perceive the supportive and integrative oncology services as important (see table). RN partners regarded physical therapy as less important than physicians and APPs (65.5% vs. 83.9% and 82.9%), while > 85% of providers from each category regarded palliative care, social work and diet & nutrition services as important. The most common barrier for both patients and providers was being unaware of the services (41.6% and 67.1%). Conclusions: Overall, healthcare providers were more familiar than patients with many supportive and integrative oncology services and considered most to be more important. Being unaware of the services was a common barrier identified by both providers and patients. [Table: see text]
Identification of pharmacogenetic markers in cancer supportive care.
Authors: Wei Min 
Published: November 2018

109 Background: Precision medicine has become increasingly critical in cancer supportive care, with implications for treatment selection, medication dosing, and side effect prediction. The presence of clinically actionable germline variants brought the hope that accurate prediction of drug efficacy and toxicity would be in the future. This will greatly improve the comprehensive oncology care, where supportive care treatment options can be subjective and personalized. Methods: The changes in drug effect and toxicity caused by genetic variations were characterized in 4,287 patients submitted for clinical pharmacogenetics testing using a gene panel including key pharmacokinetic and pharmacodynamic genes. For each patient, the need to select an alternate medication and adjust medication dose was determined for the treatment of pain (CYP2D6, CYP1A2, OPRM1), nausea/vomiting (CYP2D6), antifungal prophylaxis (CYP2C19), and depression (CYP2D6, CYP2C19). It is recognized that there are many other factors playing in the variations of the response and toxicity to these classes of medications. Results: Of the 4,287 patients, 964 (22%) would have a recommendation to choose alternatives of oxycodone, codeine, or tramadol therapy and 3,394 patients (79%) for a non-standard dosage. A change in certain antiemetics such as ondansetron would be suggested for 171 patients (4%). If voriconazole antifungal prophylaxis was clinical required, 1,228 (29%) would need a dose increase, while 133 (3%) should be switched to a different regimen. 2,727 patients (64%) should avoid or adjust dosage on some of the commonly used agents for depression due to reduced efficacy or heightened risk of toxicity. Conclusions: Pharmacogenetics markers associated with reduced drug efficacy and higher rate of ADRs were commonly observed for medications used in cancer supportive care. Identification of these markers would help clinicians achieve optimal treatment outcome with manageable time and cost. This provides great opportunities to apply precision medicine principles to patient management.
Inpatient hospitalization costs associated with nausea and vomiting among patients with cancer.
Authors: Roeland Eric , Nipp Ryan David , Ruddy Kathryn Jean , Binder Gary , Bailey William L. , Amari Diana T. , Kanakamedala Hemanth , Navari Rudolph M. 
Published: November 2018

112 Background: Reducing hospitalizations for chemotherapy-related toxicities represents an opportunity to improve both the quality and cost of cancer treatment. Nausea and vomiting (NV) account for almost 10% of “avoidable” toxicity-related post-chemotherapy hospitalizations (2016 Medicare data). We sought to evaluate the event cost of NV-related hospitalizations among patients with cancer from a US payer perspective. Methods: From a large US claims database (Truven MarketScan), we identified hospitalizations with NV as the primary diagnosis and cancer as a secondary diagnosis (01/2011-06/2017). This method increases specificity for NV as the principal hospitalization factor, while underreporting the prevalence of NV as a contributory factor. To determine event costs, we evaluated hospital and other reimbursement during the hospitalization. To explore subgroup differences, we stratified results by tumor type, payer type, admission route, receipt of highly emetogenic chemotherapy (HEC; 2017 definition includes carboplatin AUC ≥4) and antiemetic prophylaxis. We adjusted all costs to 2017 US dollars. Results: Among 918,192 hospitalizations involving cancer, we identified 80,995 with both NV and a cancer diagnosis code. Of these, 5,293 had NV as the primary diagnosis and 62 lacked cost data. Patients (mean age = 57.7±16.2) were 67% female. Median hospital length of stay was 4 days and mean cost per hospitalization was $15,085. Non-Medicare admissions (82%) had a higher mean cost vs. Medicare ($15,737 vs. $12,111, p < 0.01). We found < $1,000 difference between the highest and lowest cost per hospitalization among the 6 most common tumor types. We found the 65% of patients with a chemotherapy claim ≤30 days prior to hospitalization had costs of $13,882 per event. Among the 45% of chemotherapies that were HEC, > 50% lacked an NK1 receptor antagonist as prophylaxis. Conclusions: The average cost of NV-related hospitalizations among patients with cancer exceeds $15,000 per event, highlighting the need to effectively address this symptom. Roughly half the hospitalizations involved HEC, with over half of those patients not receiving guideline-based antiemetic prophylaxis.
The implementation of a palliative care intervention during induction chemotherapy for patients with acute myeloid leukemia (AML) at a community cancer institute.
Authors: Lattanzio-Hale Annamaria , McNaughton Caitlyn , Wilson Wendy , Nelson-Przywara Heather , Balepur Shyam S. , Jupin Peter , Ryan Miriam , Sivendran Shanthi 
Published: November 2018

113 Background: Patients with hematologic malignancies are referred to palliative care less than patients with solid tumor malignancies. Clinical trials are underway at academic centers exploring early inpatient palliative care for patients newly diagnosed with AML receiving induction chemotherapy. Feasibility of such interventions have not been studied in a community setting. We structured a multi-faceted intervention for our community hematology and palliative team on the benefits of early palliative care in hematologic malignancies with the aim to increase utilization. Methods: In 2017, 24% of patients with AML admitted to Lancaster General Hospital for induction chemotherapy received an inpatient palliative consultation. Needs assessment performed on the hematology and palliative teams demonstrated a need for integration of palliative care into clinical pathways, automatic triggers for consultation, a need for increased education on AML, and creation of standard elements in inpatient consultations. Results: In the spring of 2018, we integrated palliative care into institutional AML clinical pathways such that all patients receive inpatient palliative consultation within 72 hours of admission. A consultation trigger was placed within the admission order set and is currently being incorporated into the chemotherapy treatment protocol. An educational program on AML was created and presented by the hematology team to the inpatient palliative team. This intervention included creation of minimum standards for inpatient palliative consultation including provider assessment within 72 hours of referral, two visits per week by a provider and a minimum of one visit by the interdisciplinary team during admission with a focus on symptom management, psychosocial assessments, and advanced care planning. Conclusions: We have demonstrated feasibility of creating standards for early palliative care intervention in AML patients with collaboration from the hematology and palliative teams. Next steps will include assessing whether these interventions increase uptake of palliative care utilization and specific patient outcomes.
Use of palliative care among patients with metastatic breast cancer at a safety net hospital.
Authors: Bushan Sita , Li Hsiao Ching , Syed Samira K. , Unni Nisha , Sadeghi Navid 
Published: November 2018

117 Background: Palliative Care (PC) has been shown to improve quality of life in lung cancer patients, and ASCO recommends it as an adjunct to standard oncologic care. Data regarding the use of PC in other cancers and in disadvantaged populations is scant. We studied the patterns of use of PC in patients with metastatic breast cancer (MBC) at a safety net hospital. Methods: Electronic health records (EHR) of 234 patients who were diagnosed with MBC from 2010 to 2016 at Parkland Health and Hospital System (PHHS) were reviewed, and data on demographics, diagnostics, treatments, and palliative care elements were collected. Results: 105 of 234 (44.8%) patients with MBC were referred to PC, either as outpatients, inpatients, or both. The average time from the first visit with medical oncology to placement of an outpatient referral to PC was 390 days. Of the 79 patients with outpatient referrals to palliative care, we have hormone receptor status on 50. 12 of these patients had triple negative breast cancer; 30 had hormone receptor positive breast cancer. 77 (32% of all patients) patients had formal documentation of advanced directives (AD) in the EHR. Of these, 69 (89.6%) had seen PC. 133 patients have died, and 37 (27.8% of expired patients) died at the Parkland Hospital. Among the 96 patients who did not die in the hospital, 73 (76%) patients had some discussion of hospice prior to death. Conclusions: Less than half of patients with MBC at PHHS were referred to PC, and among those who are, referrals are placed late in the disease course, on average, more than one year after the first medical oncology visit. Lack of a sustained relationship with PC results in truncated goals of care discussions. As a result, most patients do not have formal documentation of AD in the EHR. Furthermore, they do not benefit from discussions with PC that could guide the management of their malignancy while they still have therapeutic options. Instead, patients discuss hospice with their providers toward the end of life, only when they are no longer candidates for cancer directed therapies. Although the use of PC resources at PHHS does not meet clinical guidelines, it is consistent with data from other studies showing inadequate use of PC resources among patients with advanced cancer.
Refining the TEACHH model: Towards improved clinical utility in the modern era.
Authors: Krishnan Monica Shalini , Hertan Lauren Michelle , Chen Yu-Hui , Nichipor Alexandra , Khouj Yaseer Mohammed , Zaslowe-Dude Cierra , Balboni Tracy A. 
Published: November 2018

128 Background: The TEACHH model was previously developed to predict life expectancy in patients with metastatic cancer receiving palliative radiation. However, the model was developed prior to the immunotherapy era and limited in its clinical utility due to broad ranges of survival in each prognostic group. The aim of this project is to refine the TEACHH model to improve its clinical utility in a modern cohort. Methods: We retrospectively reviewed the charts of patients seen in consultation for palliative radiation at two tertiary centers and 4 community satellite practices from 7/1/2015 – 12/31/2016. Cox proportional hazards regression was used to construct a prediction model for overall survival (OS), with a goal of predicting the probability of surviving to the clinically relevant timepoints of 2 months, 6 months, and 1 year. The model was stratified by consult location (tertiary vs. community). Results: A total of 744 patients were included in this analysis. The final model included: 1) Gender (Male HR 1.35, 95% CI 1.11 – 1.64) 2) ECOG PS (ECOG 1 HR 1.63, 95% CI 1.20 – 2.22, ECOG 2 HR 2.59, 95% CI 1.86 – 3.60, ECOG 3/4 HR 4.12, 95% CI 2.84 – 5.98) 3) Consultation type (Inpatient HR 1.87, 95% CI 1.40 – 2.49) 4) Primary histology 5) Number of metastases 6) Number of prior palliative chemotherapy courses. Due to interactions between primary histology and number of metastases as well as primary histology and number of prior palliative chemotherapy courses, hazard ratios for these variables are shown in Table 1. Conclusions: Our final refined TEACHH model includes 6 variables to predict OS. We hypothesize that its increased complexity will increase its sensitivity and we will validate the model in a separate patient cohort. A web-based calculator will then be created to facilitate easy use of the model. Hazard ratios of variables with significant interactions. [Table: see text]
How family caregivers assist with upstream health care decision making by community-dwelling persons with advanced cancer: A qualitative study.
Authors: Dionne-Odom J Nicholas , Ejem Deborah , Wells Rachel , Barnato Amber , Taylor Richard , Rocque Gabrielle Betty , Turkman Yasemin E. , Ramsey Thomas , Kenny Matthew , Ivankova Nataliya , Bakitas Marie , Martin Michelle Y. 
Published: November 2018

13 Background: In the palliative care context, the family caregiver role in patients’ healthcare decision-making has focused on being a surrogate decision-maker at end of life. Less is known about family caregiver’s role in supporting upstream patient decision-making in advanced cancer. Methods: Qualitative descriptive study consisting of one-on-one, semi-structured interviews with persons with metastatic cancer and their family caregivers. We elicited family members’ perspectives on how they assist their relatives with any current and prospective healthcare decisions. Transcribed interviews were analyzed using a thematic analysis approach. Co-investigators reviewed and refined themes. Results: Caregivers (n = 20) averaged 56 years of age and were mostly female (95%), White (85%), and the patient’s partner/spouse (70%). Patients (n = 18) averaged 58 years of age and were mostly male (67%) in “fair” or “poor” health (50%) with genitourinary (33%), lung (17%), and hematologic (17%) cancers. Themes describing family member roles in supporting patients’ decision-making were: 1) seeking information about the cancer, its trajectory, and different treatments options; 2) identifying treatment and disease decision points, including decisions about seeking emergent care; 3) ensuring family members have a common understanding of the patient’s plan of care; 4) initiating and facilitating conversations with patients about coping, values, beliefs, and “what if” scenarios about current and potential future health states and treatments; 5) implementing choices (e.g., providing transportation) and addressing “spillover” decisions (e.g., work arrangements) resulting from medical treatment choices; and 6) making upstream healthcare decisions on behalf of patients who preferred to have decisions made by their family caregivers. Conclusions: These data highlight a previously unreported and understudied set of critical decision partnering roles that cancer family caregivers play in patient healthcare decision-making. Optimizing these roles may represent novel targets for early palliative care decision support interventions for family caregivers.
AMTRA: An ambulatory and tailored symptom management and intervention system in patients with cancer initiating treatment.
Authors: Rasschaert Marika Anna , De Keersmaecker Sven , Vandenborne Kathleen , Vulsteke Christof , Dias Stefanie , Verschaeve Vincent , Vuylsteke Peter , Peeters Marc 
Published: November 2018

142 Background: The purpose of this non-randomized prospective cohort analysis was to implement and validate a tailored symptom management and intervention system, which integrates tailored education and advice for improving symptom self-management among cancer patients. We hypothesized that improved symptom self-management allows for early symptom control, better compliance, better dose intensity and reduce the necessity for extra visits / ER-visits. Methods: Patients initiating systemic therapy for malignant disease used a pre-programmed device in order to register compliance (in case of oral treatment), 12 clinical symptoms and 2 biometrics (weight and temperature). These real time data were collected onto a central platform, stratified according to different grades based on the PRO Common Terminology Criteria for Adverse Events (PRO-CTCAE ); and processed by an algorithm to render personalized advise when necessary. In case of severe (≥ Gr III) toxicity a dedicated nurse would intervene. Our primary outcome was symptom burden assessed via patient report tool. Secondary outcomes included relative dose intensity. Results: 168 Cancer patients were recruited from June 1st 2017 to December 31st 2017 across 4 sites, 76 men and 92 women. The median age 63 years (range 23-88 yr). 8275 Registrations were analyzed, pain was most frequently scored and loss of appetite was the most frequent gr III PROM. 108 patients scored toxicities (1413) requiring follow up or intervention by a dedicated nurse; resulting in 99 extra interventions: 34 extra consultations and 15 hospitalizations. Supportive treatment was adapted in 2, supportive advice given in 40 and in 12 instances no registration of the action was retrieved. Conclusions: The ambulatory follow up of patients with anti-cancer treatment appears feasible and reliable. Further effort to provide at home symptom management is warranted and requires both a logistic framework, as well as continuous education of motivated caregivers and patients. Evaluation on dose intensity and compliance of treatment will follow.
Frontline oncology care team primary palliative symptom guideline education, the oncology care model, and emergency department visits.
Authors: McInnes Susan , Carrino Cheryl M , Shoemaker Laura 
Published: November 2018

143 Background: The Oncology Care Model (OCM) is a novel 5-year quality-based Oncology payment and care delivery program established by the Centers for Medicare & Medicaid Service in 2016. OCM prioritizes high-quality, coordinated care for patients undergoing chemotherapy (chemo pts.) Participating centers provide augmented services to enhance care and meet quality goals. Challenging symptoms (sxs) are common among chemo pts and may lead to hospitalization and decreased quality of life. Specialist palliative care teams are not able to see all chemo pts with active sxs. Front line oncology care teams (FLC) need education on primary palliative sx management. Methods: Cleveland Clinic Taussig Cancer Institute is one of 181 practices voluntarily participating in OCM. Locations include main campus and 5 regional cancer offices with 100 oncologists caring for about 4,000 chemotherapy patients annually. Our OCM team engaged Oncology (Onc) and Palliative Medicine (PM) providers to standardize sx management. Education was provided to FLC of all disciplines. Electronic record analytics were used to determine emergency department (ED) utilization. Results: A multidisciplinary team of Onc and PM experts developed guidelines for 4 common sxs (chemotherapy-induced neuropathy, persistent cancer pain, nausea/vomiting and constipation. Guidelines were approved by key Onc and PM staff and made available to all providers online. There were 4 educational sessions for FLCs to all sites in 2017. Urgent sx outpatient appointment slots were created in oncology offices to address uncontrolled sx. From Dec 2017 to May 2018, ED visits for all cancer patients at main campus decreased from 500/month to 453/month (9.4%.) Reductions in ED visits were also seen at 2 hospitals adjacent to regional cancer centers (16% and 6%.) Conclusions: OCM participation provided an opportunity to improve care quality at our institution. Primary palliative sx guidelines were successfully developed by an interdisciplinary team and disseminated to FLC. Urgent sx management appointments were made available in oncology offices. These interventions coincided with a reduction in ED visits for all cancer patients.