bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving time to initiation of bone modifying agents in patients with newly diagnosed multiple myeloma.
Authors: Rosko Nathaniel , Lee Sarah , Samaras Christy Joy , Mejia Alex V. , Anwer Faiz , Faiman Beth , Mathur Saveta , Hamilton Kimberly , Reed Janice , Karam Mary Ann , Valent Jason Neil 
Published: May 2019

6528 Background: Current ASCO and IMWG guidelines recommend that all patients (pts) on active anti-myeloma therapy receive concurrent supportive care treatment with a bone modifying agent (BMA) to decrease the risk of skeletal related events (SRE). Unfortunately, recent data shows only 51% of Medicare pts with myeloma received a BMA within 90 days of first chemotherapy. We implemented a quality improvement project to identify the average time to BMA initiation at all Cleveland Clinic affiliated sites, with the primary goal to improve time to initiation of BMA in newly diagnosed multiple myeloma (NDMM) pts by 4 weeks at Cleveland Clinic Main Campus (MC). Methods: Barriers with BMA initiation were identified using quality improvement tools developed at the ASCO Quality Training Program. The first PDSA cycle was implemented between September 2018 – January 2019 with an emphasis on education. This included review of updated guidelines, literature review of risks and toxicities associated with BMAs, and strategies for choosing BMA based on pt factors. Baseline data on time to start BMA and data to evaluate impact of PDSA intervention was completed via chart review. Results: 161 NDMM pts were evaluated between 2015 to 2018 at all sites. The average time difference between the start of anti-myeloma therapy and the start date of a BMA in NDMM pts was 10.5 weeks. Subset analysis based on whether pts were treated at MC vs affiliate sites was 10.6 weeks vs 9.1 weeks, respectively. During the first PDSA cycle, 14 NDMM pts were treated at MC. 86% (12/14) pts were treated with a BMA. The average time between cycle 1 day 1 of first line treatment and first dose BMA was 4.3 weeks (range 4-12 weeks). Conclusions: With increased physician education and awareness of internal baseline data, we achieved our initial goal and observed a significant improvement in time to initiation of BMA from 10.5 weeks to 4.3 weeks. Obstacles regarding effective communication with patients on the benefit of BMAs as well as need for dental clearance were barriers identified early on. We plan to incorporate BMA guidelines in our institutional care path with the goal to decrease time to initiation at all affiliated practices. Further mechanisms to ensure reinforcement of BMA initiation in NDMM patients is warranted to maintain therapeutic benefit.
Evaluation of a risk-based approach to follow-up care for breast cancer survivors: From oncology specialist to primary care provider (PCP).
Authors: Keenan Kathleen , Dunne Megan 
Published: May 2019

6529 Background: The number of cancer survivors in the Unites States is expected to exceed 18 million by the year 2020. Predicted care demands coupled with an anticipated shortage of oncologists have led to alternate follow up care models and providers. This nurse practitioner- (NP) led survivorship team was charged with developing a risk-based discharge plan for the > 8,000 breast cancer survivors in our survivorship clinic at this NCI-designated cancer center. Methods: In collaboration with breast oncologists and surgeons, a risk-based strategy to identify and transition eligible survivors to their PCPs was developed. Low risk was determined by: stage, absent disease and significant late-effects, and time since diagnosis. Interventions: Evidence supporting the willingness, availability and expectations of PCPs to provide follow-up care to cancer survivors was reviewed. Criteria for eligibility were developed; patient and PCP educational documents were created. Continued breast cancer screening at our center was offered with results sent directly to PCP. Outreach educational programs were provided to local PCP groups to build relationships and provide breast specific follow up recommendations. To promote communication and collaboration between NP and PCP prior to and at the time of transition, clinic notes were shared after each survivorship visit. A comprehensive transition note including detailed follow-up recommendations was provided at the time of transition. Patients were assured of rapid return to the oncology provider in the event of recurrence or cancer related issue. Results: 5080 patients were offered transition, with 3642 accepting. Mitigating factors and facilitators to transition for both patients and PCP will be discussed and educational strategies to overcome barriers will be described. Conclusions: Transition of breast cancer survivors’ care to PCPs is successful approximately 56% of the time. Key factors include seamless communication among providers and early discussions with patients to set expectations and normalize the transition early in the care pathway.
The effects of immunotherapy and novel therapies on medical oncology work load in a Canadian province.
Authors: Ramjeesingh Ravi , Colwell Bruce , Rayson Daniel 
Published: May 2019

6532 Background: Both novel targeted therapies and immunotherapies have dramatically changed the landscape in a number of disease sites with previously limited treatment options. This has resulted in an impact on clinical workload for oncologists with subspecialty practices in the areas of non-small cell lung, (NSCLC), melanoma (M), and genitourinary (GU) cancer. Our aim was to investigate the shift in workload amongst these practices as compared to other disease sites within a single academic cancer center in Nova Scotia (NS), Canada. Methods: The NS Cancer Center is the academic cancer center for the province of NS providing consultative and ongoing care for approximately 72% of provincial patients. We manually quantified appointment visits (new consultation, treatment and follow up visits) as well as telephone toxicity and chart checks booked from February 1 to April 30 across a 3-year interval (2016, 2017, and 2018) and then extrapolated this data to derive full year estimates. Disease sites most impacted by therapies that have changed treatment landscape (NSCLC, M and GU) were compared with the Breast and Gastrointestinal disease sites. Results: Clinical workload increased across all domains over the 3 year period but the majority of the increase is attributed to the 3 disease sites (Table). Conclusions: Medical oncology workloads are increasing over time and novel treatments (including immunotherapy) in disease sites with previously limited options likely account for a significant portion of that increase. New patient consultation metrics, taken in isolation, do not reflect current trends in medical oncology workload. Hiring practices, space allocation and use of physician extenders must take into account these shifting workload dynamics to mitigate physician burnout and potential impacts on quality and timeliness of care. [Table: see text]
Proactive, multidisciplinary approach to supportive medicine: Improving health outcomes and care utilization.
Authors: Worster Brooke , Csik Valerie P , Minetola Jared , Garber Gregory D. , Petok Alison , Yocavitch Liana , Lama Jasmine Tenpa , Gandhi Krupa , Lu-Yao Grace L. 
Published: May 2019

6537 Background: Evidence suggests that cancer patients who receive palliative care early in their disease have improved quality of life, decreased emergency department (ED) visits, and less aggressive end-of-life care. In 2017, the Sidney Kimmel Cancer Center at Jefferson established the Neu Center for Supportive Medicine and Cancer Survivorship (NCSMCS) as a model for integrated care in the outpatient setting for all cancer patients. A multidisciplinary team consisting of palliative care physicians, social work, psychology, and navigation conducts biopsychosocial screening and initiates a personalized care plan for each patient to clarify treatment goals and offer assistance. Objectives: To use biopsychosocial screening at specified time points to identify needs and evaluate the impact of supportive care as part of standardized oncology care regardless of stage. Methods: This assessment utilized Oncology Care Model (OCM) data for Jefferson Medicare patients between 7/1/16 to 7/31/18. Incidence of ED admits ED/Observation and admissions were evaluated as well as ICU utilization and advanced care planning. Poisson regression was used to generate incidence rate ratios (IRR) and 95% confidence intervals (CI) to facilitate the comparison of post- vs. pre- incidence rates of hospitalization. Results: The post-intervention hospital admissions decreased by 31% in NCSMCS (IRR 0.69; 95% CI 0.48-0.98) and by 10% in Non-NCSMCS (IRR 0.90; 0.84-0.96) and advanced care plans were more likely to be on file for NCSMCS (9.0% vs. 4.9%). The intensive care unit (ICU) admissions were decreased by 17% among Non-NCSMCS (IRR 0.83; 95% CI 0.74-0.93). The utilization rates for ED admissions were not statistically different among both the groups. Conclusions: The preliminary data is promising and impact will be monitored as the intervention is expanded. Reducing admissions has benefits from both a cost savings as well as quality of life perspective. Future analyses will consider the impact of the intervention on a patient’s quality of life.
Safety and outcomes of a cancer patient urgent care clinic.
Authors: Bevins Jack S , Fullington Hannah , Froehlich Thomas W. , Hobbs Stephanie , Halm Ethan , Lee Simon Craddock , Hong Arthur 
Published: May 2019

6542 Background: Several cancer centers describe cancer-patient dedicated urgent care clinic (UCC) that address commonly anticipated complaints of adults with cancer. UCC may be capable of preventing some ED visits, but little is known of the safety and outcomes for patients after a UCC visit. Methods: We identified UCC visits made by adults at our comprehensive cancer center between 2013-2016 and compared the cohort to patients who did not visit the UCC. We linked patients to tumor registry data and their electronic health record from the UCC visit, then tracked ED visits, inpatient and intensive care unit (ICU) admissions occurring within 24 hours of the UCC visit. Results: Between 2013-2016, 551 patients generated 772 UCC visits, compared to 17,496 who did not visit. UCC users had significantly (p<0.001) more advanced-stage cancer than non-UCC users (37.3% vs 18.9%), but there were no significant differences in mean age, race/ethnicity, or death within 180 days of diagnosis. The most common chief complaints accounted for nearly half of all UCC visits: (17.4%), URI symptoms/fever (12.6%), nausea/vomiting/diarrhea (7.8%), and fatigue/weakness (7.6%). After 10.0% of UCC visits, patients had an ED visit, while 12.3% were admitted to the hospital; only 5 UCC visits (0.7%) had an associated ICU stay. Most patients (75.7%) only had a single UCC visit, but patients who visited the UCC more often tended to have higher rates of ED visits and hospitalizations within 24 hours (Table). The mean time from UCC arrival to ED arrival was 3.0 hours, and 6.5 hours from UCC arrival to inpatient arrival. Conclusions: The majority of patients seen in UCC did not require ED or inpatient hospitalization. Patients with subsequent ED or inpatient visits had minimal delays in care. Findings suggest that triaging cancer patients for commonly anticipated complaints to a UCC does not result in high rates of mis-triaging or major delays in care. Patients with ED, Inpatient, or ICU visit after UCC, stratified by UCC visits per patient (2013-2016). [Table: see text]
Validation of an oncology-specific instrument to measure cancer patients’ perception of care coordination.
Authors: Okado Izumi , Cassel Kevin , Pagano Ian , Fukaya Erin , Kelleher Timothy , Hewitt Tracey , Holcombe Randall F. 
Published: May 2019

6543 Background: According to the IOM, effective coordination of care (CC) is a critical component of high-quality cancer care; however, lack of a reliable and validated measure limits our current understanding of cancer care coordination. We examined psychometric properties and utility of a Care Coordination Instrument (CCI), a survey developed to assess cancer patients’ perceptions of care coordination. Methods: The 29-item CCI was administered to 200 patients receiving active treatment for cancer at private oncology practices and hospital-based facilities from Oct. 2018 to Jan. 2019. The CCI includes subscales that evaluate CC in 3 domains (Communication, Navigation, Operational) across 4 areas of CC (patient-physician; between health providers; during inpatient-to-ambulatory care transitions; during transitions across different phases of care). All items were rated on a 4-point Likert scale. Results: Psychometric analyses of the CCI demonstrated that it has good internal consistency reliability (α = .917) and the three-factor solution was an acceptable fit (CFI = .853, SRMR = .065). Overall, cancer types (leukemia, myeloma) and having an identified patient navigator significantly predicted higher patients’ ratings of CC ( p < .05). Similar trends were found for Communication and Operation subscale scores ( p < .05). Having an identified navigator predicted higher Navigation scores ( p < .05). Marginally significant differences were found for practice setting, with patients receiving care in hospital-based facilities reporting better CC ( p = .085). Item-level analyses revealed significant differences in specific aspects of CC (e.g., physician-patient communication) across cancer type, presence/absence of a patient navigator, and practice setting. Conclusions: The results demonstrate that the CCI is a reliable and valid instrument for measuring cancer patients’ perceptions of care coordination. Perception of CC correlated with the presence of a navigator, underlying cancer type and (trending) practice setting. Use of this instrument may reveal important information about cancer care coordination and may identify areas of targets for improvement in patient-centered cancer care delivery.
Nurse Navigators telephone and web application follow-up intervention for patients treated with oral anticancer medication: an optimization of oncologists' medical time.
Authors: Ferrua Marie , YATIM FATIMA , Fourcade Aude , Lacaze Marilène Guillet , Mir Olivier , Minvielle Etienne 
Published: May 2019

6544 Background: Many interventions to improve safety and quality of oral anti-cancer medication have occurred the past few years. Frequently, these systems involve Nurse Navigators (NN) but rather limited data is actually available describing their activities and quantifying which intervention could have been performed without an oncologist's expertise. This is a major issue in optimizing the workload of oncologists statewide. Methods: The study was conducted at Gustave Roussy (Villejuif, France) as part of an assessment program of an intervention combining NN and mobile app dedicated to patients receiving oral cancer medication (cytotoxic, targeted therapies). A coding grid was developed to classify the NNs' activities from the intervention reports. NN interventions consist in regular follow-up calls and requests from patients and their relatives (via phone calls or mobile app). NN interventions recorded over a 24-month period were all encoded by two researchers. Results: 2395 interventions were analyzed concerning 236 patients, 1880 of which were regular follow-ups, and 515 patient requests. The majority of contacts were carried by phone conversation (94%). 52% of the interventions were followed-up upon by at least one additional action by the NN (n = 1250). In 25% (n = 318) of the interventions, the oncologist's expertise was required mainly because of the presence or aggravation of symptoms and/or toxicities or concerning oncological treatment (therapeutic protocol, biological assessment). 75% (n = 932) of the interventions have been processed successfully by NN by themselves. The principal actions carried out by the NN were: A. Contact or provide referral to a health professional or institution 24%, B. Advice to the patient 43%, C. Management of medical documents and appointments 6%; D. Administrative management 2%. Conclusions: Patients' needs for oral cancer drugs are mainly related to advice, information and coordination of the care pathway. In the majority of interventions, the NNs were able to manage these situations by themselves, which could optimize the workload of oncologists.
The diagnosis and outcomes when the outpatients receiving chemotherapy visited the emergency room: A tertiary referral center retrospective study of 734 cases.
Authors: Ogata Takatsugu , Satake Hironaga , Ogata Misato , Yasui Hisateru 
Published: May 2019

6552 Background: Today, the chemotherapy is performed in outpatient, but there is no research on the safety. This study aimed to determine the safety of outpatients receiving chemotherapy and the points to note when they visit the emergency room. Methods: We retrospectively collected data from July 2011 to October 2018 in tertiary referral center of outpatients receiving chemotherapy when they visited the ER within 3 months from the administration of chemotherapy. Results: Seven hundred and thirty-four cases (345 patients) were enrolled (median age, 71 years; male 410, female 324). The median days of the patients visiting the ER was 16 days after the administration of chemotherapy. The tumor types were gastrointestinal (226 cases), urological (199 cases), respiratory (112 cases), and the other (197 cases). The cytotoxic agents, antibody, or hormonal agents were 530 cases, 150 cases, or 173 cases, respectively. The median body temperature and systolic blood pressure were 36.8 °C and 130 mmHg, respectively. The median estimated glomerular filtration rate was 68. The cases of emergent admission were 256 cases. The tumor-associated disease was 184 cases and the chemotherapy-associated disease was 105 cases. The most frequent chemotherapy-associated disease was febrile neutropenia (FN) (35 cases). The admission of tumor-associated disease or chemotherapy-associated were 94 cases or 41 cases, respectively (p = 0.273). Conclusions: The outpatients receiving chemotherapy visited the emergency room because of the tumor-associated symptoms rather than chemotherapy-associated symptoms. It was safe that the chemotherapy is performed in outpatient. FN was the most frequent chemotherapy-associated disease. It is important to be careful that not only chemotherapy-associated symptoms but also tumor-associated symptoms when the outpatients receiving chemotherapy visited the ER.
Reasons for discordance in treatment approaches between oncology practice and clinical decision support in China.
Authors: Liang Jun , Li Tianle , Zhang Shan-shan , Chen Cheng , VanHouten Courtney , Preininger Anita , Dankwa-Mullan Irene , Jackson Gretchen Purcell 
Published: May 2019

6555 Background: Therapeutic clinical decision-support systems (CDSS) are often evaluated by comparisons between CDSS options and actual practice decisions or expert opinions. Few such studies have carefully examined reasons for discordance. Methods: We reviewed 11 concordance studies from different hospitals across 8 provinces in China, published between 2017 and 2018. The studies compared IBM Watson for Oncology (WfO) therapeutic options to treatments selected by oncologists or a tumor board involved in review of cases for lung, colon, rectal, breast, gastric, and gynecological cancers. We identified given reasons for discordance and summarized themes across studies. Results: Of the 11 studies, 9 provided 1 or more reasons for discordance which could be analyzed. We found three major themes related to discordance: formulary restrictions, treatment-protocol differences, and physician or patient preferences (Table). Formulary differences between WfO and regional practices included off-label drug uses or unavailable therapies. Treatment-protocol differences included variations in regimens, such as simultaneous versus sequential treatments. Physician or patient preferences included factors such as the cost of treatment and logistics associated with various treatments. Conclusions: This study identified multiple reasons for discordance between an oncology CDSS option and oncologists’ treatment choices in China. Treatment differences arose from local formulary or protocol differences as well as provider and patient preferences. Future studies of CDSS should include reasons for discordance when assessing system performance in this manner. [Table: see text]
Accelerating advanced precision medicine through a harmonized data exchange platform and research consortium (PMEC).
Authors: Sohal Davendra , Doudement Julien , George Ben , Alexander Brian Michael , Grant Stefan C. , Kim William Y. , Gutierrez Martin , Kelly William Kevin , Knudsen Karen E. , McPherson John , Hoimes Christopher J. , Davis Elizabeth J. , Singal Gaurav , Webster Jennifer , Chan Lindsay , Cristofanilli Massimo , Miller Vincent A. 
Published: May 2019

6557 Background: Clinico-genomic data sharing is consistently identified by the global oncology community as a critical requirement to accelerate the discovery and development of new targeted therapies. However, lack of effective collaborative models, fragmented and lengthy legal contracting processes, paucity of funding, and inadequate technological platforms have historically been obstacles for effective data sharing. Methods: In 2015, 10 US academic medical centers (AMC) and Foundation Medicine Inc. (FMI) formed PMEC. Feasibility assessments included creation of a master agreement across sites and willingness to use a central IRB. Oversight and research steering committees were created within the consortium. Through a centralized, secure web-based platform, FoundationInsight, we combined and shared de-identified, harmonized comprehensive FoundationOne genomic profiling data. Research proposals mining this data warehouse are invited quarterly from participant AMCs and peer-reviewed; approved studies are executed at all sites. Results: All 10 AMCs collaborated to execute a master registry participation agreement, followed by a master IRB protocol (New England IRB # 120180008), subsequently approved by individual site IRBs. Since its launch, the PMEC database has grown, on average, 60% per year, to now house over 14,000 cases. The shared dataset covers all tumor types (most commonly lung [17.2%], gastrointestinal [13.8%] and breast [9.2%]), encompasses genomic alterations in >300 genes, and reports relevant supplementary data such as tumor mutation burden and microsatellite instability status. To date, 15 studies have been proposed and evaluated using this platform, with 2 projects currently approved and in progress. Conclusions: We demonstrated the feasibility of creating a collaborative academic consortium that facilitates data sharing and potential discovery efforts in oncology. Technology solutions can accelerate the ability of AMCs, in partnership with central labs, to share and harmonize data to advance precision medicine. This approach lays the groundwork for conducting prospective, biomarker-enriched clinical trials among participating AMCs.