bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early case ascertainment and prospective multidisciplinary review for management of new melanoma diagnoses within an integrated healthcare system: The Kaiser Permanente Northern California experience.
Authors: Truong Thach-Giao , Chohan Kirun , Price Angeles , Fevrier Helene B , Peng Peter D , Kavanagh Maihgan A , Jones Maris S , Soni Alpana X , Price Mark A , Rasgon Barry M , Adad Basil , Martin Paul A , Rangel Javier , Kavecansky Juraj , Reddy Mala N. , Wang Stephen E. , Herrinton Lisa J. , Kolevska Tatjana , Morris James P , Chang Ching-Kuo 
Published: May 2019

6523 Background: Appropriate surgical treatment of early-stage melanoma yields a high cure rate, but this management can be nuanced. In particular, surgical management, including sentinel lymph node biopsy (SLNB), of thin melanoma (≤1.0mm) is not well-defined. Methods: Biopsies with new melanoma diagnoses were identified electronically and manually reviewed. In a community oncology setting, we organized a review panel of physicians specialized in melanoma from dermatology, medical oncology, nuclear medicine, radiation oncology, and surgical subspecialties (oncology, plastics, head and neck). Patients were assigned to care pathways based on NCCN and ASCO guidelines, including guidance on SLNB for thin melanomas with high-risk features like lymphovascular invasion, high mitotic rate, positive deep margin, and ulceration. These recommendations were documented in the chart and communicated directly to the patients care team. Results: From 11/2016 through 10/2018, our multidisciplinary committee reviewed 3626 patients with new melanoma from 22 sites in our integrated, regional hospital system. Median age was 66 (range 19-99); 60% were male. cT2N0 tumors comprised 7%, cT3 3%, and cT4 2%. Thin melanomas ≤1.0mm represented 71% of cases, of which 34% were ≤0.5mm. SLNB was performed in 9.8% of thin melanomas, and 18% were positive, much higher than historical positive rates of 3-4%. Conclusions: Early case ascertainment and prospective multidisciplinary review in a community oncology setting resulted in increased identification of high-risk thin melanoma, and consequently increased identification of nodal disease through SLNB. Positive SLNB triggers important clinical decision-making regarding need for node dissection versus clinical surveillance, and need for adjuvant therapy, which have been shown to improve survival. This clinical practice structure improved risk-stratification and adherence to national guidelines. We plan to further study the impact of these improvements to melanoma care on disease-free survival and overall survival.
Effect of exercise during adjuvant chemotherapy for breast cancer.
Authors: Haas Barbara K , Osborne Cynthia R. C. , Vukelja Svetislava J. , Selman Jennifer , Davis Trevor , Kimmel Gary T. ,   Texas Oncology-Tyler and Texas Oncology-Baylor Charles A. Sammons Cancer Center
Published: May 2019

6524 Background: In 2018, an estimated 266,120 women faced the challenge of living with breast cancer and approximately 40,920 died from their disease. Nearly 100% of these women experienced significant treatment related side effects that negatively impact quality of life (QOL). Exercise has repeatedly demonstrated to alleviate many of the side effects, improve QOL, and decrease cancer recurrence and mortality. In spite of this evidence, women do not maintain exercise during treatment for breast cancer. The purpose of this randomized controlled trial was to determine the effectiveness of exercising the day chemotherapy is administered on 1) the persistence with an exercise program, 2) side effects, and 3) QOL. Methods: Eligible women were randomly assigned to a control or experimental group. As part of their treatment plan, all participants were referred to one of 14 community-based exercise centers to exercise. Experimental group also exercised at one of two cancer centers each day chemotherapy was administered. Outcome measures include exercise retention and chemotherapy, completion; cancer-related fatigue, nausea/vomiting, peripheral neuropathy, weight gain, and QOL. Outcome measures were assessed prior to every second course of chemotherapy and 3- and 6-months post-chemotherapy. Results: 273 women with Stage I-III breast cancer receiving chemotherapy were enrolled in the study. The number of participants who withdrew from exercise was higher among those in the control group (n= 16; 12.4%) compared with those in the experimental group (n = 10; 6.9%). At cycle 5, those in the experimental group reported less motor peripheral neuropathy than those in the control group (p = .018) and higher physical well-being scores than those in the control group (p = .047). Conclusions: The highest impact of the intervention was on attrition from exercise. Since participants in both the control and experimental groups exercised throughout chemotherapy, it is not surprising that the groups performed comparably with regard to side effects and QOL. Given the positive effects exercise has demonstrated on persons receiving cancer treatment in numerous studies, having patients exercise in the cancer center on the day of chemotherapy is a significant step toward engaging persons receiving chemotherapy in an exercise program.
Clinical outcomes and cost-effectiveness of breast cancer screening for childhood cancer survivors treated with chest radiation: A comparative modeling study.
Authors: Yeh Jennifer , Lowry Kathryn P. , Schechter Clyde B. , Diller Lisa , Alagoz Oguzhan , Armstrong Gregory T. , Hampton John M. , Leisenring Wendy , Liu Qi , Mandelblatt Jeanne S. , Miglioretti Diana L , Moskowitz Chaya S. , Oeffinger Kevin C. , Trentham-Dietz Amy , Stout Natasha K. 
Published: May 2019

6525 Background: Survivors of childhood cancer previously treated with chest radiation face elevated breast cancer risk similar to BRCA1 carriers. Children’s Oncology Group (COG) guidelines recommend annual mammography with breast MRI, yet the benefits and costs of various screening strategies are uncertain. Methods: We used two breast cancer simulation models (Model 1 and 2) from the Cancer Intervention and Surveillance Modeling Network (CISNET) and data from the Childhood Cancer Survivor Study to reflect high breast cancer and competing mortality risks among survivors. We simulated 3 screening strategies: annual mammography with MRI starting at age 25 (COG25), annual MRI starting at 25 (MRI25), and biennial mammography starting at 50 (Mammo50). Performance of mammography+/-MRI was based on published studies in BRCA1/2 carriers who have similar cancer risk. Costs and quality of life weights were based on US averages and published studies. Results: Among a simulated cohort of 25-year-old survivors treated with chest radiation, the lifetime breast cancer mortality risk in the absence of screening was 10-11% across models. Compared to no screening, Mammo50, MRI25, and COG25 screening avert approximately 23-25%, 56-62% and 56-71% of deaths, respectively; averted deaths for COG25 compared to MRI25 were higher in Model 1 than Model 2 (9% vs. <1%). In Model 1, both MRI25 and COG25 were cost-effective; in Model 2, MRI25 was preferable (more effective, less costly than COG25). Conclusions: Compared to no screening, initiating annual screening at younger ages for at-risk survivors averts >50% of breast cancer deaths and is cost-effective. Additional data on test performance are needed to inform recommendations on screening modality. [Table: see text]
Use, attitudes, and perceptions of tumor genomic testing: Survey of TAPUR physicians.
Authors: Bruinooge Suanna S. , Dueck Amylou C. , Gray Stacy W. , Butler Nicole L. , White Carol B. , Smith Mary Lou , Mangat Pam K. , Kurian Allison W. , Railey Elda , Hawley Sarah T. , Schilsky Richard L. 
Published: May 2019

6531 Background: This survey of Targeted Agent and Profiling Utilization Registry (TAPUR) Study physicians examined use, attitudes, and perception of tumor genomic testing (TGT), defined as any DNA test performed on tumor specimen/plasma. TAPUR is a multibasket study of marketed agents targeting tumor genomics. Methods: 333 physicians at 54 TAPUR sites were surveyed (2016-2017). Survey domains included use of TGT, barriers to ordering TGT, and genomic confidence. Surveys included 3 scenarios for TGT ordering 1) pretreated advanced cancer patients (pts) without options, 2) newly diagnosed, untreated, metastatic pts and 3) early stage/potentially curable pts with standard options. Data were analyzed with descriptive statistics. Results: 112 physicians responded (33%). The table displays demographics and genomic confidence. Respondents reported a median of 25% of their pts had TGT in past 12 months for trials/routine care (range 0-85%). Barriers to testing included access to tumor specimen (86%), insurance coverage (67%), concerns that results will not be actionable (55%), and test issues (wait time, unsure which test/lab to use, test accuracy) (54%). TGT was ordered most often for scenario 1 (96%) and 2 pts (70%). Few respondents (32%) would order testing in scenario 3. Of those who reported testing for scenarios 1 & 2, most told pts that results could inform treatment/prognosis/trials (97%) or may be uninformative (84%). In all scenarios, pt expectations of TGT results were discussed prior to testing. A minority reported frequently telling pts in advance that results could inform heritable cancer susceptibility (37%). Conclusions: Confidence in using TGT was high. TGT was performed most for pts with advanced cancer and few options. Availability of specimens was largest barrier reported, indicating the importance of blood-based tests. Few respondents discussed implications of germline findings in advance, despite growing evidence of germline findings in somatic testing. [Table: see text]
A prospective blinded study of 1000 cases analyzing the role of artificial intelligence: Watson for oncology and change in decision making of a Multidisciplinary Tumor Board (MDT) from a tertiary care cancer center.
Authors: Somashekhar S.P. , Sepúlveda Martín-J. , Shortliffe Edward H , C Rohit Kumar , Rauthan Amit , Patil Poonam , Yethadka Ramya 
Published: May 2019

6533 Background: Artificial intelligence is being used to provide support for information-intensive decision making. In this report, we present our experience in explaining how artificial intelligence adds value to MDT’s decision making ability & paves way for personalized therapy. Methods: 1000 cases involving breast, lung, and colorectal cancer were evaluated by a multidisciplinary tumor board at a major cancer center in India between 2016 and 2018. After the tumor board decision was made, MDT was presented with the Watsons recommendations contemporaneously. MDT reviewed their decision after going through Watson’s recommendations and also the evidences that it put forth supporting its decision. Cases in which decision was changed, objective assessment was done by asking MDT to quote the reasons for reviewing and changing their decision. Results: Of 1000 cases, breast, lung, colon & rectal cancers were 620, 130,126 & 124 respectively. There were 712 non-metastatic & 288 metastatic cases. Mean age of the patients was 54.3 ± 12.2. Treatment concordance was observed in 92% for all cancers combined, 93% for rectal cancer, 92% for breast cancer, 89% for lung cancer, and 81% for colon cancer.MDT changed their decision in 136 cases (13.6%). The reasons for tumour board to change their decision was, Watson provided recent evidences for newer treatment in 55%, better personalized alternative in 30% & new insights from genotypic and phenotypic data and evolving clinical experiences in 15% of time. Conclusions: The study suggest that cognitive computing decision support system holds substantial promise to reduce the cognitive burden on oncologists by providing expert, updated, recent evidence-based insights for treatment-related decision-making. The 13.6 % incremental advantage over and above in a tertiary cancer centre with functioning MDT speaks in itself the value of having a learned colleague like Watson for oncology at our disposal. It will certainly add more value in settings lacking ready access to high quality cancer expertise and information. These systems can be valuable adjuncts to strong patient-clinician relationships in the delivery of high quality cancer care.
Leveraging a conversational agent to support adherence to oral anticancer agents: A usability study.
Authors: Mooney Berges Bethany , Cambareri Christine , Takvorian Samuel U , Serpa Mike , Shulman Lawrence N. , Bekelman Justin E. , Rendle Katharine A. , Argon Jesse , Rosin Roy 
Published: May 2019

6534 Background: Identifying effective, scalable strategies to ensure patient adherence to oral anticancer agents (OACAs) is a major challenge. Previous studies have shown widely variable rates of adherence, and suboptimal adherence is associated with decreased effectiveness and higher costs. A small but growing literature supports digital health behavioral interventions across a variety of chronic illnesses, including in cancer. In particular, conversational agents—or technologies that mimic human conversation using text or spoken language—have shown early promise in supporting behavior change, but have yet to be rigorously tested in the context of OACAs. Methods: A rapid cycle prototyping approach led to the development of ‘Penny’ – a bidirectional, conversational agent that engages patients via text messaging, and leverages natural language processing and machine learning to learn from clinical interactions. Core functionalities include: (1) real-time dosing instructions, (2) motivational reminders, and (3) symptom monitoring with self-management support. We conducted a four-month usability study between December 24, 2017 and May 1, 2018 in a large academic cancer center. At monthly intervals for the first 12 weeks of follow-up, research staff conducted qualitative interviews with participants to evaluate usability and acceptance. Results: 11 patients with gastrointestinal neuroendocrine cancer on capecitabine and temozolomide were approached regarding the study. Of these, 10 agreed to participate (ages 45 to 71). Overall, participant satisfaction was high with a Net Promoter Score of 100. Reliability of Penny’s algorithmic branching to provide accurate dosing information and symptom triage was also high: symptoms were accurately graded 100% of the time, and there was appropriate self-management advice or provider triage 100% of the time. Average daily adherence (based on self-report) was 98%. Participants reported that 3 emergency room visits were avoided during the study period. Conclusions: In preliminary testing, a mobile phone-based conversational agent was a usable and acceptable means of supporting OACA adherence. Expanded study testing patient safety and efficacy is underway.
Risk stratification and daily symptom monitoring for oncology patients.
Authors: Daly Robert Michael , Perry Claire , Chiu Yeneat O. , Katzen Lauren L. , Rozenshteyn Margarita , Kuperman Gilad , Dhami Amandeep K , Salvaggio Rori , Baldwin Abigail , Holland Jessie C. , Chow Kimberly , Dang Chau T. , Grisham Rachel N. , Veach Stephen R. , Zervoudakis Alice , Wagner Isaac , Simon Brett A , Reidy Diane Lauren , Perchick Wendy 
Published: May 2019

6535 Background: Monitoring and managing patient reported outcomes (PROs) has been recommended for oncology patients on active treatment but can be time and resource intensive. Identifying patients likely to benefit and the optimal frequency of PRO capture is still under investigation. We tested the feasibility of monitoring patients who are high-risk risk for acute care with daily PROs. Methods: Using data from our institution, we developed a model that employs over 400 clinical variables to calculate a patient’s risk of an emergency room visit within 6 months following the onset of treatment. From October 15, 2018 to January 23, 2019, we enrolled patients identified as high risk through a technology-enabled program to monitor and manage those patients’ symptoms. Enrolled patients entered PRO assessments daily via an online portal. Symptoms were monitored and managed by a centralized clinical team. Tiered notifications informed the team of concerning or escalating symptoms. We assessed how frequently patients completed symptom assessments and the frequency of symptom notifications. Results: During the pilot, 28 patients were identified as high risk and enrolled in the program (median age 65; 64% percent female). Disease types were: 15 (54%) thoracic, 7 (25%) gynecologic, 6 (21%) gastrointestinal. Median time in the program was 50 (6-98) days. Patients completed 840 of 1,350 assessments (62%). There were 328 assessments that triggered moderate alerts (39%) and 220 that triggered severe alerts (26%). The table describes the prevalence of symptoms at the patient-level. Conclusions: A model can be employed to identify high-risk patients in collaboration with clinicians. Our adherence rate with a daily symptom assessment was similar to those found in studies of less frequent PRO capture. Future work will expand to a larger patient population with other cancer types, evaluate impact on outcomes, and assess optimal frequency for PRO collection and alert thresholds. [Table: see text]
Capacity to provide specialized care for older adults in community oncology practices: Results of the NCI Community Oncology Research Program (NCORP) Landscape survey.
Authors: Williams Grant Richard , Weaver Kathryn E. , Lesser Glenn Jay , Dressler Emily Van Meter , Winkfield Karen Marie , Neuman Heather B. , Kazak Anne , Carlos Ruth , Gansauer Lucy Jean , Kamen Charles Stewart , Unger Joseph M. , Mohile Supriya Gupta , Klepin Heidi D. 
Published: May 2019

6539 Background: American Society of Clinical Oncology guidelines recommend that patients ≥65 years of age starting chemotherapy undergo a geriatric assessment (GA) to inform and guide management; however, little is known about resources available in community oncology practices to facilitate geriatric specialty care and implement these guidelines. Methods: Community oncology practices were electronically surveyed in 2017 regarding the availability of various providers, supportive services, and practice characteristics, as part of a larger survey of cancer care delivery research (CCDR) capacity at NCORP sites. Designated CCDR leads provided information about their site. Descriptive statistics were used to report prevalence of resources available at each community practice. Results: Of the 925 NCORP practice locations, 504 (54%) responded to the survey, representing 227 practice groups. Of respondents, 58% included a free-standing clinic or private/group practice and 82% included inpatient services. The median number of new cancer cases per year ≥65 years of age was 443 (Interquartile range [IQR] 220-903). The median number of medical oncology providers was 5 (IQR 3-11). Only 1.8% of practices had a dual fellowship trained geriatric oncologist on staff. Geriatricians were available for consultation or co-management for 34% of sites, but only 13% of those had availability within the oncology clinic. Among those with access to geriatricians, consultations were primarily outpatient (90%) versus inpatient (54%). Ancillary services that could support GA were variably available onsite: social work (83%), nurse navigators (78%), pharmacist (77%), dietician (69%), supportive caregiver services (62%), rehabilitative medicine (57%), psychologist (41%), and psychiatrist (39%). Most sites utilized electronic health record systems (84%) and patient portals (89%). Conclusions: Availability of geriatric-trained providers is limited in community oncology practices. Use of primarily self-administered GA tools that direct referrals to available ancillary services may be an effective implementation strategy for guideline-based care.
Using real-world cohorts to assess the generalizability and relevance of randomized clinical trials (RCTs).
Authors: Bennette Caroline Savage , Nussbaum Nathan Coleman , Curtis Melissa D. , Meropol Neal J. 
Published: May 2019

6540 Background: RCTs are the gold standard for understanding the efficacy of new treatments, however, patients (pts) in RCTs often differ from those treated in the real-world. Further, selecting a standard of care (SOC) arm is challenging as treatment options may evolve during the course of a RCT. Our objective was to assess the generalizability and relevance of RCTs supporting recent FDA approvals of anticancer therapies. Methods: RCTs were identified that supported FDA approvals of anticancer therapies (1/1/2016 - 4/30/2018). Relevant pts were selected from the Flatiron Health longitudinal, EHR-derived database, where available. Two metrics were calculated: 1) a trial’s pt generalizability score (% of real-world pts receiving treatment consistent with the control arm therapy for the relevant indication who actually met the trial's eligibility criteria) and 2) a trial’s SOC relevance score (% of real-world pts with the relevant indication and meeting the trial's eligibility criteria who actually received treatment consistent with the control arm therapy). All analyses excluded real-world pts treated after the relevant trial’s enrollment ended. Results: 14 RCTs across 5 cancer types (metastatic breast, advanced non-small cell lung cancer, metastatic renal cell carcinoma, multiple myeloma, and advanced urothelial) were included. There was wide variation in the SOC relevance and pt generalizability scores. The median pt generalizability score was 63% (range 35% - 88%), indicating that most real-world pts would have met the RCT eligibility criteria. The median SOC relevance score was 37% (range 15% - 74%), indicating that most RCT control arms did not reflect the way trial-eligible real-world pts in the US were actually treated. Conclusions: There is great variability across recent RCTs in terms of pt generalizability and relevance of SOC arms. Real-world data can be used to inform selection of control arms, predict impact of inclusion/exclusion criteria, and also assess the generalizability of the results of completed trials. Incorporating real-world data in planning and interpretation of prospective clinical trials could improve accrual and enhance relevance of RCT outcomes.