bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypertension and use of bevacizumab among patients treated in community settings.
Authors: Klepin Heidi D. , Garrett-Mayer Elizabeth , Kaltenbaugh Melinda , Bruinooge Suanna S. , Rubinstein Wendy S. , Meersman Stephen C. , Miller Robert S. , Lyman Gary H. , Gray Stacy W. , Nekhlyudov Larissa , Osterman Travis John , Thota Ramya , Tsimberidou Apostolia Maria , Visvanathan Kala , Schilsky Richard L. , Hershman Dawn L. 
Published: May 2019

e18279 Background: CancerLinQ Discovery (CLQD) is a real-world dataset (RWD) derived from electronic health records across the US. This analysis builds on the prior observation of cautioned use of bevacizumab (Bev) among older adults using Medicare claims data. The goals of this study are to estimate the prevalence and incidence of hypertension (HT) and blood pressure (BP) patterns among patients (pts) with breast cancer (BC) or lung cancer (LC) treated with Bev. Methods: The cohort consists of all BC and LC pts in the platform at the time of CLQD dataset creation. At least one administration of Bev was required for inclusion as was diagnosis date and date of first Bev use. Elevated BP was defined as > 140 mmHg for systolic and > 90 mmHg for diastolic BP; elevated and max BP within 90 days of first Bev and 120 after were calculated for each pt. Summary statistics and proportions were calculated within these subgroups: baseline HT, race, age, and ECOG performance status (PS). Results: Overall, 1941 pts with BC and 4590 pts with LC treated from 2005 to 2017 were included. Baseline characteristics included % female (99 BC, 48 LC); % white (71 BC, 81 LC); % age > 65 years (34 BC, 52 LC). PS was available for N = 2118; most pts were PS 0-1 (88% BC, 82% LC). At baseline, more than half of pts were hypertensive (57% BC, 52% LC). An increase of at least 10mmHg in systolic BP within 120 days of treatment occurred in over half of pts with a normal baseline BP (54% BC, 56% LC) and in one-third of those with baseline HT (34% BC, 32% LC.) A significant proportion experienced at least a 20mmHg increase in systolic BP among those normotensive (29% BC, 32% LC) or hypertensive at baseline (16% BC, 16% LC). A majority of pts > 65 years had at least one elevated BP prior to Bev treatment (81% BC, 72% LC) although there were no clinically significant differences in rates of post treatment HT by age, race or PS. Conclusions: RWD provides important insights regarding the use and safety of medications outside the clinical trial population. Bev administration among pts with baseline (or pre-existent) HT is common in these practices. BP elevation post Bev exposure is also common, particularly among those with normal BP at baseline.
Feasibility of text-based symptom monitoring of ovarian and endometrial patients during treatment.
Authors: Naughton Michelle Joy , Salani Ritu , Peng Juan , Backes Floor , O'Malley David M. , Cohn David E. , Bixel Kristin Leigh , DeGraffinreid Cecilia , Moon Jennifer , Loyan Hibaq , Paskett Electra D. 
Published: May 2019

e18299 Background: Unreported symptoms during cancer treatment can lead to poorer patient care and quality of life. Newer technology enables effective means to track patients’ health in real time. We evaluated the feasibility of implementing systematic patient symptom monitoring during the first 12 months after diagnosis. Methods: Newly diagnosed endometrial and ovarian cancer patients were enrolled post-surgically to respond to monthly text message symptom surveys. Patients’ fatigue, sleep quality, pain, and quality of life during the past 7 days were rated on a 0 (worst) -10 (best) scale, and depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Patients’ responses were captured in REDCap and monitored by program staff, with patients’ oncologists receiving monthly feedback. Patient navigators were also engaged for patients needing assistance during treatment. We provide the results of the first 6 months of this program. Results: 134 patients were approached, and 120 patients (ovarian [n = 70] and endometrial [n = 50]) were enrolled among 5 physicians. The mean participant age was 63 (range: 35-87), 85% were non-Hispanic White, and 66% had education beyond high school. The most commonly reported monthly symptoms for both cancer types were moderate levels (scores of ≥ 4-7) of fatigue and sleep disturbance. 35 patients with PHQ-9 scores ≥ 10 and/or with suicidal ideation were reported to their oncologists for appropriate follow-up. At the 6 month survey, patients were asked to evaluate the text messaging program: 97% found the symptom surveys easy to complete on their smart phone or computer; 77% believed reporting their symptoms monthly was useful all or most of the time; 78% liked being monitored for symptoms all or most of the time; and 89% liked being asked if they needed any assistance prior to their next clinic visit. Patient navigators were used by 13 patients, and 17 patients dropped from the program over the 6 months due to death (n = 9) or lack of need/interest (n = 8). Average monthly compliance was 81%. Conclusions: We established the feasibility of enrolling patients in a monthly text-based monitoring program to facilitate symptom management during treatment. Patient follow-up is continuing.
Practical exploration and research of Watson for oncology clinical decision support system in real-world and localized practice.
Authors: Yu Zhonghe , Wang Zuochao , Ren Xuemei , Lou Defa , Li Xia , Liu Hongli , Zhang Xiuliang 
Published: May 2019

e18304 Background: Watson for Oncology (WFO) is a cognitive computing system developed by the IBM and trained by Memorial Sloan Kettering Cancer Center to provide evidence-based treatment recommendation for cancer patients. This study is to explore the impact on clinical treatment decision and patient communication based on the standard workflow we established of applying WFO in real-world clinical practice. Methods: From May 2018 to January 2019, 57 patients with advanced malignant tumors, including lung, breast, colorectal, gastric, esophageal, liver, ovarian and endometrial cancer, treated at Oncology Department of Beijing Chaoyang Integrative Medicine Emergency Medical Center were included in the study, of which 28 males and 29 females aged 29-89 years old. Treatment plan of each patient generated by WFO was compared with NCCN guidelines and Chinese local CSCO guidelines, and then evaluated and determined by MDT for final decision. Proportion of WFO recommendation fully or partially followed by clinicians was analyzed. Moreover, survey by questionnaire was conducted to collect feedback from these patients on their satisfaction of treatment and communication process. Results: Of all 57 patients enrolled, WFO’s options were highly concordant with NCCN guidelines and CSCO guidelines, and the finally adopted treatment plans after deliberately evaluated and discussed by MDT were 100% in the WFO recommended or for consideration category. Patient satisfaction and the compliance with instruction was significantly improved compared with historical data. Localization was most required in gastric, liver and esophageal cancer due to local drugs and therapies not available in WFO. Conclusions: This study verified that the artificial intelligent clinical decision supporting system can be applied in Chinese clinical practice to achieve high patient satisfaction and good efficacy. WFO meets Chinese and international standards for treatment, which will promote the standardized development of cancer treatment in China. Optimization, iteration, upgrading and localization are required for better practicability of WFO.
Symptoms and characteristics of cancer patient visits to an emergency room.
Authors: Gallaway Michael , Idaikkadar Nimi 
Published: May 2019

e18306 Background: Cancer patients are increasingly likely to visit an emergency department (ED) for acute care compared to the general population. Cancer patients who visit the ED often have long wait times, increased exposure to infection, and lesser quality treatment. The Centers for Medicare & Medicaid Services (CMS) is encouraging efforts to decrease survivor acute care visits. The purpose of this study was to examine cancer-related ED visits using a national population-based sample to understand why they are seeking care in an ED. Methods: A retrospective cohort study of U.S. patients who visited EDs between June 1, 2017 and May 31, 2018 was conducted using the National Syndromic Surveillance Program (NSSP) BioSense Platform. Cancer patients were identified using International Classification of Diseases, 10th Revision (ICD-10) codes for any cancer type and specifically for cancers of the bladder, female breast, cervix, colon and rectum, kidney, liver, lung, ovary, pancreas, prostate, or uterus. Symptoms were identified using syndromic definitions and key-word queries. Significance testing (p-value ≤0.01), was used to assess differences in the prevalence of symptoms by cancer type. Results: There were 97 million visits to EDs during the study period, 710,297 (0.8%) were among cancer survivors. Slightly more were female (50.1%) than male (49.5%); more were aged 65 or older (53.6%) than 18-64 (1.4-35.3%). The most common symptoms were pain (19%), gastrointestinal (14%), respiratory (12%), neurologic (5%), fever (5%), and injury (4%). Prevalence of symptoms differed significantly by cancer type. Some symptoms were higher among those with specific cancer types compared to all cancers in aggregate: pain (cervical, liver, pancreas); gastrointestinal (pancreas, liver, colorectal); respiratory (lung); neurologic (liver, lung), fever (pancreas, liver), injury (prostate), and bleeding (colorectal, liver). Conclusions: Use of NSSP data enabled a descriptive characterization of more than half of the U.S. ED visits among cancer patients. These comprehensive findings inform best practices to reduce unplanned acute care and help inform possible modifications in treatment and care protocols among survivors of specific cancers.
Evaluating the challenges of cancer care in Botswana: Chemotherapy utilization and stock outs.
Authors: Kaur Sukhdeep , Chandar Ashwin , Mayer Tina M. , Toppmeyer Deborah , Strair Roger , Marlink Richard , Antony Reena , DiGiacobbe Marilyn , Lebelonyane Refeletswe , Gaolathe Tendani , Ralefala Tlotlo Bathethi 
Published: May 2019

e18309 Background: As a significant percentage of cancer deaths are occurring in low- and middle-income countries, there is an unmet need in facilitating cancer care delivery in these countries. Data on stock-outs and shortages of cancer medicines in Botswana have been reported as one of the roots hindering treatment and potentially increasing mortality, with at least 40% of essential drugs being out of stock for at least 30 days in 2015. A methodologic approach was published in 2018 to forecast chemotherapy (CT) volume, however, this was based on incidence and prevalence data, using multiple estimated assumptions. To obtain objective data, we examined trends in CT utilization at Princess Marina Hospital (PMH), largest referral hospital in Botswana, over a 12-month period evaluating indications for CT, dosages, and potential issues with stock outs of essential medications. Here we present the 21 injectable essential CT utilized during this period. Methods: This is a retrospective analysis, with data collected from October 2017 to September 2018 from the log book which is used daily by the pharmacy at PMH to record CT preparations. Data was organized to reflect dosage of CT, regimen used, and its indication. Results: Over 1 year period, 21 injectable CT agents were utilized for cancer therapy, with common treated diseases being Kaposi Sarcoma, Gyn cancer, Breast cancer, and Lymphomas. The 10 most utilized agents are listed with the monthly dosage used. Conclusions: We hope to analyze trends in CT utilization based on the available stocks of drugs at PMH to help optimize plans for purchasing and storing medications, with goal of reducing stock outs. In addition, we will analyze treatment regimens used at PMH and compare to current standard of care CT in the US and Sub-Saharan Africa to optimize cancer pathway protocols used in Botswana. [Table: see text]
Laboratory and clinical data integration: Toward an evidence development framework.
Authors: Anderson Lori , Goede Patricia , Koskimaki Jacob , Kakamada Sirisha , Rubinstein Wendy S. 
Published: May 2019

e18318 Background: Decision making in precision oncology relies on the timeliness of diagnostic testing. Uncertainty surrounding the clinical utility of laboratory developed molecular and next generation sequencing (NGS) tests (LDTs) has engendered a predominantly manual claims review process. Denials and delays may create hurdles for optimally treating patients, and denials may contribute to financial toxicity. ASCO’s CancerLinQ aggregates clinical data from EHRs of participating oncology practices to improve the quality of care for patients. We hypothesized that standardized clinical data could be used in the short term to appeal denials of NGS LDTs and in the long run, lead to evidence-based coverage decisions. Methods: Using National Provider Index IDs, CancerLinQ participating physicians were cross-walked to ordering physicians of tests offered from 100 U.S. laboratories using XIFIN for billing services in 2018 to evaluate the feasibility of using CancerLinQ clinical data for claims adjudication. We determined the proportion of molecular and NGS tests (based on CPT coding) initially denied and the proportion of successful appeals through a manual submission process for clinical documentation (not including CancerLinQ data). CancerLinQ clinical data were evaluated for key elements necessary for successful appeals. Results: Sixty-five percent of CancerLinQ participating physicians ordered tests from the laboratories identified. Approximately 80% of NGS and 40% of molecular services were initially denied. After appealing with clinical information through the manual process, 55% of denials were successfully overturned. Key clinical data provided manually could be automatically extracted from CancerLinQ at high rates, such as ICD-9/ICD-10 cancer diagnosis (100% of 1,082,606 patients), Stage Group (47.6 %), and treatment plan (35.9%). Metastatic disease status is available through M1-stage (23.2% of total M-Stage), AJCC Stage IV (29.0% of total AJCC Stage) and Metastatic diagnosis codes (17.2%). Conclusions: CancerLinQ contains key data elements necessary for successful appeals and can streamline the claims adjudication process, ultimately helping to build the evidence base for coverage decisions.
Association of patient characteristics with real-world ROS1 NSCLC testing patterns among community practices in the United States.
Authors: Wong William Bruce , Wu Ning , Gupta Ravindra , Mansfield Aaron Scott 
Published: May 2019

e18321 Background: Despite the availability of targeted therapy for ROS1 NSCLC since 2016, there is limited information on real-world ROS1 testing practices to identify patients potentially eligible for targeted treatment among community practices. The objective of this study was to characterize ROS1 testing rates and identify potential barriers to ROS1 testing. Methods: The Flatiron Health EHR-derived database was used to identify patients diagnosed with advanced NSCLC between 7/1/2016 - 7/30/2018 and received systemic treatment in a community practice setting. Descriptive statistics were used to summarize the population, biomarker testing rates and timing of testing. Logistic and multinomial regressions including patient demographics and clinical characteristics were used to identify factors associated with the following outcomes: ROS1 testing, testing for biomarkers other than ROS1 (PDL1, ALK, EGFR) , longer times from advanced diagnosis (adv. dx) to ROS1 test results and initiation of therapy prior to ROS1 testing. Results: Of 9,275 eligible patients, ROS1 testing rates in squamous (SQ) and non-squamous histologies increased over the study period (30% to 52%, 62% to 75% respectively). Older age, males, poorer performance status, SQ histology, history of smoking and recurrent disease (RD) patients were significantly less likely to be tested. Among patients not tested for ROS1, 62% were tested for other biomarkers including > 50% of non-squamous patients tested for PDL1, EGFR or ALK and 51% of squamous patients tested for PDL1. The median time from adv. dx to test result was 24 days, with patient characteristics (i.e. Hispanic ethnicity, history of smoking) as well as test type predicting longer times to test results ( > 41 days vs. < 24 days after adv. dx). Patients who had a delay in test results were more likely to receive other therapy prior to availability of their ROS1 test results (25+ days vs. < 24 days OR [95% CI]: 9.18 [7.87, 10.70]). Conclusions: In real-world practice, patient characteristics were associated with ROS1 testing and testing delays which may result in some patient subgroups being less likely to be identified for potential targeted therapy.
The practical ethics of medication shortages: Understanding patient preferences for allocation, decision making, and disclosure through narrative inquiry.
Authors: Hantel Andrew , Hlubocky Fay J. , Quinn Michael , Lee Sang Mee , Siegler Mark , Daugherty Christopher 
Published: May 2019

e18323 Background: Hospital medication shortages (HMS) are pervasive throughout the U.S. healthcare system. Current management mechanisms are heterogeneous but routinely include the use of alternatives and the rationing of medications between patients. Little is known about oncology patient preferences for decision-makers, ethical allocation systems, or thresholds for disclosure during HMS. Methods: Oncology patients previously hospitalized for inpatient care within the last 24 months underwent qualitative interviews supplemented with validated instruments measuring: trust (Trust in Oncologist Scale), therapeutic alliance (Human Connection Scale), and shared decision-making (Shared Decision-Making Questionnaire). Qualitative data underwent Framework Analysis for thematic identification. Results: To date, 16 patients have been interviewed: median age 61y (31-77); 44% female; 56% married; 56% > college education; median number of treatment regimens 2 (1-6), days in hospital 18 (3-66), number of hospitalizations 2(1-8). All patients (100%) reported extremely high levels of trust, therapeutic alliance, and shared decision-making with their oncologist. Two patients (13%) reported personal experiences with HMS, 43% reported knowledge of HMS within the U.S., and no patients reported knowledge of local hospital HMS. Framework Analysis revealed that virtually all patients preferred that their oncologist act as the primary decision-maker during allocation/rationing and favored pharmacist and ethicist involvement. Most patients preferred allocation systems that prioritized efficacy, age, and degree of illness. No patients desired the use of a lottery or reciprocity-based decisions. Virtually all patients favored disclosure of shortages if alternatives were used, independent of the level of difference in efficacy/toxicity, and in the case of both chemotherapeutics and supportive medications. Conclusions: Despite ubiquitous HMS in oncology, patients are generally unaware of local HMS and prefer: multi-disciplinary decision-makers during HMS allocation, prioritized allocation schemes, and more frequent HMS disclosure than presently occurs. Study recruitment is ongoing.
Development and feasibility of virtual molecular tumor board.
Authors: Verma Amit , Kaur Jatinder , Gupta Amit , Aggarwal Aakriti , Kushwaha Arpana , Julka Pramod Kumar , Mehta Prashant , Singh Randeep , Lal Vandana 
Published: May 2019

e18334 Background: Practicing precision oncology is challenging due to the complex molecular interpretation and its implications in deciding pertinent treatment options. This is addressed by institutional Molecular Tumor Board (MTB) which is presided by all oncology sub-specialists including molecular biologist and bioinformatician, doing a meticulous job in untwining the intricacies but fail to obtain experiences across institutes. Further, meeting of all MTB members is neither always feasible nor accessible for the community oncologists. We hereby offer a virtual formation of MTB that is easily accessible and remotely attended by various experts across institutes, giving their opinion objectively at their ease that can be documented and archived. Methods: Virtual MTB (vMTB), a mobile cloud-based application was developed for both android and iOS platforms. The vMTB process involves submission and review of cases, whereby assigned members can opine blindly and rate different treatment options. Followed by averaging of rating score and then a final recommendation generated by the vMTB case-convener within 7 days, based on clinical context. A pilot study (2 months duration) was carried out where clinical cases bearing molecular information were invited from various oncology centers across India. Results: 21 cases were submitted (19 relapsed refractory, 3 treatment naïve) that included Breast (6), Lung (5), Leukemia/Lymphoma (3), Gall bladder (2), Uterine (2), Urinary bladder (1), GBM (1) and Sarcoma (1) cancers. The molecular query was based on 18 somatic (8 FoundationOne & 10 Others) and 3 germline testing. Cases assigned to vMTB members (~7 members/case) had ~ 6 treatment options/case with a response turn-around time ~4 days. Therapeutic final recommendation(s) were given for all cases with 95% concordance among the members; 6 cases where multiple options were advised, discordance rate was 14%. Additional molecular diagnostic workup was advised in 3 cases. vMTB recommendations including 10 off label treatment options were accepted by majority of the submitting physicians (82%). Clinical benefit was observed in 5 (24%) cases within the stipulated analysis duration. Conclusions: vMTB is a user-friendly, feasible, acceptable mobile solution alternate to MTB for objectively generating clinically meaningful consensus document for complex molecular clinical case scenarios, where guidelines are limited. To best of our knowledge, this is a first smart mobile solution connecting various oncology experts and have an immediate utility for the practicing community oncologists globally.