bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survey to evaluate quality of cancer patient care: A questionnaire based analysis in a tertiary hospital.
Authors: Ackula Haritha , Ning Ying , Jindal Vishal , Patil Shekhar , Siddiqui Ahmad Daniyal 
Published: May 2019

e18320 Background: As the burden of cancer is on the rise, there is a need to understand the logistics in caring for cancer patients. Internists and nurses are integral part of cancer care team, alongside oncologists. Our aim was to assess their knowledge, attitude and practice in order to identify areas of strength and limitation to help devise opportunities to enhance care. Methods: A close ended cross-sectional survey was conducted among internal medicine physicians, residents and nurses. We developed 36 questions broadly based on cancer-care and distributed them randomly. Additionally, subjects were asked to list factors limiting their ability to provide effective care. We semi quantitatively graded the depth of awareness amongst participants. A total of 95 health care providers were included in the final analysis. Results: Only 62% of participants were accurate in knowledge based questions. About 57% believed all cancer patients benefit from less aggressive treatment and considered chemotherapy side-effects to be the most common cause of hospitalization. Total of 94% reported effective care coordination by visiting nurses, primary care providers in outpatient settings decrease readmissions. Seventy percent thought a dedicated inpatient service run by Oncologists would be better for cancer patient care, with 96% preferring co-management. Around 80% felt they were better able to manage decompensated heart failure and fulminant liver disease than oncological emergencies like neutropenic fever. All the attendings (100%) were comfortable discussing new cancer diagnosis compared to 65% residents and 60% nurses. However 58% of them would like the health care proxy to be involved in all goals of care decisions, irrespective of patient’s capacity. Conclusions: Surprisingly, the baseline knowledge about cancer-care is suboptimal and there is a significant gap in expected versus real cancer-care delivery. Most commonly encountered factors hindering patient-care were lack of awareness of cancer illness trajectories and unclear goals of care with inter-provider disparities/gaps in understanding them. Initiatives such as targeted education, shared care plan and engaging patients at every step is crucial.
Predictors of death for patients treated with palliative intent radiation using prospective databases.
Authors: Agrawal Namita , McClelland Shearwood , Shiue Kevin , Bartlett Gregory , Zellars Richard C. , Watson Gordon A , Tim Lautenschlaeger , Ellsworth Susannah G. 
Published: May 2019

e18325 Background: Radiation therapy (RT) effectively palliates pain and other symptoms due to cancer and is frequently offered to patients with metastatic disease. Standard palliative RT schedules range from one to ≥10 fractions; however, prognostic variables related to survival following palliative RT are not well studied. A better understanding of prognostic factors in this setting will assist in selecting appropriate palliative RT regimens for patients with short life expectancies. Methods: Prospectively maintained institutional databases tracking morbidity and mortality and outcomes of a departmental peer review process were used to identify patients who received palliative RT between April 2015 - December 2018. Cox proportional hazards model was used to identify factors correlated with overall survival (OS) and mortality within 30 days (30DM) after completing palliative RT, including age, sex, admission status (inpatient versus outpatient), Karnofsky Performance Status (KPS), treated site and primary site. Results: Of 421 patients, 389 received palliative RT; 30DM rate was 25.7% (n = 100). Median age was 61, median KPS was 70, and 196 patients (50.4%) were female. The most common primary sites were thorax (N = 121, 31.1%) and genitourinary tract (N = 60, 15.4%), while the most commonly treated sites were brain (N = 136, 35.0%) and bone (N = 71, 18.3%). KPS and treatment site were strong independent predictors of both OS and 30DM. Patients with KPS < 70 had an HR 2.61 (95% CI 1.54 – 4.43, p < 0.0001) for 30DM and an HR of 2.22 (95% CI 1.57 – 3.13, p < 0.0001) for death at any time after RT. Treatment site was also independently associated with OS and 30DM (p = 0.01 and p = 0.03, respectively). Median OS durations (95%CI) were: abdomen/pelvis not reached, bone 340 days (133.9-546.1), spine 207 days (28.0 – 386.0), head and neck 184 days (55.2 – 312.8), brain 104 days (34.3 – 173.7) and thorax 76 days (10.3 – 141.7). Age, sex, admission status and primary site were not correlated with OS or 30DM. Conclusions: RT can effectively palliate distressing symptoms related to primary or metastatic cancers. However, early mortality is common following palliative RT and is associated with poor performance status and treated site. Hypofractionated RT courses should be considered in patients with such risk factors to reduce the burden of prolonged therapy on patients and their families at the end of life.
Pneumocystis jiroveci pneumonia during first and second-line chemotherapy for solid tumours.
Authors: Shaughnessy Emma , Armstrong Kevin , Rogers-Seeley Madeline , Das Adarsh , Higgs Domenic , Dean Andrew Peter 
Published: May 2019

e18330 Background: Pneumocystis jiroveci pneumonia (PJP) is an opportunistic fungal infection, historically associated with individuals with advanced immunodeficiency, sustained temozolamide chemotherapy and in those who have undergone multiple lines of chemotherapy. PJP is now increasingly being recognised in patients undergoing first-line chemotherapy. This is a retrospective study of ten cases of PJP at our institution amongst patients undergoing first or second-line chemotherapy for solid tumours. Methods: An electronic database search was conducted, looking at cases of PJP diagnosed in our institution over a five year period. Ten patients with a history of PJP were identified. These patients’ pharmacy records, pathology, imaging and laboratory results were examined. Results: All identified patients developed PJP whilst undergoing first-line (70%) or second-line (30%) chemotherapy for solid tumours. These included metastatic cancers such as: pancreatic adenocarcinoma (50%), lung cancer (20%), prostate adenocarcinoma (10%), gastric adenocarcinoma (10%); and colon adenocarcinoma (10%). Eight of ten patients were lymphopenic, with lymphocytes counts of 0.1 - 0.5 (reference range 1.0 - 4.0 x 109/L). One patient had a recorded CD4 count of 114 (reference range 500-1500). On the basis of clinical context, ground-glass changes on CT and/or a positive sputum PCR for PJP, each patient was treated with intravenous high-dose trimethoprim/sulfamethoxazole until they were clinically stable. Patients were then switched on to a life-long prophylactic dose. Four patients required intensive care for management of respiratory failure. Nine out of ten patients recovered well without any long-term sequelae and one patient died. Conclusions: PJP is being diagnosed more frequently than previously thought in those receiving first and second-line chemotherapy. Limited research has been conducted into the potential benefit of prescribing trimethoprim/sulfamethoxazole prophylaxis to patients commencing chemotherapy. Monitoring of CD4 count prior to each chemotherapy cycle could provide guidance to oncologists regarding when to commence prophylactic treatment as a means to reducing patients diagnosed with PJP.
Mobile short message service (SMS) alerts for reducing the toxicity and improving protocol compliance during cancer chemotherapy: A randomized controlled trial.
Authors: Chawla Tanuj , Mallath Mohandas K. 
Published: May 2019

e18331 Background: Text message-based interventions has been used to facilitate patient care and enhance compliance in clinical oncology. This trial assessed the benefit of text message in reducing emergency room visits and other outcomes related to toxicity and expenses during cytotoxic chemotherapy. Methods: The study was funded by an International Innovation Grant from ASCO. This single center randomised controlled trial was done after approval from our Institutional Review Board. Briefly patients due to take 3-weekly chemotherapy for stomach/gastroesophageal cancer, colorectal cancer, breast cancer and lymphoma were enrolled. Randomization (1:1) was stratified by site and type of chemotherapy. Patients in standard care arm (STD) were given verbal and/or written instructions at the start of each chemotherapy cycle. The interventional (SMS) arm received periodic text messages in addition to the standard care on early warning signs of toxicity at regular intervals during each chemotherapy cycle. Participants were evaluated at the baseline and then followed up for 3 cycles (adjuvant setting) or 4 cycles (palliative setting). Primary endpoint was emergency room (ER) visits. Secondary endpoints included Suspected Unexpected Serious Adverse Reactions (SUSARs), delayed chemotherapy cycles, dose reductions, total cost of care and out of pocket expenditure. The study was designed with a sample size of 400 subjects with an interim analysis planned when 190 patients were randomized. Results: From May 2015 to June 2016, 191 patients were randomized and 189 completed the study [97 in SMS arm and 92 in STD arm]. The median age was 51 years (Range: 23-69) and male:female was 1:2. The relative risk (RR) for ER visit compared to STD arm was 1.09 (95% CI: 0.86-1.38; p = 0.46). The RR for SUSARs was 1.04 (95% CI: 0.99-1.09; p = 0.2); the RR for dose delay was 1.06 (95% CI: 0.9-1.26; p = 0.44) and the RR for dose reduction and 1.16 (95% CI: 1-1.33; p = 0.03). This study was closed prematurely for futility. Conclusions: Text (SMS) message-based patient education during cancer chemotherapy does not to reduce ER visits, SUSARs or cost of care. Clinical trial information: CTRI/2015/02/005491.
Implementation and evaluation of video-based tumor board conferencing in Haiti.
Authors: Lormil Joarly Kerwick , Bhangdia Kayleigh , Svoboda Ludmila , Pierre Viergela , Buswell Lori , Greenberg Lauren , Damuse Ruth , Triedman Scott Andrew , Fadelu Temidayo 
Published: May 2019

e18333 Background: Lack of local oncology specialists remains a challenge in delivering cancer care in low-resource areas. Since 2013, Dana-Farber Cancer Institute has partnered with Zanmi Lasante, a Haitian non-profit to support the oncology department at University Hospital Mirebalais, a tertiary government hospital. In an effort to build local capacity, the partnership established weekly remote tumor boards between US oncologists and Haitian clinicians. For five years, the tumor boards were conducted by phone; they were limited by inconsistent participant engagement and suboptimal sound quality. The goal of the project was to enhance the tumor boards by implementing a video-based system, and to evaluate its feasibility and acceptance. Methods: We conducted a baseline mixed-methods assessment of satisfaction among tumor board participants. We trained participants on the new video-platform (ZOOM) and implemented its use. We conducted weekly surveys over an 18-week period, using a Likert 1-5 scale to assess call quality and satisfaction with discussion. We collected general information about cases and call logistics. Lastly, we conducted a post-implementation survey. Two-sample T-test was used to examine changes in satisfaction scores. Results: Over the study period, 12 calls occurred; six calls were cancelled –due holidays (2), lack of cases (4). A total of 32 cases were presented, an average of 2.67/call. The cases by cancer type were: 75% breast, 9.38% gynecologic, 9.38%, hematologic, and 6.26% others. Baseline overall satisfaction ranking from 11 participants (response rate-RR 78.6%) was 3.18, while post-implementation from 8 participants (RR 66.7%) was 4.24, P-value= 0.0025. Summary of Weekly Calls (Averages). Conclusions: There was improved call quality and overall satisfaction with transitioning to video-based tumor boards. During longer video calls with didactics, Haiti participants noted lower call quality and satisfaction, likely due to low internet-bandwidth. Videoconference tumor boards are feasible in low resource settings.[Table: see text]
Experience and impacts of remote telepathology consultation in improving cancer patients’ diagnosis and management in China.
Authors: He Gang , Yan Mingfei , Wu Qingqing , Wang Ying , Zhang Yujie , Lu Jing Amanda , Wu Jiejun , Li Xiaomei , Zhao Songqing , Gu Ping , Iqbal Jameel , Zhang Yue Hua 
Published: May 2019

e18337 Background: Over the past 4 years, we have conducted over 30 telepathology consultation cases from China covering a wide spectrum of cancers. Through our experience, we realized that the diagnostic accuracy and report integrity from Chinese pathologists is lower than US standards. which brings great concern about diagnosis, treatment and prognosis of cancer patients in China. Methods: Consultation cases were submitted by Chinese patients, their family members or physicians. Specifically, all clinical reports were sent for consultation including imaging studies, laboratory tests, pathology reports, and histology slides for review which covered a wide spectrum of malignant neoplasms, including lung, esophagus, stomach, colon, ovary, breast, prostate, neuroendocrine, melanoma, head/neck, and soft tissue sarcoma; for most cases (27/30) additional immunostaining or molecular tests were performed. All cases and reports were analyzed at top pathology institutions in the United States, including Memorial Sloan Kettering Cancer Center, Johns Hopkins Hospital, or Brigham Women’s Hospital/Beth Israel Medical Center. Following the review of the original materials, final diagnostic reports between the Chinese and US medical centers were compared for major discrepancies in diagnosis. Results: All consulted cases had major discrepancies in diagnosis (100%). Specifically, 75% of cases had improper cancer classifications or grading, 2 cases had improper quality control in immunostains rendering interpretation questionable; 3 cases lacked appropriate molecular tests; finally, 29/30 (97%) of cases lacked cancer staging based on CAP/AJCC/UICC TNM classification of cancer report protocols. Conclusions: Our consultation experiences demonstrated great discrepancies in malignant neoplasm diagnosis and reports among pathologists between the US and China. These findings raise concerns for Chinese patient’s clinical management and prognoses; moreover, they might help explain the observed difference in cancer patient's total 5-year survival between China and USA (40% vs 70%). These findings emphasize the importance of providing support and consultations for pathologists in China, especially those who practice in non-metropolitan, small county or rural local hospitals which lack updated information, technical and academic supports.
Economic benefits of adaptive abiraterone therapy for advanced prostate cancer.
Authors: Mason Neil Thomas , Burkett Jason M , Nelson Ryan , Pow-Sang Julio M. , Gatenby Robert A , Kubal Timothy Edward , Peabody John Williamson , Letson Douglas D. , McLeod Howard L. , Zhang Jingsong 
Published: May 2019

e18343 Background: We recently completed a study showing that adaptive abiraterone therapy (AT) led to more than a doubling of the time to radiographic progression (TTP) compared to continuous therapy (CT) in patients with metastatic castration resistant prostate cancer (mCRPC), [Nat Commun. 2017; 1816]. This study compared the cost of care in the AT cohort versus the standard of care CT cohort. Methods: We conducted a retrospective economic analysis of mCRPC patients receiving intermittent AT compared to patients receiving CT abiraterone. The study followed the adaptive therapy trial protocol (NCT02415621). The primary endpoints were costs of care per patient per year and cost per treatment month. We used itemized billing data and standardized to Medicare reimbursement rates to determine the pharmacy, lab, and imaging costs. Results: Patients receiving adaptive abiraterone therapy (N = 15) had a mean annual cost of care of $80,668 compared to a mean annual cost of care of $132,631 for CT patients. The cost of treatment per month was $6,713 for the AT versus $11,088 for the CT. The economic benefits persisted even after taking into account the cost of abiraterone (Table). Conclusions: The reduction in cost of care in patients with mCRPC with nearly an additional year of TTP from adaptive abiraterone therapy demonstrates the potential value of novel precision medicine approaches. If confirmed by other, larger scale studies, AT may provide significant economic value from far more effective therapy. [Table: see text]
Proper dosage of primary pegylated G-CSF prophylactic use for breast cancer patients receiving adjuvant or neo-adjuvant chemotherapy.
Authors: Yu Liang , Lei Xin , Lin Ying 
Published: May 2019

e18354 Background: Myelosuppression during chemotherapy can lead to life-threatening infections, dose reductions, treatment delays, as well as prolonged hospitalizations, early morbidity, and early mortality. According to NCCN guideline, Pegfilgrastim 6mg per cycle is recommended for breast cancer patients receiving chemotherapy, and dosage modification based on body weight is not required. However, primary PEGylated G-CSF prophylaxis comes with significant extra cost, which has a great impact on health care resources, especially for patients without insurance coverage. Methods: We analyzed clinical data of patients, weighing between 45 and 65 kilogram, received a single subcutaneous PEGylated recombinant human G-CSF injection at fixed doses of either 3 mg or 6 mg per chemotherapy cycle approximately 24 hours after completion of each cycle of chemotherapy. Data for this retrospective study were obtained from Thyroid and Breast Surgical Department of the First Affiliated Hospital of Sun Yat-sen University between July 1, 2017, and October 31, 2017. Results: 41 cycles in 33 patients were included in 3mg PEGylated G-CSF group, and 46 cycles in 39 patients were included in 6mg PEGylated G-CSF group. Among chemotherapy cycles, the incidence of neutropenic event was19.5%and 2.2% in 3mg PEGylated G-CSF group and 6mg PEGylated G-CSF group, respectively. No patients experienced dose reductions or treatment delays in both groups. Using single-factor Logistic Regression Analysis, we found that dose of PEGylated G-CSF(3mg vs 6mg) was significantly associated with occurrence of neutropenic event(p = 0.028). Multi-factor Logistic Regression Analysis also showed that dose of PEGylated G-CSFwas significantly associated with occurrence of neutropenic event (p = 0.031). Conclusions: Our study showed that dose of prophylactic PEGylated G-CSF was significantly associated with occurrence of neutropenic events. So adequate dose of PEGylated G-CSF is important to reduce chemotherapy induced neutropenic events and to guarantee the quality of chemotherapy in patients with breast cancer.
Economic analysis of ceritinib used as second-line versus third-line treatment for patients with ALK-rearranged non-small-cell lung cancer.
Authors: Wu Bin , Li Hongchao 
Published: May 2019

e18355 Background: Targeted therapy with ceritinib notably improves survival in patients with advanced non–small-cell lung cancer (NSCLC) harboring anaplastic lymphoma kinase (ALK) rearrangement tumors after the failure of chemotherapy and crizotinib. However, the economic outcome of ceritinib used as the second-line versus third-line treatment is still unclear. Methods: A mathematical model was constructed to project 21-day patient transitions. The clinical data were primarily extracted from the ASCEND-5 trial. The health resource consumption data were estimated from the perspective of the Chinese health care system. The cost, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) was measured in a 10-year time horizon. Sensitivity analyses were conducted to test the impact of uncertainties. Results: Comparing with the 3rd-line strategy, ceritinib 2nd-line strategy achieved the comparable life years and additional 0.06 QALYs with the less cost of $6,694 (Table), which suggested that ceritinib used as 2nd-line treatment is a dominant strategy. The utility of disease-free survival and the cost of ceritinib were the factors that had the considerable impact on the model outcomes. Conclusions: These results indicate that ceritinib used in 2nd-line setting is a more favorable treatment option than in the 3rd-line setting. [Table: see text]
Demographic factors associated with financial toxicity: Results from the multisite cost study.
Authors: Parikh Divya Ahuja , Ragavan Meera Vimala , Dutta Ritika , Edwards Jeffrey , Maitra Debeshi , Patel Manali I. 
Published: May 2019

e18362 Background: Financial toxicity (FT) is a major cause of distress for cancer patients. We have previously reported that FT was high among patients at a county hospital and a tertiary academic center. In this study, we sought to compare factors associated with FT at these institutions. Methods: Patients with clinic visits were asked to fill out an 11-item validated FT survey, the COST tool, and demographic questions from 10/2017 - 2/2018 at the county hospital and 7/2015 - 10/2018 at the academic center. We used a logistic regression model to analyze demographic factors associated with FT. Results: Mean COST score was significantly higher at the county hospital (28.7) compared to the academic center (20.4) (p < 0.001). Distribution of cancer stage was similar between the institutions. Patients at the county hospital were more likely to have an annual household income (AHI) < $25K (p < 0.001), and be insured by Medi-cal (p < 0.001). Patients at the academic center were more likely to be White (p < 0.001). Monthly OOP spending was more likely to be > $500 at the academic center (p < 0.001). Conclusions: Overall, FT was higher at the county hospital as compared to the academic center. FT at both institutions was associated with higher OOP spending and lower AHI. However, variations in FT among other demographic factors may reflect differences in care delivery systems and patient populations. Our study demonstrates that demographic groups at risk for FT differs between institutions suggesting the factors that contribute financial toxicity are complex and variable. Thus local assessments of FT may be necessary for individual health systems to develop targeted interventions to improve FT among their patients.[Table: see text]