bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing infusion wait time: Redesigning medication order verification workflow at a comprehensive cancer center.
Authors: Kearney Michael D , Wolfberg Rachel A , Sudol Mark , Shukla Shital , Fine Barbara , Rabin Michael S. , Matulonis Ursula A. , Yakowec Jing Jing Wang , Hilton Nancy , Wagner Andrew J. , Bartel Sylvia , Lakhani Hakim 
Published: September 2018

129 Background: Many factors contribute to long wait times for cancer patients on the day of their infusion. At Dana-Farber Cancer Institute (DFCI), a contributing factor is patient flow between exam and infusion. Order verification affects patient flow and begins when the following two criteria are met: provider signed an order and the patient’s scheduled infusion appointment arrives. Patients often check-in to infusion before their scheduled infusion appointment. Order verification has three sequential steps: nurse verification, pharmacist 1 verify (V1), and pharmacist 2 verify (V2). Methods: A team of pharmacists, nurses, providers, and process improvement leads designed a pilot in which V1 moved before nurse verification, concurrent with patient check-in to infusion. Further, V1 began as soon as an order was signed; the pharmacist did not wait for a patient’s scheduled infusion appointment. Nurse verification and V2 occurred in sequence after V1. Timestamp data were extracted from Epic and analyzed via Tableau to assess reduction in verification throughput, defined as time between infusion check-in and V2. Fourteen providers and one pharmacist joined a 6-week pilot to adopt the redesigned workflow beginning 4/23/18. Results: At baseline, time between check-in and V2 was consistent for pilot and non-pilot orders. During the pilot, time between check-in and V2 was shorter for pilot orders, showing a sustained decrease of approximately 10 minutes. The table below provides time in minutes between infusion check-in and V2 for pilot and non-pilot orders at baseline (3/12/18-4/20/18) and following workflow redesign (4/23/18-6/1/18). Conclusions: Implementing the pilot workflow reduced order verification throughput time and enabled drug preparation to begin sooner. Expanding this workflow to all medication orders can decrease infusion wait time at DFCI.[Table: see text]
Economic burden of brain metastases in patients with anaplastic lymphoma kinase positive (ALK+) non–small cell lung cancer (NSCLC) receiving second-line ALK inhibitors.
Authors: Lin Huamao Mark , Pan Lucy , Hou Peijie , Huang Hui , Desai Avinash , Jahanzeb Mohammad 
Published: September 2018

13 Background: De-novo brain metastases (BM) occur in 15-35% of patients with ALK+ NSCLC, and the prevalence increases to as high as 60% over the course of first-line crizotinib therapy. Reports on the economic burden of brain metastases in patients who progress on first-line therapy are scarce. The objective of this study was to evaluate the economic impact of BM among patients with ALK+ NSCLC treated with second-line ALK inhibitors. Methods: This retrospective study used the Optum Research database to identify adult patients with a lung cancer diagnosis code (≥1 inpatient claim or ≥2 outpatient claims ≥30 days but ≤1 year apart) and use of a second-line ALK inhibitor (e.g. alectinib or ceritinib) after crizotinib, between January 2011 and March 2017. Index date was defined as the date of the first claim with a second-line ALK inhibitor. BM were identified if the patient had BM diagnosis prior to index date. Healthcare costs and resource utilization were calculated on a per-patient-per-month (PPPM) basis up to 12 months of follow up after index date. Multivariate regression was used to assess the impact of BM on PPPM cost, while controlling for patient demographics, comorbidities and type of second-line ALK inhibitor. Results: 523 patients with NSCLC received at least one ALK inhibitor during the study period. Use of a second-line ALK inhibitor (alectinib or ceritinib post-crizotinib) was observed in 112 patients (43 alectinib, 69 ceritinib). Among second-line ALK inhibitor users, 52.7% (n = 59) had BM. In those with BM, the PPPM total healthcare costs were $26,415 compared with $21,278 in those without BM. Regression results showed that the adjusted mean total PPPM cost for those receiving second-line ALK inhibitor with BM was 1.39 times as high as those without BM (p-value = 0.0287). Conclusions: Economic burden of brain metastases is high for ALK+ NSCLC patients receiving second-line ALK inhibitors. The study highlights the economic value of novel therapies to delay brain metastases during early lines of therapy in these patients.
Advanced care planning and selection of therapy: Influence on hospitalization for patients with metastatic lung cancer.
Authors: Drzayich Jankus Dana Angela , DeClue Richard W , Stemkowski Stephen , Casebeer Adrianne Waldman , Lobo Francis , Loy Bryan A. , Korytowsky Beata 
Published: September 2018

130 Background: Advanced care planning (ACP) allows patients to express preferences for medical treatment toward the end of life. Reduced healthcare resource utilization has been observed with ACP. The association of ACP and hospitalization was assessed among patients who initiated second line (2L) therapy for metastatic non-small cell lung cancer (mNSCLC). Methods: Adults who received 2L treatment for mNSCLC were identified in a retrospective study of claims from Humana Medicare Advantage, following its launch of ACP programs in 2015. In this cohort, patients who participated in ACP programs and patients who did not were matched 2:1 by age, sex, race, population density of residence, and year of 2L termination. Categories of 2L therapy were chemotherapy, immuno-oncology (IO), and targeted therapy. Extent of comorbidity was assessed using the Deyo-Charlson Comorbidity Index (DCCI). The odds of hospitalization in the 12 months following initiation of 2L therapy for patients who participated in ACP programs and patients who did not were assessed with a logistic regression model, offset for patient months of follow-up, and considering therapy category and DCCI. Results: Ninety-eight patients who participated in ACP programs were matched to 196 patients who did not. More than half the cohort was male; median age was 71. There was no difference in therapy category or DCCI by ACP program participation. A greater proportion of patients with no ACP were hospitalized post-2L treatment, 57.7% vs 42.9%, P< 0.001. ACP was associated with a 52.1% decreased odds of hospitalization. Patients treated with IO or targeted therapy had reduced odds of hospitalization, 54.8% and 75.4% respectively, relative to patients treated with chemotherapy. Conclusions: This early assessment of ACP programs in patients with mNSCLC suggests ACP program participants may have fewer hospitalizations near the end of life. Possibly, ACP program participation presents opportunities for staff to identify changes in health status and prevent escalation to hospitalization. Also, because of its potential to reduce hospitalizations, selection of therapy should be considered as a part of ACP.
Efficacy of an antiemetic therapeutic interchange protocol driven by a medically integrated pharmacy.
Authors: Wilfong Lalan S. , Patt Debra A. , Wallace Kathryn , Mikan Sabrina Q. , Portnoy Carla , Kipley Leigh , Dave Neal , Schwartz Jim R. , Hoverman J. Russell 
Published: September 2018

133 Background: Control of chemotherapy induced nausea and vomiting (CINV) remains an unmet need. An antiemetic therapeutic interchange protocol was developed to enhance control of CINV. This abstract reports the efficacy results of patients treated with highly emetogenic regimens as defined by NCCN guidelines. Methods: Medically integrated pharmacists imbedded within 2 centers of a community oncology practice evaluated each new chemotherapy order and adjusted antiemetics including a 5HT3 antagonist, steroids, olanzapine and an NK1 inhibitor using an NCCN based protocol. Exact medications depended on insurance coverage and copays. Medications were adjusted for patient comorbidities, drug interactions and patient refusal. All patients were given prochlorperazine and ondansetron for breakthrough nausea and vomiting. Medication education to increase adherence was provided by the pharmacist, nurse and advance practice provider. Patients were evaluated by nursing or pharmacist calls on day 2 and 3 and as needed to characterize CINV using the Multinational Association of Supportive Care in Cancer (MASCC) antiemesis tool that scores CINV on a Likert scale. Based on review of the literature, a score of 3 or higher reflected symptom management failure. Additionally, due to drowsiness as the most commonly reported side effect of olanzapine, each center sought to characterize the risk of drowsiness. Results: 367 consecutive patients treated with highly emetogenic chemotherapy regimens were identified at two centers by pharmacists and followed by nursing or pharmacy calls over a 9-month timeframe: November 2016 to August 2017. 89% of patients had complete control of nausea with only 11% reporting nausea greater than a 3. Additionally, 11% of patients reported drowsiness greater than a 3. Conclusions: Administering a pharmacist driven antiemetic protocol is an effective way to control CINV. While CINV did occur, evaluation shows CINV was mild. We have shown that utilizing an antiemetic therapeutic interchange protocol with a collaborative care team including medically integrated pharmacists facilitates excellent control of CINV.
Improving support for smoking cessation in medical oncology patients: A quality improvement initiative.
Authors: Raskin William , Phillips Cameron , Perdrizet Kirstin , Raphael Michael J. , Herman Michael , Del Paggio Joseph , Panetta Monica , Gandhi Sonal , Enright Katherine 
Published: September 2018

148 Background: Smoking cessation is integral to cancer care. Active smoking is associated with increased toxicity of treatment, poorer response to therapy and is associated with worse overall survival. Patients who quit smoking at diagnosis have better survival outcomes. Cancer Care Ontario has aimed to improve rates of smoking screening and referral to smoking cessation programs based on the validated Ottawa model. Methods: We aimed to implement an “opt-out” referral process for recent or current smokers to a smoking cessation program at the Credit Valley Hospital. We aimed to achieve a referral rate of 20%, based on an institutional baseline of 8.5% and a provincially defined target of 20%. Key stakeholders targeted included nursing, administration, physicians, smoking cessation counsellors and patients. Sequential education interventions were delivered to address gaps in patient and provider knowledge; these included grand rounds, an informal lecture and an educational pamphlet. Results: After the initiative was launched, the referral rate increased from 8.5% to 14.3%. The impact of each intervention is summarized in Table 1. Conclusions: Smoking cessation referrals increased with new process but not to target. Patient refusals lead to a low rate of referral, warranting efforts aimed at addressing patient barriers. Future outcome measures may include smoking cessation rates. [Table: see text]
Assessment of scheduled pharmacy follow-up for patients receiving oral chemotherapy.
Authors: Mackler Emily R. , Beekman Kathleen W. , Yarrington Carol , Gentz Anne , Bushey Laura , Davis Kathleen , Griggs Jennifer J. , Farris Karen B 
Published: September 2018

151 Background: Management of oral chemotherapy presents many challenges to oncology practitioners. The purpose of this study is to describe how incorporation of pharmacy scheduled calls to oncology patients receiving oral chemotherapy can identify patients who are experiencing moderate-to-severe symptom burden and/or medication non-adherence and require a therapeutic intervention. Methods: We utilized multiple resources from a statewide quality collaborative aimed at the management of patients receiving oral chemotherapy including patient education, a patient reported outcome (PRO) assessment, and templated documentation. As part of our planned workflow enhancements, our pharmacist provided patient education before chemotherapy started and regularly called patients within 2 weeks of starting their oral therapy. The pharmacist asked the patient about symptoms and adherence using the PRO assessment. A chart audit was performed to summarize the patient reports and recorded interventions. Results: 203 patients taking oral chemotherapy were called by the pharmacist in an 18-month time period between 10/1/16 - 3/28/18. In this study, we will summarize patient demographic information including age, gender, diagnosis, oral chemotherapy medication; PRO assessment results including symptom burden based on the Edmonton Symptom Assessment Scale (ESAS), most bothersome symptom, confidence to self-manage, medication adherence, and reasons for non-adherence, and pharmacist interventions and consequential treatment modifications. Conclusions: Patients taking oral chemotherapy for the treatment of cancer are at risk of side effects from their treatment and suboptimal therapeutic benefits in the setting of non-adherence. Our analysis will summarize the degree of symptom burden patients experience in the first couple weeks of treatment and areas were a pharmacist may optimize their medication regimen prior to their scheduled follow-up with their oncologist. We plan to use this data to improve patient self-management support.
A tale of 2,000 charts: Measuring provider response to patient-reported outcome measures.
Authors: Hurwitz Gillian , Ismail Zahra , Moody Lesley , Barbera Lisa Catherine 
Published: September 2018

157 Background: Patients undergoing cancer treatment often experience physical and psychosocial symptoms that go undetected by clinicians, which highlights the need to incorporate patient-reported outcome measures (PROMs) in routine care. Systematic symptom screening for cancer patients using the Edmonton Symptom Assessment System (ESAS) is standard practice in Ontario. However, provider response to PROMs is essential to addressing symptom burden. To measure provider response, Regional Cancer Centre (RCC) Leads and Cancer Care Ontario developed a chart audit process. The objective was to determine whether the clinical team acknowledged, assessed and/or addressed symptoms identified by ESAS screening. Methods: RCCs received a chart audit tool with preset options and a data dictionary. Sites audited at least 140 charts for seven of the ESAS symptoms. Sites used a business intelligence tool to access patient charts based on sampling parameters. RCCs were required to audit charts of patients whose ESAS symptom scores were moderate to severe (4-10), with at least five charts in the moderate range (4-6). Results: 2,380 charts from 13 RCCs were audited based on ESAS scores from September to December 2016. Symptoms were most often acknowledged when the intensity was severe (69.9%), regardless of symptom type. Acknowledgement (71.5%), assessment (67.7%) and intervention (55.8%) were most often offered to patients reporting pain. Patients reporting depression and anxiety were the least likely to have the symptom acknowledged (44.5%, 45.0%, respectively) and be offered assessments (45.8%, 50.1%, respectively) and interventions (35.7%, 36.6%, respectively). Patients reporting moderate to severe depression and anxiety most commonly declined interventions (7.8%, 7.7%, respectively). Conclusions: These data show that providers disproportionately respond to physical symptoms, which may be easiest to treat due to clear management plans and referral pathways. To truly offer person-centred care, the emotional burden related to cancer must also be addressed, and providers must be trained to properly respond to psychosocial symptoms. Chart audits identify gaps in symptom management and areas for quality improvement.
Cancer burden: Exploring the parallels between cancer hardship and the well-being of cancer caregivers.
Authors: Raymond Martha 
Published: September 2018

162 Background: The latest 2016 data from the National Cancer Institute’s Surveillance, Epidemiology & End Results (SEER) Program estimates there are 15.5 million cancer survivors in the U.S. Millions of cancer survivors rely on cancer caregivers every day. Cancer caregivers play a vital role throughout the care continuum, and greatly impact a patient’s quality of life. Caring for a cancer patient affects all aspects of a caregiver’s life, including: changes to daily routine, work and family life; financial hardship; and emotional and psychological distress. Our study explores the cancer burden, unmet needs and well-being of cancer caregivers. Methods: Beginning in September 2015-September 2017, our professional facilitator with over 25 years of cancer advocacy experience hosted nationwide caregiver focus groups. Primary goals were reaching caregivers in rural, urban and community oncology settings to gain perspective from diverse populations. We met with cancer caregivers in 32 states via traditional focus group settings and online via facetime conferencing. Results: 778 caregivers (42% male, 58% female) participated in our focus groups. 88% reported high levels of stress and anxiety (I struggle to concentrate & walk around feeling like I was kicked in the stomach); 78% were employed full time with an average of an additional 20+ hours per week devoted to caregiving responsibilities (Pulled in every direction – need balance); 66% reported self-health decline (No time for me – worry I will get sick and then what?) Describing in one word their current feelings, the top three responses were: Exhausted; Lonely; Overwhelmed. Conclusions: The burden of caring for a cancer patient is immense and all-consuming. Our conversations with caregivers will continue as we collaborate with partners, develop meaningful programs, and expand our outreach and resources to help lessen the burdens of cancer on caregivers.
Social workers first-time treatment assessment.
Authors: Poole Christa , Nelson Tori , Barnes Jacqueline , Clay Angela , Coyle Erica , Dimitrov Juliette , Douglas Emily , Golias Brittany , Barrat-Gordon Rene , Spaulding IIana , Zeiter Rebecca , Carrino Cheryl M , Rothacker Andrew , Truchanowicz Rosemary , Cummings Chad W. 
Published: September 2018

164 Background: Supporting emotional, psychological, financial and spiritual well-being of patients has been shown to have a positive impact on quality of life and patient experience. Social workers in our outpatient cancer center are responsible for completing new patient assessments at the start of chemotherapy treatment to provide early access to psychosocial support services. Assessments are to be completed within three weeks of the patient’s first chemotherapy treatment. Connecting with patients early in the care experience allows social workers to proactively assist with education, support and link patients to vital resources. Methods: Completed assessments were tracked and from October through December 2017. The social workers leveraged the use of data analytics and a team based approach to increase the number of new patient assessments completed within the first 3 weeks of chemotherapy. Weekly 30-minute huddles were held using problem solving methods, including brain storming, cause and effect diagrams, force ranking, and polling. Results: A team identified 39 potential causes to why 65.14% of patients were not receiving assessments within the first 3 weeks of chemotherapy treatment. Potential causes were grouped and themed. Work prioritization, inconsistent methods of identifying patients receiving chemotherapy for the first time, and lack of visual management to monitor progress of this metric were identified as key objectives for improvement. Countermeasures were developed and implemented; a dashboard was created to analyze the first time treatment assessment completion percentages by disease group and standardizing the process of notifying social workers of patients in need of an assessment. Social worker assessment completion rates improved from 34.78% (December 2017) to 75.35% (April 2018). Conclusions: This project demonstrates the value of utilizing problem solving, visual management, and data analytics for continuous quality improvement projects related to clinical care and processes. Cross-disciplinary collaboration should be explored with the use of visual tools and other resources to facilitate communication that is understood by all disciplines.
Defining the patient experience in medical oncology.
Authors: Odai-Afotey Ashley , Kliss Andrea , Hafler Janet , Sanft Tara B. 
Published: September 2018

167 Background: The relationship between the physician and patient is directly associated with positive patient satisfaction. High patient satisfaction is associated with improved health outcomes, treatment adherence, and quality of life. The goal was to explore patients’ perceptions on their hospital experience, focusing on quality of care. Methods: A mixed-methods study design with a sample of 58 patients at Yale New Haven Hospital. Data were from patient interviews and observation of rounds. Results: Two themes emerged: patient experience and patient communication with physicians. Within patient experience positive factors identified were feeling attended to (45.9%), nurses (43.2%), staff (27.0%), doctors (27.0%), facility (10.8%) and coordination of care (8.1%). Negative factors were low quality of life (82.8%), lack of physician emotional support, attentiveness and availability (24.1%), and poor coordination of care (20.7%). Within physician communication positive factors included effectively engaging the patient (27.5%) and attending to patient needs (7.5%). Negative factors were nature of distilling information (17.5%), lack of coordination of care (15.0%), inadequate involvement of the patient and/or family (12.5%), use of medical jargon (10.0%), and inability to elicit patients’ perspective (7.5%). The quantitative data supported qualitative results of overall satisfaction with 72.4% of patients (n = 58) rating their experience as an ‘A’. Areas of dissatisfaction (an ‘A’ rating < 70% of time) included describing team member roles, explaining next steps in care or treatment to the patient and/or family, and meeting patients’ needs. Conclusions: Our findings, demonstrate that physician attentiveness or lack thereof defines the quality of patient experience, is an important theme in communication and that patients perceive their needs are not being fully addressed. Agreement in themes from mixed-method approach shows effectiveness of methods in exploring patients’ perceptions on quality of care. The study intends to inform clinical and operational practices physicians can incorporate into their patient relationships. These data are being used to design a faculty development program to address physician communication.