bluuebunny/crossref_metadata_2025_split huggingface dataset:
Building a novel near real-time multisource database to assess and improve infusion wait time at a comprehensive cancer center.
Authors: Yakowec Jing Jing Wang , Pettengill Mark , Mahmood Sadiqa , Fraile Belen , Lakhani Hakim 
Published: September 2018

4 Background: Evidence has shown that long infusion wait time is one of the main contributors to oncology patient dissatisfaction. To identify bottlenecks and inefficient processing, a comprehensive understanding of the infusion workflow at Dana-Farber Cancer Institute was explored. The goal of the project is to leverage existing data sources to quantify time to process completion and to serve as the database for multiple wait time improvement projects. Methods: Infusion workflow from patient check-in or appointment time to first infusion medication administration (wait time) was mapped. Data from Epic and Real-Time Locating System (RTLS) were pulled into a single integrated source in Tableau and SAS for analysis. Using a custom SQL query, the following tables including crucial timestamps were pulled and pooled: encounters, pharmacy processing and dispense, treatment plan and protocol, RTLS events related to infusion chair occupancy, and medication administration records. Further programming was written to flag categories such as investigational versus non-investigational drugs, linked versus un-linked to exam appointments, and inclusion and exclusion criteria regarding date range, infusion floor, and encounter type. Results: The final clean infusion database includes data from September 1, 2017 through the day before current day via automatic data pull. Processing and wait times were analyzed at multiple levels by drug, encounter, department, staff, and protocol. To date, four known wait time improvement projects that aim to shorten processing time, such as early signing of orders by providers, have leveraged this near real-time dataset to monitor and evaluate the impact of the projects. The automation of data to pre-built visualizations in Tableau comparing baseline processing time to post-pilot impact and overall wait time trends has been extremely well received by all improvement stakeholders at the institute. Conclusions: A novel database merging Epic and RTLS data was successfully built to explore and improve infusion patient wait time. This technique can be applied at other institutions interested in reducing wait times and improving patient satisfaction.
Tiers of service: Outpatient medical oncology services for British Columbia, Canada.
Authors: Letwin Shallen , Pereira Astra , Currie Tammy , Pansegrau Gary K. , Hawkins Marie 
Published: September 2018

40 Background: The vision is for cancer care in British Columbia to be delivered in a coordinated, efficient manner, governed through effective partnerships between the Regional Health Authorities and BC Cancer. Systemic Therapy is delivered throughout BC by several providers, however service provision standards do not exist. BC Cancer and Fraser Health embarked on a process to develop a provincial Tiers of Service that outlines the responsibilities and requirements for the delivery of systemic therapy. Methods: From October 2017-April 2018, a working group drafted a Tiers of Service framework to be further approved by a Provincial Working Group. A scan of the literature and review of other jurisdiction's frameworks were evaluated. BC Cancer in partnership with the Regional Health Authorities have identified that the increased need for outpatient medical oncology services, combined with human resource and healthcare facility constraints requires a framework for organizing and delivering cancer care services in British Columbia. Therefore, a need to update the framework and shift nomenclature from the current “Levels of Service” to “Tiers of Service” was identified. Results: A survey of the working group was utilized to understand their level of confidence with regards to the development and utilization of the framework. Overall the working group increased their level of confidence from 33% to 100%. Conclusions: Tiers of Service: Outpatient Medical Oncology Services provides a practical framework which will be used to define and plan medical oncology services in British Columbia utilizing a common language and methodology. It describes the minimum responsibilities and requirements of each tier in providing a safe, sustainable and appropriate level of service. Tiers of Service will set standards and provide clarity for service provision, help build a capacity plan, plan where resources should be located, measure and monitor performance and improve the quality of the patient experience.
Pan-Canadian Oncology Drug Review (pCODR): A unique model to support harmonization of cancer drug funding decisions in Canada.
Authors: Trudeau Maureen E. , Chambers Alexandra , Christiansen Kendra , Mai Helen 
Published: September 2018

41 Background: Unlike most other countries, Canada has a dedicated HTA process to review cancer drugs. pCODR, a program of CADTH, conducts thorough and objective evaluations of clinical and economic evidence; as well as considering clinician and patient perspectives, and using this information to make recommendations to the participating jurisdictions to guide their drug funding decisions. Previously, Canadian provinces had separate regional drug review processes to inform their local funding decisions. The pCODR process reduces duplication of effort by individual funders and ensures that reviews are done in a timely and consistent manner. Methods: In a retrospective review, we identified all anticancer drugs reviewed by pCODR from July 2011 to March 2018. Results: As of March 31, 2018, pCODR has issued 103 notifications to implement a final recommendation. Of note, 96% of the submissions include patient group input and 88% of the submissions include clinician input. The median time to complete a review is 146 business days. The pCODR Expert Review Committee has issued 21 negative recommendations, while the remainder were either positive recommendations (n = 10), or conditional recommendations (n = 72). The “condition” that must be addressed most frequently in the conditional recommendations is the cost-effectiveness of the drug. Over 75% of the 82 positive and conditional recommendations have received uptake from one or more participating jurisdictions. The concordance rates are as follows: Conclusions: With the implementation of the pCODR process, there is greater harmonization in cancer drug funding decisions and supports equitable access across Canada.[Table: see text]
Impact of nontreatment oncology research trials on physician engagement in clinical research in an oncology community practice setting.
Authors: Night Susan S. , Roemisch Juston S. , Smith David A. 
Published: September 2018

44 Background: The rapid development of new oncology drugs has created a significant increase in the number of clinical research studies. This underscores the need for greater participation in research by physicians as well as patients. Many physicians hesitate to participate in oncology clinical trials that provide treatment options for their patients given the complexity of the protocols. Non-treatment clinical trials may serve as a bridge for engaging physicians in clinical research and enhance the culture of research in community oncology practices. Methods: A large non-treatment oncology clinical trial was opened in a network of community oncology practices with approximately 1,000 physicians. We evaluated the number of physicians who did not enroll a patient onto a clinical trial in Year 1 but did enroll patients onto the non-treatment study. We further examined the number of physicians who enrolled a patient onto the non-treatment study that also enrolled patients onto a treatment clinical trial. Overall physician engagement in clinical research was measured by comparing practices where non-treatment study was offered to locations that did not participate in the non-treatment study. Negative impact on treatment accruals was also evaluated. Results: There were 105 physicians that practice at a site with the non-treatment study who had 0 accruals in Year 1 but enrolled a patient to any clinical trial in Year 2. Ninety-two of those physicians were responsible for enrolling over 900 patients to the non-treatment study in Year 2. Additionally, 46 of the 0 accruing physicians in Year 1, enrolled a patient to the non-treatment study also enrolled a patient to a treatment clinical trial. We also found that 24 physicians who did not did not enroll a patient in Year 1 and did not enroll a patient to the non-treatment study did enroll patients to a treatment clinical trial in Year 2. Conclusions: Participation in oncology treatment clinical trials can be difficult in the community oncology setting. Participation in a non-treatment study may serve as a bridge to engage more physicians in clinical research and enhance the culture of research within a community oncology practice.
A nonrandomized study on compliance with IDSA guidelines on the choice and dosing of empiric antibiotics for patients with febrile neutropenia after implementation of a new Computerized Physician Order Entry (CPOE).
Authors: Meleveedu Kapil , Kaza Sai , Phuong Lisa , Perry Edward Belk , Tannenbaum Susan 
Published: September 2018

48 Background: More than 80% of patients with hematologic malignancies and 10-50% of patients with solid tumors are expected to experience fever after one cycle of chemotherapy. Studies have shown all-cause mortality to be 15% higher in cancer patients with febrile neutropenia than comparably matched patients without febrile neutropenia and compliance for choice of empiric antibiotics in febrile neutropenia to be as low as 56%. Methods: We conducted a retrospective chart review of patients who presented with febrile neutropenia to our institution for one year prior to and after implementation of a CPOE set. Data was collected on basic demographics, oncological diagnosis, labs, choice of antibiotics and dosing frequency. Awareness sessions were conducted among admitting staff following the initial retrospective analysis followed by implementation of a CPOE set in order to improve guideline concordant management of febrile neutropenia patients. The IDSA risk was assessed based on the above data and the pre and post order set compliance with IDSA guidelines were compared. Fisher’s exact test was applied to assess the percentage of compliance before and after implementation of the order set, with significance set at two-sided p value < 0.05. Results: Among the patients managed before order set, 15 of the total 26 (58%) were found to be non compliant with IDSA guidelines in terms of either antibiotic choice or dosing frequency. A post order set analysis showed that only 7/27 (26%) were non compliant with IDSA guidelines. The Fisher exact test showed a statistically significant value of 0.0267 (p < 0.05). Conclusions: Education and implementation of a CPOE order set showed significant improvement in compliance with IDSA guidelines for management of febrile neutropenia. Based on the data from our study an IDSA concurrent institutional guideline for management of febrile neutropenia was formulated and further efforts are under way to incorporate results in our new EMR order set entries.[Table: see text]
Implementation of a multifaceted program to improve uptake of guideline recommendations for adolescent and young adults (AYAs) with acute lymphoblastic leukemia (ALL).
Authors: Hahn Erin Elizabeth , Ghai Nirupa R. , Cooper Robert Michael 
Published: September 2018

50 Background: ALL is one of the most common malignancies in the AYA population (age 15-39) and is associated with poor survival in AYAs when compared with children. There is compelling evidence demonstrating a survival benefit for AYAs treated with pediatric regimens vs adult regimens, and guidelines from the National Comprehensive Cancer Network now recommend consideration of pediatric inspired treatment. However, uptake has been suboptimal, with only 25%-35% of AYAs with ALL receiving a pediatric regimen in the U.S. There are several potential barriers to uptake, including lack of knowledge and guidance about the recommendations. For this study, we implemented and evaluated a multi-faceted program to improve uptake in a large health care system, Kaiser Permanente Southern California (KPSC), with 14 medical centers across the region. Methods: The program was initiated regionally in 2013 across all 14 medical centers. Content included education of clinical leaders, rapid identification of newly diagnosed AYA ALL patients by the hematopathology team, and guidance and support from a pediatric oncologist for adult oncology teams treating AYA ALL patients emphasizing a pediatric regimen when appropriate. We subsequently identified AYA ALL patients diagnosed and treated between 2012-2016. A detailed chart review was conducted to determine treatment regimens prior to implementation of the program and post-implementation. Results: We identified 58 patients, 11 in the period prior to implementation and 47 post-implementation. Overall, 18% of patients in the pre-intervention period were treated on a pediatric regimen vs. 77% post-implementation. We found an increasing trend over time in the post-intervention period, with 46% receiving a pediatric protocol in 2013, 64% in 2014, 92% in 2015, and 100% in 2016. Conclusions: We were successful at increasing the proportion of eligible patients who received pediatric protocols for treatment of AYA ALL. Implementing a multi-faceted approach to improve care for this rare condition was feasible and acceptable to oncology clinicians across the region, with potential for large-scale scale-up and spread.
Patterns in breast cancer staging imaging: Are we choosing wisely?
Authors: Barlow Brett , Williams Courtney , Gilbert Aidan , Watkins Stacey M , Rocque Gabrielle Betty 
Published: September 2018

51 Background: The American Society of Clinical Oncology’s Choosing Wisely guidelines recommend no staging imaging in early stage breast cancer (ESBC) patients with low risk of metastasis, as it is potentially harmful and provides no survival benefit. This study evaluates local adherence to this recommendation and identifies factors contributing to unnecessary staging imaging. Methods: This retrospective cohort study included patients with AJCC stage 0-II BC diagnosed from 2013-2015 at a single-site, academic medical center. Data was abstracted from chart review. Imaging included computed tomography, positron emission tomography, or bone scans. Imaging for documented symptoms was considered appropriate. Abstracted patient data included demographics, medical oncologist, and clinical characteristics. To evaluate factors influencing inappropriate screening imaging, risk ratios (RR) and corresponding 95% confidence intervals (CI) were estimated using generalized linear models with a log link and Poisson distribution with robust variance estimates. Results: Of the 872 ESBC patients, 262 (30%) underwent staging imaging. Median diagnosis age of patients receiving imaging was 55 (IQR 48-63) compared to 60 (IQR 52-68) for patients with no or appropriate imaging. Risk of inappropriate screening imaging was increased for patients who were younger (RR 0.98, 95% CI 0.97-0.98), had triple negative disease vs any hormone receptor positive (RR 2.98, 95% CI 2.25-3.95), had higher stage BC (I vs. 0, RR 3.58, 95% CI 2.05-6.25; II vs. 0, RR 10.86, 95% CI 6.43-18.33), and did not have Medicare insurance (RR 1.52, 95% CI 1.22-1.89). Rates of imaging did not vary by race (non-white vs. white: RR 0.98, 95% CI 0.78-1.23). For medical oncologists with at least 15 patients, prevalence of inappropriate imaging varied from 26-68%. Conclusions: A substantial proportion of ESBC patients received unnecessary and potentially harmful staging imaging inconsistent with guidelines. Staging imaging was associated with patient demographic and clinical characteristics related to increased recurrence risk, suggesting a need for further physician education about the low-risk nature of this ESBC population to ensure high value oncologic care.
Improving radiotherapy quality of care: Examining practice patterns in regional centers.
Authors: Stosky Jordan , Wu Jackson S.Y. , Fairchild Alysa M. , Kerba Marc 
Published: September 2018

53 Background: Radiotherapy (RT) is a resource intensive cancer treatment. Benefits may take weeks to realize, whereas side effects are more immediate. RT is commonly delivered with palliative intent often near the end of life (EOL). In patients with limited life expectancy, single fractions (sf) may substitute for multi-fraction (mf) treatments. Objectives were to document RT courses delivered to patients with cancer at EOL, with the goal of informing treatment practices, developing a clinical decision-making tool and reducing potentially futile treatment and side effects for patients. Methods: Cancer Registry data was examined with ethics approval. Patient and prospective treatment data were collected and analyzed to determine the number of RT courses starting within 90 days of death (EOL) among those with cancer diagnoses who died between January 1, 2016, and July 31, 2017. Data was stratified by demographics, disease factors, RT center and prescription factors. Results are reported in aggregate and explored using tests of association (Stata 11.1). Results: Among 1874 patients who died, 2448 RT courses were identified across 4 RT centers. Of those prescribed RT at the EOL, there were 442 sf courses 100% completed, 1267 2-5 fraction courses 90% completed, 552 6-10 fraction courses 77% completed, and 187 11+ fraction courses 57% completed. Among patients prescribed RT 14 days prior to death, 24% had been prescribed a sf of RT compared to 18% of those within 90 days of death (Chi2 17.92, p < 0.001). Among patients prescribed RT 90 days prior to death, 25% of patients in tertiary Centre A were prescribed a sf compared to 13% of patients in tertiary Centre B (Chi2 121.90, p < 0.001). Patients were half as likely (RR = 0.47, 95% CI [0.39, 0.56], p < 0.001) to complete a mf treatment within 14 days of their death as compared to within 90 days. Patients who had a diagnosis to death interval of under a year were less likely to complete RT than those over a year (RR = 0.82, 95% CI [0.79, 0.85], p < 0.001). Conclusions: Multi-fraction RT is often not completed prior to death. Treating RT center is associated with differences in prescribing patterns. Better understanding of factors influencing RT practice patterns may lessen the proportion of potentially futile RT.
Implementing an EHR guideline–based intervention in paper ordering systems.
Authors: Bell-Brown Ari , Egan Kathryn , Kreizenbeck Karma L. , Watabayashi Kate , Lyman Gary H. , Hershman Dawn L. , Bansal Aasthaa , Barlow William E. , Sullivan Sean D , Ramsey Scott David 
Published: September 2018

56 Background: Studies show Colony Stimulating Factor (CSF) prescribing is inconsistent with national guidelines. SWOG trial S1415CD is a pragmatic study comparing outcomes of CSF use in usual care with care that uses guideline-informed standing CSF orders. The intervention includes embedded CSF orders based on Febrile Neutropenia (FN) risk and system note wording describing guideline recommendations. Of 24 intervention sites, five (20.8%) use paper, presenting the challenge of translating an electronic health record (EHR) intervention to paper order entry systems (OES). Methods: Paper sites were surveyed on their chemotherapy OES to inform translation of the intervention. We worked with sites to develop a workflow consistent with the key principles of the intervention: Recommendation language 1) is present before prescribing CSF, 2) reaches all study-authorized orders, 3) reaches all patients on study-authorized orders, and 4) chemotherapy and CSF are ordered before the patient is enrolled. Results: Each site had a distinct workflow that was reworked (Table 1). Paper sites took 4-10 months (average 7.6) for implementation; EHR sites took 1-10 months (average 4.5). Conclusions: Implementing an EHR-centric intervention in paper sites is feasible with appropriate time and resources built into a project to account for the unique challenges. As paper sites represented one fifth of the intervention sites, it is vital to include paper sites in OES interventions for generalizability of results. Clinical trial information: NCT02728596. [Table: see text]
Utilization of a web-based supportive oncology training curriculum for healthcare professionals (HCPs).
Authors: Lo Shelly S. , Roggenkamp Betty , Hasson Kristin , Trosman Julia Rachel , Rosenberg Carol A. , Lillis Teresa , Knightly Eileen , Pasquinelli Mary , Wiebe Lauren Allison , Gerhart James , Penedo Frank J. , Martin Joanna , Robinson Patricia A. , Scheu Amy , Berardi Rosa , Weldon Christine B. 
Published: September 2018

59 Background: A challenge in supportive oncology is training the HCP workforce. The Coleman Supportive Oncology Collaborative clinicians (faculty) from 25 institutions (academic, community & safety net) developed a unique and easily accessible supportive oncology training curriculum (Trosman JR JNCCN 2017). Methods: Using data provided by The National Comprehensive Cancer Network (NCCN) Continuing Education team, we evaluated completion rates of survivorship and supportive oncology education courses using simple frequencies. Results: Over 4748 on-line courses were completed (pretest, course, post-test, evaluation) of 7184 accessed. Of 4748 courses, nurses completed 45%, physicians 17%, advance practice clinicians 16%, and others 22% (social workers, chaplains, MAs). Course completion improved from 65% to 69% after articles describing collaborative work were published in Cure and Oncology Nursing News, p = 0.0014. Conclusions: A variety of HCPs successfully completed supportive oncology guideline education via the NCCN’s education portal. These on-line courses are an efficient way to train HCPs in supportive oncology. Curriculum advertising improves course completion.[Table: see text]