bluuebunny/crossref_metadata_2025_split huggingface dataset:
Precision oncology experience at a tertiary care center.
Authors: Sadaps Meena , Funchain Pauline , Grivas Petros , Estfan Bassam N. , Abraham Jame , Stevenson James , Pennell Nathan A. , Khorana Alok A. , Bolwell Brian James , Sohal Davendra 
Published: September 2018

e18118 Background: Precision oncology – use of tumor genomic profiling to guide therapies – is widely discussed but with limited real-world data. We have previously reported our prospective study on feasibility and clinical utility of routine somatic genomic testing of solid tumors [ J Natl Cancer Inst. 2015; 108(3)], and here we report our longitudinal experience, focusing on therapeutic impact. Methods: Records were reviewed for consecutive adult patients seen at Cleveland Clinic for a solid tumor malignancy without known curative options where tumor genomic profiling was ordered using FoundationOne™ (Cambridge, MA). Results were discussed at the Cleveland Clinic Genomics Tumor Board, and therapeutic recommendations were conveyed to the primary oncologist. Data for this cohort study approved by the Cleveland Clinic IRB included subsequent therapies and clinical outcomes. Results: From 2013 to 2016, 330 patients had tumor genomic testing ordered. Median age was 61 years (range, 24-94); 170 (51.5%) were female; 289 (87.6%) were Caucasian. Colorectal (21.5%), breast (17%), lung (16.1%), and pancreatobiliary (11.5%) cancers were the most common diagnoses. In 300 resulted cases, a median of 4 (0-20) alterations per specimen were noted; the most commonly altered genes were TP53 (n = 174), KRAS (n = 75), APC (n = 65), CDKN2A/B (n = 49), and PIK3CA/ PIK3R (n = 46). A specific therapy targeting an actionable alteration was recommended in 51% (153/300) of patients, and 11.7% (n = 35) received such therapy: 14 on clinical trials, 5 on-label, and 16 off-label. Most common targets for therapy were PIK3CA/PIK3R/PTEN (n = 7), HER2 (6), BRAF (3), EGFR (3), and ALK, FLT3, NTRK1 and RET (2 each). At last follow-up, of 35 patients receiving targeted therapy, best responses were: complete response (n = 1, 2.9%), partial response (n = 5, 14.3%), stable disease (n = 14, 40%), progressive disease (n = 11, 31.4%); data not available for 4 patients. Non-availability of clinical trials was a common reason for non-receipt of targeted therapy. Conclusions: Tumor genomic profiling influenced treatment in 11.7% of patients in this cohort, and 57% of those receiving targeted therapy experienced clinical benefit. These data can help guide real-world discussions of precision oncology.
Formal assessment of teamwork among cancer health care professionals in 3 large tertiary centers in Nigeria.
Authors: Ibraheem Abiola Falilat , Awolude Olutosin Alaba , Habeebu Myhammad-yaqub Murtazha , Sowunmi Anthonia Chima , Olaniyi Popoola Abiodun , Olopade Olufunmilayo I. , Polite Blase N. 
Published: September 2018

e18126 Background: Cancer is fast becoming a common cause of death in developing world. Over the last decade, there have been strategies to bring quality cancer care to underserved patients around the world. In low-income countries, poor utilization of principles of teamwork is a major barrier to achieving quality services. The intent of this study is to assess teamwork as perceived by the health care workers caring for cancer patients Methods: We conducted a survey among health care professionals involved in cancer care in 3 tertiary centers in the southwestern part of Nigeria from July to November 2016. Respondents rated teamwork using the previously validated ÒSafety Attitudes QuestionnaireÓ. For this analysis we focused on the teamwork climate subscale. This subscale is scored on a scale of 0-100 with mean (SD) values,in US ambulatory population of 69.7 (17). We compared ratings by professionals using analysis of variance Results: Overall 373 professionals completed the survey: Physicians (47%), nurses (14%), pharmacists (6%) and others (33%). Some results are shown in table Conclusions: Cancer care is complex and depends on teamwork amongst health care professionals to achieve optimal outcomes. While overall teamwork scores was consistent with US ambulatory studies , there are important variations that provide targets for intervention. Physicians rated teamwork poorly both intra and inter professionally. Pharmacists rated inter professional teamwork with nurses particularly poorly. Further data on additional subscales of the instrument and by individual centers will be presented. Efforts to transform cancer care need to focus on building trust among the key stakeholders. This is true in developing world where there is a need to maximize the use of limited resources to improve patient outcomes. [Table: see text]
Evaluation of an online tool providing management guidance for adverse events associated with immune checkpoint inhibitors.
Authors: Marcello Krista , Obholz Kevin , Rosenthal Kristen , Weber Jeffrey S. 
Published: September 2018

e18131 Background: Immune checkpoint inhibitors (ICIs) are altering the treatment paradigm in oncology; but many healthcare providers (HCPs) are still unfamiliar with ICIs and the unique associated immune-related adverse events (irAEs). An online tool was developed to give HCPs easy access to fair-balanced guidance and algorithms that extend beyond standard recommendations found in the respective product inserts. Methods: Tool users input patient symptoms, organ system affected, and the grade of the event along with their planned management strategy; they were then provided an expert recommendation to guide management of that specific irAE. Recommendations in the tool comprised algorithms developed from peer-reviewed studies and personal clinical experience of several experienced physicians. Case entries (collected from 11/9/16 through 1/17/17), variation of intended management with recommended management, and impact on practice were analyzed. Results: To date, 918 unique tool queries have been entered by HCPs. Cases of GI symptoms were most frequently (29% of all cases) entered into the tool (Table). The planned management of pulmonary- and endrocrine-related AEs differed from expert recommendations for the highest percentage of cases (53% and 65%, respectively). Overall, the intended management plans differed from expert recommendations in 49% of HCP tool queries. Most (93%) HCPs indicated that this online tool either changed their management plan or that their planned strategy was reinforced by using this tool. Conclusions: These data suggest that many HCPs are challenged to manage irAEs associated with ICIs and that an online tool can provide a resource to improve patient care and safety. A detailed analysis of the tool, including case entries and planned management vs expert recommendation for each irAE and grade will be presented. [Table: see text]
The Cancer Care Treatment Outcomes Ontology (CCTO): A computable ontology for profiling treatment outcomes of patients with solid tumors.
Authors: Lin Frank Po-Yen , Groza Tudor , Kocbek Simon , Antezana Erick , Epstein Richard J 
Published: September 2018

e18137 Background: Systematic enhancement of knowledge about outcomes of cancer therapy is a central goal for oncology research, practice and audit. However, there is no resource standardizing the disparate vocabulary used to describe treatment outcomes, which prevents translating the data acquired into value-adding information for better cancer care. Methods: To build an application ontology that organizes high-level concepts describing treatment outcomes in solid tumors, provisionally named Cancer Care Treatment Outcomes (CCTO), we extracted all trial endpoints listed in ClinicalTrials.gov, queried it using the keyword ‘cancer’, followed by an expert appraisal. Term definitions and synonyms were automatically imported from the National Cancer Institute thesaurus, and extra terms were imported from Common Toxicity Criteria for Adverse Events. Logical relationships between concepts were represented by forward chaining rules, aiding conversion between concepts. The coverage of CCTO was tested against MEDLINE abstracts, and the applicability of 1825 rules was tested in a case of metastatic colon cancer (index case). Results: After removing duplicated terms from 54705 trial entries, an ontology (CCTO), holding 1145 terms and organized into 13 concept groups (including but not limited to efficacy, safety, and quality of life), was built. CCTO not only captures a comprehensive taxonomic hierarchy (through is_a relationships) but also an evaluative hierarchy ( is_assessed_by) to aid the acquisition of treatment outcome data. At least one CCTO term was mentioned in 29493 of 29951 (98%) MEDLINE abstracts on phase 1-3 cancer trials; concepts about efficacy were mentioned in 7208 (79%) phase 1, 15051 (92%) phase 2, and 3884 (86%) phase 3 trials. We show that, by applying the relationship rules in an expert system shell, the event sequence of the index case can be readily converted into a comprehensive profile that incorporates survival measures, treatment responses, and adverse events. Conclusions: CCTO efficiently captures and categorizes high-level concepts of treatment endpoints in oncologic practice and enables rapid profiling of clinical outcomes for cancer patients.
Prognostic significance of geriatric assessment.
Authors: Edwards Beatrice Jara-Almonte , Zhang Xiaotao , Sun Ming , Song Juhee , Dinney Colin P.N. , Popat Uday R. , Champlin Richard E. , Valero Vicente , Tripathy Debu , Hedberg Ann-Marie , Stroehlein John R 
Published: September 2018

e18140 Background: More than 60% of cancer patients are older adults, and by 2020 the proportion of older adults with cancer will rise to 70%. Objective: To assess risk factors for overall survival (OS) in older cancer patients seen in a comprehensive cancer center. Methods: This is a single center, retrospective cohort study of older cancer patients (65 years of age and older). Patients receiving active cancer care underwent comprehensive geriatric assessment (including cognitive, mood, functional, nutritional, physical, and comorbidity assessment using validated scales). Hematologic, and solid tumors (urologic, breast, gastrointestinal cancers) were evaluated. Targeted interventions were implemented. Analysis: Univariate and multivariable Cox proportional hazards regression analysis were performed to identify factors associated with OS (SAS 9.4). Results: Among 304 eligible patients, the median follow-up was 12.7 months, 98 (32%) died, the median OS was 25.4 months. Median age is 78 years. Univariate analysis revealed known risk factors for mortality (advanced age [p = 0.004], and metastatic disease [p = 0.002]), functional impairment (ADL scores 0-4, p = 0.02), and major depression (p = 0.005). Comorbidity (p = 0.07) and functional impairment showed a marginal significance on OS. Factors with a univariate p-value less than 0.1 were considered in multivariable regression models. A final multivariable model included age group, cancer stage, functional impairment, and major depression. Risk factors for OS include major depression (HR 1.88 (95% CI, 1.12, 3.15), p-value = 0.02), functional impairment (HR 2.47 (95% C.I. 1.28, 4.74), p = 0.007), and metastatic disease (HR 2.2 (95% C.I. 1.30, 3.97), p = 0.004). Conclusions: Major depression and functional impairment were identified as risk factors for OS in older cancer patients. Prospective studies are recommended.
Temporal associations between prognostic indicators and overall survival after breast cancer.
Authors: Plichta Jennifer Kay , Thomas Samantha Marie , Fayanju Oluwadamilola Motunrayo , Rosenberger Laura Horst , Park Tristen Sinae , Hyslop Terry , Greenup Rachel Adams , Hwang Eun-Sil Shelley 
Published: September 2018

e18144 Background: Breast oncologists have little guidance on predicting long term outcomes after interval survival. We aim to evaluate the association of overall survival (OS) with select factors at multiple time points. Methods: Women ages 18-80 with non-metastatic invasive breast cancer were identified from the NCDB (2004─2014). Using multivariate survival analysis, we estimated the association of OS with tumor and treatment factors for those with follow up surviving at least 2, 5, and 10y post-diagnosis. Results: 685598 women (median age 59) were identified; 573757 were alive with follow up at 2y, 254303 at 5y, and 18640 at 10y. The majority had early stage, hormone receptor (HR) +, invasive ductal carcinoma. 57% underwent lumpectomy; 49% received chemotherapy; 89% of lumpectomies received radiation (RT); and 83% of HR+ tumors received endocrine therapy (ET). Of those alive at 2y, improved OS was associated with ER+, PR+, chemotherapy, RT, and ET. Reduced OS was associated with higher cT/cN stage, grade, and mastectomy. Of those alive at 5y, improved OS was associated with chemotherapy, RT, and ET. Reduced OS was associated with higher cT/cN stage, grade, and mastectomy. Of those alive at 10y, reduced OS was associated with higher cT stage and grade. Conclusions: Tumor and treatment factors are associated with OS, but the association of some factors may change for women surviving at least 5y or 10y. These findings may contribute to more tailored prognostication for patients based on interval survival. [Table: see text]
Nonspecific tumor markers in the era of value based medicine: Role of CA 19-9 in the pelvic mass workup.
Authors: Underwood Jenny , Saeed Haleema , Chae Esther Y. , Hanna Rabbie Kriakoss 
Published: September 2018

e18194 Background: When encountering a pelvic mass, CA 125 and CEA are usually obtained to evaluate for ovarian or colon cancer. The clinical importance of ordering a CA 19-9 level is unknown. Does it offer valuable information or merely add confusion and additional workup if elevated? Methods: 3,370 women were retrospectively identified via CPT codes for pelvic mass and CA 19-9. Initial analysis reviewed the subspecialty of the primary investigator using CA 19-9 in their initial workup, and its correlation to a gynecologic pathology. In the cases where an OBGYN was the primary investigator additional tumor markers, age, race, menopausal status, imaging, surgical interventions and final pathology were further analyzed. Results: Out of 3,370 women 982 had an abnormal CA 19-9. The distribution of subspecialties that utilized CA 19-9 in their initial work up was Hematology Oncology 31.6%, Internal Medicine 18.7%, Gastrointestinal 18.2%, Gynecology 9.2%, Surgery 8.8%, Emergency Medicine 5.7%, Transplant 4.9%, and Family Medicine 2.9%. Of the patients evaluated by Gynecology, 32.2 % were found to have elevated CA19-9 which led to additional work-up of the upper GI tract in 18.9% including MRI, and PET preoperatively. Further analysis revealed that there was no correlation between the elevation of CA 19-9 and whether the tumor was malignant or benign [p value = 0.45] even after being adjusted for: menopausal status, presence of endometriosis, or pathology including mucinous cell type. Conclusions: The majority of adnexal masses are benign; the main goal of diagnostic evaluation is to exclude malignancy. Value based medicine is implemented to help improve health care quality, and efficient utilization of health care resources. Based on this retrospective analysis the use of CA 19-9 in evaluation of a pelvic mass does not offer information that directly improves patient outcome, but rather correlates to the increased misuse of health care resources.
Real-world practice patterns in community U.S. oncology practices: A quality improvement approach in HER2-positive breast cancer.
Authors: Hurvitz Sara A. , Simone Laura C , Carter Jeffrey D , Mateka James JL , Moreo Kathleen , Sapir Tamar 
Published: September 2018

e18196 Background: In breast cancer (BC), quality measures related to care coordination (CC), HER2 testing (testing) and use of HER2-targeted therapy (Tx), provide parameters for assessing care quality. We assessed the influence of quality improvement education (QIE) on alignment with BC quality indicators. Methods: 20 community oncologists participated in an IRB-approved QIE program. At baseline, 200 randomly selected charts of women with HER2+ invasive BC were retrospectively reviewed for adherence to quality measures pertaining to testing, Tx and CC. The cohort participated in accredited QIE activities for developing action plans for improvement. Follow-up chart reviews were completed 6 months after the QIE. Results: Patient and disease characteristics were generally similar across the 2 cohorts. At baseline, documentation of cancer staging was 90%, ECOG functional status assessment was 67% and cardiac testing was 33%. Treatment in the adjuvant setting was most common, followed by neoadjuvant, and metastatic. Documentation of CC varied greatly across specialties, and was highest for primary care physicians. At follow-up, randomly selected charts (n=60 to date) revealed increases in documentation of patient assessments and care coordination. A shift towards increased treatment in the neoadjuvant setting was also observed. Conclusions: QIE interventions that engaged oncology teams showed a positive impact on documentation across several parameters. A complete analysis of follow-up charts (n=200) will be presented. [Table: see text]
Internal medicine residents' perception of cancer prognosis.
Authors: Acoba Jared David , Belyea Loni 
Published: September 2018

e18214 Background: Cancer is the second leading cause of death in the US. Many internal medicine physicians feel uncomfortable having to prognosticate, however oncology patients often ask this of them. The inability to provide an accurate prognosis could lead a patient to make a treatment decision incongruent with their true wishes. We conducted this study to assess resident and attending physicians’ knowledge of cancer prognosis. Methods: We conducted a prospective cross-sectional study to assess internal medicine resident and attending physician knowledge of median survival for seven different oncologic case scenarios. We asked participants to choose a median survival of: (a) ≤6 mo, (b) 10-12 mo, (c) 24-36 mo, or (d) 48-60 mo for each scenario. Residents were asked to identify the source(s) of information that most significantly influenced their choices. All internal medicine residents and attending physicians affiliated with the University of Hawaii Internal Medicine Residency Program were invited to participate. Results: A total of 67 of 85 surveys were completed, representing 41 residents and 26 attending physicians. Overall, the respondents correctly estimated median survival 42.6% of the time. The respondents underestimated more often than overestimated median survival (46.3% vs 14.9%, p = 0.0001). Survival in colon and pancreatic cancer were most often underestimated (61% and 53%, respectively). We found no statistically significant difference between resident and attending physician responses. Of the residents who underestimated survival, 73% sited inpatient experience as influencing their oncologic knowledge. Conclusions: Internal medicine residents and attending physicians correctly estimate median survival of cancer patients less than 50% of the time and often underestimate survival. Inpatient rotations, where residents care for the oncologic patients experiencing significant complications of their cancer and treatment, may be giving them an unbalanced perspective on cancer prognosis. Improving oncologic education to provide a more balanced perspective may be critical in improving perception of prognosis so that patients can be provided with accurate information when trying to make critical treatment decisions.
Concordance rates of provider selected pathway decisions to actual delivered therapy.
Authors: Shamah Corey J. 
Published: September 2018

e18220 Background: In November 2014, Aurora Cancer Care (ACC) adopted a new software package called Via Oncology (Via). It is a software driven, algorithmic, decision support tool. Via's goal is to help providers make the best decision in the treatment plan for patient care. Eligible clinical trials are the preferred therapy choice. If not available, treatment choices are then ranked by efficacy, toxicity, then cost. Its use has been mandated for every patIent visit in the department of Medical Oncology. ACC has 19 sites of service. While our current electronic medical record (EMR) and Via do communicate, it is limited to demographics and sending a link of the selected pathway from Via to the EMR. However, this link does not need to be selected in the EMR and another treatment could be selected. Our group does not penalize for off-pathway decisions, but it is possible that providers are selecting one protocol in Via to count as "on-pathway", and entering another treatment plan in the EMR. The goal of this study was to determine the concordance of stated pathway on Via and the actual ordered therapy in the EMR. Methods: One month of pathway decisions for a large, hospital based, multisite oncology group were obtained. Those decisions in Via that were recorded as new "on-pathway" treatment decisions were manually audited in the EMR to determine if there was concordance. If discordant decisions were corrected on a subsequent visit, it was felt that there was likely a mitigating circumstance and these decisions were not included in the final analysis. Results: Over one month, our 39 oncologist made 1534 new decisions for patients. Of these, 368 were "on-pathway" in Via. There was concordance of 319 (87%) to our EMR. The discordant charts were mostly due to differing drugs (19), dosing schedule (8), drug omitted (7), never given (7), additional drug (2). Conclusions: Despite the mandated use to two mostly independent software systems, agreement was high among patient records. Further integration of these systems will likely result in even greater concordance.
Designing comprehensive patient and family centered oncology care to achieve value based quality outcomes: Lessons learned from the field in creating sustainable change.
Authors: Harris Tamira , Wilfong Lalan S. 
Published: September 2018

e18225 Background: Of all clinical specialties cancer care is often thought of as one of the most patient and family centered due to the nature of the disease and course of treatment. Traditionally a strong relationship is held among the physicians, office practice staff and patients and family. Cancer care requires multidisciplinary collaboration and alignment for the optimized patient experience. Comparatively speaking this has been the case. The office based oncology care team has worked side by side to move the patient through the system during various treatments and settings. Most often the relationships and bonds that are formed are long lasting as cancer is a life changing experience. Opportunities for change however do exist and are needed in today’s increasingly complex healthcare environment. As demographics shift, and treatment methodologies continue to be discovered costs have escalated giving rise to the need to evaluate different care delivery models such as value based care. The Centers for Medicaid and Medicare Innovation Center (CMMI) Oncology Care Model (OCM) initiative has addressed this in their 5 year OCM pilot. Methods: Using qualitative and six sigma lean techniques practices redesigned patient throughput and experience based on data from gap analysis assessments, observation and collaboration. Results: The session will highlight lessons learned from the practice setting in initiating the changes required to meet CMS objectives and change the face of oncology care. Learn how practices designed patient navigation, created care team huddles, designed technology that facilities decision making, identified new models and partnerships for care, and standardized approaches across practice sites among other successes. Conclusions: This interactive session will explore what worked well, what physicians would change, and next steps planned.