bluuebunny/crossref_metadata_2025_split huggingface dataset:
National lung cancer screening utilization trends in the Veterans Health Administration.
Authors: Lewis Jennifer A. , Denton Jason , Matheny Michael E. , Slatore Christopher G. , Maiga Amelia W , Grogan Eric , Massion Pierre P. , Sherrier Robert H. , Dittus Robert S. , Keohane Laura , Roumie Christianne L. , Nikpay Sayeh 
Published: May 2019

6547 Background: Low-dose CT (LDCT) is an effective means for early lung cancer detection, but is often underutilized. An estimated 900,000 Veterans are eligible for lung cancer screening. We are the first to describe national lung cancer screening utilization trends in the Veterans Health Administration (VHA). Methods: We assembled a retrospective cohort of patients within the VHA’s Observational Medical Outcomes Partnership (OMOP) Common Data Model who underwent lung cancer screening. LDCT scans with Common Procedure Terminology (CPT) codes G0297 or 71250 from January 1, 2011 to May 31, 2018 were eligible for inclusion. We further selected exams described as “lung cancer screening,” “screening,” or “LCS.” We used descriptive statistics with frequencies and medians to calculate the total exams per Veteran and evaluate utilization trends over time and by region. Results: At initial screening, Veterans had a median age of 66 (IQR 61, 70), 95% were male, 76% Caucasian. From January 1, 2011 to May 31, 2018, 75 VHA facilities performed 129,363 LDCT exams for lung cancer screening; 87,950 (68%) initial and 41,413 (32%) subsequent exams. Screening has increased over time (226 in 2011-2012; 7848 in 2013-2014; 41,225 in 2015-2016; 80,064 in 2017 until May 31, 2018) in all regions. Providers in primary care/internal medicine (56%), family medicine (16%), pulmonology (6%), oncology (0.3%), other specialties (21%) ordered screening exams. Conclusions: Lung cancer screening with low-dose CT within the VHA increased over time within all geographic regions. Future strategies aimed at the Veteran, provider, and healthcare system levels are needed to increase lung cancer screening utilization among eligible Veterans. [Table: see text]
Use of machine learning to identify relevant research publications in clinical oncology.
Authors: Suarez Saiz Fernando Jose , Sanders Corey , Stevens Rick J , Nielsen Robert , Britt Michael W , Preininger Anita , Jackson Gretchen 
Published: May 2019

6558 Background: Finding high-quality science to support decisions for individual patients is challenging. Common approaches to assess clinical literature quality and relevance rely on bibliometrics or expert knowledge. We describe a method to automatically identify clinically relevant, high-quality scientific citations using abstract content. Methods: We used machine learning trained on text from PubMed papers cited in 3 expert resources: NCCN, NCI-PDQ, and Hemonc.org. Balanced training data included text cited in at least two sources to form an “on topic” set (i.e., relevant and high quality), and an “off-topic” set, not cited in any of the above 3 sources. The off-topic set was published in lower ranked journals, using a citation-based score. Articles were part of an Oncology Clinical Trial corpus generated using a standard PubMed query. We used a gradient boosted-tree approach with a binary logistic supervised learning classification. Briefly, 988 texts were processed to produce a term frequency-inverse document frequency (tf-idf) n-gram representation of both the training and the test set (70/30 split). Ideal parameters were determined using 1000-fold cross validation. Results: Our model classified papers in the test set with 0.93 accuracy (95% CI (0.09:0.96) p ≤ 0.0001), with sensitivity 0.95 and specificity 0.91. Some false positives contained language considered clinically relevant that may have been missed or not yet included in expert resources. False negatives revealed a potential bias towards chemotherapy-focused research over radiation therapy or surgical approaches. Conclusions: Machine learning can be used to automatically identify relevant clinical publications from biographic databases, without relying on expert curation or bibliometric methods. The use of machine learning to identify relevant publications may reduce the time clinicians spend finding pertinent evidence for a patient. This approach is generalizable to cases where a corpus of high-quality publications that can serve as a training set exists or cases where document metadata is unreliable, as is the case of “grey” literature within oncology and beyond to other diseases. Future work will extend this approach and may integrate it into oncology clinical decision-support tools.
Impact of travel time on healthcare costs and resource utilization by phase of care for older cancer patients.
Authors: Rocque Gabrielle Betty , Williams Courtney , Miller Harold D. , Azuero Andres , Wheeler Stephanie B. , Pisu Maria , Hull Olivia Margaret , Rocconi Rodney Paul , Kenzik Kelly 
Published: May 2019

6560 Background: Closures of hospitals and clinics may have unintended consequences, including increasing patient travel time. Increased patient travel time to healthcare facilities has the potential to adversely impact patient outcomes. Limited data exist on the impact of travel time on healthcare costs and resource utilization. Methods: This retrospective cohort study from 2012-2015 evaluated drive time to cancer care site for Medicare beneficiaries age ≥ 65 in the Southeastern US. The primary outcome was Medicare spending by phase of care (initial, survivorship, end of life [EOL]). Secondary outcomes included resource utilization measured by hospitalization rates, hospitalization sites, intensive care unit (ICU) admissions, and chemotherapy-related hospitalization rates. Hierarchical linear models with patients clustered within cancer care site and adjusted for pertinent covariates were used to determine the effects of drive time on average monthly phase-specific Medicare spending. Results: Median drive time was 32 minutes (IQR 18-59) for the 23,382 included Medicare beneficiaries, with 24% of patients driving > 1 hour to their cancer care site. During the initial phase of care, Medicare spending was 14% higher for patients traveling > 1 hour than those traveling ≤ 30 minutes.Hospitalizationrates were 4-13% higher for patients traveling > 1 hour vs. ≤ 30 minutes in the initial (61 vs. 54), survivorship (27 vs. 26), and EOL (310 vs. 86) phases of care (all p < .05). The majority of patients traveling > 1 hour were hospitalized at a local hospital rather than at their cancer care site, whereas the converse was true for patients traveling ≤ 30 minutes. Conclusions: As healthcare locations close, patients living farther from treatment sites may experience more limited access to care, and healthcare spending could increase for Medicare.
Racial comparisons in receipt of timely guideline-based colon cancer treatment in an equal-access health system.
Authors: Eaglehouse Yvonne L , Georg Matthew W. , Shriver Craig D. , Zhu Kangmin 
Published: May 2019

6563 Background: Non-Hispanic Black (NHB) adults with colon cancer may have longer time-to-treatment and be less likely to receive guideline-based therapy than Whites (NHW) in the U.S. This may be largely related to racial differences in access to care and insurance coverage. This study aimed to determine whether there were racial differences in receipt of timely guideline-based colon cancer treatment in the equal-access Military Health System (MHS). Methods: Patients age 18-79 years diagnosed with colon adenocarcinoma between January 1, 1998 and December 31, 2007 were identified in linked databases from the Department of Defense Central Cancer Registry and MHS Data Repository. Odds ratios (ORs) and 95% confidence intervals (CIs) of receiving stage-specific treatment within recommended timeframes [surgery within 6 weeks of diagnosis (stages I-III); adjuvant chemotherapy within 8 weeks of surgery (stages II-III); treatment within 4 weeks of diagnosis (stage IV)] for NHB relative to NHW patients were estimated using multivariable logistic regression. Results: Patients (n = 2,170) had a mean age at diagnosis of 59.6 (SD 11.8) years and the racial distribution was 78.6% NHW and 21.4% NHB. The likelihood of receiving timely surgery between races was similar across the stage groups (I-III). NHB patients were equally likely to receive adjuvant chemotherapy as NHW patients (OR 0.90, 95% CI 0.57, 1.41) and to receive it within 8 weeks of surgery (OR 1.19, 95% CI 0.75, 1.87). The likelihood of receiving timely treatment for patients with stage IV disease was similar between races (OR 0.82, 95% CI 0.39, 1.69). The overall likelihood of receiving treatment adherent to stage-specific guidelines in the study sample was similar between NHB and NHW patients (OR 1.00, 95% CI 0.77 to 1.31). Conclusions: In the MHS population, the likelihood of receiving timely treatment adherent to recommended guidelines was similar between races. Our results support the role of equal access to medical care and insurance coverage in reducing racial disparities in colon cancer treatment.
Development of a financial navigation program to ease the burden of financial toxicity.
Authors: Monak Melissa , Bell Kimberly , Whitt Antoinette 
Published: May 2019

6565 Background: Due to the rising cost of cancer care, even well-insured patients are at risk for financial toxicity. Cancer treatment costs can be challenging for patients and families because of increasing deductibles, increasing premiums and frequent co-payments. At Cleveland Clinic Cancer Centers, our goal is to identify patients at risk for financial distress and help ease the financial stress and hardship associated with cancer care. Methods: In 2015 we initiated huddles for all new patients to ensure seven day access for our patients as well as out of network authorizations. During this work we identified the need for a position to help manage the costs of care for our patients. The Financial Navigator (FN) role was created in 2016 to complete benefits investigations to determine covered services and minimize the patient’s out of pocket expenses. We are participants in the Oncology Care Model and are expected to provide and document the estimated out-of-pocket costs in the patient’s medical record. Navigators conduct telephone outreach calls with treatment patients to educate them on their benefits. The FN also assists with applications on copay assistance and free drug options. Finally, the FN will connect patients with resources for premium assistance and household expenses when copay assistance isn’t an option. The FN team has grown to 7 FTE’s since 2016. Results: Since 2016 the dollar amount approved through copay assistance applications has increased by 70%, the free drug value received increased by 55%, and end of year 2018 data shows that we more than doubled what was collected towards patient out of pocket costs from copay assistance programs compared to 2017. We have also been able to comply with the out of pocket expense metric for OCM, not only for our Medicare patients, but for all of our treatment patients and compliance has risen from 44% in December 2017 to 98% in April 2018 and we continued to obtain a goal of 96% or higher throughout 2018. Conclusions: In conclusion our Navigators have built relationships with Social Workers, Care Coordinators, and community services that are available to patients. This added benefit helps patients with non-medical financial stressors. The team can connect patients to organizations that can assist with household utilities, childcare concerns, food concerns, and mortgages. Utilization of the FN role has helped the healthcare team and patients to identify ways to mitigate the costs of care and distress related to financial concerns.
Venous thromboembolism (VTE) in patients with ALK-rearranged non-small cell lung cancer (ALK-LC): A population-based cohort.
Authors: Zer Alona , Joseph Lilach , Battat Erez , Shochat Tzippy , Leader Avi , Goldstein Daniel A. , Hammerman Ariel 
Published: May 2019

6608 Background: Advanced NSCLC is associated with an increased risk for VTE, with a reported rate of 8-15%. Clinical observations suggest a higher rate of VTE in patients with ALK-rearranged NSCLC. Clalit Health Services (CHS) is both a healthcare payer and provider, covering over 50% of the population in Israel, with individual patient data recorded in a centralized electronic database. We aimed to determine the incidence of VTE in patients with ALK-LC using a population-based cohort. Methods: We identified all patients diagnosed with NSCLC between 01/2012-12/2017 within CHS. Clinical and demographic data (including VTE risk factors, i.e. components of the Khorana score) were extracted from the CHS registry for all patients. Patients with ALK-LC were identified according to crizotinib prescriptions (dispensed after an approved CHS' pre-authorization for an ALK-LC diagnosis). VTE was identified by ICD diagnosis codes 415.xx, 444.xx, 451.xx and 453.xx. VTE risk factors (Khorana score) were also extracted. Association between ALK-LC and VTE were analyzed using logistic regression, estimating univariate and multivariate Odds Ratios (OR). Results: Overall, 4327 patients with a diagnosis of NSCLC were identified. 149 (3%) had at least one prescription for crizotinib for advanced ALK-LC. The rate of VTE in these patients was 25% (38 of 149 patients), while in the non-ALK-LC the rate was 14% (596/4178), OR = 2.05, p = 0.0004. The association was significant also in a multivariate analysis adjusting for, age, smoking status, BMI, platelet count, hemoglobin and Charlson co-morbidity score (OR 1.66, p = 0.018). Conclusions: This pooled analysis of individual patient data confirms prior data from smaller retrospective studies, suggesting ALK-LC is associated with a high risk of VTE. Randomized trials with prophylactic anti-coagulation are unlikely to be performed in this rare subtype, thus increased awareness and consideration of VTE prophylaxis in high risk patients is warranted.
Impact of an oncology urgent care clinic on emergency department rates.
Authors: Sedghi Tannaz , Canavan Maureen , Gross Cary Philip , Davidoff Amy J. , Gould Rothberg Bonnie Elyssa , Strait Michael , Sinanis Naralys , Adelson Kerin B. 
Published: May 2019

6615 Background: Oncology-specific urgent care clinics (UCC) may play a key role in reducing unscheduled emergency department (ED) visits among patients with cancer. We sought to determine if establishment of an Oncology UCC was associated with lower ED utilization among patients receiving cancer care at Yale’s Smilow Cancer Hospital (SCH) and two nearby, integrated community practices. Methods: SCH opened its UCC in April 2017 to provide supportive care and symptom management for patients with cancer who need acute medical attention outside of regular clinic visits. We identified patients who had at least one visit with an oncology provider during the Pre-UCC period (9/1/16 – 12/31/16) or Post-UCC period (9/1/17 – 12/31/17) and received chemotherapy within a year preceding their provider visit. For each patient, we captured all ED visits in a four-month window starting from their last provider visit in each study period. The ED visit rate for both periods was defined as the total number of ED visits divided by the total number of unique patients in the period. To determine the impact of the UCC on ED utilization, we evaluated the absolute difference in the ED visit rate between the Pre- and Post-UCC period using a two-sample t test. Results: There were 3,754 patients in the Pre-UCC period and 4,734 patients in the Post-UCC period. In the full study sample, the mean age was 62.9 and most common cancer types were Hematologic, Gastrointestinal, and Breast. Prior to opening the UCC, the ED visit rate was 0.27 per unique patient. After opening the UCC, we found a 13.9% relative decrease in the overall ED visit rate from 0.27 to 0.23 (p = 0.02). The SCH patient ED visit rate declined by 12.5% (p = 0.03) and the community practice rate declined by 37.1%; however, the latter decline was not statistically significant, potentially due to a small sample size (p = 0.19). Conclusions: Our study found a decrease in the ED visit rate after the opening of an Oncology UCC. An urgent care strategy for cancer centers may serve as an efficient way to manage patients while minimizing ED use. [Table: see text]
Adherence to the guidelines: A comparison of biomarker testing implementation in metastatic non-squamous, non-small cell lung cancer in university versus community institutions.
Authors: Shikdar Sufana , Trisel Zachary Michael , Correa Erika , Vazquez Martinez Mariola A. , Hou Kevin Ye , Hanson Shaun Bryan , Edlukudige Keshava Vinay , Lambert Peter , Thirumaran Rajesh , McCormack Michael Joseph , Ward Kristine Marie , Styler Michael 
Published: May 2019

6618 Background: Molecular biomarkers have become essential in determining optimal treatment for patients with advanced non-small-cell-lung cancer (NSCLC). Few studies have evaluated the implementation of biomarker assessment (e.g. EGFR, ALK and ROS1) in routine clinical practice. We endeavored to assess adherence to biomarker testing guidelines in different clinical settings, specifically in a university hospital versus a community hospital in the same region. Methods: A retrospective analysis was conducted in newly diagnosed metastatic non-squamous-NSCLC patients comparing the compliance of biomarker testing based on nationally established guidelines available at the time of diagnosis. De-identified electronic health record (EHR) data were collected from Mercy Catholic Medical Center (MCMC) and Hahnemann University Hospital (HUH) between 1/1/15- 1/30/19. Results were compared in each setting to determine utilization of biomarker testing. Results: 27 patients were identified at MCMC and 41 at HUH. 22 (81%) patients at MCMC and 36 (88%) patients at HUH underwent appropriate molecular testing based on guidelines available at the time of diagnosis. Conclusions: Our data suggests that both university and community institutions have appropriately adapted the evolving guidelines for molecular testing for patients with non-squamous NSCLC. In the rare instances that molecular testing was not performed, the most common reason was inadequate amounts of tissue available. Newer technologies, such as next-gen sequencing and serum based testing, will make compliance with guidelines easier in the future, particularly as increasing numbers of molecular markers will need to be assessed.
Is neratinib following trastuzumab in early-stage HER2-positive breast cancer cost-effective?
Authors: Schwartz Naomi RM , Flanagan Meghan Rose , Babigumira Joseph B , Steuten Lotte Maria Gertruda , Roth Joshua A. 
Published: May 2019

6625 Background: Neratinib after adjuvant trastuzumab significantly improves disease-free survival (DFS) in human epidermal growth factor receptor 2-postiive (HER2+) breast cancer, but the median absolute DFS gain is only 1.3 months. There has been much controversy in the clinical and lay media as to whether the substantial cost of neratinib is justified by its effects, including a prominent ASCO Post article from Dr. Vogl about a year ago. We performed a cost-utility analysis to formally assess the value of adding neratinib based on Phase III ExteNET trial results. Methods: We developed a Markov state-transition model to assess the value of neratinib in Stage I-III HER2+ breast cancer. Five-year recurrence rates were derived from ExteNet. Mortality and recurrence rates after 5 years were derived from the HERceptin Adjuvant (HERA) trial. Costs were derived from wholesale acquisition costs and peer-reviewed literature. Health state utilities were derived from ExteNET and prior publications. Outcomes included life years (LY), quality-adjusted life years (QALYs), direct medical expenditures, and cost per QALY gained. The analysis took a payer perspective over a lifetime horizon and results were discounted at 3% per year. One-way and probabilistic analyses were conducted to evaluate uncertainty. As neratinib conferred more clinical benefit in hormone receptor-positive (HR+) disease, we also assessed value in that specific subgroup. Results: Base case results are presented in Table. At typical U.S. willingness to pay thresholds of $100,000 and $150,000 per QALY gained, neratinib had 16.7% and 27.2%, probabilities of cost-effectiveness, respectively. In the HR+ subgroup, neratinib had a cost of $275,311 per QALY gained (19.9% & 31.2% probability of cost-effectiveness at $100,000 & $150,000 per QALY). Conclusions: In the first independent assessment of the value of neratinib after adjuvant trastuzumab, neratinib is not projected to be cost-effective, even among patients who derived the most clinical benefit. Future analyses should reassess the cost-effectiveness of neratinib treatment as trial data mature. Base case results. [Table: see text]
Cost of oral cancer drugs: Trends in the United States Medicare population in 2013 and 2015.
Authors: Seiger Kira Rose-Madison , Ruiz Emily S 
Published: May 2019

6631 Background: Rising pharmaceutical costs threaten affordability and access to cancer care. Methods: The 2013 and 2015 Medicare Part D claims databases were queried for CareFirst’s 2017 list of oral cancer drugs. Drugs with on-label indications for conditions other than cancer were excluded. Cost in 2013 were adjusted for inflation to 2015 dollars according to the Bureau of Labor Statistics consumer price index. Results: The total cost of oral cancer drugs paid by Medicare nearly doubled from 2013 to 2015, rising from over $4.8 billion to over $9.1 billion. The number of prescriptions increased by 21.6% from 640,193 to 778,357, suggesting that increased spending is driven more by rising drug prices than by increased utilization. Cost per patient increased for 81% (46) of the 57 drugs prescribed in both years and decreased for the remaining 19% (11). While only seven drugs cost more than $50,000 per patient in 2013, more than fifteen drugs cost more than $50,000 per patient in 2015. The overall average cost per beneficiary increased by 56% from $7,521.64 to $11,734.68, and seven drugs more than doubled in per patient cost. Cost per patient increased by 4.5 times for imbruvica (ibrutinib), 3.5 times for targretin (bexarotene), 3.2 times for soltamox (tamoxifen citrate), 3.1 times for nilandron (nilutamide), 2.6 times for gilotrif (afatinib dimaleate), 2.6 times for cyclophosphamide, and 2.5 times for iclusig (ponatinib hydrochloride). Conclusions: Medicare costs for oral cancer drug nearly doubled from 2013 to 2015, largely due to increased per patient costs. [Table: see text]