bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meeting requirements for survivorship visits: Interventions for patient identification.
Authors: Termer Nancy K. , Richardson Margie , Adams M Jacob , Alongi Alexander , Bellohusen Patricia , Bruckner Lauren B. , Cowen Richard , Fritsch Susan , Hettler Dwight , Kerns Sarah L. , Pandya Chintan , Williams AnnaLynn , Constine Louis S. 
Published: May 2018

59 Background: A major challenge in providing quality survivorship care to cancer patients is efficiently and effectively identifying and scheduling patients who need a Survivorship Visit (SV). While the Commission on Cancer (CoC) Standard 3.3 defines which patients require a Survivorship Care Plan (SCP), staff need to operationalize the definition and search the clinic’s patient records on a regular basis to accurately identify eligible patients. This is a challenge for a busy cancer center. Methods: In July 2017 the Judy DiMarzo Cancer Survivorship Program instituted a full time Data Analyst (DA) to assist in identifying survivors using the OncoLog Cancer Registry and the Electronic Medical Record (EMR). Previously the identification process was limited to the EMR, and the Survivorship Program Nurse Coordinator (NC) was a combined role overseeing metrics, identifying patients and assisting with SVs. Currently the DA has piloted a method extracting data monthly from OncoLog and the EMR to assess eligibility of Standard 3.3. The data is compiled and sent to the NC who assists the cancer-specific service lines responsible for the patients identified to ensure SVs occur in a timely manner. Results: Our pilot intervention resulted in a 283% increase in SVs per month, from an average of 30 SVs to 115 SVs per month. The overall achievement for the CoC SV delivery requirement increased from 16% prior to the intervention to 33% in just 3 months. GI increased from 5% to 20%. Lung increased from 16% to 39%. The average SV was 3 months after the end of treatment. Approximately 60 hours was dedicated to establishing this method and 35 hours per month in the eligibility, identification process. Conclusions: By adding a DA role, extracting data from Oncolog and the EMR, as well as increasing accountability at the service line level to improve identification and scheduling of eligible patients, the delivery of SCPs to eligible patients substantially increased. Nevertheless this process is time consuming and will likely not be sufficient to ensure that all eligible survivors receive appropriate care. Consequently, additional, systematic improvements in this process should be explored such as EMR methodologies to automate patient identification.
Using electronic medical records system to advance cancer survivorship programs.
Authors: Lanigan Megan , Lee Theresa M. , Torp Lisa , Rudge Beth , Lu Kit Yu ,   UPMC Pinnacle Breast Care Center
Published: May 2018

65 Background: Survivorship care is now being increasingly recognized as an important part of cancer care. The Commission on Cancer (CoC) Standard 3.3 now recommends 100% compliance in the delivery of Survivorship Care Plans (SCP) by 2019 to eligible survivors. However, there are no systematic ways of ensuring compliance of Care Plan delivery and assessing patient eligibility. There are also no standardized methods for documentation or data collection to ensure appropriate consolidation of information from the electronic medical record (EMR) to a SCP, to assess for patient eligibility for survivorship follow up, or to appropriately report on timely delivery and follow-up with Survivorship Programs. Methods: Our survivorship team worked closely with the Cancer Registry Program, nurse navigators, and Information Technology team to optimize our institution owned EPIC electronic medical records system to populate and consolidate information automatically into patient specific care plans. By having electronic care plans, we are able to deliver plans to all members of the care team and to the patients. We also created discrete methods of flagging eligible survivors and automated data reporting and collection to ensure compliance and timeliness of care plan delivery. Results: By optimizing our electronic medical records system and our workflow process for Care Plan delivery, we were able to increase our delivery compliance rate to 100%. We are able to track patients through their care delivery and appropriately refer to our survivorship program and track care plan delivery. Conclusions: The CoC has implemented new standards to encourage appropriate survivorship care delivery and proper communication for ongoing survivorship care and follow up. With these new standards comes the challenge of developing and implementing a system for creating, delivering and evaluating the delivery of SCP. For our team to provide quality survivorship care that is measurable, we have developed data analysis and reports through our EMR with assistance from our IT department. These improvements utilizing our IT and EMR more efficiently has provided us with the ability to achieve 100% care plan delivery compliance.
Piloting a screening tool in a breast cancer survivorship clinic.
Authors: Kircher Sheetal Mehta , Garcia Sofia F. , Slocum Megan , Rutsohn Joshua P , Fisher Allison , Weldon Christine B. , Penedo Frank J. 
Published: May 2018

66 Background: Breast cancer survivors experience physical, psychosocial, and practical concerns. Our Adult Survivorship Clinic provides patients a comprehensive survivorship visit following curative intent therapy to identify and address these needs. This study assessed patient and staff feasibility, usefulness, and burden of a screening tool. Methods: Patients seen in the Robert H. Lurie Breast Cancer Survivorship Clinic were randomly assigned to receive a screener (Coleman Supportive Oncology Tool including a concerns checklist & the 4-item Patient Health Questionnaire [PHQ-4]) versus no screener prior to their survivorship clinic appointment. All patients were asked to complete the FACIT-TS-PS to assess treatment satisfaction following the appointment. The screener group also completed an additional set of screener acceptability questions. The survivorship clinician completed a questionnaire after each patient visit. Results: Patients with breast cancer (n = 100) were randomized. Twenty-six (52%) of the participants not given a screener and 26 (52%) of the participants given a screener completed the FACIT TS-PS. 48% of participants were age 55 years or older and 54% received chemotherapy. While there were no statistically significant differences between the groups, both groups scored high on the FACIT TS-PS. Screener patients provided high ratings for the satisfaction survey with 100% of the respondents reporting the screener was “probably” or “definitely” clear and relevant. 85% reported that the questions provided little or no distress. The median time to complete the tool was 4 to 5 minutes. The survivorship provider reported that in 47% of patients (23/49) the screener uncovered an additional significant concern. In 35% of screened patients (17/49), the provider felt the screener prompted an additional referral to supportive oncology services or a medical specialist. Conclusions: A comprehensive and brief screener for patient concerns was feasible and acceptable for both patients and provider. Even in the context of a comprehensive survivorship visit, a screening tool uncovered additional concerns that led to supportive care referrals.
Shared medical appointment for early stage melanoma survivorship.
Authors: Funchain Pauline , Song Jung Min , Stanek Carolyn , McNamara Michael J. , Tarhini Ahmad A. , Gastman Brian , Marcus Joel Daniel 
Published: May 2018

69 Background: Shared medical appointments (SMA) are a newer patient care format that involve both education and creation of individualized medical plans for multiple patients in a group setting. SMAs have been found to be cost-effective with high patient satisfaction scores. Methods: We describe an SMA model for early stage melanoma surveillance. The development of our SMA required multidisciplinary input from oncology, psychology, social work, schedulers, business, nursing and cancer center administration. We emphasized creation of a nonjudgmental environment to educate and promote healthy behavior. Results: Our early stage melanoma SMA involves 4-6 patients with an APP as group leader, RN as facilitator, and PsyD to provide psychosocial support. The 90-minute visit starts with a private physical exam followed by group education, activities, and formation of an individualized surveillance plan. An integral component of our SMA is the use of a self-assessment Melanoma Risk tool that has been found to be an efficient method to promote sun protective behaviors. Patients self-identify behavioral risks and personalize strategies to combat long-term effects of unhealthy behaviors. Psychosocial aspects are monitored with the NCCN distress management tool to identify areas of distress. The primary goals of care are to diminish isolation, enhance self-management, and provide professional expertise in combination with first-hand information from peers. Long-term goals are to decrease anxiety and increase survival with prevention. Conclusions: The first project to our knowledge utilizing an SMA format for cancer surveillance, this effort identifies a population at risk and provides education and psychosocial support to change high-risk behaviors. Future areas of research include quantifying outcomes of SMA-based surveillance and the addition of significant others to enhance surveillance.
Assessing perceptions of transition readiness in the adolescent and young adult oncology population.
Authors: Agrawal Vaibhav , Blessing Kristina K. , Berger Andrea , Schleicher Amanda , Styer Mike , Seel Vicki , Khan Sharif S. , Miller Michal A. 
Published: May 2018

73 Background: Childhood cancer patients have distinct health-related needs as they transition from patient to survivor and from pediatric to adult-based care. This study used the Transition Readiness Assessment Questionnaire (TRAQ) to assess transition readiness and compare variation in readiness perceptions between patients, parents, and physicians. Methods: The TRAQ was completed by patients between ages 12 to 26 and their parent and oncologist at Geisinger Medical Center from Sept. 2015 to Dec. 2016. Surveys were scored according to validated methods (min. 1, max. 5). Statistical analysis was completed using SAS 9.4. Results: The study enrolled 49 patients, including 6 patients (12.2%) and 43 survivors (87.8%). There were 29 males (59.2%). The patient’s mean age at the time of survey was 18.4 years. Cancer types included: acute lymphoblastic leukemia (n = 17), lymphoma (n = 12), and sarcoma (n = 7). There were no significant differences in overall TRAQ scores between parents, patients, and physicians (mean 3.2, 3.5, and 3.7, respectively). The highest interobserver agreement was seen between patients and parents; the lowest was seen between physicians and patients. The greatest competency was assessed in the activity of talking with providers, and the lowest was measured in appointment keeping. In the domain of tracking health issues, providers assigned higher scores than patients (p = 0.003) and parents (p = 0.001). In the skill of talking with providers, patients ranked themselves higher than providers (p = 0.003). There was no significant variation in scores based on disease type, length of therapy, or insurance type. Patient age at diagnosis, patient age at therapy completion, and patient age at survey were correlated with higher patient (p = 0.004, p = 0.002, p = 0.0001, respectively), parent (p = 0.017, p = 0.019, p = 0.0001, respectively), and physician (p = 0.027, p = 0.03, p = 0.0001, respectively) scores. Conclusions: This study demonstrated that the overall assessment of transition readiness in the adolescent and young adult oncology population was similar between patients, parents, and physicians. The TRAQ is a tool that can be effectively used to guide healthcare transition in this population.
Identifying challenges to breast cancer care coordination at urban community-based primary care clinics.
Authors: Hamlish Tamara , Moton Zakiya N , Zhang Zuoli , Sohmer Dana , Olopade Olufunmilayo I. , Johnson Daniel , Hong Susan 
Published: May 2018

83 Background: Primary care providers (PCPs) are well positioned to play a significant role in improving cancer care in the U.S. and achieving the Institute of Medicine (IOM) recommendation for patient-centered, coordinated, comprehensive cancer care across the care continuum. This is particularly important in underserved communities where fragmented care contributes to widening disparities in cancer mortality. However, PCPs can face considerable challenges delivering cancer care. This research examines challenges to breast cancer survivorship (BCS) care coordination at federally qualified health centers (FQHCs). Methods: We conducted a chart review at five Chicago FQHCs to assess BCS-related follow-up care provided by PCPs. We reviewed patient electronic medical records for documentation of breast cancer-related health information by the PCP and for documentation from cancer specialists, including consultant notes, pathology reports, and treatment histories. Based on BC ICD -9 codes we identified 109 patients who had a BC diagnosis within five years and a primary care visit at one of the five FQHCS within 2 years. Results: The patient population was primarily comprised of African Americans (81%), with 16% Hispanic, and 4% Asian or non-Hispanic White. Mean age at diagnosis was 55 years with 30% diagnosed < 50 years. Medicaid (59%) was the most common health insurance. More than half of the patients had ≥1 chronic disease. Critical clinical BC information was missing from patient medical records, including BC pathology (65%), mammogram (60%), last clinical breast examination (49%), and cancer specialist notes (45%). Documentation of family history and genetic counseling were missing from 76% and 98% of the records, respectively. Conclusions: Our data indicate that PCPs at FQHCs currently have a limited role in delivering IOM recommended patient-centered, coordinated, comprehensive cancer care across the care continuum. The research results underscore a need for improvement in two key areas: 1) support for PCPs to build capacity in BCS care and 2) enhanced communication and care coordination between cancer specialists and PCPS in order to make PCPs an active part of the BCS care team.
Evaluation of coordination of cancer care between designated cancer hospitals and primary care providers: Results from a nationwide survey in Japan.
Authors: Tomizuka Taro , Watanabe Tomone , Kamitani Satoru , Higashi Takahiro 
Published: May 2018

84 Background: To improve coordination of cancer care between cancer specialist hospitals and primary care providers (PCPs), the Japanese government accredited cancer specialist hospitals, so called “designated cancer care hospitals (DCCHs)” and introduced “Cancer care coordination instruction fee” which PCPs can receive if they share a cancer critical path (Japanese version of Survivorship Care Plans) of each cancer patient with DCCHs. We sought to assess the current status of coordination of cancer care in Japan and communication between DCCHs and PCPs from PCPs’ point of view. Methods: A cross-sectional mail survey was administered to randomly selected clinic-based PCPs (4,000 clinics) from a nation-wide database of medical institutions authorized by Ministry of Health, Labour and Welfare Japan to treat patients with health insurance (87,869 clinics). The survey evaluated how much PCPs provided cancer follow-up care and how well DCCHs coordinated care and communicated with PCPs in cancer survivorship. Results: 1,873 PCPs returned the questionnaire (response rate: 46.8%). 1,223 (65.3%) answered to provide cancer follow-up care in outpatient setting. Most of the PCPs which provided cancer follow-up care evaluated the care coordination and support by DCCHs were satisfactory (946, 77.4%) but the degree of good evaluation varied by region (highest: 91.3%, lowest: 45.8%). In regression analysis, provision of palliative care by PCPs (OR 1.52 95%CI 1.05-2.17) and use of cancer critical path (OR 2.10 95%CI 1.63-2.71) were significantly correlated with better evaluation of communication and care coordination. Conclusions: DCCHs communicated well with PCPs and PCPs were satisfied with the communication and care coordination by DCCHs. Provision of palliative care by PCPs and use of cancer critical path are likely to lead good care coordination in cancer care.
Effects of oral vitamin B12 for the treatment of aromatase inhibitors (AI)-related musculoskeletal symptoms in women with early stage breast cancer.
Authors: Nahleh Zeina A. , Campbell Aleli , Heydarian Rosalinda , Dwivedi Alok Kumar 
Published: May 2018

86 Background: Breast cancer patients receiving Aromatase Inhibitor (AI) therapy experience many side effects including arthralgias, myalgias and stiffness of joints. The objective of this study was to evaluate the effect of vitamin B12 supplements on pain related symptoms. Methods: In this study, patients taking AIs and experiencing pain at baseline were given 2500 mcg of vitamin B12 sublingually daily for 90 days. The validated Brief Pain Inventory-Short Form (BPI-SF) questionnaire using a 10 scale rating was evaluated prior and post- intervention. The BPI-SF asseses pain level and its interference with other daily life events on a scale from one to ten, one meaning pain does not interfere. Item 9 from the BPI assesses 7 important dimensions that are reported here. Results: 36 patients were recruited and scores were evaluated at baseline and at 90 days after taking vitamin B12 for general activity, mood, walking ability, normal work, relations with people, and for enjoyment of life post interventions as shown in the table. Conclusions: This study suggests that by taking a high dose of vitamin B12, significant improvement was observed in several dimensions related to pain scales in patients with AI -related musculoskeletal symptoms. Preliminary data confirms that vitamin B12 not only help improve pain, but it also aids in improving patient’s mood, well-being and relations with others. Larger randomized studies are warranted to confirm these promising findings. Clinical trial information: NCT03069313. [Table: see text]
Piloting a supportive oncology screener with adult survivors of childhood cancers.
Authors: Garcia Sofia F. , Kircher Sheetal Mehta , Wortman Katy , Kinahan Karen , Fisher Allison , Slocum Megan , Weldon Christine B. , Didwania Aarati , Penedo Frank J. 
Published: May 2018

9 Background: Adult survivors of childhood cancers experience a host of late effects. Our Survivors Taking Action and Responsibility (STAR) clinic treats those needs. Methods: We piloted the Coleman Supportive Oncology Tool (CSOT, which includes a concerns checklist & the 4-item Patient Health Questionnaire [PHQ-4]) that patients completed before STAR visits. We used chi-square, T-tests, and logistic regression to identify differences in CSOT scores associated with patient characteristics. Results: Patients (n = 115) completed the CSOT: 54% women; 81% White; 34% leukemias, 30% lymphomas, 10% brain tumors, 8% sarcomas, and 18% other cancers. Mean years: current age = 33.48 (SD = 7.71) and age at diagnosis = 9.8 (SD = 5.84). The majority had chemotherapy (95%) and radiation (74%). A minority underwent surgery (38%) and transplant (22%); experienced a cancer recurrence or second malignancy (each 20%). We assessed 21 potential late effects; the mean number per patient was 1.92 (range = 0-9); most frequent were cardiologic (23%), endocrine (17%), musculoskeletal (17%) and infertility (16%). Controlling for current age, each 13 years (a) since diagnosis was associated with roughly 1 more long term effect (β = 1.02, p < 0.01) and (b) at age of diagnosis was associated with 1 less (β = -1.02, p < 0.01). Receiving > = 300 mg anthracycline was associated with a nearly 8-fold increase in cardiologic late effects (OR = 7.94, p < .01). Recurrence, second malignancy, and age < 10 years at diagnosis were associated with significantly more late effects (p = < .001, 01, < .01, and .02 respectively); those variables were not associated with greater CSOT concerns. We assessed 32 CSOT supportive care concerns; the mean number per patient was 3.23 (range = 0-18); the most frequent were difficulties with body weight (34%), sleep (19%), work / school (18%), concentration and health insurance (each 17%). On an item assessing fear of recurrence (FoR) frequency, most (74%) endorsed “not at all” but any FoR was associated with endorsing a greater number of CSOT concerns (p < .0001). Conclusions: Using a brief screener was feasible in a clinic providing follow-up care to adult survivors of childhood cancers to identify patients’ current medical and supportive care needs.
Yoga as a survivorship tool in cancer patients and caregivers.
Authors: Tan Winston , Ailawadhi Meghna 
Published: May 2018

90 Background: Preliminary data suggest that yoga is one of the most popular complementary and alternative therapies and most likely to improve quality of life. In spite of the methodologic limits,studies suggest an improvement in a range of symptoms of patients with cancer among those who did yoga. The absence of side effects and the excellent cost-benefit ratio make it a very interesting symptom management tool. Methods: We advertised to our cancer patients the availability of a free yoga class twice a week. (August 2016-present). This was run by one trained instructor. All patients with different cancers were allowed to participate including caregivers. A post session survey was done at one time point to evaluate the benefits of the class. Results: Usually between 8-15 individuals attend the class. In one session a written survey was conducted, 13 patients/caregiver agreed to fill up the survey. 9 were patients (breast , sarcoma, lymphoma, brain tumor melanoma and spine tumor) and 5 were caregivers.4 never had any prior yoga class before, the reasons for attending the class included stress relief, improve balance, help pain, support spouse, suggestion by MD and exercise. Among those who answered the question 7 were new to yoga 0-3 month, they mainly did restorative and gentle yoga. The perceived benefits among attendees included being more relaxed, calm down, peaceful, increase strength, more mindful and better health. 8/13 perceived that it did improve quality of life very much, 3/13 quite a bit 1 a little. All were very satisfied with the yoga sessions. Conclusions: In an undifferentiated group of cancer patients, yoga classes participants have positive perceived benefits in majority of the individuals who did restorative/gentle yoga. This led to symptom control and also had significant participant satisfaction.