bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and outcome of interval breast cancer among women participating in the provincial population based screening program in Manitoba, Canada.
Authors: Niraula Saroj , Biswanger Natalie , Decker Kathleen 
Published: May 2019

6595 Background: The province of Manitoba, Canada has an organized population based biennial mammographic screening program. Here we report outcomes of women diagnosed with Interval Cancers (IC), defined as cancer diagnosed within 24 months of a normal screening mammogram and before the next screening mammogram, compared to Screen Detected (SD) cancers. Methods: The Manitoba Cancer Registry was used to obtain data about tumor and host characteristics and cause-specific mortality for women 52 to 64 years of age diagnosed with invasive breast cancer from January 2004 to December 2010. Lead time bias in SD cancers was adjusted based on Duffy's correction factor. Competing risk analysis was used to examine the risk of death by cancer detection method. To examine the relationship between breast cancer detection type and personal and tumour characteristics, we performed multinomial logistic regression analysis with age, area-level income quintile, tumour grade, hormone receptor, and HER2 receptor as independent variables. Results: There were 5,884 women diagnosed with invasive breast cancer during the study period of which 1,338 were SD, 362 were IC, and the remainder were diagnosed outside the screening program or were non-compliant to screening. IC were more likely than SD cancers to be high grade [Odds Ratio (OR) 3.8, 95% Confidence Interval (CI): 2.1-6.8], and ER negative [OR 1.7, 95% CI: 1.02-3.12]. At data cut-off date of June 30, 2012, risk of death from breast cancer was significantly higher for IC compared to SD cancers [Hazard Ratio (HR) 4.18, 95% CI: 1.97-8.87)], for sojorn time (period when tumour is asymptomatic but screen detectable) of 2 years adjusting for area-level average income quintile and age. Sensitivity analyses with sojourn times of 1, 3, and 4 years showed similar results. Risk of non-breast cancer death was not increased with IC compared to SD cancers (HR 1.33, 95% CI: 0.43-4.15). Conclusions: Among women who participated in a systematic population-based screening program, IC occurred frequently; breast cancer-related death for IC was 4-times that of SD cancers. These results highlight the discordance between the principles underpinning population based breast cancer screening and natural history of these more lethal breast cancers.
Mortality within 30 days of immunotherapy (checkpoint inhibitors) in metastatic cancer patients treated at Australian tertiary cancer center.
Authors: Mandaliya Hiren A. , Kim Sang , Quah Gaik Tin , Tun Min Sandy , Carlton James , Faulkner Jack , Oldmeadow Christopher , Mallesara Girish 
Published: May 2019

6600 Background: Cancer treatment has evolved rapidly since the advent of immunotherapy (checkpoint inhibitors). As compared to chemotherapy, immunotherapy is associated with a more favourable but distinct side effect profile. Mortality within 30 days of chemotherapy in cancer patients has been accepted as a clinical indicator of preventable harm and used as an auditing tool for clinical practice and improving quality of life. This should be investigated in the current era of immunotherapy, as it has been the standard treatment for advanced melanoma, lung cancer, renal cell cancer and others. Methods: We conducted a retrospective study on patients with advanced cancer treated with immunotherapy and died within 30 days of treatment. Clinical data on patients treated with immunotherapy at Calvary Mater Newcastle between 2006 and 2018 was collected. Data were compared with 30-day mortality statistics of chemotherapy. Results: A total of 601 metastatic cancer patients received immunotherapy agents (Pembrolizumab, Nivolumab, Ipilimumab, Atezolizumab, Tislelizumab and MSB0011359C) on 5022 occasions. Seventy-six (12.6%) patients died within 30 days of receiving immunotherapy. Median age was 68 years (35-90). Melanoma was the most prevalent cancer type (63%) followed by lung (20%). Forty-seven (47%) of patients received immunotherapy as first-line treatment and 39% as second-line. Patients died within 30 days received an average 2 (1-16) immunotherapy doses. A quarter of patients had ECOG 3 and ECOG 4 before last dose. Majority of deaths were related to disease (86%). Nearly 80% of patients died in hospital. One patient died due to treatment-related pneumonitis. In univariate analysis, there was no association between mortality and patients’ demographic variables such as age, sex, BMI, cancer type, ECOG performance status, immunotherapy agent and prior treatment. Conclusions: To our knowledge, this is the first ever real-world data on 30-day mortality after immunotherapy in advanced cancer. Thirty-day mortality rates were comparable to published data on patients treated with chemotherapy. Results emphasise significance of careful selection of advanced cancer patient for immunotherapy. Due to small sample size, the power to detect a significant association between patients demographics and survival is reduced.
Does the innovative 4R Cancer Care Delivery Model improve patient self-management in safety net and non-safety net centers?
Authors: Trosman Julia Rachel , Weldon Christine B. , Makower Della F. , Rapkin Bruce D. , Bozier Moreen , Knightly Eileen , Schaeffer Cathleen M. , Hoskins Kent , Gallagher Christopher , Lo Shelly S. , Grace-Louthen Cathy , Throckmorton Alyssa , Vanderwalde Lindi , Krueger Editha A. , Van Horn Jennifer , Schapira Lidia , Santa-Maria Cesar Augusto , Ravelo Arliene , Benson Al Bowen , Gradishar William John 
Published: May 2019

6601 Background: Under the NCI ASCO Teams Project, we proposed a 4R Model of teamwork and patient self-management (pSM) (Trosman JOP ’16). 4R (Right Info / Care / Patient / Time) enables patient (pt) and care team to manage complex care continuum with an innovative multimodality 4R Care Project Plan. 4R includes a novel “project” feature – a graphical description of care interdependencies. 4R was previously piloted at 3 Chicago centers (Trosman ASCO ‘18). Methods: In this new study, we improved and tested 4R for impact on pSM at 4 safety net and 3 non safety net centers across the US. 4R Plans were provided to stage 0-III breast cancer pts Jan - Nov’18 (4R cohort). We surveyed the 4R cohort and a historical control cohort of pts who received care at same centers pre-4R, Jan - Dec ’17. Results: Survey response rates: 65%, 105/162 (4R cohort); 44%, 190/432 (control). 4R markedly improved 4 of 5 pSM metrics vs control (Table). Additional analyses showed that safety net pts had a significant increase in 4R vs control cohort in “seldom overwhelmed” (84%, 49/58 vs 64%, 67/104 respectively, p = .007), while non safety net pts had nonsignificant increase. Other metrics improved to a similar extent for safety net vs non safety net pts. Within the 4R cohort, 85% found 4R useful in organizing their care and 73% found 4R’s novel “project” feature useful in understanding care interdependencies. Safety net pts reported similar usefulness of 4R in organizing their care as non safety net pts (88%, 51/58 vs 81%, 38/47, NS) and similar usefulness of the “project’ feature in understanding care interdependencies as non safety net pts (74% vs. 72%, NS). Conclusions: 4R significantly improved patient self-management, but further efforts are needed to expand the benefit to as close to a 100% of pts as feasible. Safety net pts benefited from 4R at similar or higher rates than non safety net pts, indicating that 4R may reduce care disparities. An expansion of 4R across the US continues this work. [Table: see text]
The impact of NCI-sponsored network group clinical trials on guideline care and new drug indications.
Authors: Unger Joseph M. , Nghiem Van T. , Hershman Dawn L. , Vaidya Riha , LeBlanc Michael Leo , Blanke Charles David 
Published: May 2019

6604 Background: National Cancer Institute Clinical Trial Network (NCTN) groups serve a vital role in identifying new antineoplastic regimens. However, the clinical impact of their trials has not been systematically examined. We analyzed the influence of network group cancer clinical trials on clinical guidelines and new drug approvals. Methods: We evaluated Phase III cancer clinical trials which the SWOG Cancer Research Network coordinated or participated in (1980-2017). Included trials were completed and its results published. A documented practice influential (DPI) trial was one with verified influence on National Comprehensive Cancer Network (NCCN) clinical guidelines (available starting in 1996) or on U.S. Food and Drug Administration (FDA)-approved package inserts. We estimated the rate of DPI trials overall and over time. The total federal investment supporting the set of trials was also determined based on public data. Results: In total, 182 trials comprising 148,028 patients were studied. We identified 79 DPI studies (43.4%); 73 influenced NCCN guidelines, 12 influenced new drug approvals, and 6 influenced both. The rate of DPI trials was 72.3% (47/65) among formally positive trials (i.e., achieved their protocol specified endpoint) and 27.4% (32/117) among negative trials. Thus 40.5% (32/79) of DPI trials were based on negative studies, half of which (16/32 = 50.0%) reaffirmed standard of care over experimental therapy. There were no differences between DPI and non-DPI trials in key study design characteristics. Total federal investment for the programs conducting the trials was $1.36 billion (USD2017), a rate of $7.5 million per trial, or $17.2 million per DPI trial. Conclusions: Nearly half of all phase III trials by one of the NCTN’s largest groups had documented practice influence on clinical care guidelines or new drug approvals. Even many negative trials impacted guideline recommendations. Compared to the costs of a new drug approval in pharmaceutical companies – typically estimated at > $1 billion – the amount invested by federal funders to provide this valuable evidence was modest. These findings highlight the major role of the NCTN’s clinical trial program in advancing oncology practice.
Survivorship care: Improving delivery of care plans for hematology patients at the Washington Cancer Institute (WCI).
Authors: Latif Hira , Beplat Maya , Singh Prabhjyot , Dilawari Asma Ali 
Published: May 2019

6605 Background: Cancer and long-term sequalae of its treatment impact the future health and psychosocial wellness of these survivors. ASCO guidelines recommend providing survivorship care to cancer patients who have completed treatment with curative intent. The Commission on Cancer (COC) recommends that survivorship care including treatment summaries be delivered to 50% of eligible patients. In our ASCO Quality Training Program project, we aimed to achieve this COC goal of 50% for the year 2018. Methods: Baseline data collected from Jan 1, 2016 to June 30, 2018 indicated that 33% of hematologic malignancy survivors at WCI received treatment summaries and survivorship care. For the year 2018, there were 11 survivors of hematologic malignancy, and 4 of them (36%) had received survivorship care prior to initiation of the project. We surveyed 12 providers to obtain data for perceived challenges to deliver survivorship care. Large volume of patients, lack of resources, no standardized process and high no-show rates were identified as the most important barriers. A bi-monthly survivorship clinic run by hematology/oncology fellows was initiated in September 2018 to address some of these barriers. Patient referral forms were mounted in the clinic work rooms to assist providers with identifying patients that qualify for survivorship; a pathway for referrals to the survivorship clinic was created and providers were informed about the clinic. Information flyers regarding survivorship care and the clinic were placed in the waiting room to increase awareness amongst patients. Results: By November 30, 2018, 63% of hematological cancer survivors received survivorship care and treatment summaries. Compared to the average from the preceding two years, survivorship care delivery increased by 30%. Conclusions: Our institution was able to meet the COC requirement by delivering survivorship care to 63% of survivors of hematological malignancies through the intervention from this quality improvement study. We intend to extend this process to other tumor types to increase the delivery of consolidated survivorship care at the WCI.
Impact of specialist palliative care delivered over three months prior to death on a colorectal cancer patient’s risk of experiencing aggressive end-of-life care.
Authors: Sinnarajah Aynharan , Earp Madalene , Cai Pin , Fong Andrew , Blacklaws Kelly , Karim Safiya , Cheung Winson Y. , Kerba Marc 
Published: May 2019

6614 Background: More patients are experiencing aggressive end-of-life (EOL) care. This is concerning as aggressive EOL care, on a population level, is associated with poor quality care. Specialist palliative care (PC) has been shown to help relieve EOL symptoms, improve patient quality of life, and reduce aggressive EOL care. This study aimed to estimate the impact of the timing of specialist PC, specifically PC delivered at least 3 months prior to death, on a colorectal cancer (CRC) patient’s risk experiencing aggressive care in the last 30 days of life. Methods: A population-based retrospective cohort study of adult patients who died from CRC in Alberta, Canada from 2011-2015. The Alberta Cancer Registry was used to identify the cohort, which was linked to healthcare resource use data in local, provincial, and national databases. Individuals who died < 30 days from CRC diagnosis were excluded. Patients who accessed any of the provinces specialist PC services were deemed exposed to specialist PC (includes PC consult team, intensive PC unit, palliative home care, hospice). Aggressive EOL care was defined as having experienced at least one of: hospital death, > 1 emergency department visit, > 1 hospital admission, > 14 days of hospitalization, ≥1 intensive care unit admission, ≥1 new chemotherapy program (or any treatment in the last 14 days of life). Logistic regression was used to model factors (specialist PC timing and clinical characteristics) associated with aggressive EOL care. Results: The cohort comprised 2979 patients. Most patients received specialist PC before death (58%); 60% had ≥1 indicator of aggressive EOL care. Relative to patients who received specialist PC > 3 months before death, patients who received specialist PC < 3 months before death were 1.5 times more likely to experience aggressive EOL care (CI: 1.2-1.9). Patients who received no specialist PC were 2.1 times more likely to experience aggressive EOL care (CI: 1.7-2.8). Short disease duration ( < 1 year from diagnosis to death), younger age at death, living in a rural area, and male sex, were also associated with higher odds of experiencing aggressive EOL care. Conclusions: Specialist PC delivered > 3 months before death reduces a CRC patient’s risk of experiencing aggressive EOL care over PC delivered < 3 months before death.
Evaluating the impact of telephonic nurse care management during high toxicity chemotherapy treatment.
Authors: Hunter Craig A , Krueger Andrew C , Soliman Omar A , Inman Angela S , Glenn Erika R , Johnson Kjel Andrew 
Published: May 2019

6623 Background: Care management is aimed at improving quality and cost of cancer care. To measure this we evaluated inpatient (IP) and emergency room (ER) admissions and costs of chemotherapy patients receiving versus not receiving telephonic nurse care management. Methods: 1,609 patients were studied over a 35 month period, of which 802 enrolled in a voluntary holistic telephonic nurse care management program. Patients were identified based on having been prescribed or initiating treatment with a high toxicity chemotherapy agent within the previous 60 days, following which notification was received from an oncology pathways intermediary. Nurse care managers engaged patients one or more times per month based on patient need, educating on side effects, pain management, where to seek care, and general well-being. IP and ER were measured during the 14 days following chemotherapy administration (Risk-Period) and compared to a baseline of all remaining patient claims history, excluding 28 days following chemotherapy administration (14 day Risk Period and 14 day washout period). Results: IP rates per 1,000 Risk Period Days for managed patients decreased during the 14 days following chemotherapy by 44% as compared to their baseline (3.02 v 5.39, p≤0.001), while non-managed patients increased by 29% (2.33 v 1.81, p=0.003). ER rates per 1,000 Risk Period Days were not significantly different for managed patients (2.72 v 2.35, p=0.188) and significantly increased by 117% for non-managed patients (2.34 v 1.08, p≤0.001). Baseline utilization for managed patients was more than twice the rate of non-managed patients, suggesting that a greater need for support may influence voluntary participation in care management. Conclusions: Telephonic nurse care management meaningfully reduced IP and ER admissions and their associated costs. [Table: see text]
Cost disparities with age in the treatment of advanced non-small cell lung cancer (NSCLC) in Ontario, Canada.
Authors: Wang Ying , Ellis Peter Michael , Pond Gregory Russell , Seow Hsien , Gafni Amiram 
Published: May 2019

6629 Background: Previous studies noted an association between age and cost of care in NSCLC. The drivers of these cost disparities have not yet been fully examined. We conducted a cost analysis study examining the differences in, and drivers of, costs of NSCLC care across age groups in Ontario, Canada. Methods: We conducted a retrospective cohort study of patients diagnosed in Ontario from Apr 1, 2007 to Mar 30, 2014, who received palliative chemotherapy for stage IV NSCLC. Variables of interest were extracted from registry data linked by the Institute for Clinical Evaluative Sciences (ICES). The mean total cost of care including systemic therapy and supportive care, was calculated in 2015 CAD dollars by fiscal year of diagnosis. Results: Of all NSCLC cases diagnosed in Ontario (n = 37,786), 17,203 (45.5%) were de novo stage IV, of which 29.7% of patients received any chemotherapy for their disease (n = 5,113), and 281 patients are presumed alive. In this population, median age was 65 to 69 years, 51.9% were male, 43.5% were adenocarcinomas, and 25.1% received second line chemotherapy. After adjusting for comorbidities, income, gender, year of diagnosis, and rural versus urban living, the average lifetime costs per patient remains significantly inversely related to age (p < 0.001). Belonging to the highest income quintile (p = 0.006) and being diagnosed in more recent years (p < 0.001) contributes significantly to increasing overall healthcare costs. Elderly patients (80+) cost less (71%) and have shorter survival time (HR of death 1.28, 95% C.I. 1.10 to 1.50) compared to younger patients (≤45 years old). Accounting for longer survival in younger patients, the youngest group still incur a higher cost per day alive than other age groups ($471/day in ≤45 group, $301/day in > 85 group). Hospitalization accounts for ~30% of total cost in both age groups. Chemotherapy accounts for 1% of total health care costs amongst the elderly (80+) age group and 10% of costs in ≤45 group. Conclusions: Our study shows that, despite everyone receiving systemic therapy in this patient population, younger patients incur significantly higher costs than elderly patients with advanced NSCLC, both before and after adjusting for survival. While hospitalization accounts for the biggest component of total costs, patients with high income and more recent years of diagnosis drive the higher costs of care, and chemotherapy remains a driver of higher costs amongst younger patients.
Clinical outcomes of patients with stage IV cancer receiving immune checkpoint inhibitors in the inpatient setting.
Authors: Durbin Sienna , Zubiri Leyre , Niemierko Andrzej , Petrillo Laura A , Bardia Aditya , Sullivan Ryan J. , McEwan Corey , Mulvey Therese Marie , Allen Ian Matthew , Lawrence Donald P. , Cohen Justine Vanessa , Hochberg Ephraim P. , Ryan David P. , Reynolds Kerry Lynn 
Published: May 2019

6634 Background: Immune checkpoint inhibitors (ICI) represent a major leap in the treatment of many cancers. Use has rapidly expanded in recent years, yet it is unknown whether hospitalized patients, who are often sicker than those who were studied in clinical trials, derive benefit from ICI. The primary objectives of this study were to characterize the clinical features and outcomes of inpatients receiving ICI at a single institution, and to identify predictors of survival. Methods: After IRB approval, we conducted a retrospective chart review of inpatients with Stage IV solid tumors receiving ICI between 2015 – 2018 at a tertiary care referral hospital. Patients receiving ICI on clinical trial were excluded. We examined the clinical characteristics, readmission rate, and post-discharge survival. We then conducted a Cox multivariable regression analysis to identify predictors of post-discharge survival. Results: A total of 103 patients with Stage IV solid tumors were treated with ICI as inpatients between 2015 – 2018. Average age was 57 years (range = 26 to 85); 57% were male; 27% had ECOG performance status (PS) 3-4; average Charlson Comorbidity Index score was 8.3. Most common tumor types were melanoma (35%) and lung (22%). Seventy-six percent began ICI as an inpatient and 24% received ICI as continuation of outpatient therapy. Seventeen percent experienced an immunotherapy related adverse event, most commonly colitis and pneumonitis. The 30 day readmission rate was 41%. The median post-discharge survival was 31 days; 47% of patients died during admission or within 30 days of discharge; 14% survived more than 6 months. Factors predictive of shorter post-discharge survival were PS of 3-4 relative to PS 0-2 (HR 2.0, p < 0.004), and lung cancer (HR 2.0, p < 0.024) and other tumor types (HR 2.1, p < 0.004) relative to melanoma. Conclusions: While the majority of inpatients receiving ICI died during admission or within 30 days of discharge, a subset of patients with stage IV disease were alive at 6 months. Tumor type and ECOG PS predict post-discharge survival and may be used to identify inpatients more likely to benefit from ICI. These novel findings, which are unique to a single institution, require additional validation.