bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ensuring evidence-based cancer medicine by influencing prescribing behavior.
Authors: Hrushesky William J. , Huff Dinah , Davis Sharon , Bobolts Laura Rose , Fishman Marc L. , Shimp William S. , Kogler Jurgen Wilhelm , Fishman Val , Walton Robert 
Published: February 2017

212 Background: Oncology Analytics, Inc. (OA) promotes evidence-based, guidelines-compliant cancer therapeutic decision-making on behalf of healthcare payers. The OA web-based 1,300 protocol treatment request system screens several hundred applications each month. Evidence-based requests are automatically approvable within seconds (Auto); those needing medical director (MD) review, within hours (Non-Auto). Some 10% of all requests require real-time consultation between OA board-certified medical oncologists/hematologists and the prescribing cancer specialist. Three-quarters of these non-compliant residual requests are rescinded by the treating oncologist. The remainder are either approved because of additional information while about 1% are recommended for an adverse determination. Methods: We hypothesize that OA’s presence in a cancer market gradually improves the likelihood of evidence-based oncologist prescribing behavior. We tested this over 44 consecutive months of rapid growth, from May 2009 through December 2012, within a single southeastern US market. Since Auto requests are evidence- and guidelines-based, and Non-Auto requests are either not supported by evidence or have evidence support but with less toxic or less costly alternatives available, we reasoned that any sustained directional change in the ratio of Auto to Non-Auto represents a characteristic change in cancer specialist behavior over that span. The monthly ratios of Auto to Non-Auto were analyzed for trends by least squares and the slopes of each were contrasted by ANCOVA. Results: During the first six months, Auto-processed requests approximately equaled Non-Auto-processed request numbers, for a baseline ratio of one. Over the next 38 months, this ratio rose to approximately 1.4, meaning that 40% more requests were eventually approved automatically each month than those requiring MD review. The slopes of this relationship between Auto and Non-Auto approvals are statistically distinct (F = 43.34; p<0.001). Conclusions: This progressive quality improvement reflects malleability of cancer doctor prescribing behavior, results in substantial savings, occurs quickly, persists and grows over time.
Improving the care of acute lymphocytic leukemia (ALL) at a large county hospital.
Authors: Karuturi Meghan Sri , Yorio Jeffrey Thomas , Titus Annie , Pharr Stephenie Jeanette , Rieber Alyssa G. 
Published: February 2017

213 Background: The treatment of ALL involves complex chemotherapy regimens that are difficult to deliver to underserved populations. Lyndon B. Johnson General Hospital (LBJGH) provides care to uninsured and underinsured patients in Harris County, the third largest county in the United States. Our goal is to achieve 80% adherence to National Comprehensive Cancer Network guidelines in the care of newly diagnosed ALL patients at LBJGH. Methods: The charts of 14 patients with newly diagnosed ALL were reviewed. Demographics, initial work-up (e.g., bone marrow biopsy and aspirate), type of treatment, adherence to scheduled treatment, use of supportive medications, outpatient follow-up, stem cell transplant referral and quality of provider documentation were collected. Areas of potential improvement were then identified using provider focus groups and Ishikowa Diagram. The project was approved by the MD Anderson Quality Improvement Assessment Board. Results: 12/14 patients were evaluable, having received their full course of care at LBJGH. The median age was 35, 9/12 (75%) were female and 9/12 (75%) were Hispanic. 6/11 (55%) cases expressed CD20 (CD20+) and 3/11 (27%) were Philadelphia chromosome positive (Ph+). All 12 patients received induction and consolidation therapy with the HyperCVAD regimen (cyclophosphamide/vincristine/doxorubicin/dexamethasone alternating with high-dose methotrexate/cytarabine). Bone marrow biopsy at time of diagnosis, use of a tyrosine kinase inhibitor for Ph+ ALL, and use of supportive medications occurred >80% of the time. Administration of outpatient chemotherapy, use of rituximab for CD20+ ALL, outpatient lab follow-up, intrathecal chemotherapy and appropriate referral for allogeneic transplant occurred 50-80% of the time. Provider documentation was appropriate <50% of the time. Conclusions: Based on these findings, we established a standard algorithm of care for ALL patients at LBJGH, enhanced provider education through the design and distribution of teaching tools, created a checklist to facilitate handoffs between providers and established expectations for documentation. In the future, we would also like to add a patient navigator to further improve coordination of care.
Leveraging the strengths of an academic health system to improve community cancer care.
Authors: Harse Kay M. , Wolf Terri P. 
Published: February 2017

218 Background: To improve community cancer care quality, UC Davis Health System formed the UC Davis Cancer Care Network (CCN) to partner with select cancer centers in California to offer leading-edge care close to home. Hospital-based community cancer centers become affiliates of the UC Davis CCN through an evaluation process led by UC Davis. By synergizing the strengths of an academic health system and community-based oncology care, the network formalizes the commitment to collaboration with community providers. Methods: This quality model relies on a central university-based team interacting with affiliate sites to support them in their local missions. Affiliates progress through three phases of development of their cancer program. Each phase adds layers of quality to the organization. CCN staff members coordinate the phases: 1) Review and Develop Operations—site specific structures needed to be a comprehensive community cancer center; 2) Make Connections—within the network and the local community; 3) Become Self-Directed—identifying own needs and direction. The partnership attributes include: joint marketing, system synergies, certification assistance, coordinated service line development, dedicated personnel resources, on-site educational opportunities, and quality oversight. Results: Performance measurement includes: local market share, ACOS accreditation, adherence to national quality and patient satisfaction standards, assessment of community health needs and benefits, and enhancement of local capabilities (inpatient oncology unit, radiation, pathology, radiology, and surgical oncology services). Conclusions: This model demonstrates the benefit of partnering the strengths of an academic health system and community cancer programs to provide quality care.
Timely management of febrile neutropenia in children with cancer.
Authors: Vedi Aditi , Cohn Richard Jules , Pennington Victoria , O'Meara Matthew , Stark Kylie , Hunstead Paul , Londal Wendy , Adnum Kirsten , Senner Anne , Maurice Lucy , James Alan 
Published: February 2017

220 Background: Sepsis is a major cause of morbidity and mortality in pediatric oncology patients, particularly during periods of neutropenia, which is a well-recognized complication of immunosuppressive therapy. The current international standard of care is recognized as rapid assessment and delivery of empiric antibiotics within one hour of onset of fever for all febrile and potentially neutropenic patients. Although pediatric oncology services are centralized to tertiary hospitals in Australia, peripheral referral centres regularly provide essential supportive care for this immunosuppressed group of patients close to home in a “shared-care” model. The objective of this study was to ensure delivery of empiric antibiotics to all children with fever and suspected neutropenia within one hour of presentation to tertiary and peripheral hospitals. Methods: The records of all oncology patients presenting to an emergency department over a 3-month period were reviewed and time to first antibiotic administration recorded. Potential causes of delay in commencement of antibiotics were identified through focus groups and a questionnaires involving patients, medical and nursing staff. These were evaluated to develop an algorithmic management guideline using current available consensus data, and the introduction of the practice change was supported by staff education. Follow-up data was collected at 12 and 60 months post intervention at the tertiary and peripheral hospitals. Results: The median time to empiric antibiotics was reduced from 180 minutes to 75 minutes at 12 months post intervention, and the results were sustained at 5 years, with the median time being 65 minutes. Conclusions: The introduction of the guideline has resulted in an improvement in practice, meeting international standards and sustained results at 5 years at both tertiary and peripheral hospitals. [Table: see text]
Enhancing your culture of safety and quality through practice accreditation.
Authors: Sinicki James , Heron Dwight Earl , Huq M. Saiful , Koen Martha , Bednarz Greg 
Published: February 2017

227 Background: To strengthen the culture of quality and safety in an NCI-designated, multi-institution radiation oncology network by obtaining accreditation. Methods: Accreditation was sought by our geographic diverse, but integrated cancer center network made up of 20 radiation oncology sites. Accreditation standards were reviewed and compared to the current practices in place. Each site was internally audited for compliance to these measures and a process of education for any noncompliance instances. After submitting the application for accreditation, the process began with data collection from all locations, which included staffing levels, services provided, treatment and physics equipment used, beam data, as well as numerous pieces of documentation for quality reports and regulatory documents. Patient data was then submitted from each location for physician peer review followed by an onsite visit by a physicist and administrator. Results: After several internal site visits and respective multidisciplinary meetings with site physicists and managers, all locations underwent a thorough evaluation by an accrediting body. This third party found the quality and safety of the organization to meet the minimum standards set forth. All 20 sites were therefore given the stamp of approval and accredited. Conclusions: Preparing for accreditation and going through this process greatly strengthened each of our sites’ culture of safety and quality. It enabled all of our locations to do an in depth self-evaluation as a form of self regulation and continuous quality improvement. It was an opportunity to ensure that we not only had the appropriate quality practices in place, but could show through documentation that we, in fact, were a quality organization. The lessons we have learned from this experience can be used as a model for individual and network sites to pursue practice accreditation in an era of increasing emphasis on safety and quality in radiation oncology.
Hepatitis B reactivation in patients with lymphoma: A meta-analysis.
Authors: Mozessohn Lee , Chan Kelvin K. , Feld Jordan J. , Hicks Lisa K. 
Published: February 2017

228 Background: Patients with hepatitis B virus (HBV) who are HBsAg+ are at risk of HBV reactivation if rituximab is administered in the absence of antiviral treatment. Recently, it has been reported that patients with so-called “resolved HBV infection”(HBsAg-/cAb+) may also be at risk; however, the degree of risk is not known. Methods: We performed a systematic review of the English and Chinese language literature in Medline (1996 to June week 3 2013) and Embase (1996 to 2013 week 26) using the MeSH terms “lymphoma” and “hepatitis B”. Eligible studies were limited to those reporting primary data on HBV reactivation rates in HBsAg-/cAb+ patients receiving rituximab. We excluded case series with less than 5 patients. Pooled estimates were calculated for HBV reactivation and the impact of HBsAb status on HBV reactivation rate was explored. We also examined reactivation in HBsAg+ patients receiving rituximab by performing a systematic review of the English language literature in PubMed (1997 to June 21, 2013) using the terms “hepatitis B virus”, “reactivation” and “lymphoma”. Results: Data from 550 HBsAg-/cAb+ patients in 12 studies were included. Using a standardized definition of HBV reactivation, (increase in HBV DNA from baseline or HBsAg seroreversion +/- ALT >3 x upper limit of normal), the pooled estimate for the risk of HBV reactivation in HBsAg-/cAb+ patients was 8.1% (I2 = 55%, P = 0.007). Significant heterogeneity was apparent. Exploratory analyses suggested that patients were less likely to reactivate if they were HBsAb+ (OR = 0.32; 95% CI 0.12-0.85, P = 0.0285). In HBsAg+ patients we meta-analyzed prospective, controlled studies. Without antiviral prophylaxis, the reactivation rate for HBsAg+ lymphoma patients was 51.0% (I2 = 0%, P = 0.93). Conclusions: Our meta-analyses confirm that there is a risk of HBV reactivation in HBsAg-/cAb+ patients exposed to rituximab. HBsAb+ patients may be at lower risk than those who are HBsAb-. However, heterogeneity in the risk estimates limits their generalizability. Without prophylaxis, significant reactivation in HBsAg+ patients exists. Large prospective studies are needed to clarify the risk of HBV reactivation in HBsAg-/cAb+ patients and to inform decisions about best practice.
Complementary and alternative medicine and other health behaviors.
Authors: Graham Donna M. , Espin-Garcia Osvaldo , Brown Catherine , Halytskyy Oleksandr , Mahler Mary , Pringle Dan , Eng Lawson , Niu Chongya , Lam Christine , Charow Rebecca , Villeneuve Jodie , Shani Ravi M. , Tiessen Kyoko , Howell Doris , Jones Jennifer M. , Alibhai Shabbir M.H. , Xu Wei , Liu Geoffrey 
Published: February 2017

23 Background: Complementary and alternative medicine (CAM) use in patients with cancer has increased. A patient’s decision to seek CAM alongside conventional cancer treatment is complex. We evaluated whether patients who sought CAM were also more likely to engage in other healthy behaviours such as exercise, smoking cessation, alcohol reduction, and maintaining a healthy weight. Methods: As part of a larger survey of cancer survivors, 551 cancer patients across Princess Margaret Cancer Centre (Canada) were queried on clinico-demographic information, their use of CAM and other health-related behaviors (smoking, alcohol use, healthy weight, etc.). Multivariable logistic regression assessed each health behavior, adjusting for clinical factors associated with CAM use. Results: Females: 53%; median age: 54 years; Caucasian: 83%. Primary tumor sites: breast/gynecologic 22%; gastrointestinal/genitourinary 28%; hematologic 23%; lung/head and neck 12%. Following their cancer diagnosis, 43% used CAM. Being female (odds ratio=2.55, 95% CI [1.8-3.7], having higher education (2.08 [1.4-3.1]) or higher income (1.80 [1.2-2.7]), and having breast/gynaecological cancers (vs. all others; 2.82 [1.8-4.3]) were associated with greater CAM use. These factors served as adjustment variables for the analysis of behaviors. Behaviors associated with increased use of CAM included: use of CAM prior to diagnosis (10.6 [6.5-17.2]), participation in support groups (3.39 [2.1-5.6]), not being overweight or obese one year prior to diagnosis (1.82 [1.2-2.7]), and meeting Canadian physical activity guidelines either before diagnosis (1.80 [1.2-2.8]) or currently (1.70 [1.0-2.8]). No association was observed between CAM use and smoking status or cessation, alcohol intake or reduction, self-described diet habits prior to cancer diagnosis or dietary changes after diagnosis. Conclusions: Some behaviors such as baseline and current physical activity, participation in support groups, not being overweight, and prior use of CAM were each associated with greater CAM use. Smoking, alcohol and diet were not associated with CAM use. Improved understanding of the reasons for CAM use can an improve patient-physician communication, decision-making, and treatment planning.
Assessment of knowledge of vincristine toxicities in outpatient pediatric hematology/oncology nurses: An educational intervention.
Authors: Tishler David , Isenalumhe Leidy , Khazal Sajad , Mushrif Sujata , Rushing Teresa 
Published: February 2017

231 Background: Vincristine (VCR) is a chemotherapeutic agent with a unique neurological side effect profile and is integral to the treatment of many pediatric hematological and solid malignancies. Side effects requiring VCR dose modification include peripheral neuropathies, intestinal ileus, cranial nerve abnormalities, hyponatremia and seizures. In our institution, orders for weekly VCR are written in advance by oncologists and administered by outpatient nurses independent of a provider physical examination. We sought to increase knowledge of VCR toxicities and improve pre-chemotherapy evaluation skills among outpatient Hematology/Oncology (Hem/Onc) nurses. Methods: A 23-question written quiz was given as a pre-test to 14 outpatient Hem/Onc nurses to assess their fund of knowledge regarding VCR toxicities. An educational intervention was then provided to the cohort as a lecture by a Hem/Onc fellow physician. The lecture was followed by the same quiz given as post-test to the nurses. Individual participant and group scores were tabulated comparing pre and post-test responses to assess improvement in identification and recognition of VCR toxicities. Results: 12/14 nurses demonstrated improvement in their fund of knowledge regarding VCR side effects (mean change in individual scores + 4.7). As a group, mean scores increased from 15.2 to 18/23 (the two-sample paired t-test was significant with a two-tailed p<0.005). Conclusions: An educational intervention significantly improved outpatient Hem/Onc nurses fund of knowledge regarding identification and evaluation of VCR toxicities. Future objectives include follow-up evaluation of retention of knowledge of VCR side effects and incorporating a VCR toxicity checklist into the electronic medical record outpatient nursing note.
Use of the Internet to connect radiation oncologists and medical oncologists with disease site-specific experts: 3-year outcomes of chartrounds.com.
Authors: Hardenbergh Patricia H. , Gehl Brigitta , Lyons-Mitchell Kimberly Anne 
Published: February 2017

241 Background: The purpose of this project is to improve the quality of cancer care by connecting disease site-specific experts with community oncologists through web-based technology. Methods: Chartrounds.com is a conferencing web-site developed to allow community oncologists to present real cases to disease site specialists in oncology on a scheduled basis. Chartrounds was developed initially for radiation oncologists and subsequently has expanded to include multidisciplinary tumor boards and medical oncology specific sessions. Presently 43 disease site expert oncologists including surgeons, medical oncologists and radiation oncologists from 38 academic institutions in the US host sessions. Feedback reports following the completion of each session were designed to assess the impact of the project. Results: Since its inception in December 2010, 43 disease site-specialists have lead 366 sessions, connecting 3,793 participating oncologists from all 50 US states and 24 countries.Broken down by specialty, 348 radiation oncology sessions have linked 3,632 participants, 14 medical oncology specific and multidisciplinary tumor board sessions have included 161 participants. On a 5 point Likert scale with 5 representing the greatest possible impact, the mean response to feedback questions is as follows: session quality: 4.7 for radiation oncology, 4.6 for multidisciplinary; time used effectively: 4.6 for radiation oncology, 4.5 for multidisciplinary; discussions relevant to daily practice: 4.6 for radiation oncology, 4.6 for multidisciplinary; session is likely to result in a change of practice: 4.0 for radiation oncology, 4.0 for multidisciplinary. Chartrounds sessions qualify for 1 CME credit and is approved for a practice quality improvement project by the American Board of Radiology. Conclusions: Chartrounds.com is impacting oncology practices which results in changes in community practice. Future directions of this project include providing chartrounds sessions for oncology nurses and providing a library of video recorded archived sessions. This work has been funded by the Improving Cancer Care Grant of the ASCO Conquer Cancer Foundation.
Adherence (adh) to and beliefs about oral anticancer medications (OAMs) in patients (pts) with metastatic renal cell carcinoma (mRCC).
Authors: Geynisman Daniel M. , Hlubocky Fay J. , Kocherginsky Masha , Stadler Walter Michael , Daugherty Christopher 
Published: February 2017

25 Background: Suboptimal adh to drugs is a problem in chronic diseases. In mRCC, OAMs are the mainstay of treatment (tx). Adh and its determinants in exclusively mRCC pts has not been studied in the US. This study aimed to evaluate adh to OAMs in mRCC pts, and describe pts understanding and beliefs about OAMs and their disease. Methods: Cross-sectional study of pts on OAMs for at least 60 days. Standardized assessment instruments used: Adh—MMAS-8 questionnaire (Q); beliefs and expectations regarding OAMs—Beliefs about Medicines Q (BMQ) and Brief-Illness Perception Q (IPQ); Quality of Life (QOL)—BSI-18, FKSI. Semi-structured interviews assessed financial burden, barriers to adh, understanding of prognosis and goals of therapy. Results: 52 pts interviewed with median age 65 (range 36-90), 73% male, 71% Caucasian, 40% college graduates. OAMs used: 38% sunitinib, 31% pazopanib, 21% everolimus, 8% axitinib. 1st line OAM tx: 46%; 2nd line tx: 33%; 3rd or beyond: 21%. MMAS-8: 10% low adheres, 25% intermediate, 65% high. Income: 35%<40K, 24%=40-60K, 41%>60K. Adh decreased as income increased across the 3 income levels from 82% to 67% to 45% (P=0.02). 13% reported financial difficulty paying for OAMs; 19% had ≥ $100/mo (0-500) out-of-pocket (OOP) cost. BMQ-N: 20 ± 4 (8-25); BMQ-C: 12 ± 4 (5-24). IPQ: 40 ± 12 (6-71). QOL: BSI 9 ± 8 (0-38); FKSI 43 ± 8 (21-60). No significant difference between adherers and non-adherers in regard to demographic, QOL, OOP costs or belief variables was noted. 29% reported not receiving counseling on taking OAMs. 59% believed mRCC is a chronic disease, 41% believed that their OAM can cure them and strongly agreed or agreed with “I expect to be free of cancer in the future.” 48% reported discussing prognosis with their MD. Conclusions: Self-reported adh to OAMs in mRCC is much better than in other chronic diseases, but not ideal. Surprisingly, adherence was negatively associated with income. Many pts felt mRCC was a chronic disease and over 40% believed they could be cured. Further research is needed addressing the development of an oncology-specific adh tool and defining an optimal adh benchmark for OAMs via prospective studies of self-reported adh, serum drug levels, and outcomes.