bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recall and uptake of survivorship care plan recommendations.
Authors: Salner Andrew L. , Walker Deborah , Seltzer Amanda , Panzer SarahLena , Stricker Carrie , Dornelas Ellen A 
Published: February 2017

67 Background: Despite the growing delivery of survivorship care plans (SCPs), little research has examined survivors’ recall and adoption of SCP recommendations, including those based on patient-reported symptoms and concerns. Methods: 65 stage 0-III breast cancer survivors participated in this pilot project. Patients completed an electronic patient-reported outcomes (ePRO) survey prior to a visit with a nurse practitioner, who delivered a tailored SCP generated by the Carevive Care Planning System (CPS) using evidence-based algorithms driven by ePRO and diagnosis/treatment data. Approximately 6 weeks later, patients completed a survey to evaluate their recall and any corresponding action taken. Actual SCP recommendations were extracted from the Carevive CPS database and matched to follow-up surveys to determine recall accuracy. Results: Data were analyzed for 35 patients completing follow-up surveys to date. SCPs contained an average of 22.2 recommendations per patient, almost half (n = 10.7) for active symptoms/supportive care issues. Recommendations were broken down into 3 groups 1) Surveillance, 2) Prevention, and 3) Intervention; see table below for select results. Of note, lymphedema-related recommendations were recalled accurately more often (p = 0.005) by those with symptoms vs. those advised on prevention. Conclusions: Incorporating an ePRO survey into SCP delivery enables tailoring to patient needs and concerns, which may in turn enhance recall and follow through given saliency. Patients tended to recall more accurately SCP recommendations for active or more severe symptoms. Additional research is needed to maximize retention and follow through on SCP recommendations. [Table: see text]
Implementing survivorship care planning in a large integrated cancer program.
Authors: Cairo Jamie , Huibregtse Carol , Ferry Adam , Weese James L. 
Published: February 2017

69 Background: Aurora Health Care is comprised of 15 hospitals and 22 oncology clinics. Aurora Cancer Care (ACC), a Commission on Cancer (CoC) accredited program, diagnoses and treats 7,000 adult cancer patients annually, more than any other healthcare system in Wisconsin. The CoC’s Survivorship Standard 3.3 requires accredited cancer programs to provide cancer patients with survivorship counseling and a written care plan. ACC was challenged to develop a consistent model of survivorship care that can work at multiple sites across the system. Methods: Workflow planning and education began at all oncology clinics in fourth quarter of 2014. Thirteen disease specific survivorship care plan templates were built into the EMR with some-auto population functionality. A system wide delivery plan was launched in first quarter of 2015 with the goal of targeting 10% of eligible patients. Initial focus was on breast cancer patients with some sites also including other cancers. The model of survivorship care is an “embedded consultation” in medical or surgical oncology with an advanced practice provider (APP) completing the care plan and meeting with the patient at the end of first line treatment. Results: Initial required volumes were estimated based on 2013 registry data with a goal of completing approximately 700 care plans in 2015 to meet the 10% CoC standard. During Q1 & Q2 of 2015, 444 care plans were generated and given to patients, mostly for breast cancer survivors. The most significant barrier surrounded retrieving data from the EMR. Conclusions: Data from the first half of 2015 demonstrates success with the approach. Aurora Cancer Care will exceed the benchmark of 700 care plans. There has been a high level of engagement with the APPs who have taken ownership of survivorship care planning, contributing to the success of the program thus far. Because of difficulty retrieving data from the EMR, manual tracking was still required. Future modifications will address this and other barriers.
Advanced practice providers and survivorship care plans.
Authors: Mikan Sabrina Q. , Carter Patricia , Patt Debra A. 
Published: February 2017

70 Background: The American College of Surgeons mandate in 2012 challenged organizations to create and develop quality survivorship care programs. The NCCN and Commission on Cancer set the standard for quality psychosocial care recognizing distress as part of the cancer continuum. In order to meet this challenge, community cancer care organizations are incorporating delivery of survivorship and psychosocial care into the Advanced Practice Provider (APP) role. APPs include Physician Assistants (PAs) and Advanced Practice Nurses (APNs). We describe the development and feasibility testing of an APP-led survivorship program in a large network of community oncology practices. Methods: A descriptive study design was used with ten practices participating in the implementation of a structured APP-led survivorship program. The goals of each survivorship visit were to: review recommendations for care and healthy lifestyle behaviors, review surveillance recommendations, and to reconnect patients with their primary care providers. Nineteen APPs in the study site practices offered survivorship management between October 2012 and May 2015 to female breast and colon cancers at all stages. Results: Study sites used structured process maps to identify and refer patients to survivorship visits. Evaluations of additional referral strategies are ongoing. Participating APPs reported high self-efficacy in delivering survivorship care plans and high patient satisfaction following visits. All female breast or colon cancer patients, regardless of stage at diagnosis, attended the appointment and received a complete care plan based upon the ASCO Survivorship Care Plan. Surveillance education was provided specific to diagnosis utilizing the NCCN guidelines delivering person-centered care. Visits lasted an average of 60 minutes and were billable as counseling and coordination. Conclusions: Patients diagnosed with breast or colon cancer make up the largest majority of cancer survivors. This project reveals that an APP-led survivorship program is feasible and can help to meet the ASCO and NCCN challenge of providing survivorship care to this large population.
Do nurse-navigated TSSCPs improve treatment and follow up compliance in underserved populations?
Authors: Manoukian Camille , Altamirano Maria , Ashing Kimlin Tan , Callahan Ann Falor , Sun Virginia , Sudan Nimit , Lai Lily L. 
Published: February 2017

72 Background: Multiple cancer organizations advocate for the use of treatment summaries and survivorship care plans (TSSCPs) in cancer patients. To better quantify the benefits of a nurse-navigated, culturally and linguistically responsive TSSCP in underserved breast cancer patients, we compared rates of compliance with treatment and follow up in 26 patients who were treated with TSSCPs to 38 similar controls who were treated without TSSCPs. Methods: We prospectively enrolled 26 consecutive, newly-diagnosed breast cancer patients who were given nurse-navigated TSSCPs under an IRB-approved protocol. At their first clinic visit, a trained nurse educated and assisted the patient in the use and completion of the TSSCP. Nurse-navigated TSSCPs were completed at each subsequent visit through 12 months of surveillance. Rates of compliance with treatment and follow up guidelines were compared to 38 similar control patients using a two group Fisher’s exact chi-square test. Statistical significance was set at p-value < 0.05. Results: All patients were treated under Medicaid insurance and 47% were racial and/or ethnic minorities. Time from diagnosis to treatment and time from initial clinic visit to treatment were similar across groups. The rate of compliance with first treatment recommendations was 96% (25/26) in the TSSCP group compared to 79% (30/38) in the non-TSSCP group (p = 0.07). The number of patients compliant with all follow up visits was similar: 22/25 (88%) of TSSCP patients and 22/30 (73%) in non-TSSCP patients (p = 0.31). Of the recommended total follow up appointments, 6/67 in the TSSCP group and 25/120 in the no TSSCP group were “no shows” (p = 0.04). Conclusions: Although the use of nurse-navigated TSSCPs may not improve time to treatment in medically underserved patients, adherence to first treatment recommendations and follow up appointment attendance shows some improvement in patients who participate in nurse-navigated TSSCPs. Further study is needed to fully assess the role of nurse-navigated TSSCPs in improving treatment and surveillance compliance rates and how these rates impact clinical outcomes. Acknowledgement: Funded by a Community Grant from the Los Angeles County Affiliate of Susan G. Komen.
Impact of an inpatient palliative consultation in terminally ill cancer patients.
Authors: Vegunta Radha Krishna Rao , Blue Brandon Jamal , Fernandes Hermina Deepika , Upadhyayula Satya , Burhanna Patricia , Rodin Miriam B. , Poddar Nishant 
Published: February 2017

77 Background: Terminally ill cancer patients have complex medical and psychosocial needs at the end of life. Given these complexities, limited data is available to suggest the appropriate timing of palliative care involvement in the treatment of cancer. Our study aims to describe the referral patterns of inpatient palliative care consultations in advanced cancer patients in a tertiary care center. Methods: A retrospective review was performed. Inpatient palliative consultation was obtained in cancer patients from January 1, 2014 to December 31, 2014. Descriptive statistics are used in data analysis. Results: Inpatient palliative care consults (IPCC) were obtained for 245 cancer patients admitted to Saint Louis University Hospital. Of the 245, 130 were male (53.06%), 115 were female (46.93%), 128 were White (52.24%), and 114 were Black (46.53%). Newly diagnosed patients with cancer during the current admission were 79(32.24%). 57 (23.26%) patients were admitted to the Intensive care unit during hospitalization. A total of 39(15.91%) patients died in the hospital; among those who died in the hospital 34 had ICU stay during the hospitalization or died in the ICU (87%). Malignancies most common were lung 71(28.97%) followed by pancreatic-biliary 33(13.4%), lymphoma and leukemia 22(8.9%), hepatocellular carcinoma 18(7.34%), head and neck 16 (6.5%), and upper GI 16 (6.5%). Disposition at discharge included home hospice 67 (28.3%), hospice in facility 27(11%), home without hospice 71(28.9%), facility without hospice 39(15.9%). Conclusions: According to the National Hospice and Palliative Care Organization as of 2013, 7.0% hospice patients die in acute care hospitals. Our data shows 15.9% who received IPCC died in the hospital with 87% dying in ICU. This is likely due to delays in the initiation of palliative care consultation as outpatient leading to increase strain on tertiary referral centers. In another study 22% of eligible Black patients received IPCC. Our rate of IPCC in Blacks was 46.5%. This highlights the disparity in access to outpatient palliative care in this population. Future efforts should be made to promote early outpatient palliative services to reduce ICU admissions, hospital re-admissions and healthcare costs.
Telephonic assesment of consumer satisfaction of telephonic case management of cancer patients.
Authors: Rossof Arthur H. , Rosen Michael W. , Lindholm Melissa , Schumacker Pam , Richards Diane 
Published: February 2017

80 Background: Feedback provided by customers/consumers has become an established means of assessing the quality of goods and services. The Optum division of UnitedHealth Group maintains two telephonic case management programs for cancer patients to support quality and cost effective care: Cancer Resource Services (CRS) and the Cancer Support Program (CSP). In each case, the purpose of the telephonic intervention is to provide support, education, and, when appropriate, steerage to one of our contracted Centers of Excellence (COEs). Methods: In this report, we provide satisfaction data collected during 2014 from surviving patients whose cases were closed or reached their 1-year anniversary in these case management programs. These telephonic surveys were conducted by a contracted third party. Results: For CRS, 363 members were contacted and surveys were completed; for CSP, 400 were contacted and completed. Average age was 61 (CRS) and 57 years (CSP). 61% were women. Sixty-two % of the CRS patients were treated at a COE as were 59% of the CSP patients. For CRS members, 90% experienced a positive health care experience (satisfied or very satisfied); for CSP, 94%. Quality of life was improved in 51% for CRS and 65% for CSP. For all four of these measures, there was a statistically significant (p < 0.05) improvement compared with the survey data from 2013. There was 96% overall satisfaction with the program for both CRS and CSP, while overall satisfaction with the nurse/case manager was 96% (CRS) and 98% (CSP). 96% (CRS) and 94% (CSP) are likely to recommend these services to others while 97% and 91% are likely to use these services again if needed. Positive comments outweighed suggestions for improvement. The most common suggestion for improvement was to expand the availability of these services. Conclusions: We conclude that our members with cancer are benefiting from the experience of telephonic case management by our experienced oncology nurse/case managers who are, in turn, assisted by our associated staff of social workers and medical directors.
Approach to offering remote support to mesothelioma patients: The Mesothelioma Survivor Project.
Authors: Bates Gleneara Elizabeth , Bressler Toby , Hashmi Anisah Khurshid , Hesdorffer Mary , Taub Robert N. 
Published: February 2017

82 Background: From the moment of diagnosis, malignant mesothelioma (MM), decreases health-related quality-of-life (QOL) in patients and their caregivers. In addition to symptoms of disease, aggressive treatments such as surgery, radiation, and chemotherapy can cause extreme side effects – specifically, chemotherapy is associated with chronic fatigue, unremitting nausea, vomiting, and systemic pain. These side effects of treatments can be burdensome enough to lead to noncompliance or outright refusal of continuation of care.[1] Data from 13 frequently cited QOL studies focus on chest pain and shortness of breath as the two chief symptoms of pleural mesothelioma. The largest QOL study to date enrolled 495 patients, evaluated MM using the LCSS (lung cancer symptom scale). Investigators reported MM’s most common symptoms as: fatigue (94%), dyspnea (89%), loss of appetite (86%), chest pain (85%), cough (75%), and hemoptysis (24%). In addition, mesothelioma has a number of emotional consequences. A study by the British Lung Foundation (BLF) reported significant impairment of emotional function and/or emotional state in patients with mesothelioma and their family members.[2] Methods: The platform for the support group was remote, consisting of both online and telephone domains. Participants would utilize both online and phone systems during sessions, held once a week for a total of 6 weeks. Sessions were guided and kept closed, available only to those affected by mesothelioma. Participants completed surveys after each support group. Session summaries and follow-up information were provided online after support meetings. Results: Using a 0-5 Likert Scale, consistent attendees reported support groups as very helpful (4). Irregular attendees had mixed feelings ranging from extremely helpful (5) to neutral (3). 80% of attendees participated in support groups prior to ours. Conclusions: Active participation in a guided and closed support group allowed participants to share their experiences and concerns about their diagnoses, comfortably – supporting transition beyond active-treatment. The online portion of the platform was helpful in assuaging common negative concerns.
Exploring patient-provider communication about cancer survivorship care in community-dwelling survivors.
Authors: Palos Guadalupe R. , Gilmore Katherine Ramsey , Lewis-Patterson Paula A. , Chapman Patricia , Rodriguez Maria Alma 
Published: February 2017

86 Background: Patient-provider communication about survivorship care and care plans is a core tenet of quality cancer care. Our objective was to examine gaps in communication about maintaining health, importance of follow-up care, and unmet information needs in community-based survivors. Methods: A convenience sample of adult survivors attending a community-based cancer survivorship conference were eligible to take this survey. Consenting adult survivors completed a self-administered survey with selected questions from the NCI Follow-Up Care Use among Survivors Survey. Participants were informed that survey completion was voluntary and confidential. Descriptive statistics were used to summarize and analyze data. Results: 284 surveys were distributed and 169 surveys returned, resulting in a response rate of 59.5%. After excluding Spanish-language surveys and respondents not diagnosed with cancer, 109 surveys were included in this sub-analysis. Most survivors were female (77.7%), college-educated (86.1%), married (58.4%) and diagnosed with breast cancer (47.5%). Over half (55.5%) reported experiencing pain that interfered with their daily routine yet, 83.2% reported being in good to excellent health. The primary reason for receiving follow-up care was to check for recurrence (66.2%). Most survivors (78.5%) reported having no to some patient-provider discussions about the late effects associated their treatment. 47.6% reported not receiving information about a written care summary from their provider, 94.8% would have liked to have received a written summary, and 73.1% preferred more information about the benefits of a personalized care plan. Survivors also reported in the past 2 years, their providers did not discuss topics related to emotional concerns (35.3%), alcohol consumption (35.1%) and types of foods to eat (33.8%). Survivors wanted more information on self-management techniques such as how to improve energy (83.2%), manage fatigue (72.9%), or improve sleep (69.3%) Conclusions: Our findings highlight the need for further examination on the impact of inadequate patient-provider communication on survivors’ outcomes and providers’ practice.
Sexual health inquiry preferences among gynecologic cancer patients after radiation therapy.
Authors: Heath Gerard Edward , Fairchild Pamela , Berger Mitchell , Tolpadi Anagha , Chapman Christina , Jolly Shruti 
Published: February 2017

87 Background: Following radiation therapy (RT), gynecologic oncology patients report high rates of sexual dysfunction. However, little is known regarding communication of sexual health among these patients and their healthcare providers. The aim of this study was to assess the beliefs/attitudes of patients regarding sexual history taking. Methods: Survey results were obtained from 75 women who presented for follow up care for gynecologic cancers in the radiation oncology department. The surveys assessed patient beliefs about sexual health and its impact on overall quality of life, the role practitioners should play in obtaining an accurate sexual history, and preferences and level of embarrassment regarding sexual history collection. Overall level of sexual functioning was assessed using the Female Sexual Function Index (FSFI). Chi-squared tests were used to analyze categorical variables and logistic regression modeling was used to predict agreement with survey statements. Results: Most subjects were white and married with a mean FSFI score of 9.9 [(SD = 10.3) sexual dysfunction is defined as < 26.5]. 78.7% agreed that sexual function is an important component of overall health, and only 12.0% reported embarrassment about discussing their sexual health with healthcare providers. 62.79% agreed that medical providers should take a sexual history on a regular basis. However, 58.7% and 22.7% of women report never or almost never being asked about their sexual health by their primary care physician or Ob/Gyn, respectively. Approximately two-thirds of women expressed a preference to have a female provider obtain their sexual health history. Conclusions: Gynecologic cancer patients s/p RT report low sexual function scores. A majority agree that sexual function is essential to overall health. They report little embarrassment regarding discussions of sexual health, yet, note limited discussion about the topic with their healthcare providers. This work highlights the need for improvements in communication about sexual health. We suggest that healthcare providers caring for women with gynecologic cancers should more regularly inquire about their patients’ sexual health and function.
Education practices in prostate cancer: A comparison of patient and caregiver experiences.
Authors: Allen John Clayton , Du Liping , Ahmed Ivy A , Morgans Alicia Katherine 
Published: February 2017

88 Background: Evidence suggests that greater knowledge of an illness is associated with better health outcomes, and interventions that enhance disease-specific knowledge can improve these outcomes. Information needs among prostate cancer survivors and their caregivers are incompletely described. We assessed information needs and practices among men with prostate cancer and prostate cancer caregivers at the time of diagnosis. Methods: Using the online “Prostate Cancer Education Survey” performed by prostate cancer non-profit ZERO completed 2013-2014, we evaluated 824 patients with prostate cancer and 168 prostate cancer caregivers to determine information needs regarding prostate cancer. We used Pearson chi-squared tests and multivariable logistic regression models to determine educational needs and experiences among patients and caregivers, and their association with clinical and sociodemographic factors. Results: Among 824 patients and 168 caregivers describing information received at diagnosis, statistically significantly fewer caregivers reported receiving information as compared with patients (79% of patients vs 71% of caregivers; p = 0.002). Among 543 patients and 98 caregivers who reported receiving information, patients were more likely to report that the information was more useful, and caregivers were more likely to report that the information was less useful on a five-point usefulness scale (p = 0.05). Only time since diagnosis was significantly associated with report of receipt of educational material at diagnosis for both patients and caregivers (p < .001) in multivariable regressions. Conclusions: Although most patients and caregivers report receiving prostate cancer information when diagnosed, caregivers report this less frequently, and more frequently report that it was not useful. Efforts to address this disparity should further investigate the information needs of prostate cancer caregivers to provide them with more consistent and useful information.