bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do hospitals in a large metropolitan area utilize published breast cancer care practices and guidelines?
Authors: Tossas-Milligan Katherine Y. , Weldon Christine B. , Trosman Julia Rachel , Simon Melissa A. , Roggenkamp Betty , Gradishar William J. , Ansell David , Murphy Anne Marie 
Published: February 2017

151 Background: Insufficient utilization of guideline and evidence based care practices contribute to the cancer crisis (IOM 2013). We examined utilization of published breast cancer (BC) care practices and guidelines at hospitals in a large metropolitan area. Methods: IRB approved web survey of all 35 hospitals in a large metro area that provide BC treatment. Using guidelines/recommendations (NCCN, NAPBC, ADA, IOM) and peer-reviewed literature (62 studies) we developed a survey on BC care practices. Results analyzed by simple frequencies and Fisher's exact test. Results: Response rate: 91% (32/35 sites). Care practices, included in the table, are utilized by < 50% of sites. Radiation oncologist preoperative consults (53%, 8/15) and offering indicated pre-operative chemo* (67%, 10/15) are associated with 15 sites that have high volume (67+/year, Chen CS 2008) BC surgeons, compared to 17 sites without high volume BC surgeons (12%, 2/17) and (24%, 4/17) respectively, p=0.02, p=0.03. Indicated supportive services, such as a dental checkups (ADA 2008), are more likely at sites with patient-centered written treatment plans (IOM 2011) (58%, 7/12) than at sites without written treatment plans (10%, 2/20), p=0.006. Conclusions: Low utilization of published care practices and guidelines is concerning and requires attention. Other metro areas and regions should be examined as our findings indicate that patients may have limited local choices of care that is up-to-date on published guidelines and practices. [Table: see text]
Improving quality of care by obtaining patient-reported outcomes (PRO)-CTCAE chemotoxicities using tablet technology in daycare (DC) waiting rooms.
Authors: Wang Tian Qi , Brown Catherine , Vennettilli Ashlee , Wong Lauren , Zarrin Aein , Dobriyal Aditi , Chen Linda , Pat Vivien , Ho Anthea , Ho Valerie , Xin Cindy , Solomon Hannah , Irwin Margaret , Gonos Christina , Merali Zahra , Xu Wei , Howell Doris , Liu Geoffrey 
Published: February 2017

165 Background: In a busy chemo DC, any efficient means of tracking important chemotoxicities can improve quality of care. The study goal was to evaluate whether tablet technology available in a DC waiting room is able to capture prevalent and severe toxicities associated with chemotherapy using the patient reported outcome (PRO) - common toxicity criteria for adverse events (CTCAE). Methods: This cross-sectional PRO-CTCAE study of 160 adult solid/hematologic cancer outpatients of all stages, who were undergoing chemotherapy (CT), focused on common chemotoxicities captured using touchscreen tablets in the DC waiting room of Princess Margaret Cancer Centre (Toronto, CA). Individual health scores from the EQ-5D VAS tool and the prevalence of AEs experienced by cancer patients within the past seven days were captured. Symptoms that were listed as moderate to very severe were considered significant. Results: Across a wide range of tumours and patients on intravenous CT, the median age (range) was 56 (19-88) years; 38% were males.Patients reported a median (range) health score (100 = best health possible, 0 = worst) of 70 (4-100). The severity offiveprevalent, key side-effects of CT were tabulated (Table). 59% of patients felt their fatigue interfered significantly with their daily activities, and 30% felt decreased appetite interfered significantly. 32% experienced nausea occasionally to almost constantly. Conclusions: The common symptoms of CT were captured FEASIBLY, and found to be highly prevalent in this CT-treated population. Capturing additional symptom prevalence outside of the 7-day time frame may be important from a clinical standpoint. Administration of PRO-CTCAE instrument through tablet technology may be an excellent method to help collect such data systematically and reliably. Updated data on 300 patients will be presented at the meeting. [Table: see text]
Primary care provider (PCP) views on survivorship care plans (SCPs) generated by an electronic health record (EHR).
Authors: Tevaarwerk Amye , Donohue SarahMaria Hill , Buhr Kevin A , Hahn David , Sun Wenjun , Terhaar Abigail , Wiegmann Douglas , Sesto Mary E 
Published: February 2017

168 Background: SCPs may address inadequate provider-to-provider communication but PCP views regarding EHR-generated SCPs have not been assessed. A multiple choice survey was used to evaluate an EHR-generated SCP for appropriate content, length, perceived accuracy, need for updates and preferred method of delivery (the Clinican survEy of Care Plan [ChECkuP]). Methods: PCPs were recruited from the Wisconsin Research and Education Network (WREN), a cohort of family practitioners working in urban and rural Wisconsin. WREN practitioners were e-mailed and invited to participate if they currently saw patients with a breast cancer history. PCPs were provided a sample 10-page EHR-generated SCP and completed the ChECkuP at one time point. Results: 36 PCPs participated in Summer 2014. Most PCPs reported the sample EHR-generated SCP as accurate (75%), easy to use (58%) and useful in coordinating care (75%). Few felt using SCPs would disrupt their clinic workflow (11%) or that SCP use would take too much time (14%). Most (75%) preferred receiving SCPs via EHR, vs paper (36%), having the patient provide (19%) or viewing the SCP on an external website (6%). Most deemed consistent provision (69%) and standard location (78%) important. With regards to timing, 42% reported desiring an SCP immediately after completion of primary treatment. However, PCPs requested some changes: 33% requested a shorter SCP (ideally 1-3 pages) and 53% advocated for SCPs specifically written for PCPs rather than producing one document for both PCP and survivor. Also, most (53%) felt that SCPs should be updated based on information changes rather than on a regular schedule, including changes to screening guidelines (100%), late or long term side effects (89%) and followup recommendations (95%). Conclusions: PCPs regarded EHR-generated SCPs as useful in coordinating care between oncologists and primary care. PCPs desired a standardized SCP accessible within the EHR. EHR-generated SCP content, length and layout will be revised based on the feedback provided. Clinical trial information: OS12122.
Can we accurately identify chemotherapy-related acute care visits in administrative data?
Authors: Krzyzanowska Monika K. , Enright Katherine , Moineddin Rahim , Yun Lingsong , Ghannam Mohammed , Grunfeld Eva 
Published: February 2017

185 Background: Administrative data is increasingly being used to study treatment related complications that lead to acute care visits such as emergency department visits or hospitalizations (ED+H). We evaluated the accuracy of diagnosis codes for identifying chemotherapy related acute care visits (CRVs) among women with breast cancer. Methods: We prospectively developed algorithms to identify CRVs from administrative data in women receiving adjuvant chemotherapy for breast cancer in Ontario, Canada. Sensitivity (SN) and specificity (SP) were calculated for 3 scenarios: chemotherapy related ED visit, chemotherapy related H, and febrile neutropenia (FN) related visit using the chart as the gold standard. Since there is no specific diagnosis code for FN, three definitions of FN were considered: general (defined as fever or infection or neutropenia as main reason for visit), moderate (neutropenia as main reason for visit) or strict (fever or infection plus neutropenia). The population based cohort was generated by linking several health databases to identify women who had at least one ED+H during adjuvant chemotherapy for breast cancer between 2007-2009. The validation cohort consisted of 490 randomly selected cases from this cohort. Results: The population-based cohort consisted of 8,359 patients of whom 43.4% had at least one ED+H including 1,496 women who had multiple visits resulting in 6,293 unique ED+H. Of these, 73.1% were considered CRVs based on our algorithm. The algorithm performed well in identifying CRVs that included an H either from ED (SN 90%, SP 100%) or directly from home (SN 91%, SP 93%) but less well for ED visits that did not result in H (SN 65%, SP 80%). Depending on which FN algorithm was used, 1.4-24% of visits were considered FN related. The general FN algorithm had excellent SN regardless of whether the visit involved H (94-98%) but SP was moderate (66-80%). The strict FN algorithm had good SP (78-99%) but SN was highly variable (13-89%). The moderate FN algorithm provided the best tradeoff between SN (69-97%) and SP (76-98%). Conclusions: CRVs can be identified from administrative data with reasonable confidence, obviating the need for chart abstraction to evaluate chemotherapy related serious events.
Impact of care at NCI Comprehensive Cancer Centers (NCICCC) on cancer outcome: Results from a population-based study.
Authors: Wolfson Julie Anna , Sun Can-Lan , Kang Tongjun , Wyatt Laura , Hurria Arti , Bhatia Smita 
Published: February 2017

188 Background: Despite advances in therapy and supportive care, prognosis for certain cancers remains poor. Rigorous processes ensure quality of research, clinical care and education at NCICCC. However, impact of site of care on survival and access to NCICCC for vulnerable subpopulations (race/ethnicity, payor) remains unstudied. Methods: We constructed a population-based cohort of 53,618 patients diagnosed between 22y-65y with adult-onset cancers and reported to LA County cancer registry between 1998-2008. Geographic Information Systems (ArcGIS) was used for geospatial analysis. Results: Across multiple diagnoses, patients at NCICCC showed superior 5y overall survival (OS) as compared to those at community sites (Breast [n=31,770]: 89% vs. 86%, p<0.01; Lung [n=10,855]: 28% vs. 17%, p<0.01; Hepatobiliary [n=4,296]: 34% vs. 19%, p<0.01; Gastric [n=2,678] 32% vs. 22%, p<0.01; Pancreas [n=2,326]: 13% vs. 6%, p<0.01; Oral [n=1,838]: 68% vs. 59%, p=0.01). Adjusting for clinical (age, stage, gender) and sociodemographic (race/ ethnicity, payor, socioeconomic status [SES]) characteristics, multivariable Cox regression revealed an increased risk of mortality in patients receiving care at non-NCICCC sites: Breast: hazard ratio (HR)=1.2, p<0.01; Lung: HR=1.5, p<0.01; Hepatobiliary: HR=1.4, p<0.01; Gastric: HR=1.4, p<0.01; Pancreas (n=2,326), HR=1.5, p<0.01; Oral: HR=1.3, p=0.05. Overall 7% of patients were seen at NCICCC (range 4-16%, p<0.01). Multivariable logistic regression adjusting for clinical characteristics revealed that low SES (OR range across diagnoses: 0.4-0.5, p<0.01), public (OR 0.4-0.9, p<0.03) or no (OR 0.1-0.7, p<0.04) insurance, African-American race (OR 0.4-0.6, p<0.03) or Hispanic ethnicity (OR 0.5-0.7, p<0.02), and residing > 9 miles from nearest NCICCC (OR 0.5-0.9, p<0.01) decreased likelihood of care at NCICCC. Conclusions: Population-based data reveal superior OS among adult-onset cancer patients receiving care at NCICCC. Patients without private insurance, from low SES, African-American and Hispanic backgrounds or living more than 9 miles from an NCICCC, are less likely to use NCICCC. Barriers to care at NCICCC are currently being explored.
Medicare Part D low-income subsidy and disparities in breast cancer treatment.
Authors: Biggers Alana , Neuner Joan , Smith Elizabeth , Charlson John A. , Pezzin Liliana , Laud Purushottam 
Published: February 2017

2 Background: Breast cancer outcomes are worse among black than white women, but the role of income and out-of-pocket costs (OOPCs) in these disparities is understudied. The Medicare D program provided medication insurance for older women and also included a low-income subsidy (LIS) which eliminated or reduced OOPCs among women with low assets and limited income (based on federal poverty level). We examined differences in adherence to HT by race/ethnicity among a Medicare D population, hypothesizing that LIS might reduce racial disparities in HT adherence. Methods: With data collected from a national sample of women enrolled in Medicare Parts A, B, and D, we identified Medicare Part D enrollees ≥65 years diagnosed with breast cancer who underwent mastectomy or breast conserving surgery in 2006-07 and received either tamoxifen or an AI (anastrozole, letrozole, or exemestane) within one year of surgery. Nonadherence rates (medication possession rate of >0.80) were calculated by race and LIS status for each year after first fill up through December 2011. The association of race with HT adherence was examined in unadjusted Chi-square analyses and in regression models adjusted for age, comorbidity, chemotherapy use, and zip code level- income and education. All models utilized GEE to account for within-patient clustering. Results: Among a sample of 23,299 women (50.6% age 65-74, 40.9% age 75-84), 27.2% received LIS. LIS (but not AI use) varied substantially by race, so that 20.6% of white women and 69.7% of black women received the subsidy. In the first year of therapy, differences in adherence by race were statistically significant, but small (64.2% for white, 63.2% for black and 66.7% for Hispanic). Adherence dropped during years 2-3 of the study, but reductions were much smaller among LIS recipients. Results were confirmed in adjusted models. Conclusions: Enrollment in the Medicare D LIS was high among black and Hispanic breast cancer patients, and disparities in adherence to breast cancer HT among these women were small and remained so over three years. Our study offers important information about the role of medication subsidies and SES in adherence, and suggests their potential to reduce the breast cancer outcomes gap by race.
The role of nursing in obtaining a three-generation familial cancer history intake tool (FCHT) and the care of patients with hereditary gastrointestinal syndromes.
Authors: Fontes-Borts Lucia , Safran Howard , Perez Kimberly 
Published: February 2017

216 Background: Of patients diagnosed with colorectal cancer, 5-10% of all cancers are associated with hereditary cancer syndromes. Since hereditary gastrointestinal cancer syndromes convey a markedly increased risk for developing cancer, identification of affected families is important. Studies have found that clinicians are unlikely to adequately or routinely collect family history information on their patients. This study assessed the implementation of a validated three-generation family history intake tool by an advanced practiced nurse practitioner (APNP) and the impact on clinical practice at a mid-size academic affiliated Medical Oncology practice. Methods: From September 2013 to January 2014, 100 patients with the diagnosis of colorectal cancer were assessed after a clinic session with a physician by an APNP. The APNP utilized a validated 3 - generation family history tool. Information regarding age, sex, education, annual income, family ethnicity, diet, exercise and previous genetic testing was also collected. Data collected was then analyzed to assess risk of hereditary syndrome. A chart review of the patients was performed to analyze microsatellite instability testing and prior genetic counseling referrals. Results: Of the 100 screened, 93 patients were evaluable. There were 52 males: 39 female participants with a median age of 60.71 years (range 28-90). The implementation of FCHT was associated with an increase in identification of individuals at risk; 16 (17.2%) patients reported a diagnosis of CRC at age less than 50. The rate of referrals for genetic evaluation tripled after the implementation of the FCHT (6.5% to 16.3%). Of the 17 referred, five had been referred prior to implementation of the FCHT. Conclusions: Institution of a separate session with an APNP to assess family history resulted in a 3-fold increase in rates of detection of patients with high risk for hereditary cancer syndromes associated with colorectal cancer.This study demonstrates that APNP’s are well positioned to promote preventative health by engaging in family history intake and genetic assessment referral.
Quality and value-focused albumin-bound paclitaxel decision support for pancreatic, lung, and breast cancer in southeastern United States.
Authors: Baranwal Anmol , Hrushesky William J. , Huff Dinah Faith Q. , Shimp William S. , Mamgain Avinash , Fishman Marc L. , Bobolts Laura Rose , Schorer Anna E. , Kogler Jurgen , Davis Sharon , Armitage Melissa , Bennett Charles L. 
Published: February 2017

246 Background: Albumin-bound paclitaxel is FDA approved as single agent for breast cancer, in combination with carboplatin for non-small cell lung cancer (NSCLC), and with gemcitabine for pancreatic cancer. Oncology Analytics (OA) is a cancer care decision support group comprised of board-certified oncologists, interacting with more than 2,800 cancer doctors in the Southeastern U.S. We have been making oncologists aware of comparative efficacy data, and the relative values of albumin-bound paclitaxel vs other taxanes. We hypothesized our work has impacted albumin-bound paclitaxel use in these diagnoses with improved cost effective care and value enhancement. Methods: We analyzed all albumin-bound paclitaxel requests for FDA approved indications from April 2013 to June 2014. Requests withdrawn by the treating oncologist after OA consultation were compared with albumin-bound paclitaxel persistence over these five consecutive quarters. Financial outcomes of voluntary oncologist withdrawal of albumin-bound paclitaxel-based therapy in favor of another taxane were calculated as per standard Medicare reimbursement rates. Results: Over the entire 15 month span, we received a total of 265 evaluable albumin-bound paclitaxel requests, on a total of 181 patients. Ninety-two percent (155/168) of requests for albumin-bound paclitaxel with gemcitabine in pancreatic cancer were automatically approved by Oncology Analytics’ web based software. One third each of the requests for breast cancer (12/37, 32.43%) and NSCLC (21/60, 35%) were withdrawn by the requesting MD after OA consultation. Changing albumin-bound paclitaxel to another taxane reduced pharmaceutical costs by approximately $1,124,115 for these 15 months, or $74,941.00 monthly. Conclusions: When paclitaxel or docetaxel are safe and effective alternatives to albumin-bound paclitaxel, OA consultation enhances cancer care quality and value.
Augmentation of cancer outcomes through safe transitions.
Authors: Hiremath Adarsh , Manzano Joanna-Grace , Halm Josiah , Farroni Jeff 
Published: February 2017

250 Background: Policymakers have identified 30-day readmissions as an important quality indicator of poor care or coordination of care. Among cancer centers, there is no benchmark data in terms of readmission rates or recommendations in terms of risk adjustment models. Methods: Retrospective data analysis to estimate baseline readmission rate and identify risk factors. Interventions: (1)admitting to single floor, (2) twice weekly interdisciplinary meetings with using risk assessment tool–Cancer Outcomes Augmented through Safe Transitions (COAST) tool, and (3) re-evaluate readmission rate post intervention at 6 months and 1 year. Results: Unplanned readmission rate on the Hospitalist Service at MD Anderson was 21.5% at baseline. After 6 months of interventions, our readmission rate over 6 months was 23.3%. Age 45-65, having Medicare insurance, and being discharged to hospice were protective of a readmission. Distant metastases and having more comorbidities were associated with increased risk for readmission. Readmitted patients have a greater length of stay (7 days) and a higher average cost of inpatient stay ($20.3K vs. 17.9K). The median days to readmission was 11 days. Top comorbidities: hypertension, fluid and electrolyte disorders, anemia, diabetes mellitus, and abnormal weight loss. Top reasons: metastatic disease, biliary tract disease, GI hemorrhage, intestinal obstruction, septicemia, renal failure. Conclusions: Our project has provided insight into the rates and risk factors for readmission in oncology hospitalist service in a tertiary cancer center. The development of web-based COAST risk assessment tool is expected to give an improved understanding of our patient population. Although our readmission rates have not shown decrease over the 6 months after our interventions, this means that more interventions and more time may be necessary to impact readmission rates of services dealing with complex cancer patients. Additionally, a proportion of these unplanned readmissions in cancer patients may not be preventable. Benchmark data we have presented and that we continue to collect will help inform recommendations for effective transitions of care, patient safety practices as well as strategies for reducing readmission rates in cancer centers.
Improving the safe delivery of systemic treatment by assessing concordance with labeling guidelines.
Authors: Vu Kathy , Simanovski Vicky , Kaizer Leonard , Green Esther , Hertz Sherrie , Rae Erin , Krzyzanowska Monika K. , Ahmad Noor 
Published: February 2017

257 Background: Improper labeling of medication may lead to errors. In 2009, Cancer Care Ontario published Key Components of Chemotherapy Labeling, with recommendations for the necessary components and formatting of intravenous chemotherapy labels. A jurisdiction-wide evaluation for concordance occurred in 2011. Results were shared, improvement efforts were supported through a provincial quality network, and a re-evaluation was conducted in the fall of 2013. Methods: Three defined chemotherapy labels were evaluated at baseline and after improvement strategies were implemented at each of Ontario’s 77 hospitals providing systemic treatment. Labels were reviewed centrally and awarded points for concordance for each of 15 guideline-specified criteria. Results: The provincial average overall score for concordance increased from 59% to 80% (p<0.001). Improvement was seen for 12 of the 15 criteria evaluated and for 64 of the 77 facilities. The greatest increase in overall score by a facility was 53.4%. The greatest overall improvement in score for an individual component was 67% (TALLman lettering). The scores of 2 components were unchanged, as 100% concordance was achieved on both the baseline and re-evaluation. Conclusions: Improvement in concordance to chemotherapy labeling guidelines was observed following the implementation of a measurement strategy and improvement plans. This approach is one component of a larger strategy to promote a culture of safety in chemotherapy delivery in Ontario. [Table: see text]