bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the utility of a patient-reported screener question to detect fatigue symptoms: Improving the quality of systematic symptom measurement in clinical practice.
Authors: Tomasini Pascale , Brown Catherine , Vennettilli Ashlee , Zarrin Aein , Dobriyal Aditi , Chen Linda , Mirshams Maryam , Patel Deval , Irwin Margaret , Ho Valerie , Ho Anthea , Pat Vivien , Solomon Hannah , Thai Henry , Mahler Mary , Xu Wei , Howell Doris , Liu Geoffrey 
Published: February 2017

236 Background: In Ontario, there is a concerted effort to screen all cancer outpatients for clinically significant symptoms at every visit, without causing undue burden on the patient. Although fatigue symptoms are common in cancer patients, severe fatigue may require clinical intervention. To reduce reporting fatigue, we evaluated the use of a single item screener question to detect severe fatigue, as defined through the FACT-Fatigue Scale (FACT-F), with the goal of reducing patient reporting burden. Methods: 316 Princess Margaret Cancer Centre outpatients across a wide range of cancers at all phases of therapies and disease stages were asked to report fatigue symptoms using the FACT-F. The ability of one screener question “I feel fatigued” to detect severe fatigue symptoms in any of the six other fatigue-related questions was evaluated. Using the presence of any severe fatigue symptom as the reference, sensitivity (Se) and specificity (Sp) of the screener question was determined. Results: Median age was 59 (19-91) years; 45% were male. The prevalence of significant, severe fatigue-related symptoms for the six individual questions covering various fatigue domains ranged from 4% to 7%. 12% of patients exhibited at least one severe symptom on FACT-F (prevalence). Defining a positive screen as “quite a bit” or “very much” fatigued, with 16% prevalence, the screener question was able to correctly identify any severe symptom 81% of the time (Se) and was able to rule out any severe symptoms 92% of the time (Sp). Conclusions: The use of a screener question to accurately detect patient symptoms provide patients with the ability to be involved in their care without being overly burdened in the process. At the meeting we will provide updated results on 500 patients, the potential modifying role of clinico-demographic factors, and results of the performance two additional screener questions on fatigue. While patient-reported outcomes are widely used in research, they may also be a practical and acceptable means to accurately detect clinically important symptoms in the clinic.
Unplanned visits to hospital emergency for oropharynx patients undergoing radiation therapy in Ontario.
Authors: Gutierrez Eric , Foster Nicoda , Lockhart Elizabeth , Comrie Rebecca , Stiff Jennifer , Anas Rebecca , Warde Padraig Richard 
Published: February 2017

267 Background: Radiation therapy (RT) with or without concurrent chemotherapy is the standard of care for patients with oropharyngeal cancer. The acute toxicity of treatment is well recognized and highlights the need for a multidisciplinary approach to management. In 2009, a Head and Neck Organizational Guideline was published by Cancer Care Ontario (CCO) which emphasizes the need for a multidisciplinary team approach of surgical, medical and radiation oncologists; supportive care professionals, including speech language pathologists, dieticians, social workers; and others to support the care of this population. In order to assess the availability of appropriate supportive care for this patient group, the percentage of patients who visited an Emergency Department (ED) during their course of RT and the causes for these visits were assessed. Methods: Patients with a diagnosis of oropharyngeal cancer receiving radical RT in Ontario (10 Cancer Centres) between the period of April 1, 2011 and March 31, 2013 were identified from CCO’s Activity Level Reporting ( ALR ) database. These patients were then linked to the National Ambulatory Care Reporting System ( NACRS ) administrative dataset from the Canadian Institute for Health Information ( CIHI ) which allowed identification of patients that visited ED during their course of RT as well the reasons for the visits. Data on the use of concurrent chemotherapy was not available. Results: Over the two year period, 885 patients in Ontario had radical RT (+ concurrent chemotherapy) for oropharyngeal cancer of which 261 (29.5%) visited an ED at least once during their treatment (range of 22% to 36% across the 10 centres). The main reasons for the ED visits were dehydration and neutropenia, although coding for reason of visit was incomplete in 16% of cases. Conclusions: The high proportion of patients attending an ED while receiving daily RT would suggest that the supportive care needs of this population are not being regularly met. Further work is necessary to understand the reasons for ED visits in this group of patients and the substantial variation seen between centres would suggest this metric may be useful as a new quality of care indicator.
Clinical pathways and quality metrics.
Authors: Ellis Peter G. , Lokay Kathleen 
Published: February 2017

273 Background: UPMC CancerCenter (UPMC) participates in a number of nationally recognized quality programs and strives to maximize quality through continuous improvement of the quality measures endorsed by these programs. Clinical pathways are potential aid in driving quality improvement through decision support and measurement. Methods: When deficiencies are identified, UPMC’s quality team develops improvement strategies including working with its pathways vendor (Via Oncology) on the placement of key decision support prompts and required data fields within its physician-facing pathways portal. Gaps in data completeness have also been identified as an opportunity to use pathways for more complete data collection during chart abstraction as well as interim reporting. Results: Due to the success above, UPMC continues to actively engage with pathways as a tool to drive adherence to and capture complete data for quality measures. If release of the UPMC data is approved by the quality measurement organization(s), UPMC will share the results of its quality measures in the full poster. Conclusions: Pathways are a tool for promoting adherence to quality measures by oncologists through the use of a point of care decision support system. Pathways are also a source of reporting quality measures across all patients in time period which allows for interim measurements and proactive identification of improvement areas. [Table: see text]
Monitoring treatment wait times for cancer patients in Japan.
Authors: Watanabe Yukiko , Iwamoto Momoko , Higashi Takahiro 
Published: February 2017

289 Background: Treatment wait times for cancer patients is among the key performance indicators of cancer policy in Japan, but has never been measured across a large number of patients. We aimed to measure treatment wait times for cancer patients across a large number of hospitals in Japan using health claims data. Methods: We developed a database of claims data (Jan 2011 - Dec 2012) linked to 2011 hospital-based cancer registry data of breast, cervical, colorectal, liver, lung, prostate and stomach cancer patients from 126 designated cancer hospitals in Japan. Treatment wait time was defined as the number of days between the date of diagnosis (the date on which a pathological test or imaging exam that contributed the most to the diagnosis was performed) and initiation of treatment. Dates of diagnostic tests, therapeutic procedures, and chemotherapy (chemo) administration were obtained from health claims data. We calculated wait times by cancer type, treatment, and stage, and investigated if these factors were significantly associated with wait times even after adjusting for age using multiple linear regression. Results: Among 44,102 cancer patients who received cancer treatment, the median wait time was 31 days (IQR=18-50) for all patients, and 32, 42, 31, 22, 22, 55 and 31 days for breast, cervical, colon, liver, lung, prostate and stomach cancer patients, respectively. Wait times were longer for surgery (36 days) compared to radiation (22 days) and chemo (21 days), and shorter for later stage patients: 48, 36, 35, 23, and 14 days for stages 0, I, II, III, and IV, respectively. Cancer type, treatment type, and stages were all independently and significantly associated with treatment wait times even after adjusting for age (p<0.05). Conclusions: This is the first study to investigate treatment wait times across a large number of cancer hospitals in Japan. Treatment wait times were particularly longer for cervical and prostate cancer patients. While the effect of prolonged treatment wait times on clinical outcomes is unknown, longer treatment wait time increases the psychosocial stresses of cancer patients. Continuous monitoring and feedback of study findings to hospitals are required for improvements in the future.
Eribulin treatment patterns in patients with and without prior anthracycline use.
Authors: McBride Ali , Faria Claudio , Li Xuan , Powers Annette 
Published: February 2017

292 Background: Eribulin mesylate is indicated for patients with metastatic breast cancer after treatment with ≥2 prior chemotherapeutic regimens for metastatic disease. Prior therapy should have included an anthracycline and a taxane. Evidence examining the effects of prior exposure to anthracyclines on eribulin therapy is limited. The purpose of this study was to compare demographic characteristics and treatment patterns for anthracycline-experienced patients vs. anthracycline-naïve patients treated with eribulin. Methods: A retrospective analysis using electronic medical record (EMR) data from 1/1/08 to 3/1/14 was conducted. Chemotherapy drugs were identified by the treatment name field in the EMR. Index date was defined as the first eribulin treatment. Patients with ≥2 eribulin administrations, continuous eligibility including a 6 month pre-period prior to the index date, and no treatment gaps more than 6 months were included. Patients were stratified into an anthracycline experienced cohort (treated prior to eribulin therapy) or without anthracycline cohort (never treated with this drug class prior to eribulin therapy). Demographics (gender, age, receptor status) and treatment characteristics (number and days of eribulin therapy) were compared between the cohorts. Results: 190 patients received eribulin; 46 (24%) with prior anthracycline use, 144 (76%) without. The majority of patients were female (87% for prior anthracycline, 97% without), and the average age of both groups was 59 yrs. Most patients were HR+/HER2- (56% overall; 70% for prior anthracycline, 51% for without), followed by TNBC (29% overall; 24% prior anthracycline, 31% without). Some patients had been treated previously with trastuzumab (15% overall; 7% for prior anthracycline, 17% for without). The number of eribulin administrations did not differ significantly between cohorts (8.2 administrations for anthracycline vs. 9.6 without, p=0.268). Likewise the number of days of therapy did not differ significantly (88.1 days for prior anthracycline vs. 104 without, p=0.369). Conclusions: There was no significant difference detected for prior anthracycline use impacting the number of eribulin administrations or days of therapy.
Comparative effectiveness of first-line chemotherapies in advanced non-small cell lung cancer.
Authors: Chang Jennifer T. , Spence Michele M. , Hui Rita L. , Schottinger Joanne E. , Rashid Nazia , Millares Mirta 
Published: February 2017

293 Background: There is a variety of chemotherapy regimens used as first-line treatment in advanced non-small cell lung cancer (NSCLC). Few studies have used real-world data to compare the clinical outcomes associated with different chemotherapy combinations. The study objective was to compare overall survival between chemotherapy regimens used for patients with advanced NSCLC in an integrated healthcare system. Methods: This retrospective cohort analysis included patients age 18 or older from Northern and Southern California Kaiser Permanente with a diagnosis of Stage IIIB/IV NSCLC identified in the cancer registry. First chemotherapy date occurred from January 2008 through September 2012 with at least 6 months of follow up to March 31, 2013. Overall survival was measured as the number of months from initial chemotherapy until death, end of enrollment or March 31, 2013. Chemotherapy regimens were categorized into five mutually exclusive groups: pemetrexed-based, pemetrexed + bevacizumab, bevacizumab-based, platinum doublets and singlets. Survival was compared between the five groups using Cox proportional hazard models, adjusting for age, gender, race, region, stage, histology, days from diagnosis to initial chemotherapy and Diagnostic Cost Group (DxCG) risk score. The analysis was performed for all age groups and by age over and under 65. Results: Among 1,989 adults, those that received singlet chemotherapy were at significantly increased risk of mortality compared to doublets (HR 1.23; 95% CI 1.02-1.49). Patients younger than 65 who had received pemetrexed + bevacizumab regimens were at significantly reduced risk of mortality (HR 0.58; 95% CI 0.35-0.95) when compared to platinum doublets. Among patients over 65, there were no significant differences in survival between the chemotherapy regimens. Conclusions: Adult patients with advanced NSCLC who are younger than 65 years old have improved survival after receiving pemetrexed + bevacizumab chemotherapy regimens compared to platinum doublet regimens. No survival differences were found between regimens in patients over the age of 65.
Treatment sequencing patterns of novel agents in patients with prostate cancer.
Authors: Malangone Elisabetta , Foley Kathleen A. , Wilson Kathleen , Varker Helen , Binder Alison , McKenzie R. Scott , Ellis Lorie 
Published: February 2017

296 Background: The National Comprehensive Cancer Network (NCCN) guidelines recommend chemotherapy, immunotherapy or anti-androgen therapies for the treatment of advanced castration-resistant prostate cancer (CRPC). This study evaluated treatment sequencing of recently approved agents for CRPC [abiraterone (ABI), enzalutamide (ENZ), docetaxel (DOC), cabazitaxel (CAB), or sipuleucel-T (SIP)] among men with PC. Methods: This retrospective, observational study evaluated adult men with PC in the MarketScan Oncology EMR database, which includes data from over 900 contributing oncologists from over 100 community practices. Inclusion required a diagnosis of PC (ICD-9-CM diagnosis code 185) from 07/01/2011-03/31/2014, no treatment with ABI, ENZ, DOC, CAB, or SIP prior to 09/01/2012, no other primary cancers, and six months of medical record history prior to index date. The index date was the date of first prescription of ABI, ENZ, DOC, CAB or SIP between 09/01/2012 and 03/31/2014. First-, second- and subsequent-line treatments were evaluated prior to end of data availability or end of study. Results: In total, 812 PC patients were identified; mean age was 75 years and 68% had recorded metastasis. A single line of therapy was observed for 544 patients (67%). ABI was the most common first-line treatment (443; 55%), followed by DOC (167; 21%), ENZ (113; 14%), SIP (82; 10%) and CAB (7; 1%). A second line of therapy occurred in 268 patients (33%) and third line in 8%. The table below describes first-line and the two most common second-line therapies for those moving on to second-line. Conclusions: Of the five agents of interest, ABI was the most commonly prescribed first-line medication for advanced PC in this patient cohort. First-line DOC was more common than first-line CAB or SIP. Further studies with longer follow-up and other treatments are warranted. [Table: see text]
Understanding variation in the timeliness of diagnosis of cancer in symptomatic patients.
Authors: Lyratzopoulos Georgios 
Published: February 2017

301 Background: Diagnosing cancer promptly in symptomatic patients is a priority for healthcare systems worldwide, but little is known about how initiatives can be targeted to patients at greater risk. Methods: UK data on the number of consultations with a family doctor before specialist referral (‘pre-referral consultations’); the time interval from presentation to referral (‘primary care interval’); and stage at diagnosis, were analysed using multivariable regression models. Results: Both patient experience (41,299 patients, 24 cancers) and clinical audit (13,031 patients, 18 cancers) data indicated wide variation in two correlated measures* of the difficulty of suspecting the diagnosis of cancer once the patient had presented to their family doctor. For example, >30% of patients with multiple myeloma, pancreatic and lung cancer experienced three or more pre-referral consultations; in contrast, this was true for <10% of patients with breast cancer and melanoma (p<0.001). Adjusting for diagnostic case-mix, younger and ethnic minority patients, and women, were more likely to experience three or more pre-referral consultations. Data from 88,657 patients (10 cancers) suggested socio-demographic disparities in stage at diagnosis for some only cancers: For patients with melanoma, breast and endometrial cancer, lower socioeconomic status was associated with higher risk of advanced stage at diagnosis and for, these three cancers, the same was true for older age. Conclusions: Different diagnostic intervals vary widely by cancer diagnosis and patient characteristics. Notable disparities in stage at diagnosis are apparent for ‘easy-to-suspect’ cancers (which are associated with minimal delay post-presentation), strongly implicating psychosocial patient factors as the source of these disparities. These findings can help to appropriately target early diagnosis policy initiatives and future research to patients at greater risk of prolonged diagnostic intervals. *Number of pre-referral consultations with a primary care physician and length of primary care interval (Spearman’s r=0.70).
Hospital size and demographics associated with HCAHPS and implications for hospital value-based purchasing (HVBP).
Authors: McFarland Daniel Curtis , Ornstein Katherine , Holcombe Randall F. 
Published: February 2017

38 Background: Hospital Consumer Assessments of Healthcare Providers and Systems (HCAHPS) scores appear to be lower in densely populated areas and for urban academic medical centers (AMC). These patient satisfaction scores contribute to CMS reimbursement. We hypothesized that demographics and hospital factors such as size were significant determinants of HCAHPS. Methods: HCAHPS, hospital bed, and county demographics were obtained from the Hospital Compare, American Hospital Directory, and US Census Bureau websites, respectively. An aggregate positive score was created for each hospital. Multivariate regression modeling was performed for the aggregate positive score and all ten dimensions of HCAHPS. Standardized partial regression coefficients were used to assess strengths of postulated predictors (Table). A predictive formula based on the 4 strongest predictors was developed. An adjustment model corrected for demographic and hospital factors. Hospitals were rescored using this model to generate an adjusted score (WIPSAS – weighted individual patient satisfaction score). HCAHPS hospital ranking was compared to WIPSAS ranking for all NY State hospitals. HCAHPS were obtained from 3,192 hospitals and demographic data collected from 3,144 counties. Results: ‘Hospital beds’ and ‘non-English speaking’ were the strongest negative predictors while ‘% Bachelor’s’ and ‘white alone’ were the strongest positive predictors of HCAHPS. The adjusted r2 was.22 for the model and.155 for the predictive formula. WIPSAS altered the ranking in NY State. The adjusted ranking moved 3 AMCs into the top ten (prior #42, #43, #46). Conclusions: Demographic and hospital factors influence HCAHPS. Adjusted scores may be more representative of a hospital’s actual performance. CMS should utilize WIPSAS adjusted scores in order to more fairly calculate HVBP reimbursements. [Table: see text]
Clinician assessment of potentially avoidable hospitalization in patients with cancer.
Authors: Brooks Gabriel , Uno Hajime , Jacobson Joseph O. , Schrag Deborah 
Published: February 2017

4 Background: In patients with advanced cancer, acute hospitalization accounts for nearly half of all medical spending. Prior research has suggested that many hospitalizations in cancer patients are potentially avoidable, however the perspectives of clinicians directly involved in patient care are not known. Methods: We studied hospital admissions to an inpatient medical oncology service among patients with solid tumor malignancies. For each hospitalization, we interviewed three clinicians from the medical team: the outpatient medical oncologist, the inpatient attending oncologist, and the inpatient resident physician or physician assistant. Respondents were asked to identify whether or not each hospitalization was potentially avoidable (‘probably’ or ‘definitely’ avoidable vs. ‘definitely not’ or ‘probably not’ avoidable). The primary outcome was the proportion of hospitalizations identified as potentially avoidable by two or more of the three clinicians. Results: Complete clinician interview data were collected for 103 of 132 eligible hospitalizations (78%). The median age at hospitalization was 64 years, and 79% of hospitalized patients had metastatic cancer. The most common cancer sites were the lung, breast, and colorectum. 18% of hospitalizations were rated as potentially avoidable by the outpatient oncologist, 28% by the inpatient oncologist, and 30% by the inpatient resident or physician assistant. 24 hospitalizations (23%) were identified as potentially avoidable by two or more clinicians, but only 2% were identified as potentially avoidable by all three clinicians. Hospitalizations were more likely to be perceived as potentially avoidable when psychosocial factors contributed to the reason for hospital admission (OR 2.9, 95% CI 1.2-7.3). Median length of stay was shorter for potentially avoidable hospitalizations (2 vs. 4 days), but rates of death and readmission within 90 days did not significantly differ following potentially avoidable vs. other hospitalizations. Conclusions: A substantial proportion of hospitalizations in patients with cancer are perceived as potentially avoidable by clinicians who are directly involved in patient care.