bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical decision making for breast cancer: Treatment preferences prior to surgery.
Authors: Yao Katharine , Wroblewski Kristen , Van Haitsma Martha , Rabbitt Sarah , Williams Jordan , Kulkarni Swati 
Published: February 2017

71 Background: Contralateral prophylactic mastectomy (CPM) rates are increasing but it is unclear how many patients consider CPM prior to their surgery. Methods: We developed a 55 item survey validated with 20 breast cancer survivors which was administered to newly diagnosed breast cancer patients (n=136) at two institutions prior to surgery to determine factors associated with CPM treatment preference. Results: The median age was 58 years (range 30-85). Eighty-three (69.2%) were White. Thirty-eight (28.6%) of patients had a 1st degree relative with breast cancer. Fifty-three patients (39.8%) thought about their surgery choice prior to getting breast cancer. Seventy-four (57.8%) of patients considered undergoing a CPM during decision making process, 31 (24.2%) did not want/consider CPM and 23 (18.0%) did not think CPM was an option. Of the 74 women who considered CPM, 12 (16%) chose CPM. Nearly 70% of women who considered CPM felt that CPM reduced the chance that cancer would come back vs 43.3% of women who did not want/consider CPM (p=0.02) and 86% of women who considered CPM stated that lumpectomy and mastectomy patients have equivalent survival compared to 100% of patients who did not want/consider CPM (p=0.03). Women who considered CPM were more likely to rate the diagnostic process as very/extremely emotionally difficult (47.3% vs 22.6%, p=0.03) and to state that being diagnosed with breast cancer “sent them into a daze” than those not wanting/considering a CPM (37.5% vs 13.3%, p=0.02). Likewise, women considering CPM had higher rates of anxiety (49.3% vs 12.9%, p<0.001) and depression (19.7% vs 3.2%, p=0.03); were more likely to be very/extremely worried about getting cancer elsewhere in their body (43.8% vs 6.5%, p<0.001) and very/extremely worried about how a spouse/partner would feel about their changed body than those women who did not want/consider CPM (18.5% vs 0%, p=0.03). Women who did not think CPM was an option were older (p=0.02), less educated (p=0.05), more often single (p=0.05). Conclusions: Over 50% of newly diagnosed breast cancer patients consider CPM prior to their surgery. Women considering a CPM had greater worry about recurrence, higher anxiety levels and less knowledge than patients not wanting/considering CPM.
Pathological response and its effect on survival with neoadjuvant chemotherapy according to intrinsic subtype in locally advanced breast cancers in north India: Is it different from the West?
Authors: Agrawal Sushma , Lal Punita , Kumar Shaleen , Agarwal Gaurav , Mishra Anjali , Agarwal Amit , Agarwal Vinita , Mishra Saroj Kanta 
Published: February 2017

90 Background: Breast cancer patients commonly present in locally advanced stage (LABC) in our country. We propose to correlate the pathological response to neoadjuvant chemotherapy (NACT) and its impact on survival based on the intrinsic subtypes. Methods: Consecutive patients of LABC who underwent NACT (taxane and or anthracyclines based )followed by definitive surgery and radiotherapy during the period January 2007 to December 2012 were grouped on the basis of intrinsic subtypes (Luminal A, Luminal B, Her-2 Type, Basal). The pathological response to NACT in tumour as well as axillary nodes [complete response (pCR), partial response (pPR)] was correlated with the disease free survival (DFS) and overall survival (OS) at 5 years in the intrinsic subtypes using Kaplan Meier Analysis. Results: Among 208 patients the median age was 46 years (range 24-81 years), 46% premenopausal,54% postmenopausal, presenting tumour and node stage was 15% T2, 40% T3, 45% T4,8% N0, 42% N1, 41% N2, 9% N3.The intrinsic subtypes at presentation were Luminal A (16%), Luminal B (23%), Her-2 Type (23%), Basal (37%).The pCR rate in node was significantly higher in Her-2 type and Basal subtype (Table ). At a median followup of 34 months (range 6-84 mo)the 5 year DFS and OS was significantly higher in patients achieving pCR tumour or node in Her-2 type and Basal subtype (Table ). Conclusions: The pCR rate to NACT in tumour or node seems to be considerably higher in our population than that reported in the western literature. pCR (tumour and node) is a surrogate for both DFS and OS at 5 years in Her-2 and basal subtypes of breast cancer. [Table: see text]
Outcome of wire localized lumpectomies for nonpalpable breast lesion following neoadjuvant chemotherapy.
Authors: Khan Samreen umer , Zaidi Syed Adil Asif , Feroza Zoona , Fiaz Sohaib adil , Khan Huma Majeed , Chaudhary Mohammad Zulqarnain , Khan Amina Iqbal 
Published: February 2017

96 Background: Wire localized lumpectomies for non-palpable breast lesions is not yet a widespread practice in Pakistan. Shaukat Khanum Memorial Hospital is one of the few centers practicing this technique. It remains an effective and cost efficient procedure .The aim of this study is to evaluate wire-guided localization for nonpalpable breast cancer following neoadjuvant chemotherapy focusing on post-operative outcome and survival rate. Methods: It is retrospective analysis of consecutive series of patients treated at SKMH with BCS after wire localization for nonpalpable breast cancer following neoadjuvant chemotherapy from August 2005 to December 2011.The records were reviewed for patient, radiological, histological and surgical characteristics. The tumor volume analysis was calculated according to the Krekel et al method. Data was analyzed using SPSS (Version 19). Kaplan Meier curves were used to conduct survival analysis with respect to stage at presentation and pathological response to therapy. Results: A total of 195 patients were reviewed. The rate of positive margins; taken as less than 2mm, following initial BCT was 9.7%. Out of the 19 patients with positive margins 13 had re-excision of margins and 2 had completion surgery. One patient refused completion surgery. The rate of local recurrence was 6.6% and distal recurrence 17.9%.Out of 49 patients with recurrence 6 patients (12.24%) had both loco-regional and distal recurrence. The median resection ratio was 16.39. The median survival was 44 months (SD 17.162). There was a significant survival benefit (p = 0.03) in patients presenting at an early clinical stage whereas some clinic yet statistically non-significant survival advantage in patients undergoing surgery following complete radiological response after chemotherapy. Conclusions: Wire localized lumpectomies in post neoadjuvant chemotherapy patients at our institution has a low recurrence rate and an internationally acceptable re-excision rate. The size of the specimen can be optimized further. Early detection and management remains the mainstay of treatment for breast cancer. Patient education and screening are goals that are yet to be achieved on the grand scale in Pakistan.
Assessment for residual nodal disease after neoadjuvant chemotherapy with image-guided surgery.
Authors: Caudle Abigail Suzanne , Yang Wei Tse , Mittendorf Elizabeth Ann , Black Dalliah MaShon , Gilcrease Michael , Bedrosian Isabelle , Hobbs Brian P , Candelaria Rosalind P , Babiera Gildy , Dogan Basak , Santiago Lumarie , Hunt Kelly , Krishnamurthy Savitri , Kuerer Henry Mark 
Published: February 2017

99 Background: Staging of breast cancer patients is enhanced by axillary ultrasound (US) and needle biopsy of abnormal lymph nodes (LN). When clips are placed in sampled metastatic LNs, they can be evaluated for nodal response to neoadjuvant chemotherapy (NCT). The goals of this study were to determine if pathologic changes in clipped LNs reflect nodal response to NCT and if targeted axillary dissection (TAD), which includes sentinel lymph node dissection (SLND) in addition to selective localization and removal of clipped LNs, could increase the accuracy of nodal assessment. Methods: This prospective study included patients with US-identified axillary metastases confirmed by needle biopsy with a clip placed in the sampled LN. After NCT, patients underwent axillary lymphadenectomy (ALND) with x-ray of the axillary contents to identify the clip-containing LN. In 38 patients, the clipped LN was selectively removed using wire (n=2) or I125seed localization (n=36) before ALND was performed. Five patients did not undergo ALND. The pathologic findings of the clipped LN were reported separately from the other nodes. Results: Ninety node positive patients were enrolled. Forty (44%) had a complete nodal response to NCT and 50 (56%) had residual disease. Pathologic evaluation of the clipped LN revealed metastases in 47/50 patients with residual disease, resulting in a false negative rate (FNR) of 6% (95% CI 1.3-16.6). In 52 patients who underwent SLND, the clipped LN was not a SLN in 23% (n=12). Thirty-one of these patients had residual disease; metastases were not seen in SLNs in 5 cases resulting in a FNR for SLND alone of 16% (95% CI 5.4-34). Evaluation of the clipped LN in addition to SLND improved the FNR to 3% (1/31, 95% CI 0.1-17). Thirty-one patients underwent TAD while an additional 7 had localization and selective removal of the clipped LN without SLND with one false negative result. Conclusions: US-guided marking of LNs with documented metastatic disease allows for their selective removal and improved pathologic evaluation for residual nodal disease. The FNR of SLND can be reduced by ensuring removal and evaluation of the clipped LN. TAD is technically feasible and allows for improved assessment of nodal response after NCT.
Alleviating financial burden for cancer patients in clinical trials.
Authors: Nipp Ryan David , Powell Elizabeth , Finkelstein Daniel , Winkfield Karen Marie , Percac-Lima Sanja , Chabner Bruce Allan , Moy Beverly 
Published: February 2017

10 Background: Financial barriers may prevent cancer patients from enrolling into clinical trials. This financial burden has yet to be fully explored. The goal of this study is to establish the feasibility of a financial assistance program for cancer patients enrolled in clinical trials and to analyze patient characteristics associated with financial aid requests. Methods: We performed a cross-sectional analysis of cancer clinical trial patients who registered for a financial assistance program at a tertiary cancer center. This program is designed to fund non-clinical expenses related to clinical trial participation (e.g. travel, lodging). Patients were referred to the program by their provider and enrolled if they expressed interest. After registration, applicants were required to request reimbursement monthly in order to receive funding. Descriptive statistics and univariate analyses compared characteristics of patients who requested funding vs. those who did not. Results: From November 2013 to April 2014, a total of 86 participants enrolled into the financial assistance program; 43 received funds and 43 did not. Most patients were <65 years old (73%), female (70%), white (86%), married (67%), and enrolled in a phase 1 trial (69%). Patients with lower incomes were more likely to request funds than those with incomes > $75,000 (61% vs. 38%, p=0.01). Patients currently employed were more likely to pursue funds than disabled or unemployed patients (58% vs. 21%, p<0.01). Out-of-state patients were more likely to ask for funds than in-state patients (64% vs.19%, p<0.01). Patients who requested funds were less likely to have disease progression after enrollment than those who did not request funds (19% vs. 42%, p=0.03). Conclusions: Enrolling clinical trial participants onto a financial assistance program is both feasible and informative. The patients who requested financial aid in our program were more likely to have lower incomes, remain employed, and reside out of state. Those who requested funding were less likely to have disease progression after program enrollment. Future efforts should continue to explore and improve interventions aimed to alleviate the financial burden experienced by cancer patients enrolled in clinical trials.
Assessment of single screening questions for dysphagia for routine clinical use in a tertiary care practice.
Authors: Brown Catherine , Vennettilli Ashlee , Patel Deval , Zeman Katherine Zora , Lau Anthea , Kuang Qin , Boyd Kevin , Cella David , Mackay Helen , Darling Gail Elizabeth , Wong Rebecca , Xu Wei , Liu Geoffrey , Howell Doris 
Published: February 2017

102 Background: Dysphagia is a common symptom among esophageal cancer patients. However, there is neither a validated PROMIS tool nor a validated PRO-CTCAE tool for this symptom. Clinically, obtaining patient-reported data on this symptom systematically in specific disease sites is important, but keeping the patient survey burden low means that this may be best done using a screening question first. The goal of this study was to assess the performance of such a screening question when compared to a more standard tool for measuring dysphagia, FACT-E, in a esophageal cancer outpatient clinic setting. Methods: Adult esophageal cancer patients seen at the Princess Margaret Cancer Centre between 2012-2014 were all seen by a multidisciplinary practice. Patients completed the FACT-E and screening symptom surveys at regular timepoints. The time point where the most severe set of symptoms was present for each patient was analyzed and severity of symptoms was compared against two 5-level screeners ("How are you currently eating?" (screener 1) and "I can swallow naturally and easily" (screener 2). Prevalence of symptoms, sensitivity (Se) and specificity (Sp) of the screeners was assessed. Complete data was available and analyzed in 173 (87%) of 199 patients. Results: Mean age (range) was 64 (23-89) and 75% were male. Prevalence of moderate to severe difficulty swallowing solid, soft, liquid foods and choking was 31%, 10%, 7%, 4% respectively. 34% of patients experienced at least one moderate to severe symptom of dysphagia. Screener 1 had a Se of 84% and Sp of 79% when using any moderate or severe swallowing problem as the reference. The Se and Sp of screener 2 was 51% and 87%, respectively. Conclusions: Up to a third of esophageal cancer patients experience moderate to severe symptoms of dysphagia. Screener 1 had the better performance as a screening tool. High completion rates in this practice suggest that routine systematic collection of such data is feasible, and perceived to be important to patients. Practice level projects can improve the quality of measuring symptoms. In the future we will be testing the role of mobile and computer technology for the routine collection of dysphagia and other symptoms in this practice setting.
Value of phase II pathway in the ambulatory care setting.
Authors: Schaub Diane , Rebello Elizabeth 
Published: February 2017

115 Background: The aim of the project was to decrease PACU (Post Anesthesia Care Unit) time by implementing a Phase II pathway for patients undergoing port-a-cath placement under Monitored Anesthesia Care in the Ambulatory Setting. Methods: The process improvement interventions were centered on eliminating unnecessary patient care processes and increasing patient flow and consisted of: patient and healthcare provider education, phase II unit utilizing existing bed space, revised charting template in the PACU. Queries of our AIMS database for port-a-cath cases performed between January 1, 2012 and February 28, 2013 (pre-intervention) and then between May 1, 2013 and May31, 2014 (post-intervention) were obtained. March 1, 2013 to May 1, 2013 was a transition period used to implement the process. Only cases performed under monitored anesthesia care were included. Cases with a PACU length of stay greater than 200 minutes were excluded from the study as these patients were no longer fast track. Descriptive statistics were used to summarize PACU length of stay pre/post-intervention. Scatter plots were used to show the variability in PACU length of stay and to illustrate the average trajectory of PACU length of stay over each time frame. A t-test was used to compare the average length of stay in the PACU, pre/post-intervention. Results: There were 917 pre-intervention cases and 362 post intervention cases. Trend of minutes spent in the PACU over time is illustrated (Figure 1). The average number of minutes in the PACU during the pre-intervention was 86.8. During the post-intervention, it was 67 minutes (Difference = 19.6 minutes; p-value < 0.001). Conclusions: As a result of implementing a phase II pathway for patients undergoing port-a-cath placement, there was a significant decrease in average time spent in the PACU. In addition, there was a decrease in the variation associated with PACU length of stay. The phase II pathway allowed a significant subgroup of this patient population to be less sedated after surgery and proceed directly to chemotherapy or their next scheduled appointment in the institution. Time and cost savings to the patient and the institution were additional benefits.
Construct a computer simulation model to replicate CT operations for decreasing delayed procedure starts.
Authors: Iyer Ranganath K. , Steele Joseph Rodgers , Tannir Habib , Venable Steve 
Published: February 2017

132 Background: Patients scheduled to undergo computed tomography (CT) should be treated expeditiously and not delayed owing to a lack of either CT scanner capacity or available staff. Delayed scanning affects both patients and staff in several ways. First, patients are unhappy that they have to wait. Also, delayed scanning makes patient late for their next appointments or other events, which affects the downstream departments’ capability to operate effectively and efficiently. In addition, radiologists and their staff have to commit additional time and resources to processing patients on time. Finally, variability in the placement of patients reduces the scanner’s operating efficiency. The aim of this initiative is to optimize the appointment template using simulation software to reduce the rate of delayed CT procedures by 25% or more by the end of 2014. Methods: To further understand the CT queuing process, we hired 2 graduate students to create a simulation model using the data collected from the operations study. The simulation study modeled patients’ experience from their arrival to discharge and the steps were: (a) performed elemental analysis for each process; (b) cceated value stream map; (c) created high-level simulation model and “mini model” using operational data. The simulation models were presented to department leaders, who approved them. The models clearly showed that the time patients spent on the CT scanner was the bottleneck. Results: Changes in the CT area that have impacted on-time starts and average wait time include: (a) new fast-track for no interview patients and (b) changes in staffing hours. Progress and improvement include (a.) On-time delays decreased by 18% and (b.) a verage wait decreased by 8 minutes (19%). Conclusions: Discrete event simulation accounts for the probabilities and uncertainties associated with the processes and helps create a visual model of the work area. This adds confidence to decision makers’ ability to make decisions that have high impact. Also, the models can be used to test changes in the processes and study the impact on other processes without making true operational changes that could potentially waste resources and time.
Measuring baseline adherence to Choosing Wiselyrecommendations in regional oncology clinics: Challenges and strategies.
Authors: Kreizenbeck Karma L. , Hughes Erin E. , Egan Kathryn , Fedorenko Catherine R. , Mohedano Ada , Greer Benjamin E. , Demers Linette , Stewart F. Marc , Berkes Ken , Jafari Mehrdad , Jensen Barbara , Bredeson Chris , Rieke John , Smith Julie C. , Gunkel Mary , Guerrero Rose , Carlos Timothy , Ramsey Scott David 
Published: February 2017

133 Background: ASCO launched the Choosing Wisely campaign to reduce the use of interventions lacking evidence of benefit to cancer patients, but implementation may be a challenge. This project develops a stakeholder-informed process to prioritize and implement the 2012 ASCO Choosing Wisely (CW) recommendations in oncology clinic settings. Methods: Medical directors from 6 network-affiliated oncology clinics in the Puget Sound region selected 2 CW measures for implementation: (1) No biomarkers/advanced imaging following early breast cancer treated for cure, and; (2) No colony stimulating factor use for low FN risk chemotherapy. Results: Adherence is measured with data from each clinic’s tumor registry, billing records, lab results, pathology reports, and clinic notes. Challenges to measuring baseline adherence included translating non-specific guidelines into discrete data elements (e.g. when does surveillance start?) or required measuring the absence of something, presenting quality control challenges to distinguish between adherence and missing data. Additional challenges are shown in the Table. To address these challenges, the team developed these strategies: (1) creation of specific data elements, (2) mapping clinics separately to the criteria and (3) employing methods such as Natural Language Processing to efficiently collect data from EMR. Conclusions: It is feasible to measure adherence to ASCO CW recommendations with data sources available at oncology clinics. Variability in data platforms among clinics is inherent to the current medical landscape and must be accounted for in successful implementation of cross-clinic programs. [Table: see text]
A fall prevention and detection project: Preliminary results.
Authors: De Marino Elvira , Chesta Cristina , Rugge Elisabetta , Ferrari Paola , Posca Teresa , Lattuada Sara , Torazzo Renata , Rossetti Sabrina , Di Cola Alessandra 
Published: February 2017

142 Background: Falls often causes serious injury to cancer patients (PTS) and hospital costs account for two thirds of the total. Fall prevention and detection (FAPRE) project was planned to develop a new technology in three steps: first to identify potential high risk fallers (HRF) by Timed Up and Go (TUG) test; second to compare TUG with Conley Scale and third to hospitalize HRF in monitoring room equipped with a network of smart sensors that can identify person’s location, fall or lack of balance and posture connected by smartphone alerting watch nurse. Aim of this study is to describe general characteristic of HRF by TUG and to determine how new test instruments can identify them. Methods: A nurse performed TUG in ambulatory room equipped with pressure sensors on the floor (intelligent carpet), webcam, home gateway, WI-FI router and smartphone. PTS were required to sign informed consent. HRF were identified by TUG test >12 seconds. Results: From January to March a series of 99 consecutive PTS enter the trial, performance status ECOG < 2, age: median 73, range 34-87, 50 males and 49 females. All PTS underwent TUG and were evaluable. There were 11 hematologic (H) and 88 solid tumors (ST); 45/88 ST had metastatic disease; 97/99 were treating by chemotherapy, 2 by palliative care. Six PTS had brain metastasis and 9 bone; 33/99 had previous pathological fractures. Comorbidity: 14/99 diabetes and 33/99 hypertension 10/99 were taking psychoactive drugs, 22 were treated with opiate and 5 both. HRF identified by TUG were 44%; there were 27% H, 46% ST and 75% were older then 70 years. Previous pathological fracture in long bone were 14/33; bone metastasis (BM) 7/9; brain metastasis 3/6. HRF taking only psychoactive drugs were 5//10 and 17/22 opiate; 5/5 both. Conclusions: TUG detected HFR more frequently in ST, elderly with BM and previous long bone fractures treating by opiate and hypertension. Identify HRF by new integrated room automation FAPRE infrastructure seems a simple, reliable and manageable approach at preliminary data. Trial is ongoing and carrying on next step.