bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brentuximab vedotin (BV) consolidation post-autologous stem cell transplant (ASCT) in patients (pts) with Hodgkin lymphoma (HL) at risk of residual disease: Number needed to treat (NNT) analysis.
Authors: Gautam Ashish , Huebner Dirk , Zhu Yanyan , Ma Esprit , Lee Shih-Yuan , Zagadailov Erin , Teasell Jeremy , Richhariya Akshara , Bonthapally Vijayveer 
Published: February 2017

20 Background: AETHERA (NCT01100502) is a randomized Phase 3 study of BV and best supportive care (BSC) vs placebo (PBO) and BSC in the treatment of pts at risk of residual HL post-ASCT. BV consolidation therapy post-ASCT significantly improved progression-free survival (PFS) by independent review vs PBO (HR = 0.57, P = 0.001) and was FDA approved. Most common grade ≥ 3 adverse events were neutropenia (29% BV vs 10% PBO) and peripheral sensory neuropathy (10% vs 1%). The aim of this study was to determine the NNT with BV to avoid 1 additional event, disease progression/death. Methods: The NNT with BV was calculated as the inverse of the absolute risk reduction (ARR); ARR was the PFS event rate per investigator (INV) assessment in the PBO arm minus the event rate in the BV arm of the AETHERA trial. The AETHERA trial recruited pts ≥ 18 yrs at risk of residual HL post-ASCT defined by ≥ 1 of: history of refractory HL; relapse/progression < 12 months after frontline therapy; extranodal involvement at time of pre-ASCT relapse. Pts were randomized to receive BV 1.8 mg/kg or PBO on day 1 of each 21-day cycle, for up to 16 cycles/disease progression. Results: 329 pts (median age 32 yrs [range 18–76]; 53% male) received BV (n = 165) or PBO (n = 164). Fewer PFS events per INV analysis were experienced by pts in the BV arm vs PBO arm. The NNT with BV to prevent a disease progression/death ranged from 4.08 (95% CI 2.94, 6.96) to 7.79 pts (95% CI 5.05, 16.4) over 48 months (Table). At 24 months (time majority of pts have progressed post-ASCT), the NNT to prevent a disease progression/death was 4.92 pts (95% CI 3.29, 10.39). Conclusions: AETHERA data suggest that, at various time points, 1 in every 5–8 pts treated with BV consolidation therapy will benefit by avoiding disease progression/death. This further demonstrates BV’s clinical benefit in the post-ASCT consolidation setting. Clinical trial information: NCT01100502. [Table: see text]
Outcome analysis of breast cancer patients treated with cardiotoxic agents in the community setting: A single-institution experience.
Authors: Khelfa Yousef , Mansour Munthir , Gress Todd W. , Tirona Maria R. B. Tria 
Published: February 2017

213 Background: Anthracyclines and anti-Her-2 targeted therapy are commonly used effective breast cancer treatments. They are known to decrease Left Ventricular Ejection Fraction (LVEF), which may increase patients’ morbidity and mortality. There is currently no consensus on post treatment cardiac follow-up. Recent observations suggested that ACEI and B blocker drugs could have cardioprotective effects. We conducted a retrospective study to assess patients’ cardiac outcome using post-treatment LVEF follow-up and effect of ACEI and B blocker on cardiac outcome for breast cancer patients who received cardiotoxic agents in our institution. Methods: We reviewed 155 charts of non-metastatic breast cancer patients between 2000-2008, who received anthracyclines and/or anti-Her-2 targeted therapy. Patients were stratified into groups A (anthracycline), B (trastuzumab) and C (anthracycline+trastuzumab). Results: Patients’ median age was 52.5 years. Six patients had coronary artery disease and 45 received radiation to the left breast. After a median follow-up of 93 months, only 3 of 155 (2%) patients developed symptoms of congestive heart failure. One hundred twenty patients had pre-treatment LVEF evaluation, while only 31 patients had pre and post LVEF evaluation. Mean LVEF difference was -7.89, - 9.01, -9 and -6.08 for all patients, group A, group B and group C, respectively. Thirty patients were on ACEI, 7 of them had LVEF follow-up with mean difference of -6.86. Thirty patients were on B blocker, 7 of them had LVEF follow-up with mean difference of -15. Because of the small size of the groups who had LVEF follow-up, no statistical difference can be detected. Conclusions: Our patient population showed very low incidence of clinically significant cardiac events in relation to anthracycline and anti-her-2 directed therapy after a median follow-up of 93 months. However, further follow is required to assess cardiac outcome that may affect quality of life and survival later in life. In this regard, our institution is establishing a dedicated cardio-oncology service to closely monitor patients who have been treated with cardiotoxic agents and provide early cardiac management if needed.
A quality improvement project to increase compliance with indicated prechemotherapy pneumococcal vaccination.
Authors: Delacruz Wilfred P. , Terrazzino Sandra , Haney Brian R. 
Published: February 2017

218 Background: Severe pneumonia is associated with high morbidity and mortality in cancer patients. The most common pathogen is S. pneumoniae, responsible for 2/3 of pneumonia-related deaths. Current guidelines recommend routine use of 13-valent (Prevnar 13) and 23-valent (PPSV23) pneumococcal vaccine for immunocompromised patients (cancer patients). Of the 110 patients younger than 65 years old who started chemotherapy in our clinic from July 2013 to June 2014, only seven patients received the pneumonia vaccine through our clinic. We conducted a quality improvement (QI) project to improve compliance of pneumonia vaccination in patients who will start on chemotherapy in our outpatient clinic. Methods: We reviewed the current guidelines for pneumonia vaccinations in cancer patients with our physicians and encouraged them to prescribe the pneumonia vaccination to their patients prior to therapy. In addition to educating the primary provider, we took a multidisciplinary approach and recruited our clinic nurse practitioner who meets all patients for chemotherapy teaching to prescribe the vaccine to patients less than 65. Results: Of the 90 patients (median age 60, 20-86) who started chemotherapy during the study period, 58 were less than 65 years old of which three patients were already vaccinated prior to their diagnosis. Twenty five (45.5%) patients were vaccinated through our QI project. We have improved our compliance with pneumonia vaccination guidelines by 39%. Conclusions: We have improved compliance of pneumonia vaccination in cancer patients starting chemotherapy in our clinic through a QI project. We found that screening and intervention are best accomplished by a single person who is able to see all patients. This practice is now being conducted as standard of care in our clinic.
Shared decision-making in chronic lymphocytic leukemia: Preferences and perceptions of patients, providers, and navigators.
Authors: Rocque Gabrielle Betty , Van Laar Emily , Borate Uma , Halilova Karina I. , Peters Pamela M. , Jackson Bradford E. , Pisu Maria , Butler Thomas Wayne , Davis Randall S. , Mehta Amitkumar , Acemgil Aras , Knight Sara J. , Safford Monika M. 
Published: February 2017

221 Background: In recent years, new treatments for chronic lymphocytic leukemia (CLL) with excellent response rates and varying toxicity profiles have emerged. In the setting of multiple available options, shared decision-making is critical. Developing strategies to enhance shared decision-making requires better understanding of how patients and providers make treatment decisions. Methods: Patients with CLL and health care providers within the University of Alabama at Birmingham Health System Cancer Community Network were to assess how treatment decisions are made. Results: Forty-four patients with CLL completed telephone-based surveys. The median age was 69 years old. Thirty percent had completed ≤12 years of education, 20% had some college education. Seventy-three percent of patients preferred an active or shared role in decision-making (27% preferring to make decision, 23% making decision with physician input, and 45% a shared role). Only 2% of patients preferred the doctor select the treatment. Despite >50% preferring an active role, only 20.5% perceived having an active role (Table 1). Thirty-three lay patient navigators, 26 oncologists, and 28 nurses (RN)/advanced care providers (ACP) completed web-based surveys. Navigators and nurses perceived a greater patient role in decision-making than physicians, who perceived that decisions were most often shared. Conclusions: Patients and providers have differing perceptions of their roles in decision-making in CLL treatment. Patients desire higher levels of participation in decision-making than they perceive that they receive, suggesting an opportunity for education of patients and providers to improve shared decision-making. [Table: see text]
Better utilization of neutropenic precautions and adherence to guidelines to improve cost effectiveness and patient convenience.
Authors: Raufi Ali Mehmood , Attraplsi Shada , Lebowicz Yehuda Z. 
Published: February 2017

227 Background: Cancer patient are generally immunocompromised and are at increased risk of infections once absolute neutrophils count is less than 500. The aim of the study to evaluate the inpatient utilization of a standardized neutropenic precautions in cancer patients admitted with febrile neutropenia. Methods: From Jan 2010 to May 2015, established cancer patients were included in this retrospective study who were admitted in Cabel Huntington hospital, Huntington, WV with a diagnosis of febrile neutropenia and were placed on Neutropenic precautions (NP). We analyzed if NP were discontinued once patient is stable and no longer neutropenic during hospital stay. Results: A total of 159 cancer patients with admitting diagnosis of febrile neutropenia were identified. 107 out of 159 (67%) patients had solid malignancies while 33% had hematologic malignancies. Median age was 61 (Range of 20-88 years). 69 patients were male while 90 patients were female. Median duration of Neutropenic precautions (NP) was 4 (Mean 5.69 and range: 1-35). NP were appropriately discontinued in 30% of patients during hospital stay however approximately 70% of patients continued to be on NP even after neutropenia resolved (48 vs 111 patients). Median duration of unnecessary NP was 3 with a mean of 3.87 and range of 1-18 days. Conclusions: Better utilization of Neutropenic precautions and adherence to guidelines will improve overall cost effectiveness as well as patient convenience by avoiding unnecessary restriction.
Integrating Lean Six Sigma in the daily operations of an ICU to achieve safe, quality patient care.
Authors: Marquis Ann , Magurn Jacqueline , McGovern Joanne , Jetter Michelle , Beadling Sarah , Gregoire Dorothy 
Published: February 2017

230 Background: Developing and maintaining a culture of safety and quality in delivering patient care is critical in the intensive care unit (ICU) especially an oncology ICU. Incorporating the Lean Six Sigma program into daily operations of the ICU achieves, simplifies, and sustains continuous improvement in the delivery of safe quality patient care. This program engages the ICU team through visual management of quality, safety, and budget indicators including medication scanning, falls, sharps exposure, infection prevention including blood stream, catheter, hospital and ventilator acquired pneumonias, venous embolism prevention, and staffing compliance. Methods: The initiative focused on stakeholder development to increase professional certifications, improve engagement through development and implementation of educational events, and enhance participation in monthly journal club. Discussion of evidence-based research projects aligned each shift with data, metrics, and outcomes. Cost containment through charge capture, reduction in wasted supplies, and appropriate level of care order was implemented. With the support of Lean Six Sigma, the lean daily management board came to life each shift. Results: Outcomes included medication scanning rates increasing from 94% to 99.5%. Hospital acquired infection and pressure ulcer rates remained 0%. Venous thromboembolism prophylaxis rates increased form 77% to 100%. Staffing compliance increased from 90% to 100%. The number of chemotherapy certified nurses increased from 56% to 71%. The number of nurses with specialty certification improved from 28% to 47%. Stakeholders engaged in 32 professional educational events, and 12 journal clubs were led by the ICU nurses. Product charge capture began at $0 ending in an average of $1342 per month from 0% charge capture to 100% charge capture each month. Conclusions: Team alignment around daily production, patient flow, and staff development enables real-time problem solving around the daily issues of safety, quality, productivity, and stakeholder development. In this oncology critical care unit it has not only enhanced daily communication but every twelve hour shift engagement as well.
Understanding disease progression and treatment patterns in metastatic breast, colorectal, and lung cancer: Implications for evaluating value and quality of care.
Authors: Engel-Nitz Nicole M. , Byfield Stacey DaCosta , Bancroft Timothy , Anderson Amy J , Reyes Carolina M. , Ravelo Arliene , Ogale Sarika , Matasar Matthew J. , Chen May C. 
Published: February 2017

24 Background: Impact of strategies for evaluating value and quality of cancer care may vary for patients with metastatic tumors, particularly for strategies considering lines of treatment therapy as distinct events. To aid in evaluating the value and quality of care in patients’ overall trajectory of disease, this study examined disease progression, mortality, hospice, and treatment patterns in patients (pts) with metastatic breast (mBC), lung (mLC), and colorectal cancers (mCRC). Methods: Included were commercially insured and Medicare Advantage adults from a large US health plan administrative claims database (2007-2014); pts had ≥ 2 claims for BC, CRC, or LC, and ≥ 2 claims for metastases. Index date was defined as the first post-metastatic systemic anti-cancer therapy (TX). Health plan enrollment for 6 mo pre- and post-index date was required; pts with < 6 mo of follow-up due to death were included. Pts with other primary cancers were excluded. A line of therapy (LOT) algorithm was developed and outcomes assessed over a variable follow-up. Progressive disease (PD) was defined as: start of a new LOT, where 1) previous LOT duration > 60 days, and 2) ≥ 1 imaging/lab test occurred between previous LOT and new LOT; receipt of hospice care; or death. Results: Among 7070 mBC, 4767 mCRC and 6994 mLC patients, 73%, 72%, and 84% respectively progressed during the study period (incidence rates: 7, 7, and 13 per 10-pt-years). Mean (median) time in months to PD was 9.5 (6.5) for mBC, 9.0 (7.0) for mCRC and 6.3 (5.0) for mLC. For all cancers, median number of LOT over 1 year was 2, with means of 1.8 (mBC), 1.7 (mCRC), and 1.7 (mLC). Compared to patients without PD, patients with PD had shorter LOT1. Mortality was highest among mLC patients (50%) compared to mCRC (27%) and mBC (22%), with rates per 100-pt-years of 50, 16, and 11 respectively. Hospice rates varied by tumor type. Conclusions: The high level of progression and use of multiple lines of therapy in the metastatic setting suggests a need to delay progression with effective treatments for breast, lung, and colorectal cancers. The value and quality of cancer care should be evaluated across the entire span of patients’ disease.
Elective chemotherapy admissions: An opportunity to improve wait times.
Authors: Meyerholz Samantha , Dowling Mary E. 
Published: February 2017

240 Background: Chemotherapy wait times are a well-recognized challenge facing cancer hospitals. Recent publications have stated that not only do wait times affect patients but they increase costs and consume hospital resources. Wait times lead to longer lengths of stay and require additional staff attention. Reducing chemotherapy treatment wait times has long been a priority of Sloan Kettering, with this study focusing on inpatient chemo processes. During October and November of 2014, 6 current state observations were performed in chemo nursing verification, chemo pharmacy and an inpatient chemo unit. Metrics measured included submission of electronic chemo orders, blood work availability, clearing for treatment, PICC line placement, bed availability and drug transport. All system components were analyzed from both a clinical and industrial engineering perspective. Future state analysis was conducted from December 2014 through April of 2015. Process improvement techniques including direct observation, process mapping, waste analysis and time studies were used to assess workflow. Methods: Prior to implementing performance improvement interventions, baseline data was compiled. 12% of electronic chemo orders were submitted 24 hours prior to admission, 36% of the time blood work was not available within 72 hours prior to patient arrival, 46% of treatments experienced pending delays due to ‘Proceed to Treat’ order, 0% of PICC lines were placed prior to admission, 34% of patients were discharged before 2pm and time for drug delivery averaged 1 hour and 47 minutes. The average time from patient admission to first chemotherapy treatment was 9.7 hours. Results: Following the rollout of a newly designed pilot unit in January 2015, data was collected for 192 chemo admissions in February through April of 2015. The use of electronic chemo orders rose to 84%, blood work was available 60% of the time, pending orders reduced to 0%, PICC placement occurred prior to day of admission 98% of the time, 46% of patients discharged before 2pm and drug delivery was reduced to 0 minutes. The time from admission to chemo treatment was reduced to 2.1 hours. Conclusions: The amount of patients treated after day of admission reduced from 17% to 8%, saving 18 patient days.
Panc Support Project (PSP): Evaluating the integration of palliative care into a pancreatic cancer program at a comprehensive cancer center.
Authors: Makoff Eve , Shinde Arvind Manohar , Tuli Richard , Hendifar Andrew Eugene 
Published: February 2017

241 Background: Pancreatic adenocarcinoma is the 4th leading cause of cancer death in the US. It is predicted to become the 2nd leading cause by 2030. Advanced disease at diagnosis is common. Fewer than 20% of patients having long-term disease control. Given the high prevalence of physical and psychosocial needs, a quality initiative that embedded a PC physician in a pancreatic cancer program was initiated. Methods: From June 2015-October 2015, all stage III/IV pancreatic adenocarcinoma patients were referred for palliative consultation. * The PC physician was introduced as a supportive care medicine provider; a part of the comprehensive pancreas cancer program. *Other resources (ie RN, SW, Chaplain, RD) deployed as indicated *Patients seen initially and at least every 2 months * ESAS, PHQ2, and spiritual screens performed regularly * Data collected regarding symptom trajectory, resource utilization; and timing/place of death. Results: N=17. Conclusions: PSP demonstrated the ability of a PC provider to be effectively accepted and integrated into a pancreas program. Results suggest a benefit in the standardization of symptom screening/ intervention, and a possible favorable impact on healthcare resource utilization. Outcomes will continue to be tracked and compared with patients in the larger cancer community. Further study is indicated to assess the scalability and impact of this model of integrated care. [Table: see text]
Evaluation of leukocytosis: Benign or malignant.
Authors: Bowhay-Carnes Elizabeth Ann , Lee Shuko , Datta Paromita 
Published: February 2017

245 Background: Hematologists frequently evaluate patients with leukocytosis to differentiate between benign and malignant causes. The objective of this quality improvement project was to identify risk factors for malignant leukocytosis. Methods: A retrospective analysis of 1,330 consults in ALM VA Outpatient Hematology Clinic between 1/1/2011 and 2/22/2015 was performed. 147 patients referred for evaluation of leukocytosis were included in this study. The following data was collected: sex, age, race, ethnicity, BMI, tobacco use, total WBC, tempo of leukocytosis (constant vs intermittent), Hg level, plt count, ANC, ALC, AMC, AEC, ABC, laboratory tests performed during work-up, final diagnosis (primary hematologic malignancy vs secondary causes). 35 patients (24%) with a diagnosis of primary hematologic malignancy were compared with 112 patients (76%) with secondary causes and the relative risk of a primary hematology malignancy related to various risk factors was calculated. Results: See Table. Conclusions: Statistically significant independent risk factors for the presence of a primary hematologic malignancy as the cause of leukocytosis were identified. There was no increased risk based on race, ethnicity, BMI, AMC, or AEC. By identifying risk factors for malignant leukocytosis, we have created and implemented an algorithm outlining clinically appropriate and cost-effective laboratory evaluation for patients with leukocytosis.[Table: see text]
Publication of quality improvement in medical oncology: A descriptive numerical summary from a scoping review.
Authors: Dharmakulaseelan Laavanya , Franco Bryan B. , Cheung Matthew C. , Haynes Adam E. , Wong Brian M. , Singh Simron 
Published: February 2017

251 Background: Quality improvement (QI) is becoming a professional expectation and essential to medical oncology practice. A study of medical oncologists found that most QI interventions are not published, suggesting barriers to knowledge dissemination. We aim to describe the authors, settings of QI interventions, and publishing journals of scholarly QI literature. Methods: We conducted a scoping review using Arksey and O'Malley's framework. A search of MEDLINE and EMBASE databases found 48,186 unique English citations from January 2001 to August 2014. Two independent reviewers were responsible for screening the search results and 270 studies were included. Characteristics of first authors, settings of QI interventions, and publishing journals were charted. We used online search engines to find institutional profiles to obtain author and institutional information. A descriptive numerical summary analysis was used to summarize and report the results. Results: The number of QI publications has increased over time, with 60 between 2001 and 2006 and 199 from 2007 to 2013. The majority of first authors are clinicians (65%), of which 59% are physicians, 31% are nurses, and 5% are pharmacists. Furthermore, 27% of first authors are primarily researchers whereas 5% are solely administrators. In addition to professional degrees, having an advanced degree was common amongst clinicians (48% of physicians, 85% of nurses, 44% of pharmacists). Forty-four percent of interventions were conducted in settings affiliated with an academic institution, as opposed to community-based settings. Only 9% of articles were published in a quality of care focused journal. Conclusions: Our scoping review found that most first authors of QI interventions are clinicians, many with an advanced degree in academic settings (rather than community-based settings where most patients receive care). The lack of studies published in quality of care focused journals may result in lost opportunities for knowledge transfer. These findings suggest that more effective knowledge dissemination and increased support for QI studies are needed to further the science of quality and ultimately improve quality of care.