bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health information seeking preferences of Mexican cancer survivors: Creating an evidence base for the design of high-quality communication programs.
Authors: Soto Perez De Celis Enrique , Baltazar-Avalos Edgar , Rocha-Rojo Lorena Ali Guadalupe , Rojo-Castillo Patricia , Chavarri Guerra Yanin 
Published: February 2017

190 Background: In order to improve the quality of the communication between the healthcare system and cancer survivors, it is fundamental to understand their preferred sources of health information. In low and middle-income countries (LMICs), little is known regarding which sources are used and trusted the most. This information is crucial to develop effective communication aimed at achieving high-quality equitable cancer care. Our objective was to explore the preferred sources of health information in Mexico, and to understand which factors influence these choices. Methods: We examined sources of health information among cancer survivors in Mexico City using questions from the Spanish Version of the Health Information National Trends Survey (HINTS). The characteristics of survivors who preferred the internet were compared with those who preferred other sources (doctors, printed materials, family members, organizations) using Fisher’s exact test. Logistic regression was used to assess the effects of patient characteristics on health information-seeking. Results: Of 148 participants, 82 (56%) had internet access. Of the 88 patients who had sought health information, 61 (69%) listed the internet as their preferred source. Those 65 and older were less likely to seek health information, regardless of the source (OR 0.17, p < 0.0001). Survivors who preferred the internet were more likely to be younger (p = 0.001), male (p = 0.003) and to have a higher educational level (p = 0.009). Comorbidities, stage, cancer type, and time from diagnosis had no effect on patient preferences. Doctors were the most trusted source of information (85%), followed by the internet (28%) and government agencies (23%). Conclusions: Mexican patients who seek health information online are more likely to be young educated males. Doctors represent the most trusted source of information, particularly for patients from vulnerable populations (such as older women with low educational levels). High-quality healthcare information programs in LMICs should be designed taking these behaviors into account, and patients should continue to receive health information via their most trusted sources.
Evaluating data-driven breast surgery treatment path visualizations from registry and administrative data.
Authors: Atreya Ravi V , Taylor Alexander S , Levy Mia Alyce 
Published: February 2017

195 Background: Breast cancer patients face difficult decisions about their surgical care without a full understanding of their options. The learning health system goal is to use information from the care of prior patients to inform the care of future patients. We aim to apply this concept to generate data-driven surgical paths, develop interactive path visualizations to inform patients, and evaluate their impact. Methods: We used cancer registry and administrative CPT codes for women diagnosed with stage 0-III breast cancer between FY2010-14 at a comprehensive cancer center. We generated surgical event sequences and visualized them using interactive Sankey diagram path visualizations. We will run a prospective educational intervention this winter to evaluate their impact on the shared decision making process. A web-based application will be available to patients prior to, during, and after their surgical clinic visit; we will survey their reaction pre-visit, post-visit, and post-surgery. Results: 1556 patients had 1951 surgical events in the registry and 48% started their surgical care with a breast conserving surgery while 52% began with a mastectomy. Mastectomy paths are presented in Table 1. We have developed interactive visualizations for patients to view, will be conducting our prospective educational intervention this winter, and will be ready to present preliminary results in February. Conclusions: We have been able to develop interactive, data-driven surgical path visualizations for breast cancer patients from cancer registry and administrative data. We will be conducting a prospective educational intervention to evaluate our implementation of this learning health system concept. [Table: see text]
Using a web analytic tool to evaluate Pathways program engagement in 36 Michigan oncology practices.
Authors: Seung Amy Hatfield , Justus Rachel , Klamerus Justin Frank Antoni , Blayney Douglas W. 
Published: February 2017

198 Background: Evidence-based, cancer treatment pathways reduce unnecessary variation in care, reduce waste, and improve value. Financial incentives and sharing adherence rates may motivate oncologists to change treatment patterns. The Michigan Pathways Program (Pathways) is a statewide quality improvement program sponsored by BlueCross BlueShield of Michigan and supported on the Caret web-based registry. Pathways measures and incentivizes adherence to local treatment pathways (JOP 8e32s, 2012; ASCO 2015 Ann Mtg, abst 6584). Caret reports allow participants to review adherence rates. Using Google Analytics (GA), we measured access by participants of adherence reports and attempted to correlate this measure of engagement with adherence. Methods: Caret provides decision support for regimen selection within the Pathways. BCBSM medical claims are uploaded to ensure completeness of data. Caret generates reports allowing participants to review site-specific adherence data and compare with de-identified aggregate data from all participants. GA gathers data about page tags being accessed at a location by users, which were assumed to correlate to Pathways practices. Unique page views for web-based adherence reports were assessed for each location and compared to adherence rates. Results: 36 practices were included from 34 unique locations. 34.4% of practices are accessing adherence reports. For users the mean treatment adherence was 82.7% compared to 79.3% for non-users. Conclusions: Web analytics offers a novel method for gauging practice engagement in our program. This initial assessment will help to target education sessions based on location in addition to identifying potential best practices. At this time conclusions cannot be made to correlate application engagement to adherence rates. We predict an increased need for web analytics to measure the use of resources utilized by practices. [Table: see text]
Building a new process: Nursing verification of pediatric oral chemotherapy.
Authors: Zerillo Jessica A. , Santacroce Erin , Zimmerman Mary Ann , Freeman Melissa , Lau Greenberg Teresa , Nguyen Phuong , Chi Susan N. , Bandopadhayay Pratiti , Lane Sharon , Szabatura Audrea , Houlahan Kathleen , Billett Amy 
Published: February 2017

199 Background: While team-based safety checks ensure safe prescribing of parenteral chemotherapy, oral chemotherapy is usually prescribed by a single clinician. With the growing use of oral chemotherapy, processes are needed to protect these vulnerable patients from prescription errors. Methods: A team of nurses, clinicians, pharmacists and administrators developed a new process and checklist for nursing verification of oral chemotherapy prescriptions at Dana-Farber’s pediatric neuro-oncology program. Prescriptions are verified against the treatment plan by two pediatric oncology nurses. The verification checklist includes drug, dose with any modifications, height and weight, laboratory values and patient instructions. When available, the prescription bottle is also verified. Data was collected over a three-month pilot period. Results: From 6/18/15-9/16/15, 56 prescription verifications occurred. Verification rate of on-site retail pharmacy filled prescriptions was 47% (32/68 prescriptions). Median time for verification was 20 minutes (IQR 15, 40) per nurse. Nurses identified problems outside of prescription verification, including missing prior authorizations and unclear treatment plans. Medication bottles were not routinely available for verification. One identified near miss would have resulted in an 80% under-dose of everolimus. Conclusions: Prescription verification by nursing in a pediatric oncology clinic was feasible. While it was successful in identification of one medication error before it reached the patient, only 47% of prescriptions were verified. Since prescription bottles are usually obtained after a visit, verification of the actual bottles will require new workflows, such as additional clinic visits or uploading a picture via the patient portal. Involving the nurse in the review of oral chemotherapy not only identified a prescription error, but also highlighted issues within other aspects of patients’ care, including inconsistent documentation of the treatment plan. The inclusion of nursing in the review and management of oral chemotherapy has the potential to improve safety and outcomes for these patients.
Achieving excellence in colorectal cancer care through performance improvement: KP Georgia's implementation of the national vision.
Authors: Tomlin Juliane , Schottinger Joanne E. , Lagana Michele , Rabrenovich Violeta 
Published: February 2017

207 Background: The Care Management Institute and The Permanente Federation have partnered over the past two years to develop an Improvement Portfolio for Colorectal Cancer, with the objective of accelerating improvement of Colorectal Cancer Care quality, timeliness, reliability, and the member care experience across the continuum, from prevention, reliable screening and diagnosis, through treatment and survivorship. The portfolio includes: 1) National clinical algorithms for diagnosis and treatment (colon), and for survivorship (colon and rectal); 2) Timeliness metrics for Time to Diagnosis, Time to Initial Treatment, and Time from Surgery to Adjuvant; 3) Patient Friendly Pathway. Methods: The National team has partnered with KP Georgia's clinical and operational leaders to successfully operationalize the Colon Cancer Diagnostic Clinical Algorithm using KP's Performance Improvement methodology. Results: KP Georgia improved time from diagnosis to treatment by 40.3% and reduced variation by 60.5%. Conclusions: Development of the National CRC Improvement Portfolio consisting of clinical algorithms, and timeliness metrics within the same scope of the colorectal cancer care journey, has provided KP regions with the basic tools and resources to significantly improve the quality, timeliness, reliability, and member care experience across the cancer continuum.
Economic burden of common adverse events (AEs) associated with metastatic colorectal cancer (mCRC) treatment in the United States (US).
Authors: Latremouille-Viau Dominick , Chang Jane , Guerin Annie , Shi Sherry , Wang Ed , Yu Justin , Ngai Christopher 
Published: February 2017

21 Background: Treatments for mCRC have distinct safety and tolerability profiles. Common AEs associated with mCRC treatments may compromise the course of treatment, worsen quality of life, and increase healthcare resource utilization and costs. This study assessed the costs of common AEs in mCRC patients (pts) in the US. Methods: Adult mCRC pts treated with chemotherapy (chemo) or targeted therapies were identified from the Truven MarketScan databases (2009 - 2014). Up to the first 3 mCRC treatment episodes were considered. mCRC treatment episodes were categorized as with or without (w/o) AEs based on the occurrence of AEs, listed in product labels, during the episode. Total healthcare costs (medical and pharmacy; 2014 USD) were measured by mCRC treatment episode and reported per-patient-per-month (PPPM). mCRC treatment episodes with AEs were matched by type of treatment (monotherapy/combination, chemo, anti-VEGF, and anti-EGFR) and line of therapy to those w/o AEs. Adjusted total cost differences were estimated by comparing costs during mCRC treatment episodes with vs w/o AEs using multivariate two-part models, adjusting for potential confounding factors; 95% confidence intervals (CIs) and p-values were estimated with bootstrap. Results: A total of 4,158 mCRC pts with ≥ 1 mCRC treatment episode were included (mean age= 59 years; 58% male; 2261 [54%] with a 2nd and 1115 [27%] with a 3rdepisode). The most prevalent metastatic sites were liver (60%) and lung (14%). On average, 2 mCRC treatment episodes were observed per patient with an average length of 166 days per episode. Most mCRC treatments included chemo (96%) and were combination regimens (81%). Conclusions: The most costly AEs were hematologic, followed by respiratory, CNS, cardiovascular, and endocrine/metabolic AEs in mCRC pts. [Table: see text]
Evaluation of relative thrombocytopenia, identification of neuropathy, and bleeding risk secondary to utilization of neuromodulating agents in multiple myeloma patients receiving autologous stem cell transplant treated with melphalan, bortezomib, and lenalidomide.
Authors: Feinsilber Doron , Marcus Joel , Jackson Robyn , Ruiz Marco A. , Griffin Ryan Patrick , Khan Rubina Hafeez 
Published: February 2017

212 Background: Chemotherapy–induced polyneuropathy (CIPN) is a crippling manifestation in multiple myeloma (MM) patients that requires attentiveness to safety and quality of life.2 Bortezomib, lenalidomide, and melphalan are commonly utilized chemotherapy agents that can cause both CIPN3,4 and significant myelosuppression. Within this subset of patients we wish to insure efficacy and minimization of neuropathic pain while being mindful of bleeding risks. Methods: IRB approval was obtained for a retrospective study of patients with MM who received a bone marrow transplant (BMT). Criteria included those who have undergone treatment with melphalan, bortezomib, and lenalidomide who experienced CIPN and placed on gabapentin, pregabalin, or duloxetine with thrombocytopenia defined by a platelet count less than 100,000 K/ul. We identified all patients seen on the BMT service at Ochsner Medical Center who received an autologous BMT for MM and treated with melphalan, bortezumib, and lenalidomide. Demographic data included age at diagnosis, gender, height, and weight. We examined characteristics including date of diagnosis and progression free survival. Endpoints included signs of peripheral neuropathy, onset of thrombocytopenia, initiation of therapy with gabapentin, pregabalin, or duloxetine. Results: 62 patients were selected with data capture. A preliminary chart review shows of patients meeting selection criteria, 53% of patients identified had shown undocumented or undertreated neuropathy, significant bleeding risk, or low platelet function assays. Complete breakdown of individual factors to be provided graphically. Conclusions: The standard treatment practices for MM patients with CIPN has placed patients at higher risk for development of thrombocytopenia and adverse bleeding risks, requiring more stringent institutional documentation practices.
Effect of better communication on patient care.
Authors: Khelfa Yousef , Mansour Munthir , Abdel-Aziz Yousef , Tirona Maria R. B. Tria , Lebowicz Yehuda Z. 
Published: February 2017

216 Background: Considerable medical research done in the last decade, have brought new diagnostic and therapeutic options to the medical oncology field. This has, fortunately, greatly improved treatment options and outcomes of our cancer patients. Newer therapies such as immunotherapies have changed the toxicity profile of our interventions. In addition to “classic chemotherapy toxicity” these therapies can induce autoimmune phenomena including pneumonitis, colitis, etc. that may not initially be considered in patients’ differential diagnosis. We have noted that, we are frequently not being notified of our patients’ hospital admission. This creates an environment in which we can’t contribute to the patients care while they are in the hospital, and makes it difficult to gauge the degree of toxicity our therapies may be causing. Direct communication with the admitting services, asking them to consult us upon patients’ hospitalization would improve rate of consultation. This, we believe, will translate into better patient care. Methods: An official letter was sent to all admitting services’ head of department and program director in our hospital requesting them and their staff to notify/consult the oncology team regarding any cancer patient being admitted to the hospital. We reviewed 406 admissions prior to letter and 145 post. We compared consultation rates before and after the letter. Results: Consultation rate went up from 42 % before the letter to 59 % after, with an absolute increase of 17%. The odds ratio was 1.96 with 95% confidence interval [1.315-2.947], and statistically significant p value of 0.00066. Conclusions: Direct communication with admitting services showed an increase rate of consultation, which we believe improves inpatient care as well as outpatient follow up. This method is simple and we believe cost effective, taking in consideration that better patient care, likelihood of shorter hospital stay and proper outpatient follow up, outweigh the cost of consultation service. Also, we believe, that the presence of consulting service will provide fruitful educational environment for our residents.
HIV-testing in a cancer center emergency department.
Authors: Granwehr Bruno Palma , Merriman Kelly W. , Shelal Zeena , Bazerbashi Hadil , Brock Patricia A , Gonzalez Carmen E. , Torres Harrys A. , Rice Terry 
Published: February 2017

225 Background: HIV is a cancer-associated virus classically associated with KS, NHL, and cervical cancer, but more recently with anal cancer, lung, and head and neck cancers. HIV testing and treatment are important for cancer patients for three reasons: 1) HIV treatment is associated with reduced transmission of a cancer-associated virus. 2) HIV treatment is associated with improved outcomes of cancer therapy in many cancers. 3) HIV testing optimizes quality of care, since testing is recommended by the Centers for Disease Control and Prevention (CDC) and the US Preventive Services Task Force (USPSTF)(A level recommendation) for patients between the ages of 15 and 65 years of age. Since emergency centers (EC’s) commonly provide immunizations and other preventive care, we implemented HIV testing at our cancer center EC. Methods: In our 44 bed cancer center EC with approximately 25,000 annual visits, routine implementation by physician order was implemented in July 2014. EC information technology (IT) assisted in modification of the order sets and facilitated documentation of specific consent for HIV. Educational materials were disseminated to patients and EC providers. A new consent form with integration of HIV consent, including a check box to refuse HIV testing, was implemented on June 19, 2015. Testing results are described through August 2015. Results: HIV testing increased significantly from July 2014 and August 2015. The impact on institutional testing was considerable, increasing from 1.2% of all HIV testing in 2013 to 15.1% to date in 2015. Between July 2014 and August 2015, 1.4% (0.4% incident) of 852 patients screened positive for HIV. Notably, 83% of patients agreed to HIV testing, but less than 20% of patients were actually tested. The highest refusal rate (18.8%) was in patients over age 70 and lowest (9.9%) in those 21-29 years of age. Conclusions: Routine HIV testing is feasible in a comprehensive cancer center ED, but increased awareness is necessary to optimize testing, given the high acceptance rate. Seroprevalence of HIV is comparable to non-cancer center EC’s (0.5-1.2%). These results demonstrate the acceptance by patients of testing for HIV, with implications in reduction of transmission of this cancer-associated virus.
Evaluating the cost-effectiveness of the hospital-based palliative care program at The Johns Hopkins Hospital.
Authors: Isenberg Sarina , Holtgrave David R , Lu Chunhua , McQuade John P , Weir Brian , Gill Natasha , Razzak A. Rab , Smith Thomas J. 
Published: February 2017

23 Background: The objectives of the study were to determine whether a Palliative Care Unit (PCU) provides benefits not just from a cost perspective, but from a patient and caregiver quality of life (QOL) perspective. Methods: (1) Calculate the total costs of the PCU; (2) Leverage a threshold analysis to estimate the Quality-Adjusted Life Years (QALYs) required for the PCU to be cost effective; and (3) Determine whether it is feasible for the program to yield the required number of QALYs. Setting was the Johns Hopkins Health System Palliative Care Unit (PCU) in Baltimore, MD. Analysis was based on patient volume from March 2013-2014. Results: There were 209 palliative patients. The costs for the societal perspective was $2,044,364 and the required number of QALYs to deem it cost effective were 11.36. The net costs for the hospital perspective was $625,777 (gross cost was $993,528; however, the program generated $367,751 in savings for the hospital through treating patients in the PCU as opposed to other functional units), and the required number of QALYs to deem it cost effective were 3.48. To determine whether the program is able to achieve the number of QALYs required, the study team generated aggregated QALYs based on other studies’ evidence for palliative care’s improvement of quality of life for patients and their caregivers. Combining the QALYs generated from the aggregated calculations for patients (0.12) and caregivers (4.60), the program had the potential to yield a total of 4.73 QALYs. Conclusions: This analysis suggests that the PCU is cost effective from the hospital perspective in the sense that the benefits it provides to patients’ and caregivers’ quality of life outweighs the cost of care. Future studies should continue to evaluate palliative care from a cost effectiveness perspective that incorporates a consideration of the quality of life improvements, rather than just cost-reduction.