bluuebunny/crossref_metadata_2025_split huggingface dataset:
An interoperable HL7 document standard to improve the quality of cancer care across multiple locations.
Authors: Warner Jeremy , Hughes Kevin S. , Krauss John C. , Maddux Suzanne , Yu Peter Paul , Ambinder Edward P. 
Published: February 2017

12 Background: Cancer care is by nature interdisciplinary and increasingly depends on seamless electronic transmission of clinical data. Health information exchange and semantic understanding are critical for improved outcomes, personalized medicine, comparative effectiveness research, and cost control. While there is a growing focus on this, sharing patient information remains difficult due to a lack of standardization and general incompatibility between electronic health record products. There is a need for well-designed, oncology-specific interoperability standards. Thus ASCO is developing standards to improve the quality and insight of cancer care. Methods: ASCO volunteers formed a Standards Work Group (Standards WG) in 2012, and ASCO engaged an independent consulting firm to perform the technical work. The Standards WG first developed an interoperable standard with broad application that would also be a foundation for future standards work. They adapted ASCO’s Breast Cancer Adjuvant Treatment Plan and Summary (Breast TPS), which was originally developed as a paper-based form. This adaptation required extensive work involving input from medical and surgical oncologists, ASCO staff, and the consultants. This preparatory work was vital to define and disambiguate clinical concepts. Some value sets in the original Breast TPS were replaced with National Cancer Institute value sets. Multiple oncology and standards stakeholders reviewed the draft to ensure accurate representation of the data and harmonization with related standards. Results: The standard was developed using the Health Level Seven International (HL7) Clinical Document Architecture, a widely used XML-based markup standard with national and international recognition. The draft Breast Cancer Adjuvant Treatment Plan and Summary Standard was successfully balloted through HL7 in May 2013 and will subsequently be published for trial use in late 2013. Conclusions: The Breast Cancer Adjuvant Treatment Plan and Summary Standard will improve quality by allowing providers to efficiently transmit clinical data with semantic meaning to health professionals, patients, quality improvement initiatives, and registries.
Opportunities for improved end-of-life (EOL) care for adult patients with advanced cancer: Results of a longitudinal assessment of care provided by Quality Oncology Practice Initiative (QOPI) participants.
Authors: Dougherty David W. , Kadlubek Pamela , Pham Trang , Earle Craig , Malin Jennifer , Breathwaite Larry , Jacobson Joseph O. 
Published: February 2017

132 Background: End of life care of patients with advanced cancer has received recent attention because of evidence of widespread variation in utilization of aggressive therapies and interventions and possible suboptimal use of palliative care and hospice services. QOPI, the ASCO sponsored quality assessment program, has been available to all United States physician members since January 2006 and has assessed EOL care since its inception. The current analysis explores whether the increased national focus on EOL and increased availability of palliative care and hospice services has resulted in improvements in EOL care as reported by QOPI participants. Methods: Data was aggregated across all EOL care quality measures for 9 sequential semi-annual QOPI collection periods from 2008 through 2012. Trends were analyzed among rates of eligible patients related to hospice enrollment and timing of enrollment, palliative care referrals, discussions about hospice and palliative care, and chemotherapy administration at the end of life. The Cochran-Armitage trend test was performed to determine the significance of trends and differences in measure performance over time. Results: From Fall 2008 to Fall 2012, the rate of hospice enrollment for appropriate patients improved by 7.4% [51.8% to 59.2%; p<0.0001] and the rate of hospice enrollment or palliative care referral improved by 5.6% [63.3% to 68.9%; p<0.0001]. Modest improvements were seen in the rates of hospice enrollment more than 3 and 7 days before death [2.8%, 2.6%], discussion of hospice or palliative care with patients not referred for these services within the last 2 months of life [2.7% increase; 19% to 21.7%], and chemotherapy administration within the last 2 weeks of life [2.4% improvement from 13.7% to 11.3%]. Conclusions: Despite modest increases in the rate of hospice enrollment and palliative care referrals over time, EOL care for adult patients with cancer associated with QOPI practices remains suboptimal. Opportunities exist to increase more meaningful participation in hospice and palliative care and to reduce exposure to chemotherapy near death.
Standardizing chemotherapy education for quality improvement.
Authors: Dalby Carole Kathleen , Nesbitt Marylou , Kennerley Kathleen , Lacoursiere Lisa , Frechette Carol , Flaherty Stephen , Catalano Paul J. , Fuller Frances , Thiele Jodi , Gilchrist Heather , Kostka Judith , Buswell Lori A. 
Published: February 2017

136 Background: Variation of chemotherapy teaching at three affiliated regional oncology centers was associated with a low patient satisfaction PS; Press Ganey Survey for Adult Oncology score of 83.7% in understanding what to expect during chemotherapy treatment and 72.9% in how to manage chemotherapy side effects. Nursing staff collaborated to standardize content to improve PS and quality of care. Methods: Chemotherapy teaching tools varied across practice locations. From September-January 2012, three plan-do-study-act cycles were implemented. 1) A standardized teaching checklist, 2) electronic patient calendars, 3) 3 weeks later a patient education assessment survey (EAS). The teaching checklist detailed: 1) relevant chemotherapy information; 2) calendars listing (clinic appointments, symptoms requiring MD/NP notification, how to contact providers); and 3) ES assessed patient’s level of comprehension. Results: We used logistic regression for each PS score, estimating the time-trend of scores for each period and compared the time trend slopes pre versus post using a two-sided test for interaction. For each item, the Table displays the slope estimate (log odds-ratio per month) for each relevant intervention period, the associated 95% confidence intervals and the interaction test p-value. Negative slope indicates decreasing score trend with time while positive slope indicates increasing trend. The interaction test for each PS measure showed statistically significantly different slopes when comparing pre versus post periods for each PS item. Post intervention, scores for what to expect during chemotherapy rose 83.7% to 92.1%. Explanation of how to manage chemotherapy side effects rose 72.9% to 91.9%. Staff reported high satisfaction, highlighting its benefit to patients. Conclusions: Standardizing chemotherapy teaching improves PS as evidenced by statistically significant improvement in scores. Future endeavors will involve sharing chemotherapy teaching tools throughout the institution to improve PS scores for chemotherapy education. [Table: see text]
Screening for hepatitis B virus prior to chemotherapy: A quality improvement project.
Authors: Hicks Lisa K. , Leung Patricia , Cape Jennifer 
Published: February 2017

158 Background: Hepatitis B virus (HBV) reactivation is a well-recognized and serious complication of chemotherapy which can be prevented with prophylactic antiviral therapy. St. Michael’s Hospital (SMH) is an academic hospital in Toronto, Canada, serving an inner city population. The prevalence of chronic HBV in populations such as ours is estimated to be > 8%, compared to 2% of all Canadians. In this context, surveillance for HBV prior to chemotherapy is very important. Aim: To increase the HBV screening rate among patients starting IV chemotherapy at SMH to greater than 90% by December 2013. Methods: Repeated plan-do-study-act (PDSA) cycles targeting HBV screening in our chemotherapy unit were initiated in January 2013 and are on-going. Appropriate HBV screening was defined as at least one HBsAg test up to 3 months prior to, or 3 weeks after starting chemotherapy. Interventions included education sessions, posters, standardized HBV lab order sets, and pharmacist review of lab data prior to first chemotherapy with reminders to physicians when HBV testing was absent. Pre and post-intervention HBV screening rates were compared using process control charting. Results: Between January 1, 2012, and June 15, 2013, 407 unique patients started IV chemotherapy at SMH. Prior to our interventions a stable HBV screening rate of approximately 30% was observed. Sequential process improvements were introduced in January and April 2013. Process control charting demonstrated the presence of special cause variation subsequent to our interventions with a significant improvement in the HBV testing rate (post-intervention rate of 70%). The HBV testing rate began to improve in January 2013 and met criteria for special cause variation by February 2013. Conclusions: It is possible to dramatically increase the rate of HBV testing prior to chemotherapy through relatively simple, low tech process improvements. Further improvements are necessary to reach our goal of a 90% HBV screening rate prior to IV chemotherapy. Additional planned interventions include individualized physician report cards on HBV screening rates using achievable benchmark criteria and an education campaign directed at empowering patients to ask about HBV testing.
Perceived versus measured functional vaginal capacity in cancer patients with sexual function concerns.
Authors: Kennedy Vanessa Amy , Lindau Stacy Tessler , Yamada Seiko Diane , Wroblewski Kristen , Abramsohn Emily , Makelarski Jennifer 
Published: February 2017

170 Background: Actual and perceived loss of vaginal capacity can be a source of distress among female cancer survivors. The objective of this study was to assess perceived (PC) versus measured (MC) functional vaginal capacity in patients presenting with sexual function concerns. Methods: This was a cross-sectional registry-based study of women seen at the Program in Integrative Sexual Medicine for Women and Girls with Cancer (PRISM) Clinic. During the visit, patients were presented with graduated vaginal dilators and asked to select the largest dilator they perceived could be inserted without pain (PC) and the dilator representing their desired functional capacity (DC) (for patients with a male partner, this was the size closest to the partner’s erect penis). Two models of dilators were offered. Dilators were numbered 1-24 in order of increasing volume. If the patient could accommodate the dilator chosen as PC without pain, she was examined with dilators of gradually increasing size until the patient reported discomfort. The largest dilator tolerated without pain was MC. Differences between PC and MC, and between DC and MC were calculated. The association between penetrative sexual activity in the prior 4 weeks and accuracy of PC was assessed using the Mann-Whitney U test. Results: Mean patient age was 46 years (range 21-80, N=69). Most patients had breast (43%) or a gynecologic cancer (16%); 29% had benign disease. Nearly half reported two or more sexual concerns; painful intercourse (81%), vaginal complaints (21%), and loss of libido (19%) were most common. Median PC was 50cm3 (IQR 35-65cm3), median MC was 81cm3 (IQR 60-90cm3), and median DC was 90cm3 (IQR 81-132cm3). PC equaled MC in 22%. PC was less than MC in 75% and less than DC in 81% of patients. Of patients with PC less than DC, 41% had MC equal to or larger than DC. PC was closer to MC in patients reporting penetrative sexual activity in the prior 4 weeks (p=0.02). Conclusions: In this single-site study, many cancer survivors seeking care for sexual concerns underestimate their functional vaginal capacity. Further study is needed to determine whether correcting patient perception of capacity lessens distress and improves function.
Increasing on-treatment visit compliance for radiation therapy cancer patients.
Authors: Bar-Ad Voichita , Wilson Kathleen W. , Munro Susan , Harrison Amy , Eldredge Harriet , Siglin Joshua , Doyle Laura , Lowther Anne , Clancy Daniel , Hurwitz Mark 
Published: February 2017

175 Background: Weekly on-treatment-visits (OTVs) represent standard care in radiation oncology and have significant impact on the quality of patient care. Ensuring that OTVs are completed might decrease the severity of acute treatment-related side effects by facilitating timely treatment of symptoms. This study evaluates factors contributing to missed OTVs and formulates a plan to mitigate this problem. Methods: A multidisciplinary team of radiation oncology staff members reviewed clinical work flow data to determine the number of patients missing their weekly OTVs. These numbers generated benchmarks for the QIP. The team used 30 patient questionnaires and 291 electronic medical records to identify the causative factors for missing the OTVs. After analyzing these results the team generated an action plan for multiple interventions and future audit protocols. Results: On average, 5% of patients miss their weekly OTVs during radiotherapy course. The identified reasons which affected patient compliance with OTVs include: patient inconvenience waiting for the MD, parking concerns, difficulty navigating the clinic to find the exam room, failure of therapist to send the patient for OTVs, changes in MD’s schedule, lack of patient awareness about expected treatment related side effects and importance of immediate treatment of their symptoms. We developed a multidisciplinary plan to minimize patients missing OTVs which includes electronic medical record alerts, communication cues, physical triggers and improved patient education. Additionally, electronic data collection has been implemented for OTV performance metrics and auditing. Conclusions: Patients missing their weekly OTVs during radiotherapy course might be at risk for more severe treatment-related side effects. The details of this multidisciplinary QIP implementation and its impact on quality of care will be presented at the meeting.
Kaiser Permanente HealthConnect Oncology Beacon module.
Authors: Ichiuji Mary Mitsuko , Schottinger Joanne E. , Campen David , Fredriks Dean 
Published: February 2017

238 Background: Ordering and administration of chemotherapy was performed on paper in Kaiser Permanente until 2008. Chemotherapy is complex because treatments can be given over more than one day and over multiple cycles. Side effects may occur which require additional medications. Within the KP system, oncologists used more than 1,400 chemotherapy protocols. Each patient's regimen was physician dictated and standardization was rare. Reliable chemotherapy adminstration data did not exist for clinical quality, utilization and outcomes evaluation. The KP HealthConnect Oncology Beacon Module was created to standardize chemotherapy, enhance safety, and simplify ordering and administration of complex medications. This project required collaboration among oncologists, nurses, pharmacists and information technologists throughout the organization. This process assures that the right patient gets the right drug at the right dose at the right time. Methods: In 2005, a collaborative group of oncologists, nurses, pharmacists and IT from across KP began to develop chemotherapy protocols which included orders for medications, fluids, rates and routes of administration and nursing instructions. They worked with deployment teams to communicate change, assess workflows, develop and deliver training.The guiding principles for protocol development were: Evidence Based Effectiveness, Safety, Efficiency and Cost. Results: Decreased number of Chemotherapy Protocols through evidence review and consensus from 1,400 to 433 standardized templates. 84% or higher adherence to evidence-based templates. Reduced adverse events per 1,000 chemotherapy related medications by 9% at the San Jose Medical Center (pilot site). Increases capability to manage pharmacy and biotechnology resources and respond quickly to new knowledge about treatments or drug efficacy ( incorporated use of Gcsf to Docetaxol-Cyclophosphamide when excessive febrile neutropenia was found). Provides database for treatment outcomes research that is likely to generate important findings. Conclusions: The KP Health Connect Oncology Beacon Module exemplifies what KP is uniquely able to deliver: integration, standardization and use of technology to offer the highest quality care for our members.
Establishing a medical-legal partnership program for cancer patients.
Authors: Franco Theresa , Schreiner Susan , Rodabaugh Kerry J. , Stensland Susan 
Published: February 2017

281 Background: Treating cancer patients requires a comprehensive approach extending beyond their medical needs. Patients may have issues with legal implications, which, if not addressed, hinder ones’ ability to focus on their care. The objective in establishing a medical legal partnership program is to create a mechanism for identifying such issues and developing plans for resolution. Brought to the organization’s attention by a newly recruited gynecological oncologist, a collaborative, interdisciplinary program was developed that provides resources necessary to address legal problems such as custody, employment rights, and disability. This reduces the burden on patients and families and improves the quality of life during and after cancer treatment. Methods: The Medical Legal Partnership Program was established under the guidance of a gynecologic oncologist cancer service line administrator, social work department and representatives from legal Aid of Nebraska and Iowa Legal Aid. A memorandum of understanding was signed and the team crafted a process to provide support. This included determining issues in which legal counsel is critical, appropriate patient idenitification, communication strategies, and follow up support. Results: Results include: since the inception of the program in FY 2010 to FY 2013 (to date), 271 patients have been served; a variety of legal issues have been resolved including custody designation, receipt of appropriate benefits, development of wills, and identification of end of life issues; at program inception, one attorney worked one day/ week with a part-time paralegal; in FY 2013, assistance has grown to 20 hours/ week of attorney coverage and a full-time paralegal; and over $250,000 health care dollars have been recovered. Conclusions: Development of a medical legal partnership program has resulted in addressing legal needs that arise during a cancer patient’s course of treatment, reducing their burden to find assistance. It provides an opportunity to recover health care dollars from denied/ unpaid sources and enhances the health care team’s understanding of the important role legal support plays in cancer care.
Assessment of quality improvement efforts by ASCO’s Quality Oncology Practice Initiative (QOPI) participants.
Authors: Chiang Anne C. , McNiff Kristen , Kadlubek Pamela , Neuss Michael N. , Joseph Jacobson 
Published: February 2017

55 Background: More than 600 practices have participated in ASCO’s QOPI since 2006. 192 have achieved certification through the QOPI Certification Program (QCP) since 2010. QOPI assesses greater than 150 performance metrics, organized into modules; QCP evaluates 20 chemotherapy-related standards. QI efforts resulting from QOPI/QCP participation have not been assessed, e.g. which measure areas or standards are preferentially selected by practices for local QI projects. Methods: A survey was sent to 1,450 participants at 850 practices to assess which measure modules/standards were selected by QOPI/QCP participants as the basis for local QI efforts and to understand the nature of the improvement initiatives. Results: 89 participants responded. 96% (85/89) respondents reported QOPI/QCP led to QI efforts. Respondents were asked to select module/s that spurred subsequent QI activities: core measures (57%; n=45), symptom/toxicity management (48%; n=38), end-of-life care (38%; n=29), breast cancer (13%; n=10), colorectal cancer (10%; n=8), NHL (6%; n=5) and NSCLC (4%; n=3). Related to the QCP structural safety standards, participants reported QI projects as follows: chemotherapy planning/chart documentation (39%; n=31), general chemotherapy standards (30%; n=24), monitoring and assessment (29%; n=23), chemotherapy administration (27%; n=21), chemotherapy orders (23%; n=18), staffing (16%; n=13), drug preparation (9%; n=7). Practices reported that QOPI measures improved in subsequent rounds as a result of specific projects (n=22/25, or 88%); 100% felt that these QI projects impacted their practices for the better. QI project results were presented primarily in practice meetings (74%; n=26), hospital or community forums (17%; n=6), ASCO Quality Symposium or other meeting (9%; n=3). No projects reached publication. Of note, 17 of 31 respondents who reported practice status indicated achieving QOPI certification. Conclusions: QOPI participants select improvement targets throughout QOPI modules and standards. QOPI and QCP have succeeded in spurring local QI efforts that have led to score improvements, increased discussion of quality and standards, and a positive impact on practices.
Impact on patients’ daily life activities of NEPA, the oral fixed-dose combination of netupitant, a new NK1 receptor antagonist (RA), and palonosetron (PALO) plus dexamethasone (DEX) versus PALO plus DEX for the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderately emetogenic chemotherapy (MEC).
Authors: Aapro Matti S. , Rossi Giorgia , Rizzi Giada , Borroni Maria Elisa , Nagl Norman G. 
Published: February 2017

66 Background: Certain antiemesis guidelines recommend combining a 5-HT3 RA, a NK1RA and DEX for prevention of CINV associated with highly emetogenic chemotherapy (HEC) and with anthracycline + cyclophosphamide (AC)-based MEC. The objective of this analysis was to determine if using the oral fixed-dose combination NEPA prior to initiating AC-based chemotherapy resulted in no impact on daily living (NIDL) for patients. Methods: This phase III, multinational, randomized, double-blind, double-dummy, active-controlled, parallel group trial enrolled patients with solid tumors who were naïve to cytotoxics and scheduled to initiate AC-based chemotherapy. Patients received oral NEPA (netupitant 300 mg + PALO 0.5 mg) + oral DEX 12 mg on Day 1, or oral PALO 0.5 mg + oral DEX 20 mg on Day 1. The primary efficacy endpoint was Complete Response (CR: no emesis/no rescue medication) in the delayed phase (25-120 hours after chemotherapy) in cycle 1. Secondary endpoints including NIDL for patients was assessed using the Functional Living Index—Emesis (FLIE) during the first 120 hours. Results: 1,455 patients were randomized; 1,449 were included in the efficacy analysis. Significantly more patients achieved CR during the delayed phase in the NEPA arm compared with the PALO arm (76.9% vs 69.5%, respectively: p = 0.001). Significantly more patients in the NEPA arm reported NIDL via the FLIE (78.5% vs 72.1%: p = 0.005). A greater proportion of NEPA-treated patients reported no personal hardship imposed and no daily functioning affected (75.3% vs 70.5% and 77.1% vs 71.6%, respectively, as scored by the nausea domain of the FLIE; 95.2% vs 89.2% and 95.6% vs 89.2%, respectively, as scored by the vomiting domain of the FLIE). Adverse events were similar for both groups. Conclusions: NEPA significantly improved efficacy vs PALO for prevention of CINV in AC MEC and significantly more patients experienced NIDL compared to PALO. Both regimens were generally well tolerated.