bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cancer screening, patient characteristics, and shared decision making (SDM): A complicated equation.
Authors: Talcott James Austin , Bezuhly Maureen , Aharanoff Gina , Seiden Danielle , Osborne Michael P. , Chadha Manjeet 
Published: April 2017

164 Background: SDM may vary by patient and clinical decision. In a randomized trial of physician (MD) educational interventions to improve cancer screening guideline compliance, we studied patient (PT) and MD recall of discussions and factors that affected recall. Methods: In a cluster-randomized trial of educational supports for MDs, we are enrolling an age- (30-89 years) and sex-stratified sample of 216 PTs who underwent a physical examination at 2 urban hospitals, 18 for each of 12 primary care MDs. Screening guideline formatting (color-coding) and academic detailing were randomly assigned in a 2x2 design. Immediate post-encounter surveys recorded PT and MD recall of screening discussions. Results: The first 174 participants were diverse (63% white) and highly educated (77% college degree). PTs and MDs differed in recall of screening discussions, and the differences varied by screening test. When MDs reported a colorectal cancer (CRC) screening discussion, 21% of PTs did not; 20% of MDs disagreed when PTs reported the discussion. The discrepancies were greater for prostate specific antigen (PSA) screening, 29% and 29%, respectively, but much less for mammograms (MAM), 8% and 5%, respectively. Recall of the MD recommendation also differed: 15% of PTs disagreed when their MD reported it, and 33% of MDs when their PT reported it. For PSA, disagreement was 26% and 33%, respectively, and for MAM, disagreement was 17% and 10%, respectively. Overall, agreement between all PTs and MDs on whether screening was recommended was fair for CRC, PSA and MAM: kappa = 0.33, 0.34 and 0.29, respectively. Older PT age ( > 70) sharply eroded agreement on recalled CRC and PSA recommendations (kappa = -0.02 and -0.03, respectively) but much higher for MAM (kappa = 0.39). Recall concordance improved when elements of SDM were recalled. For CRC, kappa rose from -0.12 to 0.52 if the MD recalled any MDM element. Conclusions: In a highly educated, diverse PT population, PTs and MDs surveyed immediately after their encounter often disagreed on what had occurred in screening discussions. Disagreement was greater for CRC and PSA vs. MAM, greater for older PTs but improved when SDM was recalled. Clinical trial information: NCT02430948.
Feasibility of collecting routine information for clinical and research purposes via electronic format questionnaire.
Authors: Li Yuchen , Brown M Catherine , Estey Kathryn , Gill Gursharan , Liang Mindy , Perez Andrea Cosio , Borean Michael , Shani Kishan , Bradbury Penelope Ann , Shepherd Frances A. , Leighl Natasha B. , Howell Doris , Liu Geoffrey 
Published: April 2017

167 Background: Patient demographics, lifestyle factors, and past medical history enable clinicians to optimize care plans, and be useful for health services research. Unfortunately, these data are often recorded inconsistently in the medical chart. In 2015, we tested a paper-form questionnaire to collect such data systematically in the outpatient setting. This current study assessed the feasibility (applicability, acceptability, practicality) of administering the questionnaire via electronic format (iPad). Objectives: To examine whether the electronic format of the questionnaire was (1) applicable (reliable and complete data); (2) acceptable to patients; and (3) practical for clinic utilization. Methods: New adult cancer patients visiting the thoracic cancer clinic at Princess Margaret Cancer Centre in summer, 2016 were asked to complete a Patient Health Questionnaire via iPad devices. This questionnaire was developed through trial testing in addition to literature review, expert opinion, and prior paper-based testing. Results: In 62 new patients (57% male, mean age 66 years old), this electronic questionnaire took on average 25 minutes to complete. The electronic questionnaire was applicable (89% completed the questionnaire, reliable data) and acceptable (69% were happy to complete, 69% found questionnaire useful, 61% thought it asked the right questions, 71% did not think it made clinic visits more difficult). For practicality, although the data were easily interpretable by clinicians, 48% of patients failed to complete the questionnaire before they were seen by their clinicians. Conclusions: Though feasible to collect electronically standardized demographics, lifestyle, and past medical history routinely, timeliness was an issue. Earlier arrival times or completion at home may be necessary to improve clinical utility of the questionnaire.
Timeliness to treatment in patients with lung cancer at UVA Cancer Center.
Authors: Tola Geda , Spencer Hannah E , Hall Richard Delmar , Horton Bethany J , Gentzler Ryan D. 
Published: April 2017

169 Background: The current standard of care for lung cancer patients recommends initiation of treatment within 30 days of diagnosis; however, the effects of delayed treatment on prognosis have not been determined. Furthermore, it is unclear what factors lead to delayed care. Longer treatment delays have been associated with decreased survival outcomes in other cancers, but such associations have not been established for lung cancer. This study analyzed lung cancer patients at UVa Cancer Center to identify the factors associated with delayed treatment and the effect of this delay on overall survival outcomes. Methods: Lung cancer patients diagnosed from 2011 to 2014 were retrospectively analyzed using UVA Cancer Registry data. Two outcomes, diagnosis to treatment time interval, and overall survival were modeled. Multivariate analysis was used to identify the variables that affected timely care. Statistical tests were used to determine whether there were significant differences in overall survival between patients who received timely and delayed care. Results: 917 patients met the criteria for analysis. Most were stage I (47.5%) and received surgery as first line of treatment (57.7%). Median age was 66 years. The median treatment interval for this cohort was 32 days. Stage at diagnosis was major determinant for time to treatment (p = 0.0197), with stage IV patients being treated in shorter intervals (median 28 days) and stage III patients the longest (34 days). Treatment delay was not associated with overall survival (p-value 0.952) however, other covariates such as insurance type, primary treatment type and stage were (p-values < 0.0001, < 0.0001, < 0.0001). Conclusions: Complex multidisciplinary care can lead to delays in treatment. Stage and type of primary treatment type were determinants of treatment delays and should be recognized as obstacles to timely treatment. Although delays were not associated with survival in our study, further investigation to determine the impact of delays on symptoms, quality of life, and performance status is warranted.
Real-world palbociclib dosing patterns and potential wastage associated with dose modifications among post-menopausal women with HR-positive/HER2-negative metastatic breast cancer (mBC).
Authors: Li Nanxin , Du Ella X. , Chu Lihao , Peeples Miranda , Xie Jipan , Barghout Victoria E. , Tang Derek H. 
Published: April 2017

17 Background: CDK4/6 inhibitor palbociclib is recently approved for the treatment of HR+/HER2- mBC and its treatment patterns have not been thoroughly understood. This study described real-world palbociclib dosing patterns in the US. Methods: Postmenopausal women with HR+/HER2- mBC who initiated palbociclib-based therapy (date of initiation was defined as index date) between 02/03/2015 (palbociclib approval date) and 02/29/2016 (end of data) were identified from Symphony Source Lx database. Patients were required to have continuous quarterly medical/pharmacy activity for 1 year prior to and 6 months after the index date. Dose decrease or increase (collectively, dose modification) was defined as a change of daily dose of >=25 mg compared to the last dose. Dose interruption was defined as a treatment gap within 60 days before restarting the treatment as the last dose. Kaplan-Meier analyses were conducted to assess dose decrease rate and dose decrease/interruption rate within one year from the index date. The proportion of patients with and days of overlap in fills during dose modification were assessed. The costs of potential palbociclib wastage related to dose modification were estimated by applying the wholesale acquisition costs (as of Oct 2016) to the number of overlapping days of supply between two adjacent fills. Results: A total of 1,242 patients initiated palbociclib-based therapy in line 1 through 4 for mBC (mean age=62.7 years, median follow-up time=8.7 months). Across line 1 to 4, dose decrease rates were 31.9%-33.7%, and dose decrease/interruption rates were 63.5%-80.9%. A total of 411 (33.1%) patients had dose modification, among whom 203 patients (49.4%) experienced an overlap in prescription fills during dose modification with an average overlap of 12.3 (SD=10.6) days per patient, resulting in costs of potential wastage for $4,556 (SD=$3,920) per patient. Conclusions: This real-world study showed most patients initiating palbociclib-based therapy had dose modification or interruption over a median follow-up of 8.7 months. Half of the patients experiencing dose modifications were associated with potential wastage.
Investigating associations between health-related quality of life and endocrine therapy under-utilization in women with early-stage breast cancer.
Authors: Pinheiro Laura C , Wheeler Stephanie B. , Reeder-Hayes Katherine Elizabeth , Samuel Cleo A. , Olshan Andrew F , Reeve Bryce B. 
Published: April 2017

170 Background: Endocrine therapy under-utilization puts women at increased risk for breast cancer recurrence. The objective of this study was to determine if health-related quality of life (HRQOL) was significantly associated with under-utilization. Methods: Data came from the third phase of the population-based Carolina Breast Cancer Study. We included 1,599 women with hormone receptor positive disease aged 20-74 years. HRQOL was measured using the Functional Assessment of Cancer Therapy for Breast Cancer, on average, 5-months post-diagnosis. HRQOL domains included physical, functional, social, emotional, and spiritual well-being and breast cancer concerns. HRQOL subgroups were derived using latent profile analysis. Under-utilization was defined as not initiating or adhering to endocrine therapy by 36-months post-diagnosis. Multivariable logit models estimated adjusted odds ratios (aOR) between HRQOL subgroups and under-utilization. The subgroup with the best HRQOL scores across domains was the reference category. Chemotherapy and race-stratified models were estimated, separately. Results: Initiation analyses included 953 women with hormone receptor positive breast cancer who had not begun endocrine therapy by their 5-month survey, of whom 154 never initiated. Adherence analyses included 1,114 initiators, of whom 211 were non-adherent. HRQOL was not significantly associated with non-initiation except among non-chemotherapy users, with membership in the poorest subgroup associated with an increased odds of non-initiation (aOR 5.5; 1.7-17.4). Membership the two poorest HRQOL subgroups was associated with non-adherence (aOR 2.2; 1.2-4.0 and aOR1.9; 1.1-3.6), respectively. Membership in the poorest HRQOL subgroup was associated with non-adherence among non-chemotherapy users (aOR 2.1; 1.2-5.1). Conclusions: Our results suggest that women with poor HRQOL during active treatment may be at increased risk for under-utilization. Focusing on HRQOL, a modifiable factor, may improve targeting of future interventions early in the breast cancer continuum to improve endocrine therapy initiation, adherence, and breast cancer recurrence.
How well is interdependent care managed across specialties in breast cancer? Metrics and pre-implementation data from the 4R in Oncology Project.
Authors: Weldon Christine B. , Trosman Julia Rachel , Perez Claudia B. , Kulkarni Swati , Khan Seema Ahsan , Hansen Nora , Nelson Valerie , Stein Jennifer , Simon Melissa A. , Strauss Jonathan Blake , Espino Sasa M. , Bunce Mikele , Pan Wayne , Friedewald Sarah M. , Gradishar William John 
Published: April 2017

171 Background: The “NCI ASCO Teams” Project emphasized management of interdependent cancer care across specialties as crucial to teamwork, yet a considerable challenge (Taplin JOP 2015). Interdependent care requires well-managed timing and sequencing of events across specialties. We developed the 4R model (Right Information / Care / Patient / Time) to manage interdependent care and facilitate teamwork (Trosman JOP 2016). 4R is being implemented at 3 centers: academic, community and safety net. Pre-implementation, we identified guideline recommended interdependent care whose timing / sequencing is challenging, developed relevant adherence metrics and gathered current state data. Methods: Interviews with 42 clinicians across breast cancer (BC) specialties at the 3 sites, using theme analysis to identify challenging interdependent care. Guidelines and literature were used to define adherence metrics. Clinical data were reviewed for 162 Stage I-III patients at 3 sites to measure adherence. Results: We identified 7 interdependent BC care events for which timing / sequencing is a challenge - Table. Adherence ranged from 0% to 100%, and was < = 50% for 6 of the 7 care events. Preoperative BRCA 1/2 results and neoadjuvant consult showed highest adherence, yet were most frequently noted as a challenge: interviewees reported substantial ad-hoc efforts applied to managing timeliness of these events. Conclusions: Identified challenges and adherence gaps support the need for the 4R implementation for systematic, consistent and timely delivery of interdependent care. Established metrics will allow pre / post 4R implementation comparison and may inform broader adoption of the 4R model. [Table: see text]
Measuring quality in cancer care: Utilizing a clinical decision support system to assess pathway adherence.
Authors: Patt Debra A. , Howell Josh , Neubauer Marcus A. , He Bo , Garey Jody S. 
Published: April 2017

172 Background: Quality-based programs depend on clinical data documentation for reporting, treatment planning, and measuring pathways (PW) compliance. Adherence to treatment PW reduces variability and costs of care. Clinical decision support systems (CDSS) are tools embedded in the EHR to capture assessable data: stage, biomarkers, line of therapy, etc. With such data, CDSS can measure and report on clinical quality improvement programs like PW adherence, assessable data and exception reporting. Methods: A retrospective cohort study from Jan 1, 2014 - May 30, 2016 measured the impact of an integrated CDSS assessing compliance to PW and exception reporting across 9 independent oncology practices over a 9 month period. Assessable data, PW adherence, and exception reporting were tracked in 4 month intervals pre and post CDSS intervention by practice and physician. A one month wash out period was included post CDSS implementation. Overall rates of positivity, assessable data, and exception reporting were compared pre and post intervention using the Chi-square test. To account for the effect of time on the intervention, a segmented regression analysis was performed to analyze weekly rates of positivity pre and post intervention. Results: 9 practices, 633 physicians, and 30,666 treatment regimens were included. The weekly adherence rate increased by 7.2% after intervention (p = 0.005) across the group. Assessable data capture significantly improved across the cohort OR 6.79 (5.64-8.16) and individually for most practices. Physicians adherent to PW 75% of the time increased post intervention collectively, OR 1.83 (1.44-2.31), and individually. Exception reporting improved from 29% to 99% (p<0.0001). Conclusions: Across a cohort of community oncology practices rates of assessable data, PW adherence, and exception reporting improved after implementation of an integrated CDSS. Effective CDSSs are a critical component of quality improvement programs and may be used to improve data capture, increase adherence to PW and overall contribute to quality cancer care delivery. [Table: see text]
Oncology pharmacist opportunities: Closing the gap in quality care.
Authors: Hough Shannon , Vulaj Vera , Farris Karen B , Mackler Emily R. 
Published: April 2017

174 Background: The quality of care provided to oncology patients is beginning to be linked to hospital and practice payment models. Oncology pharmacy specialists are well trained to deliver high-quality oncology care, with a focus on the appropriate utilization and monitoring of medication therapy, patient education and collaboration with other healthcare team members. The extent to which the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) metrics identify specific areas in which pharmacists may enhance care is not known. These findings are important because Centers for Medicare and Medicaid Services designate QOPI as a Qualified Clinical Data Registry (QCDR) and over 1000 US-based oncology practices submit quality data to it. Methods: We reviewed all QOPI measures for potential oncology pharmacist involvement. We utilized a summary of services provided by board-certified oncology pharmacists to identify which services would best fit the care described by the selected QOPI measures. Three individuals identified the areas where pharmacists could contribute and consensus was reached. Metrics were only scored positively for pharmacist impact if they could be obtained via the pharmacist as the primary team member responsible for meeting the measure. Results: Two hundred QOPI quality measures from Fall 2016 were reviewed and 177 were analyzed. Potential areas of pharmacist impact were identified in 67 (38%) of the included metrics. These measures fell within 11 of the 13 possible categories of the service summary. A total of 147 services were identified for the 67 actionable metrics. Patient counseling and education (28%), symptom management and supportive care (23%), chemotherapy adjustment (10%), and participation in protocol-based care (10%) comprised services that most commonly contributed to the ASCO QOPI measure performance. Conclusions: Multiple opportunities exist for pharmacists to directly impact the quality metrics that are measured by the service summary. Focusing new services and patient care activities to address validated quality metrics is a natural next step in the care that oncology clinical pharmacists provide to patients.
Evaluating the efficacy of an advanced practice provider symptom management telephone triage program in reducing ED visits and “avoidable” admissions of oncology patients.
Authors: Hirigoyen Jorge , Kalman Leonard A. , Szymanski Jill , Lazo Carmen , Espinosa Christopher , Malespin Amy 
Published: April 2017

177 Background: One of the biggest challenges for oncology patients is timely access to care. The inability to provide the right care for the right patient at the right time many times result in overuse of Emergency Departments (ED) to receive oncology care. Approximately 77% of oncology patients have an ER visit, and 63.2% of visits result in hospital admission (Mayer et al., 2011). Furthermore, the average cancer patient receiving chemotherapy has at least one hospital admission and two ED visits per year (Klodziej, et al., 2011). Establishing a “triage” program that attempts to avoid “avoidable” admissions can reduce unnecessary ED visits and associated inpatient care, therefore improving health outcomes while reducing costs. Methods: A quality improvement value-based care (VBC) initiative to prevent ED visits and avoid “avoidable” admissions, via an “Express Symptom Management Hotline” (ESMH) was created. ESMH provides oncology patients with direct and rapid phone access to an oncology Advanced Practice Provider (APP) who can appropriately triage a patient that is in need of acute symptom management. A patient can be managed over the telephone, with a clinic visit, and/or with other outpatient oncology same day services. A next day follow up call for triaged ensures that there was appropriate management. Telephone triage, associated early intervention by an APP for cancer related symptoms and a next day follow-up call will reduce ED visits and avoid “avoidable” admissions. Results: Among the 294 calls that were received from oncology patients for acute symptoms during a 12 week trial period, only 14 led to patients requiring ED services. All 14 ED visits required an admission. Conclusions: Telephone triage by APP’s via an ESMH can effectively manage oncology patients’ symptoms by providing early outpatient interventions. Such an ESMH helps avoid “avoidable” admissions, leading to improved health outcomes while reducing costs. [Table: see text]
Delays in treatment for colorectal cancer patients in an NCI-designated cancer center serving a Hispanic majority community.
Authors: Wangjam Tamna , Rauenzahn Sherri L. , Iruku Praveena , Lindauer Stephanie Purkat , Butler Matthew James , Hung Annie , Yarta Kinan , Jones Jessica Trevino , Konkel Brandon , McCracken Andrew , Patel Sukeshi R. 
Published: April 2017

178 Background: Timeliness of cancer treatment is an important aspect of health care quality. Colorectal cancer (CRC) care requires the coordinated multidisciplinary effort of various aspects of the health care system, which can lead to delays between initial diagnoses to definitive therapy. Little is known about the time from diagnosis to cancer-directed treatment, neither about the factors that cause delays or its effect on patient outcomes. Delays to curative surgery beyond 12 weeks are associated with increased mortality in CRC. Longer time to adjuvant chemotherapy is associated with worse survival among patients with resected CRC. The objective of our study is to identify delays in initiation of CRC treatment and its causative factors. Methods: We retrospectively reviewed the medical records of colorectal cancer patients who were either initially diagnosed or had initial surgical resection at University Hospital and had further treatment at Cancer Therapy and Research Center, between 7/1/2010 and 12/22/2014. Data were collected on patient and disease characteristics, treatment timelines and outcomes, till pre-specified data cut-off date of 8/1/16. Results: Of 256 patients treated for CRC, 59 % were males, 59 % Hispanic, and 34 % were uninsured. Most had non-metastatic disease (70%). 72 % were still alive at the time of data cut-off. The median time from diagnosis to treatment (TDT) was 21 days, with 60 % between 0-30 days and 59 % between 31-89 days. Median time from first treatment to first progression or recurrence was 12 months (range 0.9- 42 mos.). Median overall survival (OS) was 17 months (0.1- 51 months). There were no statistically significant difference between the progression or recurrence free survival and OS in patients with TDT <30 days, 30-89 days and >90 days. Compared to non-Hispanics, Hispanic patients were more likely to have a TDT of 31-89 days (31% vs 37%, p= 0.0003) and >/= 90 days (3% vs 7%, p= 0.0001). Conclusions: Hispanic patients were more likely to have a longer time from diagnosis to treatment compared to non-Hispanic patients. The various factors for such disparities in health care quality and their effect on survival needs to be explored further.