bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgery and chemoradiotherapy in stage II and III esophageal cancer: A retrospective analysis of first-course treatment across different insurances using the NCDB.
Authors: Brin Lauren , Ganti Apar Kishor , Fang Xiang , Warlaumont Mary , Fuller Timothy , Whittaker Naomi , Silberstein Peter T. 
Published: February 2017

29 Background: The current standard of care for stage II/III esophageal carcinoma for patients who can withstand aggressive therapy is chemotherapy, radiotherapy and surgery (tri-modality therapy). This is the largest study of its kind to date. Methods: Using the National Cancer Database (NCDB) 46,758 patients diagnosed with stage II/III esophageal carcinoma between 2000 and 2009 were identified. The NCDB database includes data from 70% of cancer patients in the US. Results: In stage II/III esophageal cancer private insurance holders received more tri-modality therapy (39%) than VA insurance (18%), Medicaid (22%), Medicare (18%), and the uninsured (19%) (p<0.0001). There was no statistically significant difference in the amount of tri-modality therapy received in patients with VA, Medicare, or no insurance. Medicaid patients received more tri-modality therapy than Medicare, uninsured, and VA patients (p<0.05). VA and uninsured patients received no treatment more frequently (13%) than those with private insurance (5%), Medicare (10%), and Medicaid (9%) (p<0.0003). Patients over 70 less frequently underwent tri-modality therapy (13%) as compared to those under 70 (34%, p<0.0001). Conclusions: Although VA, Medicare, and the uninsured patients received similar rates of tri-modality therapy (18-19%), it was much less than private insurance holders (39%). Medicaid patients received less tri-modality therapy than private insurance holders despite similar ages. Uninsured patients received a similar amount of tri-modality therapy as those with VA and Medicare. [Table: see text]
Automated telephone reminders: Potential to improve adherence to adjuvant hormonal therapy among patients with breast cancer.
Authors: Quinn Virginia P. , Schottinger Joanne E. , Green Kelley R. , Cheetham Craig T. 
Published: February 2017

297 Background: As the U.S. population ages and life expectancy lengthens, the number of new estrogen receptor positive (ER+) breast cancer (bca) cases is expected to grow substantially from the current 150,000/year. Numerous studies show that adjuvant hormonal therapy (AHT) dramatically reduces bca recurrence (by 50%) and mortality (by 30%) among ER+ women. Daily treatment for 5 years is the recommended therapy. Yet, reports of under-utilization are alarming, ranging from 30% to more than 50%. Methods: We examined utilization of AHT among members of Kaiser Permanente Southern California, a nonprofit prepaid health care organization serving 3.6 million socio-economically diverse members. We identified 10,827 women diagnosed with bca between 2000 and 2007 from the plan’s SEER-affiliated cancer registry who were eligible for AHT. We used automated pharmacy records to assess uptake and utilization of AHT (primarily tamoxifen (TAM) and aromatase inhibitors (AIs)). Results: In this insured population, we found 14% of eligible bca survivors did not begin AHT. Among women who started AHT, over 30% had sub-optimal adherence defined as a medication possession ratio <80%. Discontinuation of AHT, defined as >90 days without medication, began in year 1 (7%) and reached 25% by year 5. To address this threat to quality bca care, the health plan recently initiated an innovative automated telephone reminder (ATR) system among women who filled at least 1 prescription for TAM. Each month, ATR calls are made to about 125 women >18 years, who are overdue between 2 and 6 weeks for a refill, and who have not developed intolerance to TAM or switched to an AI. To date, ATR calls have generated no or few complaints. Next steps include evaluation of the impact of the system on adherence to TAM and, subsequently, AIs, and incorporation of electronic prompts to clinical staff for follow-up with non-responders. Conclusions: Monitoring and intervention for improving adherence to AHT needs to begin at initiation and continue across the 5 years of recommended therapy. AVR can reach large numbers of bca survivors and may have the potential to ensure they receive optimal benefit from these life-saving treatments.
Information technology transforming quality of cancer care in developing nations.
Authors: Roy Rakesh , Dutta Shoumini 
Published: February 2017

313 Background: Quality of cancer care is not uniform across developing nations because of poor economy, poor accessibility, illiteracy, lack of technology, etc. However Information technology (IT) has bridged the gap in recent times. Methods: Case files of patients of either sex suffering from non-small cell lung cancer of any stage. Age 35 years and above. Aim is to see impact of IT in quality of care. The following criteria were selected: Staging; Histological subtype categorization; Trucut biopsy; Search for EGFR mutations; Tailormade chemotherapy; Introduction of Palliative Care early in diagnosis. Contribution of IT for the medical team: Accessibility to standard guidelines online – NCCN, ASCO, ESMO, NICE. Using online AJCC guidelines for accurate staging. Accessing e-journals, mobile applications, online search engines. Email alerts from organisations. Systematic reviews from databases like COCHRANE. Web-based tutorials. Online mock examinations. Survival data from clinical trials. Contribution of IT for hospital administration: Computerized database of phase II and P– storing patient information. Results: Data collected in two different phases. (a) 1/1/2008– 31/12/2008. (b) 1/1/2011- 31/12/2011. Staging: complete correct staging 88% 1st phase compared to 95% in 2nd. 38% of the phase I patients could not be divided into adenocarcinoma or squamous variety whereas in 2nd group categorization could not be done in 13% of the cases. The proportion of trucut biopsy rose from 6% in phase I to 45% in phase II. Search for EGFR mutations was less than 2% in phase I vs 37% in 2nd phase. Tailormade chemotherapy – tyrosine kinase inhibitors were used as third line agents in almost all cases of phase I, but in the 2nd group 21% of patients received this agent earlier. Introduction of palliative care early in diagnosis was 3% in phase I compared to 12% in the 2nd group. Conclusions: IT support immensely changed the quality of cancer care in our institution and the standard was close to what is practiced in developed nations. Overall IT industry promoted evidence based cancer care in our institute.
Comprehensive and financially sustainable survivorship care.
Authors: Rosales Alicia R. , Clifford Kathleen , Brown Michele , Watts Lori , Burnham Christa , Thomas Nicole , Graves Julie , Thurston Nicole , Byrne Dia , Zuckerman Dan Sayam 
Published: February 2017

32 Background: New 2015 Commission on Cancer (CoC) standards require that all patients who complete treatment receive an individualized survivorship care plan (SCP). To meet this new standard St. Luke’s Mountain States Institute (MSTI), with support from the NCCCP, implemented a process that is multidisciplinary, efficient and sustainable. Methods: At MSTI, the patient’s SCP is a modified ASCO template with a comprehensive care plan and is prepared in the EMR by a Registered Health Information Technician (RHIT). This document is reviewed during a one hour visit with a nurse practitioner and a social worker. The patient participates in the discussion and sets wellness goals for healthy survivorship. The provider’s dictation is mailed to the PCP with the SCP. From Aug. 2011 – June 2012, 53 breast cancer patients were seen in 1 hour joint nurse practitioner/social work survivorship visits. A chart audit was conducted for these patients and follow-up phone calls were done with 36 patients at one month post-visit to evaluate patient understanding and satisfaction. Financial analysis was also completed to determine return on investment (ROI). Results: From chart review, the most common patient concerns were nutrition and weight loss (36%), anxiety (23%), fatigue (21%), depression (17%), caregiver stress (19%) and sexuality (17%). Phone calls showed high patient satisfaction and understanding. Patients rated the following statements on a Likert scale from 5=strongly agree to 1= strongly disagree: I understand my treatment summary and care plan 92% strongly agree or agree, I feel the survivorship visit met my survivorship needs, 97% strongly agree or agree, and 76% of participants were still working on wellness goals at one month. Patient accounts were reviewed showing approximately 50% ROI. Conclusions: It is possible to implement sustainable and comprehensive survivorship care that meets the new CoC standards. The model at MSTI provides increased patient engagement, patient satisfaction, and improved patient provider communication in addition to ROI. Opportunities remain to measure long term health outcomes and downstream revenues associated with this survivorship model. Project funded with Federal funds from the NCI, Contract No HHSN261200800001E.
Implementation of electronic chemotherapy ordering: An opportunity to improve evidence-based oncology care.
Authors: Adelson Kerin , Holcombe Randall F. , Lutkowski Kristine , Peralta-Hernandez Damaris , McLean Michael , Evans-Smith Anika , Wynter Denise , Spencer-Cisek Patricia 
Published: February 2017

323 Background: On April 20, 2012, Mount Sinai Medical Center was the 63rd site to go-live with the Beacon chemotherapy module of the EPIC EMR. EPIC support reports that ours was one of the most successful launches to date. Previously, all our chemotherapy orders were handwritten with variable adherence to evidence-based chemotherapy and supportive care guidelines. Our goals were 1) reduce errors and improve patient safety, 2) increase use of evidence-based treatment, 3) optimize supportive care and 4) improve practice efficiency. Methods: Fourteen months prior to the go-live we formed a Chemotherapy Council, made up of Oncology physician, nursing and pharmacy leadership and a Beacon-trained Build Team, including an oncology nurse and two chemotherapy pharmacists. Individual disease groups submitted lists of their regimens with references, which were used to create paper orders. The council met weekly to review the orders, references, nursing communications, and NCCN treatment, antiemetic and supportive care guidelines. Once approved, these paper orders served as templates for more than 400 electronic protocols. Each protocol was validated by a utilizing physician. Results: 98% of patients had electronic orders entered prior to go-live (394 chemotherapy and 116 supportive). There were no patient safety issues during the go-live period. In a survey one-month post go-live, 72% of users felt that Beacon had improved their day-to-day efficiency and 72% of users felt that the quality of patient care had improved. Conclusions: The transition to electronic chemotherapy ordering offers an institution the chance to develop evidence-based oncology practice, standardize supportive care and enhance patient safety. It is essential to develop procedures to avoid electronically immortalizing unproven regimens or chemotherapy dosing errors. The key elements that made our Beacon transition so successful were: 1) extensive involvement of oncology leadership, 2) use of a chemotherapy council to enforce evidence-based practice, 3) clinician validation of every protocol and 4) ongoing collaboration between clinical operations and IT regarding the impact of electronic ordering on downstream operations.
Developing a cultural and socioecological patient-centered survivorship care plan template for African American survivors.
Authors: Ashing-Giwa Kimlin T. , Tapp Carlyn , Brown Shirley , Smith June , Mitchell Eudora , Santifer Rhonda , McDowell Kommah , Martin Virginia , Betts-Turner Betty , Carter DeBorrah , Adkins Jackson Paris , Rosales Monica , Fulcher Gingi 
Published: February 2017

40 Background: Cancer and its treatments bring added health and life challenges. Cancer survivors require ongoing surveillance and medical care. To facilitate best practice in follow-up care, the Institute of Medicine, the American Society of Clinical Oncology and advocacy organizations advise that cancer survivors be provided with treatment summaries and Survivorship Care Plan (SCP). African-American breast cancer survivors (AABCS) have poorer outcomes characterized by greater morbidity and mortality, hence warranting their careful surveillance and follow-up medical care. SCP investigations are urgently needed to improve follow-up care and cancer outcomes in AABCS. Methods: The study embraced a community-based participatory research framework, building upon a series of research projects conducted by the African American Cancer Coalition, a partnership of scientific researchers and community-based advocates. Three informative focus groups were conducted with AABCS (N=25) and advocates (N=3) to obtain input on cultural and socio-ecological SCP contents to increase patient responsiveness. Results: AABCS believed that increased mortality may be due to comorbidities and inadequate surveillance and follow-up care. Participants recommended that the SCP attend to and document all comorbidities and medications; allow for participation of primary care providers; referrals for providers especially surgeons who are familiar with treating AABCS to the reduce keloid, and health advisories on nutrition, exercise and stress management. Quality-of-life related components and community referrals should be included because they are important for overall health. AABCS noted the importance of spirituality in life, and the disproportionately high levels of socioecological stress in the community. Conclusions: Participants infused cultural and socioecologic relevance towards the development of a patient centered SCP template to increase acceptability and utilization among AABCS. Participants underscored that developing the SCP responsive to AABCS and facilitating adherence to SCP recommendations, are areas warranting increased intervention and research.
Standards for evaluating patient-reported outcome (PRO)-based performance measures.
Authors: Basch Ethan M. , Goertz Christine , Christenson Keri , Crawford Amaris , Dudley R. Adams , Spertus John 
Published: February 2017

45 Background: There is growing interest to use performance measures that integrate patient-reported outcomes (PROs), but there are no existing methodological standards for developing, implementing, or analyzing such measures in this context. Methods: To develop standards for evaluating PRO-based performance measures submitted to or developed by the American Medical Association-convened Physician Consortium for Performance Improvement, a multi-disciplinary expert technical panel was assembled. A systematic literature review and landscape overview were conducted to identify use cases and existing PRO standards in related contexts. Lessons learned from use cases and existing standards guided development of discrete methodological standards. Results: The systematic review identified only one use case, whereas the landscape overview identified eight. Five purposes were identified for which PROs might be measured to assess performance, including one categorized as process and four as outcome. Eight discrete methodological standards were developed which will be detailed at the meeting. Conclusions: The patient perspective is an essential but missing component of performance evaluation. When appropriately elicited, data from patients can be informative. Lack of adherence to good practices and inadequate patient input when developing measurement strategies are potential pitfalls to be avoided.
Nomogram predicting treatment-related urinary incontinence for men with localized prostate cancer treated by radical prostatectomy (RP), external-beam radiotherapy (EBRT), or brachytherapy (PI).
Authors: Klink Joseph C. , Sanda Martin G. , Litwin Mark S. , Ferrer Montserrat , Regan Meredith M. , Saigal Christopher , Kwan Lorna , Gao Tianming , Klein Eric A. , Kattan Michael W. , Stephenson Andrew J. 
Published: February 2017

49 Background: RP, EBRT, and PI for the treatment of clinically localized prostate cancer may negatively impact urinary continence. Predictions of treatment-related urinary problems from patient-reported, prospective data may be useful in treatment decision-making. Methods: Patient-reported data on treatment-related urinary incontinence was obtained from four prospective, longitudinal, health-related quality-of-life (HRQOL) protocols comprising 2,668 patients treated between 1999 and 2011 by RP (n = 1,294), EBRT (n = 630), and PI (n = 744). A single HRQOL instrument was not uniformly used for each study, although questions pertaining to the quantity (pad use) and frequency of urinary incontinence (“never” to “more than once per day”) were identical among the studies. Patient responses were obtained at baseline and at two years after treatment. The endpoint of the model was urinary continence defined as no pad use and leakage of urine less than once per day. Cox proportional hazards regression analysis was used to model the clinical information and follow-up data. Internal validation was performed using bootstrapping. Results: Overall, 1,937 (92%) of patients with complete data available were considered to be continent at baseline. Significant differences in baseline characteristics such as patient age, ethnicity, and disease severity existed between the treatment groups. The overall continence rate at two years was 66%, 88%, and 87% for patients treated by RP, EBRT, and PI, respectively (p < 0.001). In multivariable analysis, age (p = 0.001), baseline frequency of incontinence (p < 0.001), EBRT (p < 0.001), PI (p < 0.001), and ethnicity (p < 0.001) were associated with urinary continence. A nomogram based on the predictive parameters had a concordance index of 0.74 and predictions were well-calibrated with observed outcome. Conclusions: An externally-validated nomogram that predicts two-year urinary continence after treatment for localized prostate cancer has been developed and will be useful for patient counseling regarding treatment options.
How is race/ethnicity associated with patient reporting of cancer pain in recently diagnosed colorectal and lung cancer?
Authors: Martinez Kathryn Anne , Dy Sydney Morss 
Published: February 2017

50 Background: Racial and ethnic disparities in the quality of cancer pain treatment are widely documented. The purpose of this study was to examine adjusted differences by race/ethnicity in the odds of reporting pain and differences in pain severity. Methods: This study used data from Cancer Care Outcomes Research and Surveillance Consortium (CanCORS), a nationally representative cohort study of colorectal and lung cancer patients. Patients were identified following incident colorectal or lung cancer diagnosis via rapid case ascertainment. Surveys were administered between three and five months following diagnosis. Pain was assessed via patient self-report using the Brief Pain Inventory. Control variables included sex, age, education, wealth, fatalism, marital status, survey language, self-reported health status, depression, cancer stage, and care at a Veterans Administration (VA) facility. Each control variable was first individually assessed as a potential mediator in the relationship between race/ethnicity and pain severity. Final models were fully adjusted with all control variables. Results: Among 3,216 individuals with colorectal cancer (16.4% black), 40% reported pain; among 2,545 with lung cancer (12% black), 57% reported pain. The odds of reporting pain did not differ by race/ethnicity in lung or colorectal cancer patients in adjusted analyses. None of the included covariates significantly mediated this relationship. However, among those reporting pain, pain severity was higher for black relative to white patients in both lung (p=0.002) and colorectal cancer (p=0.000). Conclusions: The odds of reporting presence of pain did not differ by race/ethnicity. However, among those reporting pain, blacks reported higher pain severity than whites in both cancer types, even after adjusting for patient and health status characteristics. Differential pain severity by race/ethnicity, particularly for black patients, may be an important consideration in assessing the quality of cancer pain management.
Use of surgery and chemoradiation in stage II and III rectal cancer: A retrospective comparison of treatment modalities in major insurance types using the NCDB.
Authors: Warlaumont Mary , Brin Lauren , Fuller Timothy , Whittaker Naomi , Silberstein Peter 
Published: February 2017

64 Background: The standard of care (SOC) for stage II/III rectal cancer is neoadjuvant chemoradiation plus surgical resection. We aim to compare the treatment practices for patients with stage II and III rectal cancer in major insurance types. Methods: Using data from the National Cancer Database (NCDB), we analyzed the treatment patterns of 91,782 patients diagnosed with stage II/III rectal cancer from 2000 to 2009. The NCDB includes data from 70% of all U.S. cancer patients. This is the largest study of this kind to date. Results: In stage II/III rectal cancer, patients with private insurance received more SOC treatment (70.3%) than patients with VA Insurance (56.6%), Medicare (46.9%), Medicaid (66.5%), or no insurance (61.7%) (p<.0001). VA patients received less SOC treatment than Medicaid or noninsured patients (p<.0001). Medicare patients (26.9%) were treated with surgery alone more often than patients with private insurance (9.8%), Medicaid (10.4%), VAH (12.2%), or no insurance (9.4%) (p<.0001). VA (4.8%) and Medicare (4.3%) patients more often did not receive any “First Course Treatment” than patients with private insurance (1.3%) (p<.0001). Patients over 70 years old received less SOC treatment (42.2%) than patients under 70 years old (68.9%) (p<.0001) and received more surgery without chemotherapy or radiation (29.3%) than patients less than 70 years old (9.2%) (p<.0001). Conclusions: Stage II/III rectal cancer patients with private insurance received more SOC treatment than VA, Medicare, Medicaid or uninsured patients. VA patients received less SOC treatment than Medicaid or uninsured patients. [Table: see text]