bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing psychosocial distress screening across a health system: Herding cats or herding cats?
Authors: Sheaffer Heather 
Published: February 2017

113 Background: With the American College of Surgeons Commission on Cancer 2015 Standards in hand, Penn Medicine embarked on a project to formulate an entity-wide plan for the provision of psychosocial distress screening. Identifying psychosocial distress and providing resources to meet those needs is an essential component of quality cancer care. Penn Medicine and the Abramson Cancer Center provided more than 91,000 chemotherapy treatments, 121,000 radiation treatments, and 14,000 proton therapy treatments in FY 15 in urban, suburban and rural settings with wide variations in resources. Methods: The establishment of the Psychosocial Distress Task Force was the key to the success of the project. Participants from multiple disciplines were invited from each facility including identified stakeholders and those with experience screening patients. After reviewing the literature, the task force set the agenda for the project including what tool to utilize for screening, when to screen, who will respond and what metrics would be evaluated. Results: Penn Medicine successfully developed a process for psychosocial distress screening across the health system by the 2015 deadline. The process includes screening all first return medical oncology patients for distress using the PHQ-4 and documenting the results in either the EMR or in the paper chart depending on the facility. The screening results then trigger a consult to social work where the patients are assessed using a standardized social work assessment developed by the task force for use by all oncology social workers across the system to standardize care. Conclusions: Given the scope of Penn Medicine oncology and the diversity of locations and staff models, formulating a plan for the provision of psychosocial distress screening presented a major challenge to the organization. This challenge was met through the establishment of a system-wide task force who planned and implemented distress screening across entity in a cohesive, coordinated way meeting the 2015 Standard.
Factors associated with toxicity-related service use among community oncology patients.
Authors: Harrison Jordan M , Lavasseur Beth , Stella Philip J. , Adams Paul T. , Swafford Lauren , Lewis JoAnn , Mendelsohn-Victor Kari , Friese Christopher Ryan 
Published: February 2017

133 Background: Chemotherapy-associated toxicities occur often, yet sparse data are available to correlate toxicities with related service use. Toxicities may disrupt treatment, impair quality of life, and induce unplanned service use. We sought to understand the frequency and correlates of unplanned service use among patients receiving first-cycle chemotherapy at 5 community-based ambulatory oncology practices in southeast Michigan. Methods: A prospective survey examined the dichotomous outcome of toxicity-related unplanned service use. Newly-diagnosed patients were recruited before the first chemotherapy cycle. At the second cycle visit, patients completed a questionnaire that measured severity of nausea, vomiting, diarrhea, constipation, mouth sores, IV catheter problems, pain, fever/chills, extremity edema, and dyspnea on a 5-point scale (1 = did not experience to 5 = disabling). They also rated distress on a 10-point scale (0 = none, 10 = worst). Patients reported unplanned oncologist visits, emergency department visits, and unplanned hospitalizations, all of which were treated as unplanned service use. Mixed-effects logistic regression was used to identify factors associated with unplanned service use, with random effects for each clinic. Results: Among 106 patients (98% white, 74.5% women, mean age 60+11), common diagnoses were breast, lung, and colorectal cancer and non-Hodgkin lymphoma. Frequent toxicities were pain, nausea, diarrhea, and constipation. Thirty-six patients (34%) reported unplanned service use: 29% reported oncologist visits, 14% reported ED visits, and 8% reported hospitalizations. 45% of the total sample and 89% of patients with unplanned service use reported at least one toxicity that was severe or disabling. Factors associated with unplanned service use were high patient-reported distress and receipt of colony-stimulating factor. Conclusions: Toxicity-related service use was common in this community oncology population. Proactive symptom assessment tools may help clinicians manage toxicities between visits. A deeper understanding of toxicity patterns and correlates can inform clinical practice guidelines in community oncology practices.
The standardization of skin cancer treatment recommendations through the analysis of clinical pathways data and an evidence-based, physician-driven committee process.
Authors: Heron Dwight Earl , Barry Amanda , Benson Hans , Lorinc Zach , Lokay Kathleen 
Published: February 2017

147 Background: Clinical pathways (CP) have the potential to improve the quality and safety of care and lead to more predictable outcomes and costs through standardization. Via Oncology’s CP program aims to standardize care at radiation centers across its nationwide network. Created through an evidence-based, physician-driven committee process, CP recommend the best treatment plan for specific patient populations based on a hierarchy of efficacy, toxicity, and cost. In the absence of definitive data, reaching a consensus on the best treatment recommendation is difficult, particularly for disease states such as melanoma, squamous cell carcinoma, and basal cell carcinoma for which a wide range of radiation doses and schedules are considered effective and regional and institutional preferences may vary. Methods: After initial implementation of CP, radiation disease committees meet semiannually to review treatment recommendations and utilization data collected for the prior six months. Data reflect treatment plans selected by physicians for individual patients. At the January 2015 skin pathway committee meeting, committee members reviewed data for each patient presentation to determine which doses and schedules were used most frequently. Results: After reviewing the utilization data, the committee narrowed the recommendations to one or two treatment plans per presentation, typically including standard and hypofractionated schedules. In scenarios where multiple treatment plans were selected at a similar frequency, the committee standardized to the lower dose and fewer fractionation plan. This reduced the number of treatment plans on the pathway from 34 to 15. A decrease in pathway adherence rates was not observed following this change. Conclusions: Data gathered from CP can be used to further standardize clinical care when there are several effective and accepted treatment regimens but a lack of published data. Through a dynamic process of assessing and modifying physician practice and patterns of care, CP provide cancer centers with a platform to ensure delivery of consistent, high-quality care to patients throughout their network.
Integrating a simple screening tool in the electronic medical record to standardize patient needs identification process.
Authors: Williams Valaree , Caspar-Clark Audrey , Niznan Neal , Cammy Rebecca 
Published: February 2017

156 Background: Unidentified psychosocial and nutrition needs can impede a patient’s quality of life during cancer treatment. Nutritional, social, and logistical patient needs may be overlooked without a standardized identification process. With the increasing use of the electronic medical record (EMR), simple screening tools to identify psychosocial needs and nutritional concerns can be implemented. Methods: The University of Pennsylvania’s Department of Radiation Oncology integrated a simple six-question “yes” or “no” response screen directly into the nursing assessment in the EMR to quickly and easily trigger high-risk patient referrals to social work and nutrition services. The screen identifies multiple patient needs (i.e. home supports, weight loss) in a formalized approach across distinct time periods in the treatment course. Staff collected data on new patient encounters and the subsequent referral source (i.e. screen, physician). Results: For social work, 24.5% of the new patient referrals from July 2013 – February 2014 were triggered via the screening tool in the EMR. While it is not clear from this data that overall referrals to social work increased due to the screening tool, it can be inferred that these patients were identified earlier in the treatment trajectory for supportive services. For nutrition services, 51.2% of new patient referrals were triggered via the screening tool. A comparison of data prior to the implementation of the screen in January 2012 showed a 78% increase in nutrition referrals triggered by the screen. Conclusions: This method facilitates quick intervention and fosters better communication among staff. The screen allows the staff to readdress psychosocial and nutrition impact symptoms on a regular basis and provide appropriate interventions along the continuum of care. The screen also reduces the subjectivity of medical staff referrals and is an additional measure to identify oncology patients who would otherwise be overlooked. Lastly, the screening tool in the EMR denotes a targeted intervention and contributes to the establishment of a supportive patient relationship.
Defining user needs for an electronic tool to improve chemotherapy-related toxicity management.
Authors: Prince Rebecca M. , Parente Laura , Soung Yee Anthony , Powis Melanie , Enright Katherine , Gandhi Sonal , Grunfeld Eva , Haq Rashida , Husain Amna , Krzyzanowska Monika K. 
Published: February 2017

157 Background: Cancer drugs are associated with toxicities which can negatively impact patients’ (pts) quality of life, outcomes and increase acute care use (ACU). There is increasing interest in leveraging technology to solve clinical problems in healthcare. We hypothesized that an electronic tool (toxicity module) targeting management of chemotherapy toxicities could decrease ACU by facilitating more effective symptom management. Methods: Participatory design methodology consisting of end user needs assessment through ethnographic field study (shadowing and in-depth interviews) and focus groups was used to inform design of an interactive prototype toxicity module. Oncology pts and their caregivers, and health care providers (HCPs) including oncologists, oncology nurses and primary care providers were included in all stages of development. Contemporaneous notes were taken during ethnography while focus groups were also audio recorded. Thematic analysis through ideation sessions and time-of-day exercises allowed identification of overarching issues. Results: Eight pts and 8 HCPs participated in the ethnographic field study. Two focus groups, one with 7 pts, one with 4 HCPs were held. Most themes were common to both pts and HCPs; gaps and barriers in the current system, need for decision aids, improved HCP communication and options in care delivery, and access to credible information delivered in a timely, secure manner and integrated into existing systems. Additionally, pts further identified missed opportunities, care not meeting their needs, feeling overwhelmed and anxious and wanting to be more empowered; HCPs identified accountability as an issue. These themes informed development of a prototype for a web-based toxicity management tool, which has served the purpose of defining user needs for symptom tracking, self-management advice, and timely communication with an oncology provider. Iterative evaluation over 2 rounds of usability testing is currently underway. Conclusions: An electronic tool that integrates just-in-time self-management advice and oncology provider support into routine care may address some of the gaps identified in the current system for managing chemotherapy toxicity.
Developing and implementing EMR functionality to improve oral chemotherapy outcomes.
Authors: Hensing Thomas A. , Brockstein Bruce , Carro George W. , Hullett Ashton Marie , Hughes Brad , Spath Wayne , Huginnie Sharon 
Published: February 2017

159 Background: Approval of new oral anticancer agents (OAA) continues to rise, accounting for 75% of new oncology drugs approved so far in 2015. OAA prescriptions generated at our institution demonstrate similar growth, as the prescription volume for OAA is approximately 200% greater than it was 8 years ago. Challenges of OAA, including safe prescribing, monitoring toxicities, and assessing adherence, continue to be an obstacle to providing quality care. In recognition of these challenges, our institution employed the electronic medical record (EMR) to develop tools to enhance safe prescribing, monitoring, and follow up for patients receiving OAA. Methods: Comprehensive, regimen-specific, OAA protocols were built in the EMR using the American Society of Clinical Oncology’s Quality Oncology Practice Initiative criteria as a guide. Protocols included OAA prescriptions, laboratory tests, monitoring communications, supportive care medications, plan for follow up, and a monitoring order. The monitoring order, dated 7 to 10 days after the start of each cycle, was utilized to identify patients for follow up, and as a documentation tool. During follow up calls, pharmacists provided education, addressed adherence and toxicities, and communicated findings to team members. The initial analysis focused on six of the most commonly prescribed OAA agents at our institution. Results: Cycle 1 follow up calls were placed for 115 new start OAA patients. Over half of the patients (56.5%) required an intervention (ex: symptom management, alerting the medical team, counseling). Eleven patients had barriers to adherence (ex: confusion, incorrect technique, cost, obtaining insurance coverage, and toxicity). Overall, 98% of patients verbalized appropriate adherence. There were 191 subsequent follow up efforts, after the cycle 1 follow up call, which resulted in 39 interventions (20%). Conclusions: OAA requires the same intensive monitoring and follow up as IV chemotherapy, but is more difficult to provide given the nature of administration of these medications. Utilizing the EMR to develop prescribing and monitoring tools can help address these challenges by providing a means for enhanced documentation and follow up.
HICOR IQ: Developing a regional oncology metric reporting platform.
Authors: Fedorenko Catherine R. , Kreizenbeck Karma L. , Sadot Avital , Piehler Britt , Murray Jessi , Gersch Michael , Lyman Gary H. , Ramsey Scott David 
Published: February 2017

165 Background: The Hutchinson Institute for Cancer Outcomes Research (HICOR) has adopted a multi-stakeholder approach to identify and prioritize metrics to characterize oncology care in the Western Washington. In March 2015, HICOR released a beta version of an oncology informatics platform, named HICOR IQ, which allows regional payers, providers and patient advocates to view and interact with community-prioritized metrics. Methods: Surveillance, Epidemiology, and End Results (SEER) records for patients diagnosed with cancer in Western Washington state between January 1, 2007 and May 31, 2014 were linked with enrollment and claims from two regional commercial insurance plans. Algorithms were developed to characterize the 2012 ASCO Choosing Wisely (CW) recommendations in the claims-registry database. HICOR partnered with LabKey Software to develop a regional metric reporting platform. Results: The beta version of HICOR IQ displays regional results for the CW recommendations, then allow users to customize the reports by stratifying and/or filtering by different demographic (age, race, gender), clinical (cancer site, stage) and provider (clinic volume) characteristics. In addition, de-identified clinic specific adherence can be plotted to show variation in care throughout the region. A convenience sample of oncology clinic leaders was asked to review and comment on the beta-version. Primary suggestions were as follows: Display clinic-identifying information based on logged in user; Expand the flexibility of the tool to allow for user-created metrics; Keep the tool intuitive and easy to use; Protect the data and identity of patients. Future development of the tool will take an iterative process to allow for continued user feedback. The next planned version of HICOR IQ will incorporate user feedback by displaying clinic-identifying information based on the user and expanding the reporting of regional metrics. Conclusions: It is feasible to create a tool that reports regional adherence rates to oncology metrics. An iterative process that incorporates user feedback is an important step to build a tool that is adopted by the community.
Real-world treatment patterns, health care resource utilization (HRU), and costs among patients with Waldenstrom macroglobulinemia (WM) initiating therapy.
Authors: Schenkel Brad , Ellis Lorie , Korrer Stephanie , Byfield Stacey DaCosta 
Published: February 2017

17 Background: WM is a rare, indolent B-cell lymphoma with 1000 to 1500 new cases diagnosed annually in the US. The disease is incurable with current therapy. Prior to January 2015 when ibrutinib was approved by the US FDA for WM, there were no therapies approved in this indication. This study describes initial systemic anti-cancer therapy (SACT) and HRU among WM patients (pts). Methods: A retrospective study using a large, national US claims database from 1/2007-10/2013 was conducted. Adult WM pts ( ≥ 2 claims for WM) with ≥ 1 claim for SACT were identified; the first SACT claim date was the index date. Pts were required to have a WM diagnosis within 3 months (m) prior to the index date and be continuously enrolled (CE) in the health plan for 12m pre- and ≥ 6m post-index date. Pregnant pts and those with SACT in the pre-index period were excluded. The first line of therapy (LOT1) period was examined; the LOT started at index date and the regimen included all drugs received within 60 days. The LOT ended at the earliest of, start of a new drug, ≥ 60-day gap in receipt of initial drug regimen, death or CE end. All-cause HRU and costs during LOT1 were examined. Results: There were 161 WM pts identified. 66% of pts were ≥ 65 yrs (mean age 69), 55% were male, and by insurance type, 49% were Medicare Advantage pts vs. 51% commercially insured. Mean total follow-up time was 23m, and mean duration of LOT1 was 4.7m. The top 4 most common LOT1 regimens accounted for 71% of patients: Rituximab (R) only (39%); bortezomib+ R (14%); bendamustine+ R (9%) and cyclophosphamide+ R (9%). No other regimens identified accounted for more than 4% of pts. Overall, 96% and 81% of pts had ≥ 1 office or hospital outpatient visit with mean per patient per month (PPPM) visits of 3.55 (standard deviation, SD = 2.41) and 2.60 (SD = 3.06), respectively. Approximately 25% and 21% had ≥ 1 ER visit or inpatient stay with mean PPPM visits of 0.11 (SD = 0.24) and 0.06 (SD = 0.16), respectively. Total mean PPPM healthcare costs during LOT1 was $13,589 (SD = $13,404). Conclusions: HRU and costs were high among WM pts initiating SACT. Future studies should examine whether differences in LOT1 regimen choice are associated with differences in cost and outcomes.
Utilizing a case management system to reduce the response time for symptom management calls in a high-volume practice.
Authors: Dickson Natalie R. , Bilbrey Larry Edward 
Published: February 2017

170 Background: A five physician, three nurse practitioner,community oncology clinic experiences high call volumes (average 352 daily), many of which are related to side-effects of chemo/biotherapy and health related issues. A study was completed to decrease the time for a patient symptom management call to be addressed and concluded. Methods: Initial primary data were collected over a four month period (April-August 2015) using the phone system and the Electronic Health Record (EHR) reporting capabilities, by cross-referencing the caller-ID data with the EHR patient demographics data; only documented symptom management calls within the EHR were included. Twenty-nine percent (202 of 691) of symptom management calls were identified for the sample. Secondary data were collected prospectively using a handwritten call log completed by triage nursing, detailing the purpose of every call routed to triage nursing. Changes were made in the daily telephone call process to include a full-time operator, additional triage nursing staff, and implementation of a structured case management system. Follow-up primary and secondary data were collected for six weeks (August-September 2015) utilizing the case management system. Of the calls routed to triage nursing, 100% were captured in the case management system; call response time and call purpose were recorded. Results: During the initial primary data collection, a baseline of 48% of symptom management calls being addressed within 2 hours was established. Staffing changes resulted in an improvement to 68%, and an additional improvement to 73% after implementation of the case management system. Secondary data collection at baseline showed that 35% of calls were inappropriately routed to triage nursing; this improved to under 1% after implementation of the case management system. Conclusions: The reallocation of staff to concentrate on patient call processes, and the use of a case management system, significantly improved symptom management call response time. The implementation of a case management system nearly eliminated all inappropriate calls routed to triage nursing.
Brentuximab vedotin in relapsed/refractory Hodgkin lymphoma following autologous stem cell transplant: A cost-effectiveness analysis updated with 5-year follow-up data from the pivotal trial.
Authors: Parker Christopher , Kay Gemma , Ma Esprit , Woods Beth , Eaton James , Sajosi Peter , Engstrom Andreas , Selby Ross , Benson Eugene , Teasell Jeremy , Richhariya Akshara , Briggs Andrew , Bonthapally Vijayveer 
Published: February 2017

19 Background: In 2015, the Scottish Medicines Consortium (SMC) made a positive recommandation for brentuximab vedotin (BV) in patients with relapsed or refractory (R/R) Hodgkin lymphoma (HL) who have received autologous stem cell transplantation (ASCT) based on 3-year follow-up data from the pivotal phase 2 single-arm trial (SG035-0003; NCT00848926). At 3-years, the incremental cost-effectiveness ratio (ICER) for brentuximab vedotin compared with chemotherapy +/- radiotherapy (C/R) was £43,731 per quality-adjusted life year (QALY). This study re-evaluated the cost-effectiveness analysis with 5-year follow-up data from the pivotal trial. Methods: A partitioned survival model was developed using a Scottish health system perspective over a lifetime time-horizon. Three health states were evaluated: progression-free survival (PFS), post-progression survival, and death. The relevant comparators were C/R, or C/R with intent to allogeneic stem cell transplantation. Clinical outcomes (PFS and overall survival [OS]) for BV were estimated based on data from the pivotal trial in 102 patients. A naïve comparison with the specified comparators was conducted using published survival data. ICERs were calculated with measures of the clinical outcomes, direct costs and QALYs. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the model. Results: The 5-year follow-up data reduced the base case ICER for BV from £43,731 to £38,769 per QALY versus C/R and increased the probability of cost-effectiveness. The variation in ICER for BV generated by the deterministic sensitivity analyses was also reduced resulting from reduced uncertainty in the estimation of long term clinical outcomes. Conclusions: This update has strengthened the cost-effectiveness evidence for BV in patients with R/R HL post-ASCT. The 5-year follow-up has reduced the uncertainty in the long term outcomes and reduced the ICER, which is low in comparison to other treatments for orphan diseases approved by UK agencies. BV may therefore represent a cost-effective treatment option for this patient group.