bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors affecting multidimensional caregiver burden: Results from national surveys.
Authors: Halpern Michael T. , Fiero Mallorie , Bell Melanie 
Published: February 2017

301 Background: Quality of care for individuals with cancer is affected by the burden on their caregivers. For high quality care, it is important to understand domains of caregiver burden and factors affecting this burden. Methods: Using data from two national surveys, the National Survey of Caregiving (NSOC) linked to the National Health and Aging Trends Survey (NHATS), we identified all participants in the NHATS diagnosed with cancer who had a caregiver participating in the NSOC. Twenty-two items in the NSOC related to caregiver health, mood and outlook were included in factor analysis to develop scales capturing domains of burden. Multivariable regression analyses examined whether activities performed by caregivers and supports for caregivers were associated with these burden scales. Results: Analysis of responses from 245 caregivers of cancer patients identified three scales: emotional burden; psychological burden; and relationship with the patient. Providing assistance managing medical care was associated with increased emotional and psychological burden, while assistance with non-medical issues was increased psychological burden and worsened relationships with patients. Caregiver provision of direct patient care activities was also associated with increased burden but improved relationships with patients. Use of support services showed mixed associations with burden. Conclusions: Using a nationally-representative sample of cancer patients and their caregivers and brief publicly-available survey questions, we present three scales addressing different aspects of caregiver burden that are responsive to caregiver activities and social supports. This may assist in developing and evaluating intervention to decrease caregiver burden and thereby improve quality of care for individuals with cancer.
Ontario’s approach to tackling drug funding sustainability.
Authors: Anas Rebecca , Gavura Scott , McLeod Robin , McLaughlin Virginia , Earle Craig , Arias Jessica , Rey Michelle , Jamal Hasina 
Published: February 2017

38 Background: One of the challenges facing Ontario relates to managing the rising costs of cancer drug treatments. The annual growth rate of cancer drug spending has increased by 10-20% since 2010, exceeding other therapeutic categories and is expected to continue to grow significantly faster than expenditures in other areas. Paradoxically, the price of a drug seems to have little relation to its demonstrated efficacy ( http://www.asco.org/practice-research/cancer-care-america-2015/focus-cost ). The Cancer Quality Council of Ontario (CQCO) and Cancer Care Ontario (CCO) embarked on a journey to systematically address this challenge. Methods: The CQCO and CCO focused on identifying and reviewing the critical success factors of a sustainable drug reimbursement program with international, pan-Canadian and internal input. Recognizing that drug funding sustainability is a challenge faced by health systems worldwide, the scope of this work was broadened from a provincial focus to one that was relevant across the Canadian context. Results: Ultimately, this work resulted in CQCO providing a core set of recommendations for CCO that may also be relevant to other reimbursement programs, in order to maximize the effectiveness of cancer drug use and support overall system sustainability in a patient-centred way. The recommendations to address drug funding sustainability included: (1) Transparency in drug funding decisions; (2) development of process to incorporate current best evidence to support system sustainability; (3) development of a consistent approach to gathering and analyzing real world evidence (RWE); (4) development of a consistent process for disinvestment and renegotiation of prices with buy-in from public, patients and clinicians; (5) development of a provincial process to maximize harmonization in cancer drug funding coverage decisions; (6) refinement of the algorithm and priority setting for review of drug submissions; and (7) incorporating RWE into funding decisions and downstream re-evaluation. Conclusions: CCO is determining an action plan based on the above recommendations and developing partnerships to support successful implementation to improve sustainability in regards to cancer drug funding.
Effect of insurance status on receiving standard quality care treatment in patients with stage III colon cancer.
Authors: Master Samip R. , Liu Lihong , Dhaibar Hemangini , Mills Glenn Morris , Shi Runhua 
Published: February 2017

45 Background: NCCN (National comprehensive Cancer network) recommends adjuvant chemotherapy for stage 3 colon cancer patients. National Cancer Data Base (NCDB) data were analyzed to investigate the impact of insurance status on receiving standard quality of care with adjuvant chemotherapy for stage 3 colon cancer patients. Methods: Data was analyzed from 11,563 men and women, between ages 18-80 years, registered in the NCDB who were diagnosed with stage 3 colon cancer between 1998 and 2011 and had follow-ups to end of 2012. The primary predictor variable was payer status and the outcome variable was treatment received. Additional variables addressed and adjusted for included sex, age, race, Charlson Comorbidity index, education, income, distance traveled facility type and diagnosing/treating facility. Results: Among these 11,563 patients, the mean age at diagnosis was 60.3 years (median, 61 years). The mean ages at diagnosis were 53.3, 54.9, 53.9, 69.6, and 58.2 years for uninsured, private, Medicaid, Medicare and unknown payer status, respectively. In multiple logistic regression analysis, after adjusting for secondary predictor variables, payer status was a statistically significant predictor of not receiving adjuvant chemotherapy. Relative to privately insured patients, patients with Medicaid were 2.20 times, Uninsured were 2.16 times, Medicare was 1.76 times, and unknown insurance were 2.25 times more likely not to receive adjuvant chemotherapy, respectively. Compared to age group 18-49 years, patient with age group 50-64 years, 65-74 years and 75+ years were 1.59, 2.54 and 5.59 times more likely to not to received adjuvant chemotherapy, respectively. Of the factors analyzed, age, comorbidity index, insurance and distance travelled to treatment center were statistically significant predictors of a patient not receiving adjuvant chemotherapy. Conclusions: We observed that payer status has a statistically significant relationship with stage 3 colon cancer patients not receiving adjuvant chemotherapy. This remained true after adjusting for other predictive factors. Further research is necessary to investigate how the treatment disparities are associated with different types of insurance.
Eleven-year experience with a web-based medication occurrence (MO) reporting tool in a community oncology practice.
Authors: Hoverman J. Russell , Jang Tae W , Schwartz Jim R. 
Published: February 2017

53 Background: At ASCO 2007, we presented 2 year experience with a web-based Medication Occurrence (MO) reporting tool. We now report the 11 year experience in a single outpatient oncology practice. Methods: Since December 2003, Texas Oncology (TxO) sites have entered information on Medication Occurrence (MO) reports in an electronic Variance Reporting tool. The pharmacy management team generates reports monthly for the Texas Oncology Quality Oversight Committee and each site Quality Committee for analysis and follow-up action. The data are analyzed according to a pre-set group of parameters (retail vs. clinic, near miss vs. actual occurrence, severity level 1-8, categories of occurrence). Recently these data were analyzed for the years 2004-2014 to assess trends in MOs. Results: Over 11 years there were 2,163,249 transactions for a chemotherapy infusion or injection. There were 10845 MOs of which 5,143 were adverse drug reactions (ADRs). Near misses accounted for 16.7% of unadjusted MO rate and 31.8% when ADRs were excluded. MO rate with ADR was 0.46%, without ADR 0.24%. Retail MO rate was 0.02% on 1,771,148 transactions. Rituximab was 20.9% and paclitaxel 16.4% of ADRs. Tying reporting to clinic performance increased reporting by site and number of sites. EHR related MOs and Near Misses were each reported as MOs and artificially inflate numbers due to double counting. There were 10 deaths over 11 years. With these data, we were able to 1) Promote an epinephrine protocol for severe drug reactions, 2) Obviate the need for AEDs at every site, 3) Find no difference in rituximab reactions by geographic region, 4) Make assessments regarding cost and toxicity of iron compounds, 5) Target specific drugs for ADR risk. 6) Assess prophylactic corticosteroid regimens in taxane administration. Conclusions: Web-based reporting in the outpatient community setting is feasible and identified many topics for quality improvement initiatives. The importance of double-checking and a culture of safety is reinforced by the number of avoided MOs indicated by the near miss percentage.
Accessibility and barriers to oncology appointments at 40 NCI-designated cancer centers.
Authors: Hamlyn Geoffrey , Hutchins Kathryn , Johnston Abby , Thomas Rishonda , Tian James , Kamal Arif 
Published: February 2017

55 Background: Newly diagnosed cancer patients face fear and uncertainty regarding their prognosis and treatment options. As a first step, these patients and their family members may reach out to top-tier, comprehensive cancer centers for evaluation and treatment; however, recent literature reveals barriers to access. To identify these barriers, we evaluated obstacles patients and caregivers face in accessing services at major cancer centers. Methods: We used a ‘mystery shopper’ format to contact 40 NCI-designated, comprehensive cancer centers. We simulated a patient’s family member calling to make an initial consultation appointment using a standardized script. Each center received four calls on separate dates – two calls presented a patient with private insurance; two with Medicaid. Call order and patient name were randomized. We evaluated quantitative and qualitative components of the call, including time to next available appointment and availability of supportive services. Descriptive statistics were calculated for each quantitative measure. Results: We placed 160 calls to 40 NCI-designated cancer centers. 117 (73%) of calls were first answered by electronic prompts or voicemail, not a live person. Mean call duration was 9.4 minutes, with a range of 1 to 31.9 minutes. On average, callers spent 7.1 minutes speaking to an attendant and spent 2.4 minutes on hold or being transferred. Only a minority of callers (19.3%) were able to obtain an actual date for a next-available appointment without first registering into the cancer center’s records system. 51.3% were given an estimated date for a next-available appointment and 29.4% were told that a date for an appointment could not be estimated unless the patient was registered. When an appointment date was given (estimated or actual), only 27% were within a week. Specifically, only 1.3% of next-available appointments were within 1-2 days, 25.7% were within 3-7 days, 57.5% were within 7-14 days, 15% were not available until > 14 days. At the most extreme, the next-available appointment was not for 37 days. Conclusions: NCI-designated cancer centers often place significant roadblocks in front of patients and caregivers seeking an appointment.
Association of high rates of practice-level inpatient-intensity with end-of-life outcomes, readmission rates, and weekend hospitalizations among Medicare patients with cancer.
Authors: Clough Jeffrey D , Strawbridge Larisa M , LeBlanc Thomas William , Hammill Bradley G , Kamal Arif 
Published: February 2017

5 Background: Substantial practice-level variation exists in use of acute hospital care for patients receiving anti-cancer therapy. The aim of this study was to determine whether patient outcomes were associated with greater inpatient-intensity at the treating practices. Methods: Retrospective analysis of 397,646 Medicare beneficiaries receiving anti-cancer therapy in 2012. Each beneficiary was associated with a practice and practices were ranked based on average payments for inpatient admissions (inpatient intensity). Outcomes included 30-day readmission, weekend admissions, intensive-care unit (ICU) stays in the last month of life, and hospice stay of at least 7 days. Outcomes were measured for each quartile of practice inpatient-intensity. We fit multivariable logistic regression models to calculate adjusted odds ratios for each outcome for each quartile of inpatient-intensity. Results: Total and unplanned 30-day readmissions increased from 22.8% to 31.9% (adjusted odds ratio and 95% confidence interval: 1.45 [1.39-1.50]) and 19.8% to 27.1% (1.36 [1.31-1.41]), respectively, for patients in practices in the lowest and highest quartiles of inpatient-intensity. The proportion of admissions occurring on the weekend was similar across quartiles. The proportion of decedents with an ICU stay in the last month of life increased from 18.0% to 25.5% (1.33, 1.19–1.49) while the proportion with a hospice stay of > = 7 days decreased from 50.9% to 42.5% (0.79, 0.74–0.86) between those in practices in the lowest and highest quartiles of inpatient intensity. Conclusions: Participants in oncology practice delivery reform may find significant opportunity to improve quality and reduce costs by initially focusing on processes related to improving end-of-life care and reducing readmissions.
Confidence in self-managing side effects from oral oncolytics among a sample of Michigan oncology practices.
Authors: Mackler Emily R. , Salgado Teresa M , Severson Jane Alcyne , Lindsay Jamie , Batra Peter , Petersen Laura , Farris Karen B 
Published: February 2017

68 Background: The aim of this study was to assess patient confidence to self-manage common side effects of oral oncolytic agents among cancer patients whose providers participated in the Michigan Oncology Quality Consortium (MOQC). Methods: This was a cross-sectional study conducted between August and September 2015, enrolling a convenience sample of 125 patients currently taking oral oncolytics in 10 oncology practices who completed a brief online survey. Demographics, clinical information, health literacy (3 items) and Patient Activation Measure (PAM, 13 items) were assessed. The PAM instrument assesses patient self-reported knowledge, skills and confidence for self-management. Participants were also asked to rate on a scale 0-10 how confident they felt self-managing 3 common oral oncolytic side-effects: fatigue, nausea and diarrhea. Differences by age, gender, education level, health literacy, and PAM level were examined. Results: Respondents were 66.2 (SD, 13.6) years old and 57.7% were female. The mean length of oral oncolytic therapy was 12.9 (SD, 13.8) months and average number of medications was 5.9 (SD, 3.2). Approximately three-quarters of patients assessed had high levels of patient activation (41.5% level 3 and 32.5% level 4), with the remaining 26.0% having low involvement in their care (17.1% level 1 and 8.9% level 2). Confidence to manage fatigue was high for 79% of patients, moderate for 12.1% and low for 8.9%. Confidence to manage nausea and diarrhea was higher with 85.5% and 88.7% patients reporting high confidence, respectively, but 6.5% and 4.8% reporting low confidence to manage these two symptoms. When combining the confidence measures to manage each of the three symptoms, patients with higher health literacy (p = 0.001), higher PAM levels (p = 0.018) and older patients (p = 0.041) exhibited higher confidence at a statistically significant degree. Conclusions: Healthliteracy and PAM were associated with patient confidence to self-manage oral oncolytic side effects. Health literacy screening in clinical practice may be an efficient means to identify patients with low self-management confidence and determine needs of further education and support.
The value of secondary pathology review.
Authors: Middleton Lavinia P , Mayo Tinisha L. , Spinks Tracy E. , Cheney Richard , Chu Peiguo , Cooper Harry S. , Dintzis Suzanne , Ehya Hormoz , Fletcher Christopher D. , Gerwirtz Amy , Magliocco Anthony Martin , Martin Sue Ellen , Rosenberg Andrew E. , Sherrod Andy , Tan Lee K , Wood Brent L. , Walters Ronald Stewart 
Published: February 2017

6 Background: Improving the value of cancer care is a major focus for the Alliance of Dedicated Cancer Centers (ADCC). Looking to align with the Institute of Medicine’s (IOM) initiative to “Develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice,” the ADCC implemented a study to examine the clinical impact of expert secondary pathology review. The goal of this project was to: 1) demonstrate the value of secondary review of outside pathological specimens by ADCC subspecialty pathologists in identifying significant errors that can potentially impact treatment; and 2) create an opportunity to improve patient cancer care. Methods: All consult slides from patients referred to each ADCC center were reviewed by designated pathologists. Patient-level data for original and revised diagnoses were collected for two months in 2014. Discrepancies were classified as: 1) major - diagnosis changes treatment or surveillance; or, 2) minor - diagnosis does not change affect treatment or surveillance. To verify these assessments, disease-specific, multi-center teams of clinical experts reviewed each discrepant case and provided treatment recommendations for the original and revised diagnoses. Results: A total of 13,109 cases were collected across all ADCC centers and the discrepancy rate was 11% (1,488/1309); 3% (359/13,109) were major and 9% (1,129/13,109) were minor. The most common discrepancy was reclassification of the neoplasm cell type. The highest discrepancy rate was shown in the neuro-oncology and head and neck cases, with a 7% and 4% major discrepancy rate respectively. Conclusions: We identified an overall discrepancy rate of 11%, with 3% of cases leading to a change in treatment or surveillance. This demonstrates the importance of expert pathology review and that secondary pathology review can significantly improve clinical outcomes through precise and accurate pathological diagnoses. As indicated in the recent IOM report, this project further demonstrates that “diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions.”
Identifying tools for capturing the overall experience of dyspnea in a lung cancer population: The patient’s perspective.
Authors: Gill Gursharan , Liu Aixin , Chan Brandon , Tsui Brandon , Hall Elizabeth , Wong Lauren , Liang Mindy , Sarabia Samantha , Yeung Sabrina , Perez-Cosio Andrea , Brown Catherine , Leung Yvonne , Howell Doris , Liu Geoffrey 
Published: February 2017

73 Background: Efficient methods of tracking dyspnea can improve quality of care. We asked lung cancer patients to assess five validated patient-reported outcome (PRO) tools and determine whether these tools captured different domains of their dyspnea experience. Methods: This cross-sectional study of adult lung cancer outpatients of all stages utilized touch screen tablets to administer five dyspnea tools (Borg severity (B), Reduced Cancer Dyspnea (R), Breathlessness intensity (I), breathlessness distress (D), and MRC breathlessness (M) scales) that focused on the severity, experience, intensity, extent, and functional impairment of dyspnea, respectively. Patients were then asked whether each tool captured their dyspnea experience. Results: Of 226 lung cancer patients, 120 reported some level of dyspnea, and their responses were analyzed. Median age (range) was 67 (30-97) years; 53% were males; 37% were stage I-II; 56%, were stage III-IV. All the tools except B were completed by over 90% of patients (R 95%, I 93%, D 91%, M 91%). 71% of patients thought that M captured functional impairment well, while 58-62% of patients thought that R, S, A captured experience, intensity and distress well. B had the lowest completion rate (83%) and the lowest patient perception that is captured severity of dyspnea well (49%). Qualitative analysis suggests that most dyspnea is activity-related in this population, which would be consistent with patients favoring M (functional assessment) over B (dyspnea at present in clinic). I+D+M takes under 5 minutes to complete, whilst R takes 5+ minutes alone to complete. Conclusions: In a sample of cancer patients with high prevalence of dyspnea, patients felt four of five tools were useful in capturing various domains of their dyspnea experience. The majority of patients felt that the questions were relevant to their circumstances. I, D, M are appropriate screening tools, whilst R may be useful under specific circumstances. Our next step is the application and evaluation of self management tools in the dyspnea setting using these four tools.
Integrating nursing into oral chemotherapy education.
Authors: Shea Meghan , Weinstein Nancy , Zerillo Jessica A. 
Published: February 2017

81 Background:The shift of chemotherapy administration from the oncology infusion suite to the home has unwound systems and left patients vulnerable to errors. Many of the safeguards for parenteral chemotherapy, including education by an oncology nurse, are absent for oral chemotherapy. The 2013 American Society of Clinical Oncology/Oncology Nursing Society Standards served as the framework for improving the initiation of oral chemotherapy at Beth Israel Deaconess Medical Center. Methods: Clinicians caring for patients with melanoma and renal cell cancer were surveyed. A team of clinicians, nurses and pharmacist delineated a process map from writing an oral chemotherapy prescription to first follow-up appointment. A retrospective chart review of baseline data provided by a specialty pharmacy revealed 33 patients who initiated oral chemotherapy between July 2014 to July 2015, were not on a clinical trial and had at least two follow-up appointments. The team’s aim is by February 1, 2016 patients initiating oral chemotherapy receive nursing education by the first follow-up visit and at least 50% have documentation of a comprehensive education, including administration, safe handling and side effects. Results: The survey response rate was 9 of 9 (100%). The clinicians ranked patient education as the top priority. Second to time, lack of nursing involvement was identified as the most common contributing factor to patients not receiving a comprehensive education. At baseline, 1 of 33 (3%) patients initiated on oral chemotherapy received education from a nurse. Side effect education was documented in 21 of 33 (64%) clinicians’ notes, though education on safe handling only in 7 of 33 (15%), and education on administration was never documented. Plan-Do-Study-Act cycles are ongoing to implement varied approaches of nursing involvement, including telephone and in-person consultations. Conclusions: Lack of nursing involvement was identified as a missing element in oral chemotherapy care. Because clinicians were engaged, a survey to evaluate the current process succeeded with a high response rate. At baseline, there are significant gaps and variability in current practice, and interventions to provide patients with a comprehensive education are underway.