bluuebunny/crossref_metadata_2025_split huggingface dataset:
Living with and beyond cancer: What can be achieved by multi-organization collaboration.
Authors: Cunningham Nicola , Stanway Susannah Jane , Wiseman Theresa , Taylor Claire , Noble Jillian Louise , Doyle Natalie 
Published: March 2017

59 Background: The London Cancer Alliance (LCA), created in 2011, is an integrated cancer system consisting of 14 NHS organisations serving a population of 5.7 million. The multi-professional Survivorship Pathway Group has 18 members including a service user. The purpose of the group is to provide expert clinical leadership for the development and implementation of the pathways to imbed the Recovery Package (Holistic needs assessment (HNA)/care plan, treatment summaries, health and well-being events, cancer care reviews), treatment and management of the consequences of cancer into standard practice of cancer care. Methods: Data is collected quarterly for each NHS organisations’- HNA and care plan, treatment summaries, health and well-being events against defined metrics. Data Collection is in its fourth year. To support the implementation, guidelines have been developed, support and information provided and educational fora run. Results: The number of HNAs completed within 31 days of diagnosis from 487 to 2646 (an increase of 543%) and for HNAs completed within 6 weeks of completing treatment from 185 to 905 (an increase of 489%) (RM Partners Overall 2016) since Q2 2013/14 until Q2 2015/16. The group have mapped service availability across the LCA and developed robust survivorship pathways for lymphedema, complementary services, sexual consequences, GI consequences, onco-fertility, allied health professional rehabilitation and health and wellbeing events. Guidelines have also been developed and published on survivorship, lymphoedema, health and well-being events, gastro-intestinal and sexual consequences, complementary therapies, developing patient information leaflets, gaining patient and carer feedback. Furthermore, over 15 fora have been run on diverse topics. Conclusions: Collaborative working across London organisations has proved to be feasible and productive. The impact of the group has been demonstrated through the significant uptake in implementation of the Recovery Package. Future directions include an improvement in collection of HCP agreed data sets, the embedding of treatment summary templates into Trust cancer data systems, and further role out of electronic HNA.
Development and implementation of an electronic measurement process for survivorship care plan dissemination and compliance.
Authors: Leighton Patricia , Hoopes Stephanie , Weathers Jo Maria , Perkins Leann , McCormick Douglas , Franco Regina A , O'Rourke Mark Allen 
Published: March 2017

67 Background: Cancer programs must comply with survivorship care plan (SCP) delivery by 2018 to maintain or achieve Commission on Cancer (CoC) accreditation. Barriers to measuring and tracking SCP compliance include insufficient staffing to facilitate the documentation and input of data, lack of electronic medical record automation methods, lack of interoperability and electronic health record reporting processes. In June 2016, The Greenville Health System-GHS Cancer Institute Center for Integrative Oncology and Survivorship-CIOS developed a process to record, measure and track the number of SCP delivery visits delivered to Cancer Survivors. Methods: A patient who attends an SCP visit sees a provider in collaboration with a nurse navigator. The provider explains the elements within the patient’s SCP document. A copy is provided to the patient. The SCP document is embedded within the providers note for the SCP visit. To document the visit and delivery of the SCP, the nurse navigator clicks the “complete SCP visit” button located in the patient’s EMR. The SCP button also identifies the name of the provider and whether the SCP was complete or incomplete. This action in the EMR enables the creation of reports that record and document SCP delivery. Results: Four weeks were chosen during the initial implementation period to evaluate use of the SCP delivery button. For each visit provided, the SCP delivery button was clicked documenting the delivery of the SCP. The weekly data for #SCP deliveries documented and total #SCP visits are: Week 1, 17 of 22 (77%); Week 2, 16 of 17 (94%); Week 3, 13 of 13 SCP (100%); Week 4, 12 of 12 SCP (100%). Of the 64 SCP’s, 42 were complete and 22 incomplete. Conclusions: The development of the electronic measurement process for survivorship care plan delivery has significantly increased efficiency of reporting and has decreased time spent on chart audits.
Social support at diagnosis and noninitiation, discontinuation, and nonadherence to adjuvant hormonal therapy in the Pathways Study.
Authors: Kroenke Candyce , Hershman Dawn L. , Adams Sara , Kwan Marilyn L. , Kushi Lawrence H. 
Published: March 2017

7 Background: Exceedingly little research has examined associations between social support and adherence to adjuvant hormonal therapy (AHT) in breast cancer patients. We evaluated associations of social support and noninitiation and discontinuation of, and nonadherence to, AHT in a large, Northern California cohort. Methods: This study included 3,382 women from the Pathways Study who were diagnosed with stages I-III hormone receptor positive breast cancer from 2006-2013 and responded to the Medical Outcomes Study social support survey approximately two months following diagnosis. We used logistic regression to evaluate associations between social support and noninitiation ( < 2 consecutive prescription fills within the first year after diagnosis). Among those who initiated treatment, we used proportional hazards regression to evaluate associations of social support, discontinuation ( > 90 day gap), and nonadherence ( < 80% medical possession ratio) to treatment. Results: Of those who initiated treatment (79%), approximately one fourth either discontinued AHT or were nonadherent. In multivariable-adjusted analyses, adjusted for sociodemographic characteristics, disease severity, other treatment, and presence of comorbidity, women with low (OR = 1.31, 95% CI: 1.06-1.62) and moderate (OR = 1.18, 95% CI: 0.96-1.46) levels of social support were more likely not to initiate AHT treatment, compared to those with high support. Emotional/informational support, tangible support, and positive interaction were each significantly related to noninitiation; affection was not. Of those who initiated treatment, women with low (HR = 1.30, 95% CI: 1.07-1.58) or moderate (HR = 1.19, 95% CI: 0.98-1.44) levels of support were more likely to discontinue treatment. Furthermore, women with low (HR = 1.37, 95% CI: 1.11-1.88) or moderate (HR = 1.24, 95% CI: 1.01-1.52) support had higher nonadherence to treatment. Conclusions: Hormone receptor positive breast cancer patients with low levels of social support had higher noninitiation and discontinuation of, and nonadherence to, AHT. Information on social support may help clinicians determine who is at greater risk of AHT nonadherence.
Integration of survivorship care plans into standard care: A quality improvement project.
Authors: Deslauriers Patricia , Subbiah Shanmuga , Fall-Dickson Jane M. 
Published: March 2017

70 Background: American College of Surgeons’ Commission on Cancer accredited programs are required to provide Survivorship Care Plans (SCPs) to cancer survivors after initial cancer treatment. A critical need exists to evaluate SCP patient outcomes. The primary purpose of this quality improvement project was to integrate SCP into standard care for adult stage I, II, and III breast and colon cancer patients. Secondary aims were to examine the hypothesis that the SCP will improve participants’ knowledge base regarding their cancer, health promotion and disease prevention, satisfaction with delivery of health care, quality of life, and adherence to follow-up and surveillance testing. Methods: The IRB approved study was conducted at a hospital-based Medical Oncology Clinic (MOC) in the Western US. A pre/post design was used. Sociodemographic, Medical Outcomes Study Form-36 (MOS-SF-36), Patient Satisfaction Questionnaire Short Form-PSQ-18 (PSQ-SF-18), and Patient Knowledge of Disease Questionnaire (PKDQ) data were collected pre/post SCP. At the follow-up visit, MOS-SF-36, PSQ-SF-18, PKDQ, and open-ended evaluative questionnaire (OEEQ) data were collected. Results: Forty-two subjects were enrolled. The sample is primarily female (n = 36; 86%), Caucasian (n = 41; 97.6%), Hispanic (n = 36; 85.7%), non-high school graduates (n = 26; 61%), and unemployed/retired (n = 32; 78%). Annual incomes were primarily less than $20K (n = 32; 78%). Paticipants were post-treatment for breast cancer (n = 36) or colon cancer (n = 6). 100% of the participants returned for follow-up visits with only 2 (4.8%) delayed. There were significant increases in knowledge (p < 0.001). There were no statistically significant changes in the MOS-SF-36 ant the PSQ-SF-18. Themes in the OEEQ captured satisfaction with the provision of the SCP, changes in health promotion and disease prevention habits. Conclusions: This pilot study supports the hypothesis that SCPs improve adherence to follow-up and patient knowledge, especially in a unique setting of a low socio-economic, ethnically diverse population. A larger study is needed to show statistically significant improvements in health-related quality of life and satisfaction with delivery of health care.
Attendance to Hodgkin lymphoma survivorship care clinics in the Netherlands.
Authors: Nijdam Annelies , de Weijer Roel J. , Janus Cecile P.M. , Clevers-Petersen Eefke J. , Roesink Judith M. , Lugtenburg Pieternella J. , van 't Veer Mars B. , Aleman Berthe M.P. , Raemaekers John M. M. , Van Leeuwen Flora 
Published: March 2017

71 Background: Survivors of Hodgkin lymphoma (HL) are at risk for late adverse effects of treatment. The Dutch BETER consortium, consisting of healthcare providers, researchers and patient representatives, has set up survivorship care clinics where HL survivors are screened for late effects. Methods: In order to assess patient characteristics and clinical attendance rates, descriptive statistics were calculated for data on HL survivors who were invited to attend the BETER clinics in the University Medical Center Utrecht (UMCU) and Erasmus University Medical Center (EMC). Results: Overall 291 survivors were invited to attend one of the two BETER clinics. Median age at invitation was 46 years (interquartile range IQR: 40-55 years), median age at HL diagnosis 29 years (IQR: 22-37 years) and median time since diagnosis 16 years (IQR: 11-22 years). Survivors were referred to the BETER clinic by the general EMC/UMCU outpatient clinics where they were still under surveillance (42%) or invited by phone (37%) or letter (20%). While 79% of survivors responded to the invitation, only 53% of all patients actually visited the BETER clinic. Most common reasons to not attend were: undergoing surveillance or treatment for late effects elsewhere (91%) and unwillingness to attend (8%; e.g. due to financial or emotional burden). Ninety-eight% of survivors who were still under surveillance in EMC/UMCU hospitals attended the BETER clinic, as opposed to only 19% of survivors who were no longer under surveillance. Survivors initially invited by letter were more likely to attend (38%) than those who were first contacted by phone (11%). Age at invitation and age at HL diagnosis were similar in those who did and did not attend. Similar data for another 3 clinics are being collected and will be presented at the ASCO Survivorship Symposium. Conclusions: These preliminary data show that only half of HL survivors who were invited, attended a BETER clinic. Unfortunately, survivors who were no longer under medical surveillance were less likely to attend, especially when first contacted by phone. Future, more detailed, evaluation of (non-)attendance in more BETER clinics may reveal the need for additional implementation measures to improve the BETER survivorship care program.
Evaluating preliminary outcomes among primary care and oncology providers who participated in the cancer survivorship e-learning series for primary care providers.
Authors: Pratt-Chapman Mandi , Villalobos Aubrey , Harvey Allison , Roccio Ashley 
Published: March 2017

78 Background: The American Cancer Society estimates there are 15.5 million cancer survivors in the U.S. and projects this number will rise. Survivors are at increased risk for a variety of issues due to cancer and its treatment including long-term and late effects. In recent years, there has also been increased focused on ensuring coordinated care for survivors to address these and other issues. Methods: Launched in 2013, the E-Learning Series evaluation employs self-report pre/post surveys using a 5-point Likert scale of agreement. In an initial analysis conducted with available data, participants who took more than one module were represented more than once in the total sample. Independent samples t-tests and Mann Whitney U tests were used for tests of significance for comparisons between PCP and oncology providers. Results: Of the respondents (n = 1,662), PCPs were represented on average 30% across modules. Both PCP and oncology providers reported knowledge gains across modules from pre (Mean pre-range for PCP = 2.96-3.71, SD = 0.797-1.022; Mean pre-range for oncology = 3.28-3.92, SD = 0.717-0.964) to post (Mean post-range for PCP = 4.05-4.44, SD = 0.568-0.716; Mean post-range for oncology = 4.28-4.49, SD = 0.525-0.611). Mean change scores for PCPs ranged from 0.66-1.15 (SD = 0.671-1.093) and for oncology providers change scores ranged from 0.58-1.04 (SD = 0.700-0.967). Related to shared-care model, differences in perceived knowledge gain about treatment late effects were statistically significant (p = 0.001) between PCPs (change score mean = 0.92, SD = 0.975) and oncology providers (change score mean = 0.58, SD = 0.799). Differences were also seen in rehabilitation module, with PCPs indicating gain in ability to identify appropriate interventions (p = 0.047). Conclusions: Initial results indicate the E-Learning Series is effective in improving knowledge about needs of survivors as well as recommended care practices among providers.
The effects of global and targeted advance care planning efforts at a national comprehensive cancer center.
Authors: Zachariah Finly , Emanuel Lindsay , Ito-Hammerling Gayle , Wong-Toh Judy , Morse Denise , Klein Linda , Loscalzo Matthew J. , Garcia Nellie , Buga Sorin , Lew Michael , Horak David , Banerjee Chandana , Mooney Stefanie , Alvarnas Joseph C. 
Published: March 2017

79 Background: Advance Care Planning is a central component of patient centered care and helps assure treatment aligns with a patient’s goals, values, and priorities. Various studies demonstrate advance care planning decreases stress and anxiety, increases satisfaction, improves awareness and implementation of a patient’s end of life wishes, and reduces costs in select populations. At City of Hope (COH) National Medical Center, we made concerted efforts over the last four years to improve the overall number of advance directives(ADs), and have additionally focused on improving AD capture rates in clinically relevant populations (patients undergoing surgery, those with metastatic disease, and those undergoing hematologic transplant). Methods: The Department of Supportive Care Medicine with executive team endorsement and in collaboration with medical oncology, hematology, anesthesia, surgery, nursing, marketing, and informatics created a patient-centric advance care planning program. We developed disease specific workflows, created multi-lingual AD workshops in the Sheri & Les Biller Patient and Family Resource Center, changed policy to provide complimentary patient/caregiver and staff notarizations for ADs, leveraged the electronic medical record (assured providers were able to document discussions, know when ADs were absent, and easily retrieve ADs when present), deploy AD specific screening questions, and most recently created a culturally sensitive branding campaign coined “Plan Today for Tomorrow.” Results: The rate of advance directive capture for all patients new to COH has continuously improved from 12% in 2012 to 22% in 2016. In transplant patients, AD capture rate increased to 63%. In a pilot for bladder cancer patients undergoing cystectomy, ADs were increased to 68%, and in the pre-anesthesia testing clinic, ADs were increased to 35%. Conclusions: We have made significant strides in the capture of advance directives at City of Hope with markedly higher capture rates in selectively targeted, clinically relevant populations. We anticipate improved patient centric care as a result, with the unintended consequence of cost savings and decreased resource utilization.
Use of a web-based app to improve breast cancer symptom management and aromatase inhibitor adherence.
Authors: Graetz Ilana , McKillop Caitlin N , Stepanski Edward J. , Vidal Gregory A. , Schwartzberg Lee Steven 
Published: March 2017

89 Background: For postmenopausal women with hormone receptor-positive breast cancer, long-term use of aromatase inhibitors (AI) significantly reduces the risk of cancer recurrence and improves disease free and overall survival. Despite the known benefits of AIs, many patients are nonadherent due to adverse side effects. We conducted a pilot randomized controlled trial of a web-enabled application (app) to provide real-time monitoring and better management of treatment-related adverse symptoms among patients with hormone-receptor positive breast cancer and a new AI prescription. Methods: Eligible patients who agreed to participate were randomized into either: App: had access to the app and received weekly reminders to use it; or Usual Care: had access to the app but did not receive reminders. Concerning responses and trends triggered email alerts to the patient’s providers, who then could review responses to manage ongoing treatment and make therapeutic adjustments. The main analyses compared overall AI adherence using the Morisky Medication Adherence Scale and quality of life using the Functional Assessment of Cancer Therapy Endocrine Symptoms (FACT-ES). Results: We enrolled 44 patients, 21 in the App and 23 in the Usual Care groups; 83% of patients approached agreed to participate, 23% were African-American, and 32% were over the age of 65. Overall, 74% of participants in the App group used the app at least once per week compared with 38% in the Usual Care group (p<0.01). Reported AI adherence at 8 weeks after initiation was significantly higher among App compared with the Usual care group at 8 weeks (100% vs. 72%, p=0.01). Using a differences-in-differences analysis, we found a substantially larger decrease in quality of life in the Usual Care group compared with the App (-11.5 vs. -3.9, p=0.191), although this difference did not reach statistical significance. Conclusions: App use with weekly reminders significantly improved short-term AI adherence. If short-term gains in adherence persist, this low-cost intervention could improve survival outcomes for women with hormone-receptor positive breast cancer.
Breast cancer care redesign as an approach to streamline survivorship care: Outcomes and challenges.
Authors: Post Kathryn Elizabeth , Smith Barbara L. , Taghian Alphonse G. , Isakoff Steven J. , Peppercorn Jeffrey M. , Moy Beverly 
Published: March 2017

9 Background: Optimal follow up care for the 3.1 million breast cancer (BC) survivors in the United States has not been definitively determined. ASCO and NCCN recommend that early stage BC patients have a history and physical by their oncology or primary care provider every 3 to 6 months in the first three years post treatment. Additional visits have not been shown to improve outcomes. However, many patients are seen more frequently, leading to increased healthcare costs. In this context, we developed and implemented a BC care redesign algorithm (BCCRA) to reduce redundant follow up. Methods: The BCCRA multidisciplinary team recommended BC survivors be seen by an oncology provider every 6 months for the first five years post treatment and annually thereafter. Retrospective chart review was conducted to evaluate BCCRA adherence from November 2014 to November of 2015. Patients were deemed ineligible if there was a medically necessary reason for visits outside of the BCCRA such as reconstruction, ongoing treatment or clinical trial participation. Eligible charts were analyzed for adherence. For survivors who did not adhere, charts were analyzed for outcome of additional visits. Results: 116 patient charts reviewed and 72 (62.1%) were deemed ineligible. Of the remaining 44 survivors, 26 (59.1 %) adhered and 18 (40.91%) did not adhere. Of the 18 survivors who did not adhere, six had visits due to clinical concern and 12 had visits due to patient or provider preference. Of the 6 patients who had visits for clinical concern, 4 resulted in a change in the patient’s medical management (CMM). Of the 12 patients who had visits due to patient/provider preference, 2 resulted in a CMM. Conclusions: Despite buy-in from a motivated multidisciplinary team, there were challenges to implementing the BCCRA. 62.1% of patients were ineligible and there was a significant proportion of patients/providers who chose more frequent visit schedules. However, the BCCRA had 59.1% adherence which could result in cost reduction and increased flexibility in oncologists’ schedules. Further evaluation of the model is needed to validate these claims.
A multisite cancer survivorship clinical placement program for primary care practitioners (PCPs).
Authors: Jefford Michael , Wiley Georgina , Piper Amanda , Evans Judy , Nolte Linda , Drosdowsky Allison , Simkiss Liz , Whitfield Kathryn , Cairns Julie , Raco Giovanna , Mann Bruce , Shanahan Kerry , Pitcher Meron , Bell Bianca 
Published: March 2017

95 Background: Following a successful pilot, a survivorship placement program for PCPs (general practitioners (GPs) and general practice nurses (GPN)) was refined and extended to additional sites. The program aimed to facilitate collaborative learning, with an emphasis on the post treatment phase. Objectives were to improve clinical knowledge of the health needs of survivors and enhance confidence with shared care (ShC). Methods: Four cancer centres participated. Each received an implementation toolkit and videos, developed to promote the role of PCPs in survivorship care. PCPs received pre-placement materials and attended multidisciplinary meetings and specialist clinics for 10 hours. PCPs and hospital-based specialists completed pre and post-placement surveys, assessing perceptions of the program, perceived barriers to ShC, perceived knowledge regarding survivorship issues (9 items), confidence managing survivorship issues (8 items) and with ShC (1). Results: Forty-seven PCPs (32 GPs, 15 GPN) completed placements and pre and post-placement surveys. Median scores for all confidence items and 8 of 9 knowledge items increased; 1 remained the same. Matching of pre and post responses assessed individual changes. Across the 9 knowledge items, 57-86% of PCPs reported an increase; for the 9 confidence items, 68-89% reported improvement (no decreases). Data from specialists is currently available from 1 site; 16 specialists completed the pre- and 14 (88%) the post-survey. The majority of median knowledge and confidence scores were high and remained unchanged. Specialists (n=14, 88%) and PCPs (n=37, 76%) identified the biggest barrier to ShC as ‘lack of systems to support transition of care.’ All PCPs and specialists agreed/strongly agreed the ‘program was relevant to my clinical practice.’ Conclusions: The program enhanced PCP’s knowledge and confidence regarding survivorship care, was highly regarded and identified perceived barriers to ShC.