bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying patients at increased cancer risk: Validation of the Health Heritage risk assessment and decision support tool.
Authors: Baumgart Leigh A , Postula Kristen J , Hulick Peter J , Knaus William A 
Published: February 2017

277 Background: Family history is critical to assess risk for cancer and inherited cancer syndromes. National Comprehensive Cancer Network (NCCN) guidelines are available to aid in identification and management of at-risk patients, but the guidelines are complex and ever-changing, hindering optimal use. This leads to under-recognition and mismanagement of high-risk patients. To address this need, we have developed and have fully implemented Health Heritage (HH), a web-based risk assessment and decision support tool. HH combines clinical data automatically extracted from a patient’s EHR with information entered by patients and shared between family members to provide personalized risk assessment and recommendations related to common cancers. This study aims to validate HH’s ability to properly identify patients who meet NCCN guidelines for a genetics evaluation and to stratify cancer risk. Methods: We performed a retrospective chart review of 100 patients seen at an adult genetics clinic in 2012. Relevant personal and family medical history and genetic test results were entered into HH. Independent of the HH assessment, each patient’s information was reviewed by a genetic counselor to assess fulfillment of NCCN guidelines for a genetics evaluation. A subset of records was reviewed to compare cancer risk stratification between HH and a medical geneticist. Results: 87 patients met NCCN guidelines for a genetics evaluation for breast/ovarian cancer, 2 for colorectal cancer, and 3 for multiple cancers; 8 patients did not meet guidelines. HH had a sensitivity of 98% and specificity of 88% in identifying patients who met these guidelines. For patients at increased risk for breast, ovarian, or colorectal cancer as determined by a medical geneticist, HH agreed 83%, 86%, and 75% of the time, respectively. Discordances were the result of both complex clinical situations better handled by the geneticist and also HH’s strict adherence to incorporating all information. Conclusions: Health Heritage is a highly sensitive tool for identifying at-risk patients appropriate for a genetics evaluation and its risk stratification is complementary in high risk settings requiring management recommendations.
Outcomes in cancer patients (pts) admitted to a surgical (SICU) or medical ICU (MICU) compared to a newly opened cancer specific ICU (HICU).
Authors: Stenehjem David D. , Bannon Meredith , Boltax Jonathan 
Published: February 2017

279 Background: The University of Utah opened a cancer specific ICU (HICU) in 2011 admitting medical and surgical cancer pts. Prior to this, medical cancer pts were admitted to the MICU while the SICU admitted both and medical and surgical pts. The primary objective of this study was to compare the quality metrics of mortality and length of stay (LOS). Methods: Pts with a cancer diagnosis and admitted to the MICU or SICU from 2009-2011 or the HICU from 2011-2013 were evaluated. Pts were stratified by ICU type and the HICU was also analyzed by excluding post-operative pts (HICU-MED). Survival from admission, hospital and ICU mortality, and LOS was assessed. Results: A total of 1,375 pts were included with 259 (19%), 416 (30%), and 700 (51%) pts admitted to the MICU, SICU, and HICU, respectively. The median age was 62 years (range 18-91 years) and 57% (n = 787) were male; no significant differences in age (p = 0.1975) and sex (p = 0.7681) were observed between ICU’s. Cancer classification was oncology (65%, n = 888), hematology (32%, n = 435), and BMT (4%, n = 52). Of all pts admitted to the HICU, 44% (n = 308) were post-operative and excluded from HICU-MED (n = 392). See table for survival and LOS comparisons. Conclusions: No differences in overall survival and hospital morality (ICU and out-of-ICU) were observed comparing pts admitted to the HICU vs SICU and HICU-MED vs MICU. ICU-free days were significantly shorter resulting in shorter hospitalizations for the HICU vs SICU, which may have contributed to the reduced 30-day mortality in pts admitted to the HICU. [Table: see text]
Surgical interventions in cancer patients at the end of life: Experiences at an academic medical center.
Authors: Howie Lynn Jackson , Kamal Arif , Bhavsar Nrupen A , Power Steve , Mosca Paul J. 
Published: February 2017

281 Background: Surgical quality measures look to reduce variation and improve outcomes. Procedure goals can range from cure to symptom improvement. Knowledge of procedures used in this population can inform quality metrics, ensure palliation is included and that metrics do not discourage interventions where benefits are other than traditional measures like mortality. Methods: Clinical and administrative data from 1,343 patients treated at an academic medical center from 2006 to 2013 were obtained. Using CPT codes, procedures were identified. Patients who underwent surgical procedures within 180 days of their death were then evaluated to determine the demographic, clinical and surgical characteristics of these cases. Patients <18 years of age and those with missing data were excluded from the analysis. Descriptive statistics were used to describe interventions among patients in the cohort. Results: From 2006 to 2010, 761 patients with cancer treated at an academic medical center had surgical procedures performed within the last 180 days of life. 38.8% of these patients were female, 82% were Caucasian, 15% were African-American, and 3% were other race. Median age was 67.9 years (interquartile range: 58.1 - 78.1). 158 had procedures performed ≤30 days of death, 295 ≤60 days of death, and 530 ≤120 days of death. The most frequent type of procedure performed ≤30 days from death were thoracic procedures including bronchoscopy, thoracentesis, mediastinoscopy and catheter placement for pleural fluid drainage (20.8%), ≤60 days of death 30.3% underwent thoracic procedures, and ≤120 days of death 24.5% underwent similar thoracic procedures. Conclusions: Surgical quality measures are thought to improve surgical outcomes. Evaluation of surgical data from a academic medical center demonstrates continued use interventional procedures in cancer patients within the last 6 months of life. This may in part be due to the symptom burden associated with these diseases. Further evaluation about the goals of interventional procedures in this patient population can inform the outcomes of primary interest in this population of patients who have high mortality due to their advanced disease.
Aggregating administrative and claims data from multiple payers to estimate population-based health outcomes: A validation study.
Authors: Kuo Tzy-Mey , Schenck Anna , Meyer Anne-Marie 
Published: February 2017

285 Background: Health insurance claims data are increasingly used for estimating individual health outcomes. However, it is challenging to obtain population-based estimates because of difficulties obtaining and reconciling data from all insurance providers. With incomplete insurance data, methods are needed to estimate the entire insured population. Using multi-payer claims we demonstrate and validate a synthetic method to obtain county level morbidity estimates. Methods: We used data from the Integrated Cancer Information and Surveillance System (ICISS) data resource at the University of North Carolina (NC) at Chapel Hill. ICISS data represent a linked data resource comprised of beneficiaries enrolled in federal as well as private insurance plans and rich ecologic data; and represent 5.5 million unique individuals, about 55% of the NC population. Using specific ICD-9 diagnosis codes, claims data from 2008 were compared to state department of public health data. We computed county level hospitalization rates by summing data from three sub-groups: age 65 and older in the 100% Medicare sample, age younger than 65 in the 100% Medicaid sample, and age younger than 65 represented in the private payer data. For the privately insured population, we used census data to obtain estimates of the entire privately insured population and used the hospitalization rate from beneficiaries in ICISS data to estimate a numerator for the synthetic sample of privately insured beneficiaries. We used State Inpatient Data (SID) from NC County Data Book to validate our method. Results: Overall, our synthetic approach showed moderate to high validity with a Pearson correlation coefficient 0.77 for heart disease and 0.93 for flu or pneumonia. Our hospitalization estimates were slightly lower than the data from SID, because SID data include uninsured individuals and multiple hospitalizations for individuals. Conclusions: Our synthetic method can be useful in estimating population-based health outcomes using linked insurance claims data.
Is it time for quality time? Intensive medical oncology follow-up during treatment for esophageal adenocarcinoma.
Authors: Kothari Nishi , Shridhar Ravi , Hoffe Sarah E. , Meredith Kenneth L. , Fontaine Jacques , Fulp William J. , Almhanna Khaldoun 
Published: February 2017

29 Background: Concurrent chemotherapy and radiation for esophageal cancer patients is morbid with many potential complications. The efficacy of intensive patient follow up by medical oncology during concurrent treatment was retrospectively evaluated at our cancer center. We hypothesized that weekly follow up would result in better compliance and less toxicity, leading to better outcomes. Methods: Patients with locally advanced esophageal adenocarcinoma referred to our cancer center for potentially curable neoadjuvant therapy were identified. Age, gender, radiation dose, weight loss, hospital admissions, and outcome were compared between patients who had intensive follow up and patients who did not. Wilcoxon Rank Sum Test and Chi-squared test, both exact tests using Monte Carlo estimation, were used to compare weekly follow-up status with continuous and categorical factors, respectively. Kaplan-Meier curves and Log-Rank tests were used for OS analysis, and a multivariable model was fit using Cox Proportional Hazard models. Results: 169 were patients eligible for analysis, including 154 men and median age of 66 years. 108 patients were seen weekly by medical oncology while on treatment. Groups had balanced baseline characteristics except for age; the weekly follow up patients were older (68 vs. 63 years, p=0.007). There was no difference in hospitalization rate (33% vs. 28%) or weight loss (4 kg vs. 4.7 kg) between groups. In multivariate analysis, advanced age and stage were associated with worsened OS. Weekly follow up did not lead to improved survival at 3 years (42% vs. 50%). Conclusions: This study is retrospective in nature, but to our knowledge it is the first of its kind to investigate the impact of intensive follow up during concurrent chemotherapy and radiation. Though we did not find improved outcome in patients who were seen weekly, a potential confounder is the older age of these patients. In addition, at our institution patients have close weekly follow up with radiation oncologists, dieticians and oncology nurses. While we were not able to substantiate our hypothesis that weekly follow up by medical oncology leads to improved outcomes, our preliminary findings merit further study.
Impact of physician visits on bone density testing in men with prostate cancer who receive androgen deprivation therapy.
Authors: Yong Candice , Onukwugha Ebere 
Published: February 2017

291 Background: Clinical guidelines for men receiving androgen deprivation therapy (ADT) for prostate cancer (PC) recommend bone mineral density (BMD) monitoring. We examined physician visit patterns following ADT initiation and the implications for follow up BMD testing. Methods: We analyzed linked Surveillance, Epidemiology, and End Results (SEER) & Medicare data for men aged 65+ with incident non-metastatic PC diagnosed during 2007-2009 and receiving ADT for at least 6 months. We examined the proportion of men who visited the following physician types after ADT initiation: urologist, medical oncologist (MO), radiation oncologist (RO), and primary care physician (PCP). Physician contact was measured during 3 time periods: 3 months pre-ADT and 3 months post-ADT (P1); 3-6 months post-ADT (P2); and 6-9 months post-ADT (P3). Multivariable logistic regression models estimated the association between physician visits and BMD testing. Results: The sample included 4,631 men (median age: 75) with non-metastatic PC who received ADT over a median duration of 12 months. During follow-up, 12% received BMD testing, and median time from ADT initiation to BMD testing was 364 days. The proportion who visited any urologist, MO, RO, and PCP during P1 was 97%, 12%, 52%, and 71%. During P2, the proportions dropped to 69%, 9%, 19%, and 53%, respectively, and remained similar in P3. Physician visits during P1 were not associated with BMD testing. During P2, the adjusted odds ratio (95% CI) for BMD testing in men who saw a MO was 1.39 (1.04-1.86). During P3, the AOR (95% CI) was 1.52 (1.15-2.01) in men who saw a MO and 1.23 (1.02-1.49) in men who saw a PCP. Conclusions: In older PC men treated with ADT, physician contact was highest during ADT initiation and decreased over time. Continued contact with physicians following ADT initiation can be beneficial.
Investigating rates of CINV across settings of care in Medicare: A retrospective claims-based analysis.
Authors: Agatep Barnabie C , Faria Claudio , Knoth Russell L. , Chapman Richard H. , Inocencio Timothy J , Johnsrud Michael , Powers Annette 
Published: February 2017

297 Background: Clinical practice may differ according to settings of care and may impact both the quality of care delivered and, ultimately, patient outcomes. This study describes the differences in chemotherapy-induced nausea and vomiting (CINV) rates between chemotherapy (CT) naïve Medicare cancer patients starting CT in a hospital outpatient (HOP) or community outpatient (COP) setting. Methods: Using the 5% Medicare Fee-for-Service standard analytic files, patients with a new claim of CT and ≥1 outpatient cancer diagnosis claim between 1/1/10 – 6/30/11 were identified. Patients with a previous inpatient cancer diagnosis, multi-day CT cycles or who switched CT relevant to emetogenic potential were excluded. CINV was defined using relevant claims-based ICD-9-CM diagnosis and procedure codes within days 2-7 of the first 8 single-day CT cycles or the first 6 months following the index CT claim. CINV events were evaluated descriptively and using regression models. Results: Medicare patients receiving CT in HOP (n=1,007) vs. COP (n=1,080) were similar in demographics such as age, race, and baseline healthcare costs. However, Medicare patients receiving CT in COP compared to those in HOP settings were more likely to be female (57.0% vs. 44.7%), breast cancer patients (27.6% vs. 16.0%), live in the South region (37.7% vs. 32.3%), have higher Charlson Comorbidity Index scores (mean 5.2 vs. 4.8) and receive moderately to highly emetogenic CT (44.1% vs. 36.0%) (all p<0.05). Overall, 13.9% had any CINV in the evaluation period. More CINV events per patient were reported among those in COP compared to those in HOP settings (0.43 vs 0.27, p <0.05). However, differences between settings of care were not shown to be significantly different in adjusted regression analyses (p=0.177). Conclusions: We found the population characteristics between Medicare patients treated with CT in HOP and COP to vary on a number of factors. However, after controlling for these differences, our results suggest the number of CINV events was similar across settings of care. Future research should further clarify how differences in quality of care for antiemesis between COP and HOP settings may impact the incidence of CINV events in this population.
Association between Oncotype DX and receipt of chemotherapy in early-stage breast cancer within the Medicare population from 2004 to 2007.
Authors: Dinan Michaela Ann , Mi Xiaojuan , Reed Shelby D. , Lyman Gary H. , Curtis Lesley H 
Published: February 2017

309 Background: In 2004, the Oncotype DX (ODX) multigene assay became available to help guide physicians in their decision to recommend adjuvant chemotherapy in patients with early stage estrogen receptor (ER) positive breast cancer. ODX utilization within a non-academic, nationally representative breast cancer population has not been previously examined. Methods: Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER)-Medicare data of the association between ODX testing and receipt of chemotherapy in patients diagnosed with invasive, non-metastatic, ER-positive breast cancer between 2004 and 2007. Results: A total of 28,760 Medicare beneficiaries met study criteria. NCCN guidelines were used to stratify patients on the basis of clinical and pathologic features into low (<1 cm tumors, 24.4%), intermediate (≥ 1 cm tumors, 52.0%), and high (node positive, 23.7%) risk disease. In patients with low or intermediate risk disease, receipt of ODX was associated with increased chemotherapy utilization (13% vs. 1% and 19% vs. 8%, respectively; both P < 0.001), but not in high risk patients (30% vs. 39%, P= 0.34). Conclusions: Randomized trials have previously suggested the ability of ODX to decrease chemotherapy utilization. In this study, we observed increased chemotherapy utilization associated with receipt of ODX in patients with low and intermediate NCCN risk disease. Association between ODX and chemotherapy utilization in observational studies may be impacted by preferential administration of ODX testing to patients being considered for chemotherapy. [Table: see text]
Involving clinic patients in systematic symptom reporting to improve cancer care: Exploring prevalence of sleep disturbances (SD) and fatigue (FAT).
Authors: Irwin Margaret , Brown Catherine , Vennettilli Ashlee , Eng Lawson , Zarrin Aein , Dobriyal Aditi , Chen Linda , Mirshams Maryam , Patel Deval , Hon Henrique , Pat Vivien , Ho Anthea , Solomon Hannah , Tiessen Kyoko , Thai Henry , Ho Valerie , Mahler Mary , Xu Wei , Liu Geoffrey , Howell Doris 
Published: February 2017

68 Background: SD and FAT occur in 30-50% of cancer patients. Patient-reported outcome measure surveys are avenues through which healthcare providers (HCP) can receive symptom-related clinically relevant information directly from patients, and engage them in their own care plan. By asking patients to report symptoms rapidly through tablet/computer-based technology, HCPs can involve patients in the delivery of care. Methods: In a pilot study evaluating utility of systematic symptom reporting, 336 adult cancer patients across all stages and disease sites who were attending outpatient cancer clinics at Princess Margaret Cancer Centre (PMCC) (Toronto, Canada) completed electronic tablet-administered secure surveys on SD (Insomnia Severity Index) and FAT patterns (FACT-fatigue). These tools measured both symptom severity and interference with function. Results: With a median age of 59 (19-91) years, 55% female, across a broad distribution of cancer sites, 56% of our sample reported moderate to very severe (MTVS) SD over the last 7 days: 31% had MTVS difficulty falling asleep; 43% had MTVS difficulties staying asleep; 36% had MTVS problems waking up too early. While 62% who had MTVS SD were not distressed by their SD, 95% who were distressed by their SD met the criteria of MTVS SD. 78% of patients had any level of FAT over the last 7 days, with 40% reporting MTVS FAT. While 40% who had MTVS FAT were still able to perform their usual activities, 67% of patients who were not able to do their usual activities had MTVS FAT. Conclusions: Across all stages and disease sites of cancer patients at PMCC, the prevalence of SD and FAT was both high. Severity and interference with function by FAT and SD were often distinct and non-overlapping. Involving patients in the systematic evaluation of symptoms, particularly using newer tablet-based technology within the clinic, was feasible. Through the use of patient reported electronic applications, patients could easily and systemically report their symptoms in real-time. FAT management has always been a high priority at our institution. However, based on our results, a cancer center-wide self-management plan is being considered for SD.
Initiating a structured advance care planning (ACP) process within a telephonic disease management model.
Authors: Jameson Melissa , Abdullahpour Mitra , Taniguchi Cynthia , Neubauer Marcus A. , Hoverman J. Russell , Hayes Jad , Eagye Kathryn 
Published: February 2017

73 Background: Utilizing a telephonic disease management (DM) model for educating and assisting patients to self-manage treatment side effects is a known element of practice quality. Yet, disease management models frequently neglect important aspects of patient education regarding end of life care. A model is needed whereby structured ACP content and processes are included within the disease management scope of work and documented accordingly. Methods: Over a nine month period, a DM model with an ACP education component was applied in a community oncology setting. Practice DM services were provided through a centralized call center and delivered telephonically for patients receiving chemotherapy. DM staff was comprised of registered nurses with oncology credentialing and ACP training. The model included an introduction of ACP principles within the first telephonic outreach to the patient, highlighting the purpose of ACP and the importance of ongoing communication of patient values and goals for care throughout the treatment trajectory. On subsequent calls, with the patient’s permission, DM staff provided education regarding potential end of life treatments and advance directives. Patient education and learning outcomes were documented in the electronic health record (EHR). Results: A total of 154 patients participated in the DM program. An introduction to ACP was provided for 131 patients (85%). EHR inclusion of patient values and goals for care was achieved for 93 patients (60%). 93 patients (60%) agreed to receive subsequent education regarding potential end of life treatment interventions. During the nine-month period, 21 patients (14%) transitioned to hospice care. Conclusions: Telephonic DM offers a realistic and sustainable option for initiating the ACP process. A key learning is that patients are frequently open with discussing end of life care while in the comfort and safety of their home. EHR documentation of ACP content and patient preferences for care is a critical step for real-time sharing of information among the clinical team. Further study is needed to determine whether this intervention has an impact on appropriate hospice enrollment and other quality end points.