bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term employment outcomes among partners of patients with early-stage breast cancer.
Authors: Veenstra Christine Marie , Wallner Lauren P. , Bradley Cathy , Hawley Sarah T. 
Published: February 2017

12 Background: Undesired work loss comprises one of the many personal costs faced by cancer patients and their families. Multiple studies have described the long-term employment outcomes among patients with early-stage breast cancer, and show that a significant proportion of women face long-term job loss as a result of their cancer diagnosis and treatment. However, little is known about the employment outcomes of partners of breast cancer patients. Methods: Women with non-metastatic breast cancer identified by the Detroit and Los Angeles SEER registries between 6/05-2/07 were surveyed at 9 months (Time 1) and 4 years (Time 2) after diagnosis. Latina and black women were oversampled. Partners were surveyed at Time 2. We performed descriptive analyses of those partners who were not retired at the time they completed the survey. As part of a larger survey assessing the experiences of partners of breast cancer patients, partners were queried regarding the impact of the patient’s breast cancer diagnosis and treatment on their own employment and finances. Results: Of 774 eligible partners, 517 (67%) completed the survey. We included 280 non-retired partners in our analyses. 54% were white, 31% were Latino, and 10% were black. The majority of partners (86%) worked during the year following the patient’s diagnosis and 219 (90%) were working at the time of survey 4 years post-diagnosis. 50% of partners reported that work was a welcome source of support; 32% decreased their work hours as a result of the patient’s breast cancer. In order to maintain health insurance, 64% reported it was very/extremely important to keep their jobs and 51% reported it was very/extremely important to avoid changing jobs. 32% of partners reported their financial status was worse off because of the patient’s breast cancer; 20% were worse off regarding health insurance, and 19% were worse off regarding employment status. Conclusions: In contrast to breast cancer patients, most partners reported long-term job retention. Many partners kept working or avoided changing jobs in order to maintain health insurance. Nearly one-third of partners reported that their financial status was worse off because of the patient’s breast cancer diagnosis and treatment.
Communities of practice: A jurisdictional approach to improving the quality of care in radiation medicine in Ontario.
Authors: Lockhart Elizabeth , Ang Michelle , Reddeman Lindsay Elizabeth , Sharpe Michael , Hart Margaret , Simniceanu Carina , Breen Stephen , Kim Joon-Hyung J. , Scott Dani , Zaza Khaled , D'Souza David , Milosevic Michael F. , Gaede Stewart , Marshall Andrea , Yaremko Brian P , Sixel Katharina , Harnett Nicole , Gutierrez Eric , Warde Padraig Richard 
Published: February 2017

122 Background: The Radiation Treatment Program (RTP) at Cancer Care Ontario (CCO) established several Communities of Practice (CoPs), with the goal of improving radiation treatment (RT) quality and safety. The RTP identifies variation in practice and quality improvement (QI) opportunities in the 14 Regional Cancer Centres (RCCs) and facilitates the development of CoPs to share best practices and standardize care. Methods: Since 2010, the RTP has formed 7 CoPs ( > 185 members in total): 4 intra-disciplinary (Radiation Therapy, Medical Physics, Advanced Practice Radiation Therapy, Radiation Safety) and 3 inter-disciplinary (Head and Neck (HN), Gynecological (GYNE) and Lung Cancer). Members are recruited with the aim of securing engagement from all RCCs to ensure representation of regional diversity and to facilitate adoption of best practices. CoPs are supported with nominal funding and resources provided by CCO, but are led and driven by members, who identify and prioritize key quality issues and select corresponding QI projects to pursue. The RTP performs regular evaluation activities to assess initiative engagement and impact. Results: RTP CoPs have enhanced the quality and safety of RT delivery in Ontario through QI initiatives, advice documents and tools that have enabled: Improved RT safety (use of safety straps in RT delivery); Adoption of best practices (RT plan evaluation guidance); Education and knowledge transfer – (stereotactic body RT implementation and training framework); and Support for infrastructure improvements (recommendation for additional Magnetic Resonance-guided brachytherapy units) ( https://www.cancercare.on.ca/ocs/clinicalprogs/radiationtreatment/ ). Advice documents have improved alignment with recommended practice (40% and 50% absolute increases in two HN initiatives). Evaluation surveys indicate that members believe the CoPs have enhanced inter-regional communication and collaboration (89%), knowledge transfer/exchange (91%), and professional networking between RCCs (92%). Conclusions: CoPs can be a highly effective model for improving quality of care. The establishment of CoPs should be considered for QI in other areas of the healthcare system.
A single institution’s experience with the value of FDG-PET-CT imaging in patients with newly diagnosed stage IIB-IIIB breast cancer.
Authors: Schnur Gary , Glass Katherine , Cummings Chad W , Montero Alberto J. , Abraham Jame , Moore Halle C. F. , Budd G. Thomas 
Published: February 2017

123 Background: The Cleveland Clinic is utilizing disease specific teams to craft care paths for value based disease management. The report by Groheux (JNCI 2012; 104:1879-1887), reported 18 FDG-PET-CT detected distant metastasis in 10.7, 17.5 and 36.5% of stage IIB- IIIB breast cancer patients. Based on this report, the breast team incorporated 18 FDG-PET- CT imaging for initial staging of IIB-IIIB patients. Methods: Treatment algorithms were developed by a multi-disciplinary breast cancer team. The content was reviewed by stakeholders throughout the health system, and feedback was incorporated into the care paths as appropriate. Content was communicated using physician meetings, electronic communication, tumor boards, and operational pilots. The treatment algorithm, along with the supporting narrative, was placed on the cancer center intranet, accessible to all practicing physicians. Additional intranet analysis was performed using Google Analytics, which identifies the site location and frequency of document downloads. We retrospectively examined the impact of this posting after one year (7/2014-7/2015). Manual chart review identified new patient consults for Stage IIB-IIIB breast cancer at our main campus and highest volume regional sites. Results: PET scans were ordered in 36 stage IIB, 19 stage IIIA, and 3 stage IIIB patients. Of the 36 IIB patients scanned, occult metastatic disease was noted in 1, and 2 patients migrated to IIIA without a change in treatment. 19 IIIA patients had no change in stage, although an asymptomatic second primary lung cancer was discovered in 1 .Three stage IIIB patients were without staging change. Conclusions: PET/CT imaging did not contribute to patient management for stage IIB-IIIB breast cancer patients at our institution, unlike the results reported elsewhere. Analysis of care path metrics allows us to expediently review and adjust recommendations to affiliated physicians.
Cancer care decision support for WBC growth-factors (GF): Geographic differences in utilization and provider malleability.
Authors: Bennett Charles L. , Wurtz Kenneth Sherman , DiMarco Anna , Feliciano Lourdes , Huff Dinah Faith Q. , Knopf Kevin B. , Hrushesky William J. , Baum Michael 
Published: February 2017

128 Background: Growth factor use is the largest single category of drug expenditure for US cancer patients. Oncology Analytics is a decision support company that assists physicians in determining the appropriate use of GF based on the NCCN, ASCO, and ASH guidelines and the level one data that underlies these guidelines. We hypothesized that there would be geographic variation among GF preference and in the malleability of those practice patterns after OA entered a market. We determined the proportion of initial pegfilgrastim requests for preauthorization over other types of GF as well as the review outcomes and final drug of choice after OA intervention of inappropriate GF requests across three specific jurisdictions: Florida, Puerto Rico, Georgia and Texas. Methods: We analyzed data from drug preauthorization requests for febrile neutropenia prophylaxis submitted by providers in these four states from 10/01/2013 through 09/30/2015. We tested geographic differences in the preference for pegfilgrastim over other GFs; and in review outcomes and final GF of choice after OA intervention for inappropriate pegfilgrastim requests. Chi-square test and linear regression was employed at 95% CL. Results: Oncologists in PR are among the most evidence-based of all GF users, preferring to order the more cost-effective filgrastim. Our research indicates that, on average, 2-3 doses of filgrastim are given at a total cost of $600 to $900 per cycle, compared to pegfilgrastim at $3,800 per cycle. GA and TX oncologists, on the other hand, chose pegfilgrastim over other GFs more than their colleagues (70% GA vs. 72% TX vs 60% FL vs 33% PR) but reduced their pegfilgrastim preference substantially in the last two years by 11% and 36% respectively (linear trend, p < 0.05). Filgrastim was the most common replacement of pegfilgrastim across all states. Conclusions: There are significant geographic variations in the management of febrile neutropenia. These variations contribute to differences in financial toxicity without clinical benefit. Optimizing growth factor utilization management needs to be focused upon certain locales to be most effective. The impact of GF biosimilars has not yet been evaluated.
Integration of a clinical pathways software into an EHR in a large, multisite, hospital-affiliated community oncology setting.
Authors: Shamah Corey J. , Saphner Thomas James , Frick Jacob C. , Huibregtse Carol , Stiemke Gail S. 
Published: February 2017

129 Background: Via Oncology (Via) is a decision support tool that integrates patient information, their disease, and goals of care to develop a treatment algorithm. Via prioritizes treatments by efficacy first, toxicity second, and cost third. The recommended regimen is offered to the doctor and patient who may accept it or choose an off pathway treatment. The pathways are updated quarterly and are expected to speed the integration of new treatments into practice, standardize therapy, improve quality, and decrease cost. Physicians are often unaware that a trial is available for a patient and EHR’s are not commonly used to facilitate accrual to clinical trials. A pathway system could also alert doctors to the availability of a clinical trial and is designed to increase accrual to clinical trials. Methods: The integration of Via into the Epic EHR was facilitated by 3 major interfaces: patient information sent from the EHR to Via, the providers’ schedules sent from the EHR to Via, and the protocol selected in Via sent back to the EHR. Within the decision algorithm, clinical trials were recommended as the first option in all lines of therapy when available. Results: After 11 months and 103,515 visits, the visit capture rate was 82.7%%. With 3,844 decisions made, 83.9% of all treatment decisions were on pathway. Clinical trial enrollment was 122 patients in the 459 days prior to Via implementation, and 102 patients in the 271 days afterwards. This increase in accrual rate was significant (p = 0.00174.) Conclusions: The pathway program was rapidly accepted by physicians and the recommendations were commonly accepted. The subsequent increase in clinical accrual, while not definitive of causation, is promising. An upgrade of the Epic EHR is planned in the near future. A single log in to open Via and the EHR concomitantly is planned. An additional interface to bring staging information from the EHR to Via is being planned.
The impact of a "just culture" environment on the reporting of medication errors/near misses.
Authors: Steele Cheryl A. , Weber Shani Michelle 
Published: February 2017

131 Background: UPMC CancerCenter is a large outpatient medical oncology network of 25 locations, located within a 200 mile radius of Pittsburgh, PA. The Cancer Center administers approximately 118,000 treatments and 38,000 injections per year by 200 oncology nurses. Staff members have been strongly encouraged for years to report not only medication errors but also near misses. Despite the continual encouragement it was suspected that the actual number of reported medication errors and near misses was frequently underreported. Methods: In 2012 a Safety Culture Survey comprised of 43 questions was administered to all clinical staff in order to evaluate the comfort level of the staff in speaking up about medication safety issues. Cancer Center leadership wanted to convert from a ‘no blame’ response to errors to a ‘Just Culture’ environment that includes not only a robust accountability model but a model for addressing system and behavioral risks both before and after events occur. This survey was again repeated in 2014. At the conclusion of each survey period nursing leaders conducted on site in-services at every Cancer Center location. Individual site results along with Cancer Center aggregate results were reviewed with all participants. Participants were challenged to identify action items that could contribute to improving patient safety. Results: The results indicated a decrease in the number of respondents who reported feeling fearful of reporting in in 2012 (33%) compared to 2014 (28%). The number of reported near misses increased by 181% while actual error reported increased by 45% from 2012 to 2014. Conclusions: Staff quickly realized that should an error occur they would be treated fairly when they report medication errors. The staff also realized the positive impact that reporting has on patient safety. The conversion to a “Just Culture’ environment significantly increased the number of medication errors reported as a result of open communication and the implementation of a well-established system of accountability.
Banning the use of intracorporeal morcellation.
Authors: Schink Julian C. , Rechner Stephen F. , VanDrie Douglas M , Rogers Ralph N 
Published: February 2017

132 Background: In response to the FDA safety communication we banned the use of intracorporeal morcellation effective April 22nd 2014. Clinicians expressed frustration and a concern that an increase in the abdominal hysterectomy rate or percentage, wound complications, and length of stay would occur. Our PDCA (plan, do, check, and act) safety process reviewed these quality and safety metrics one year later. Methods: This is a retrospective evaluation of a prospective institutional decision. Data evaluated in a patient anonymous fashion using Crimson and Optum quality reporting software. Results: In 2013 the power morcellator was used in 157 cases. In the twelve months following the ban, the wound complication rate, SSI's, and LOS all decreased, and vaginal hysterectomy rate increased. Conclusions: An institutional ban of intracorporeal and power morcellation resulted in a decrease in the overall number of hysterectomies, including abdominal hysterectomy. Laparoscopic supracervical hysterectomy was replaced by vaginal hysterectomy and an associated decrease in complications and length of stay. [Table: see text]
Hepatitis B reactivation in patients with solid tumors: A systematic review and meta-analysis.
Authors: Hicks Lisa K. , Feld Jordan J. , Saluja Ronak , Truong Judy , Haynes Adam E. , Chan Kelvin K. 
Published: February 2017

138 Background: Hepatitis B virus (HBV) affects over 250 million people worldwide. Most people with chronic HBV (HBsAg positive) have no signs or symptoms of infection. However, when exposed to immunosuppression they are at risk of HBV reactivation which can cause hepatitis, liver failure and death. The risk of HBV reactivation in patients receiving chemotherapy for solid tumors, the efficacy of antiviral prophylaxis, and the clinical impact of HBV reactivation in this setting are uncertain. Primary Aim: To estimate the risk of clinical HBV reactivation (increased HBV DNA + transaminitis) among HBsAg-positive patients administered chemotherapy for a solid tumor. Secondary Aims: To estimate the efficacy of anti-viral prophylaxis and the risk of death from HBV reactivation in patients receiving chemotherapy for solid tumors. Methods: A systematic review and meta-analysis of the English language literature on HBV reactivation was completed (OVID Medline, 1946 to Aug 2013). All citations were reviewed by two or more authors. Data from patients with hematologic malignancies were excluded. Pooled probabilities of HBV reactivation risk, death from HBV reactivation, and odds ratio for the impact of anti-viral prophylaxis were estimated with a random effects model. Results: 2,667 citations were identified; 19 were eligible for inclusion. The pooled estimate for clinical HBV reactivation in HBsAg-positive patients receiving chemotherapy for a solid tumor was 21.9% (95% CI; 16.5% to 27.3%) in those not receiving anti-viral prophylaxis, and 2.4% (95% CI 0.7% to 4.2%) in those receiving anti-viral prophylaxis. The odds ratio for clinical HBV reactivation with antiviral prophylaxis compared to no prophylaxis was 0.12 (95% CI 0.06 to 0.25). In the absence of viral prophylaxis, the risk of dying from HBV reactivation in HBsAg-positive solid tumor patients was estimated at 1.3% with a 95% CI of 0.3% to 2.3%. Conclusions: Patients with chronic HBV who are administered chemotherapy for a solid tumor appear to be at substantial risk of clinical HBV reactivation; this risk may be mitigated by anti-viral prophylaxis. In the absence of anti-viral therapy, patients may experience a small but important risk of dying from HBV reactivation.
Engaging managing physicians in clinical staging prior to the initiation of cancer treatment.
Authors: Barry-Weers Anne , Huibregtse Carol , Bjegovich-Weidman Marija , Weese James L. 
Published: February 2017

143 Background: Managing physicians (medical oncologist, radiation oncologist, surgeons) have a responsibility to clinically stage patients prior to the initiation of cancer treatment. Clinical staging not only directs the treatment plan, but identifies appropriate clinical trials and estimates prognosis. We sought to determine whether engagement of managing physicians would result in increased clinical staging for various types of cancer. Methods: Baseline data on clinical staging for breast, colorectal (colon, rectal, anal, rectosigmoid junction)*, thoracic (lung esophageal)†, genitourinary (prostate, penis, testes)‡, and pancreatic primary cancers were obtained. The data were grouped by disease type and sub-specialty of the managing physicians. Based on that data, several performance improvement initiatives were implemented to provide managing physicians the opportunity to clinically stage the cancer patient prior to the initiation of treatment. The initiatives for completing and documenting staging were: a tutorial on use of Problem List in the electronic medical record (EMR); modification of history & physical and consult notes to include a field for staging; sharing among sub-specialties the smart lists within the template to allow for customization of existing templates; and 1:1 review with physicians who had outliers without clinical staging. Results: Clinical staging documented prior to the initiation of cancer treatment significantly increased in all five types of cancers studied (p < .01; Table). Conclusions: Though collaborative efforts by managing physicians continues to evolve, in many cases, use of the electronic medical record through a variety of performance improvement initiatives has facilitated documentation of clinical staging of cancer patients prior to the initiation of treatment. This engagement changed practice patterns, aligned our institution with best practice guidelines and aided in treatment selection for the best possible patient outcomes. [Table: see text]
Refining the use of an electronic medical record (EMR) to define and implement psychosocial distress screening and treatment.
Authors: Marcus Joel 
Published: February 2017

144 Background: All cancer patients experience some level of distress associated with cancer and its treatment at all stages of the disease. Psychological and social problems created or exacerbated by cancer cause additional suffering, weaken adherence to prescribed treatments and threaten patients' return to health." Health care providers often tend to under estimate psychological distress. Screening and early identification of distress promote improved management of symptoms, which facilitates medical care. Psychosocial care must be integrated into the routine treatment of cancer patients, per the Institute of Medicine's 2008 report "Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs." Methods: Developing operational standards for Distress Screening our cancer center both NCCN guideline, Commission on Cancer Standards. These operational standards integrated our Electronic Medical Record to create "best practice advisories" to alert the physician to the possible need for further evaluation of distress and the possible need for referral to Social Work staff or the on-site Psychologist. Results: Referrals to our on-site staff Psychologist at our main campus were monitored. 306 unique patients were referred to our staff psychologist for evaluation and treatment during the 2014 calendar year. In the first three quarters of the 2015 a total of 445 were made. Surgical oncology clinics (Head & Neck, Breast & Upper Gastro-Intestinal) made the majority of referrals. Conclusions: In accordance with published guidelines and accrediting standards our cancer center utilized our electronic medical record to increase our ability to identify psychosocial distress in our population.