bluuebunny/crossref_metadata_2025_split huggingface dataset:
Skin cancer surveillance and malignancies in patients with chronic lymphocytic leukemia (CLL).
Authors: Mansfield Aaron Scott , Rabe Kari G. , Schwager Susan M. , Call Timothy , Brewer Jerry D. , Shanafelt Tait D. 
Published: February 2017

184 Background: Patients with CLL are at higher risk of developing melanoma and other skin malignancies. The survival of patients with melanoma is worse, stage for stage, in patients with CLL than patients without. It is thought that early diagnosis of skin cancer is critical to improving survival in CLL patients. To promote early diagnosis and education on skin cancer prevention, the Mayo Clinic CLL group has recommended that CLL patients be referred for full body skin evaluation within 6 months of diagnosis. We sought to determine adherence to these guidelines by our group and identify prevalence of skin malignancies within 6 months of diagnosis. Methods: We identified patients who lived within 30 miles of Mayo Clinic who were diagnosed with CLL between 01/01/2004 and 01/01/2012 using the Mayo Clinic CLL database. Charts were reviewed for skin examinations, referrals to dermatology/primary care within 6 months of diagnosis of CLL, and diagnosis of a skin malignancy. Results: There were 107 patients newly diagnosed with CLL included in this study. Of the 79 patients who received their primary care at Mayo Clinic, 40 (51%) had a documented whole body skin exam by either a dermatologist or primary care provider within six months of diagnosis. Nine of these 40 patients (23% of examined patients; 8% overall cohort) had a skin malignancy: 2 patients had basal cell carcinomas, 6 patients had squamous cell carcinomas, and 1 patient had malignant melanoma. Prophylactic skin care recommendations could be documented for only 28 (26%) of patients. Conclusions: At least 8% of patients in this locally dwelling cohort with newly diagnosed CLL had a skin malignancy identified within six months of diagnosis (number needed to screen for 1 skin cancer: 13). Of patients referred to dermatology 23% had a skin malignancy (number needed to screen: 4.3). Referrals for screening skin examinations at diagnosis in patients with CLL could have an immediate impact for this at-risk population.
Compliance with established pneumonia core measures at MD Anderson Cancer Center in the emergency center.
Authors: Gonzalez Carmen E. , Johnson Tami N. , Kidin Lisa M. , Evans Scott , DeJesus Yvette , Rolston Kenneth V. I. , Walters Ronald Stewart 
Published: February 2017

189 Background: Pneumonia is the major cause of death due to infectious diseases in the United States. In the cancer patient, pneumonia is the overall leading infectious cause of death. Pneumonia Core Measures (PCM) and Clinical Pathways are frequently used by healthcare organizations to ensure the delivery of high-quality care and pathogen-directed therapy. A multidisciplinary team was organized at the University of Texas MD Anderson Cancer Center (MDACC) Emergency Center (EC) into a Pneumonia Team to optimize care and to enhance compliance with current PCM. Methods: A retrospective review of EC patients during pneumonia season was completed. Results: Three areas for improvement in the EC were identified. The areas include lack of EC staff’s knowledge on PCM, lack of standardized order-sets for pathogen-directed treatment, and cancer patients presenting with pneumonia syndromes that fall outside established Community-Acquired Pneumonia (CAP) guidelines. The identified problems were addressed through three strategies: Intense EC staff education initially and yearly prior to pneumonia season (September-March). Microbiologic analysis of the pathogens responsible for the pneumonias in our unique cancer population at MDACC. Development and implementation of an institutional pneumonia algorithm and an order-set. The Pneumonia Team also identified a gap between our patient population and the current PCM. Pneumonia patients at MDACC EC are divided into two distinct groups, solid tumor and hematologic cancers. The microbiology analyzed in both groups is consistent with Healthcare-Associated Pneumonia (HCAP) and not CAP. Microbiology analysis identified gram positive, gram negative, fungal, viral and multi-drug resistant organisms. The initial analysis demonstrated that 87% of our patients met criteria for HCAP and only 12% met CAP. Based on this percentage, antibiotic selection for our CAP patients comprises a small portion of our total population. Conclusions: Our current algorithm and order-set optimize care and minimize variation to match our patient population. These findings provide important considerations for policy makers in regard to pneumonia measurements in a cancer setting.
Evaluating the impact of a clinical universal mismatch repair screening initiative.
Authors: Hall Michael J. , Martin Kathleen Q. , Rybak Christina , Cooper Harry S. , Gustafson Karen S. , Boyd Jeff , Daly Mary Beryl 
Published: February 2017

194 Background: Immunohistochemistry (IHC)-based universal mismatch repair (UMMR) screening of incident colorectal (CRC) and endometrial (EC) tumors for deficient MMR (dMMR) associated with Lynch syndrome (LS) is supported by expert recommendations and is cost-effective. Heterogeneity in the approach to implementation of UMMR screening nationwide has been observed, suggesting knowledge gaps that could adversely impact anticipated outcomes. Studies of clinical UMMR screening can inform efforts to optimize implementation in the real world setting. Methods: In September 2011, Fox Chase Cancer Center (FCCC) began UMMR screening of incident (surgical) CRC/EC tumors. Providers were emailed a tailored UMMR Results letter intended to facilitate discussion of hereditary cancer risks and for distribution to patients. Content supported genetics consultation for an abnormal UMMR screen or for high-risk history (Hx) regardless of MMR status (i.e., personal Hx of any cancer; or 1st/2nd degree relative with a LS cancer and/or cancer <50). For comparison, clinical data on all CRC/EC surgical cases 3 months prior to implementation of UMMR screening were extracted from the medical record. Results: 55 surgeries for CRC/EC occurred in the 3 months pre-implementation (PRE) and 130 in the 9 months post-implementation (POST). 1 yr PRE and POST data will be presented at the 2012 Quality Symposium. Conclusions: The UMMR screening initiative greatly improved patient outcomes. Provider referral and documentation behavior was highly responsive to an abnormal screening result, but not high-risk cancer history alone. [Table: see text]
An IT-integrated, computer-based telephone system for monitoring patient-reported symptoms: Result of two trials.
Authors: Mooney Kathi , Beck Susan L. , Wong Bob , Dunson William A. , Wujcik Debra 
Published: February 2017

2 Background: An automated remote monitoring system of patient reported symptoms was tested in two separate trials to determine if it improved unrelieved symptoms after outpatient chemotherapy. Methods: In Study 1,250 patients and Study 2,335 patients beginning a chemotherapy course were randomized to Telephone Care (TC) (n 129/174) or usual care (UC) (n 121/162). All called daily reporting presence, severity, and distress (0-10 scale) for 11 common symptoms. Those in the Study 1 TC group had reports of moderate to severe symptoms emailed to their oncologist and oncology nurse. Those in Study 2 TC group had similar moderate to severe symptom reports sent to a study Nurse Practitioner (NP) who responded by telephone utilizing evidence based guidelines to intensify symptom care. These patients also received automated tailored self-care messages based on their specific symptoms. Results: The majority of participants in both studies were white (91%; 84%) and female (76%; 77%). The mean age was 56 years, with breast cancer most common (40%; 45%). Mean study days were 45 (Study 1) and 73 (Study 2) with 66% and 87% call completion days respectively. Fatigue, pain, poor sleep, nausea and depressed mood were reported as moderate to severe by over 50% of patients in both studies. In Study 1 no difference was found in symptom severity between TC and UC. Oncology providers found the TC symptom alerts useful but rarely initiated symptom care intensification. In Study 2 the TC group mean symptom score was significantly lower than UC, p < .001. Poisson regression showed TC had fewer Severe symptom days than UC (est. means and SE) 3.16 (0.44) vs. 10.24 (1.84), p < .001; and fewer Moderate days 8.91 (1.04) vs. 19.06 (2.22), p < .001. TC had somewhat higher Mild days 19.85 (2.81) vs. 13.75 (1.85), p = .06; and more no symptom days 66.06 (3.82) vs 52.02 (4.15), p = .01. Conclusions: Remote monitoring of patient reported symptoms after chemotherapy is effective in identifying unrelieved symptoms. It can be used to track quality improvement as well as augment symptom care. Follow up to intensify symptom treatment utilizing guidelines is necessary to achieve significant reductions in symptom severity, distress and days of moderate or severe symptoms.
Quality improvement outcomes in an academic practice participating in ASCO’s Quality Oncology Practice Initiative (QOPI).
Authors: Fenton Mary Anne 
Published: February 2017

206 Background: The ASCO QOPI is an instrument for community and academic practices to assess quality and adherence to guidelines in areas of treatment planning and goals, chemotherapy consent documentation, smoking cessation, symptom control, palliative care, and disease specific measures. Following data submission QOPI summary reports for the submitting practice and QOPI aggregate are available for review and comparison. Methods: The academic practice of Rhode Island Hospital Comprehensive Cancer Center has participated in QOPI since the fall of 2008. QOPI measure summary reports for our practice and comparison to the Academic Aggregate are reviewed by our physicians after each round of chart abstraction, measures are identified for improvement. Interventions include education on practice improvement and development of policy and procedures for implementation by our Quality Control Officer in compliance with hospital policies. Results: Presented is a summary of quality improvement interventions implemented. Additional areas of quality improvement have been identified based on QOPI data, and improvement plans are ongoing including treatment summaries for patient and primary care physicians, tools to assess patient emotional well being, documentation of family history and referral for genetic assessment. Conclusions: QOPI provides a platform for collection, analysis and comparison of quality measures. For the measures of formulating a pain plan the intervention was a reminder to document the plan. For the measure hospice enrollment, a reflection on our hospice enrollment has lead to an increase in referral to palliative care. The ASCO QOPI program is a tool for quality improvement, our Quality Control Officer was essential in implementation of our improvement projects. [Table: see text]
Physician order for scope of treatment (POST) in South Carolina (SC).
Authors: O’Rourke Mark Allen , Hudson Matthew F. , Craig Janet B. , Ropp John C. , Reeves Karen 
Published: February 2017

21 Background: Physician Order for Life-Sustaining Treatment (POLST, www.POLST.org ) is a process and tool that translates patients’ goals of care into medical orders in a highly visible, portable way. Trained providers meet with seriously ill patients (or the surrogates) and discuss the available treatment options in light of their current condition, and help clarify the patient’s preferences. The physician then documents those preferences on a standardized medical order form, which travels with the patient if he or she changes settings of care. The POLST form is 1. a physician order, 2. signed by the patient, 3. after consultation with the physician, 4. facilitated by a person trained in advance care planning, 5. directed toward people with serious, chronic illness such that death in the next year would not be a surprise, 6. addressing the decision at a moment of medical crisis to a. hospitalize with full therapeutic intervention, or b. hospitalize with limited therapeutic intervention (such as no CPR), or c. provide supportive, palliative care in the present setting (home or nursing facility), 1. addressing further decisions such as feeding tube, parenteral (IV) hydration, or antibiotics, 2. documented in a widely publicized, recognized and understood form with a distinct pink color, and 3. accepted by EMS responders, hospices, nursing facilities, and hospitals across the state. Methods: The SC Coalition for the Care of the Seriously Ill is comprised of clinical and administrative leaders representing key statewide organizational partners, healthcare entities, and individuals. The Coalition proposes a template order for statewide integration to be called POST. The target population is persons with serious illness for whom death in the next year would “not be a surprise.” Results: Presently, the Coalition is working with state government to undertake a three-county pilot study of POST. Challenges include creating a legal framework, IRB approval, and education of providers and the public. Conclusions: POST may facilitate patient-centered advanced cancer care. Implementation of the POST in SC will require collaboration by stakeholders. Collaboration will require responsiveness to constituents’ concerns in order to facilitate patient-centered care.
Improving quality of pediatric oncology care via ASCO’s Quality Oncology Practice Initiative (QOPI) program.
Authors: Cooper Robert Michael , Abasolo Robin 
Published: February 2017

212 Background: Pediatric oncologists strive to provide a high quality of care for their patients. American Society of Clinical Oncology (ASCO) developed the Quality Oncology Practice Initiative (QOPI) Program which serves to evaluate institution’s best oncology practices. The program evaluates Core Measures in Disease Modules and Domain Modules. The Disease Modules were not useful in a pediatric practice, however, the Core Measures and Domain Modules were appropriate for evaluating pediatric quality care. Methods: Kaiser Permanente Los Angeles Medical Center Pediatric Oncology participated in the QOPI Spring 2012 Collection. Thirty-five member charts were audited by a registered nurse case manager via the electronic medical record (EMR) for Symptom/Toxicity Management, Care at End of Life, and Core Measures modules over the course of six weeks. Results: Data results revealed areas that needed improvement at LAMC included oncologist’s documentation of chemotherapy treatment and consent, physician and nurse documentation of chemotherapy and disease education, documentation of oral chemotherapy adherence and documentation of fertility preservation. Only two pediatric end-of-life cases met requirements for abstraction during this round of audit. Chart audits were easily abstracted from EMR. The QOPI computer program was easy to use and concise with information and guidelines for measures to be abstracted. QOPI personnel were readily available for any problems or concerns. Conclusions: Participation in the ASCO QOPI Program can serve as a tool to help improve oncology institution’s best practices. The QOPI Program could further expand its disease modules to include more pediatric content such as acute leukemia and neuro-oncology. In addition, participation in this program offers 3-year certification for outpatient hematology-oncology practices (limited to internal medicine at this time) and could serve as your Part IV Maintenance of Certification (limited to internal medicine).
Variation in the use of intensity-modulated radiation therapy (IMRT) in the state of Michigan: 2005-2010.
Authors: Hayman James , Griffith Kent A. , Jagsi Reshma , Feng Mary Uan-Sian , Moran Jean M. , Piotrowski Tania L. , Pierce Lori J. 
Published: February 2017

219 Background: Interest is growing in value in health care, defined as better outcomes at lower costs. A primary driver of cost in radiation oncology is the use of IMRT. We examined the patterns and correlates of use of IMRT across Michigan using publicly available data. Methods: As a certificate of need state, Michigan requires every radiation oncology facility to report yearly the number of external beam and IMRT treatments delivered. Data for 2005-2008 were obtained through a Freedom of Information Act request of the Michigan Department of Community Health, while 2009-2010 data were available at its website. Percentage of external beam treatments delivered using IMRT (IMRT%) was examined across centers over time and repeated-measures longitudinal linear regression was used to identify factors associated with use. Results: During 2005-2010, 48 to 65 centers reported data. Median IMRT% (range) rose steadily during the study period: 2005 16% (0-64); 2006 21% (0-57); 2007 27% (0-79); 2008 37% (7-85); 2009 41% (0-87) 2010 45% (7-100). There was also significant between-center variation (see table). Regression modeling demonstrated that IMRT% was associated with year (+6.7% per year, p<0.0001), facility type (+7.1% freestanding versus hospital, p<0.11), facility annual volume (+5.0% high volume: 7,000+ versus low: <7,000, p=0.01) and the interaction between year and volume (low volume +2.4% per year versus high volume p<0.02). The significant interaction between year and volume suggests that the greatest IMRT% growth was in low volume centers (6.7% per year versus 4.3% per year for high volume). Conclusions: IMRT utilization has grown steadily across Michigan between 2005 and 2010. There is significant variation in its use that appears to be related in part to facility characteristics. The newly established Michigan Radiation Oncology Quality Collaborative (MROQC) is beginning to explore the use of IMRT in patients with breast and lung cancer statewide to identify those groups of patients where improved outcomes may justify its higher cost. [Table: see text]
Assessment of follow-up decisions and care after BRCA testing.
Authors: Riaz Sara Sarwar , Ahsan Samira 
Published: February 2017

22 Background: Inherited mutations in BRCA1/2 genes render high risk of development of breast and ovarian cancers in affected individuals. A spectrum of risk reducing strategies exists inclusive of preventive measures as clinical and radiographic surveillance, hormonal therapies and prophylactic surgeries. Baseline prognostic parameters direct decisions regarding adoption of each approach. Methods: We aimed to study the pattern of clinico-preventive inclination among deleterious mutation carriers, with and without personal history of malignancies. Our mode of intervention was a phone survey conducted to elicit pertinent information from individuals with high risk penetrance mutations and to assess their choice and bias toward each strategy, primarily designed to abate the oncogenic potential inherent to these mutations. Results: Analysis of subjective and sequential data revealed that 5 out of the 7 mutation carriers had a personal history of breast or ovarian cancer. All 5 of these subjects opted for prophylactic mastectomy while 4 of them underwent prophylactic oophorectomy, detecting one additional cancer. 2 of the individuals preferred surveillance as their preventive program while none of the subjects chose hormonal therapy. In terms of demographics and lifestyle, 3 patients claimed to had increased their level of physical activity, 4 modified their dietary habits and 2 incorporated vitamins and herbal supplements into their regimen. 6 of the subjects felt adequately supported while 1 individual relayed concerns regarding inadequate insurance coverage. None of the subjects felt their follow up decisions were influenced by their annual income or coverage plans. Conclusions: Decisions regarding adopting least to most aggressive measures are highly influenced by personal history of cancer shifting the focus from quality to quantity of life. Prophylactic mastectomy reduces the risk of contralateral breast cancer by 90% and oophorectomy by 50%. Estrogen and progestrogen receptors are infrequently expressed in BRCA related tumors rendering hormonal therapy less effective. Lifestyle modification and stringent surveillance are evolving areas of preventive oncology, however, their effectiveness remains to be elucidated.
Use of performance data to drive process change and improve patient wait time for chemotherapy treatment.
Authors: De Mendonca Ben , DeAngelis Carlo , Charbonneau Flay , Leung Tiffany , Trudeau Maureen E. 
Published: February 2017

223 Background: The Odette Cancer Centre (OCC) manages more than 24,000 chemotherapy visits annually. The delivery process is complex and patients have significant wait times for treatment. The OCC was faced with improving this process with no data infrastructure to support continuous quality improvement. Methods: An electronic scheduling manager, Chemotherapy Appointment Reservation Manager (CHARM) was designed that includes workflow communication between pharmacy and nursing. A multidisciplinary team created a value stream map of the process. Rate limiting steps and key milestones in the delivery process were identified. CHARM timestamps stages in the chemotherapy process, from nurse approval to pharmacy verification, medication processing and medications received on the chemotherapy unit. Extracted data was used to create a weekly report to monitor key performance indicators (KPIs). Results: An analysis of six months of data led to the establishment of KPIs and targets. Our baseline targets were established as pharmacy turnaround time (AR) < 1 hour, pharmacy verification (HP)< 13 minutes, medication processing (PR) <45 minutes and chemotherapy ready (CR) +/- 30 minutes of the patient appointment time. Since April 2012, KPIs have been reported. Over a four month period (81 clinic days and 5,920 appointments) the median AR time was 1:02 (hh:min), HP was 00:12 and PR was 00:43. The KPI targets were met AR 46%, HP 52% and PR 51% and CR 29% of the time. The data infrastructure now drives the quality improvement initiatives. An early strategy implemented queuing theory, to process orders by appointment rather than approval time, resulting in no change in median AR time, but a decrease of seven minutes AR range. Conclusions: Quality improvement is hinged on measurement and evaluation. The OCC has successfully implemented a continuous quality improvement data infrastructure that monitors quality of ambulatory chemotherapy delivery. These data describe pharmacy and nursing processes. Further work to improve the delivery process and data infrastrucutre is ongoing.