bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decreasing wait times for endobronchial ultrasound (EBUS).
Authors: Mackenney Karen L. , Faiz Saadia , Larson Andrew J , Eapen George A , Bashoura Lara 
Published: April 2017

192 Background: The department of pulmonary medicine evaluates manifestations of cancer and complications of therapy that affect the lungs. It is a procedurally oriented specialty with many diagnostic and therapeutic interventions. Endobronchial ultrasound with transbronchial fine needle aspiration (EBUS-TBNA) is a minimally invasive procedure that allows real time image guided sampling of tissue in the mediastinum. Current guidelines recommend use of EBUS for the initial test to diagnosis and stage lung cancer. It has a low complication rate, but needs specialized equipment as well as anesthesia support. Alternatives include CT-guided biopsy or surgery. The delay from time of referral to EBUS procedure has the potential to delay diagnosis and treatment, create patient anxiety, frustration and expense of travel for multiple appointments. The staff is under pressure to perform excessive cases on a daily basis resulting in overtime staffing costs. Our objectives were to reduce delays in diagnosis/treatment, improve patient satisfaction, improve referring services satisfaction and optimize the use of resources and improve staff working conditions. Methods: We used a Plan, Do, Study, Act process. Initially the process flow diagram was utilized along with a fishbone diagram to allow us to focus on the issues. The aim was to decrease EBUS wait time 20% by 7/2016. Our process flow sheet was arranged into swimlanes in order to identify focus areas. This allowed us to redesign the workflow to improve capacity and improve existing resources to be more efficient. Results: Working with anesthesia services and the cardiopulmonary center staff, we were able to open a second bronchoscopy suite 2 days a week for additional EBUS cases. We also had monthly meetings with issues and to monitor delays to other services. Conclusions: We were able to reduce our wait time from 7.5 days to 4.27 work days. The added capacity allows for surge in demand for EBUS. Our future studies will concentrate on patient and referring service satisfaction, cost savings with reduction in overtime, quantifying impact on decreasing delays in diagnosis and subsequent treatment.
Improving patient care through implementation of a QOPI-focused interactive patient note template.
Authors: Shaw Andrew , Ragon Brittany K. , Baez Vallecillo Luis , Rieber Alyssa G. 
Published: April 2017

197 Background: Participation in the ASCO Quality Oncology Practice Initiative (QOPI) has been shown to improve the quality and value of care provided by oncology practices. Our fellows’ oncology practice participates in QOPI. We sought to utilize QOPI metrics in conjunction with the documentation capabilities of our electronic medical record (EMR) to create a quality-focused standardized new patient note template to be used by all practitioners in our oncology clinic, in an effort to improve patient care through improved communication and efficiency. Methods: We examined the results from our most recent QOPI assessment cycle in spring of 2016 and identified areas where our practice met the metric less than 50% of the time. Oral chemotherapy, tobacco cessation, and fertility preservation counseling were identified as target areas. We surveyed the practitioners in the group to establish baseline knowledge of QOPI metrics and desire for a standardized note template. We then developed and implemented a note template incorporating QOPI metrics, pulling data directly from other areas within the medical record, and excluding extraneous information. Results: Only 58% of the fellows in our fellowship program responded that they had a general idea of the QOPI metrics, and only 37% believed their notes were QOPI-compliant; 84% were interested in a standardized note template that incorporates QOPI metrics. Through the assistance of EMR specialists, we created a standardized note that auto-populates information recorded elsewhere in the patient’s chart and allows physicians to select appropriate options from pre-populated lists based on the patient’s treatment. The physician cannot close the encounter until these selections are made Conclusions: QOPI metrics provide guideposts for oncology practitioners to provide quality care and communicate effectively. We created a note that encourages practitioners to complete recommended QOPI tasks in an effort to improve communication and patient care. Data collection regarding practitioner use and satisfaction with the new template and compliance with QOPI metrics is ongoing.
Development and pilot of brief surveys to evaluate the quality of patient-centered cancer care.
Authors: Winget Marcy , Haji-Sheikhi Farnoosh , Asch Steve 
Published: April 2017

202 Background: Oncology practices have increasingly engaged in patient-centered systematic quality improvement efforts. One test of their effectiveness is patient feedback, yet many existing instruments are unwieldy or insensitive to change. Here we describe the development and pilot testing of short patient surveys used to assess change in patient experience of the key domains of access, communication, and coordination. Methods: Domains and corresponding questions of patient-centered care were informed by existing literature and tools available online, with a focus on domains relevant to cancer patients. Questions were modified from validated or semi-validated instruments to have a consistent 4 or 5-category Likert response scale, put into four unique short instruments that included at most ten questions each and piloted in cancer clinic waiting rooms. Input from patients was sought to assess: 1) relevance and clarity of questions; 2) whether important concepts were missing; 3) acceptability to patients regarding place and timing of surveys and; 4) estimate top box scores. Internal consistency of the final question sets for each domain was examined using Cronbach’s alpha. Results: Patient feedback from the pilot was positive with respect to all above categories. The following modifications were made based on top box score analysis: 1) created a common 5-point Likert scale for all questions and 2) excluded questions with a top box score higher than 80%. An open comment field was also added to complement the quantitative responses. Cronbach’s alpha for all domains was ≥ 0.80 expect for the access domain which was 0.51. The final 4 complementary instruments have 7-8 questions each and take only a few minutes for patients to complete. Each return patient receives one of the instruments randomly at clinic visits so information on all domains is continuously collected and a given patient has the opportunity to provide feedback on all domains over time; response rates are approximately 60%. Conclusions: The short surveys are being used to assess the effectiveness of interventions. Other cancer centers and their patients may find similar short surveys an improvement over general patient satisfaction surveys e.g., Press-Ganey.
PROMs and PREMs in Dutch integrated head and neck cancer care: Measurements and evaluation.
Authors: van Overveld Lydia Francisca Jacoba , Takes Robert P. , Braspenning Jozé C.C. , Smeele Ludi E , Merkx Matthias A.W. , Hermens Rosella P.M.G. 
Published: April 2017

209 Background: Providing patient-centred care is an essential component of high quality integrated care. Nowadays, patient reported outcomes and experiences are increasingly used to measure quality of care. As part of a quality registration, the Dutch Head and Neck Audit, patient reported outcomes (PROs) and experiences (PREs) of patients with head and neck cancer (HNC) are measured with questionnaires and evaluated to increase patient-centred care. Methods: Patientswere recruited from nine hospitals participating in the DHNA. Validated questionnaires were distributed at baseline, 3, 6 and 12 months follow-up. Included PROMs were EQ-5D-3L, EORTC QLQ-C30 and EORTC QLQ-H&N35. Included PREMs were Consumer Quality index for Oncologic care (CQO) and Radiotherapeutic care (CQR). CQO and CQR have similar domains with different questions. With descriptive analysis, ANOVA and mixed model analysis, differences over time and between treatment groups were analyzed. Results: Questionnaires were filled in by 238 patients. Pain decreased significantly at 6 and 12 months follow-up and dry mouth increased significantly at 3, 6 and 12 months follow-up compared to baseline. Sticky Salvia, problems with social eating and sense problems increased at 3 and 6 months follow-up, but were similar to the baseline score at 12 months follow-up. Pain and sticky saliva differed between radiotherapy and chemoradiotherapy or surgery and radiotherapy respectively (p ≤ 0.05). Regarding the CQO domain scores, all treatment groups differ significantly from each other (p ≤ 0.05). This was not regarding the CQR domain scores. Except for the domain Organisation, no differences between the CQO and CQR domain scores were found. Recognizing the emotional side of HNC (care) and intensifying guidance after the treatment period needs improvement. Conclusions: This study gives clues to improve healthcare according the experiences of the patient and we can predict more carefully the outcomes of the patients with different treatment types. PROMs according to the ICHOM criteria and PREMs are promising for measuring and improving quality and personalization of HNC care. However, the usage of two PREMs had no added value to evaluate and address points of improvement.
The Quality Oncology Practice Initiative program: Experience in Spain.
Authors: Camps Carlos , Diaz Rubio Eduardo , Lopez Rafael , Carrato Alfredo , Gascon Pedro , Margarita Feyjoo , Guillem Vicente 
Published: April 2017

214 Background: Patient care quality is a discipline that is being considered highly important in today’s healthcare. Quality Oncology Practice Initiative (QOPI) is a referral worldwide in terms of quality for oncology practices. The ECO Foundation is a platform of experts representing the major Spanish hospitals involved in the treatment of cancer patients. ECO reached an agreement with QOPI in order to involve Spanish hospitals in the participation of the QOPI program. Methods: Two rounds of data collection were carried out (Fall 2015 and Spring 2016). Practices had to registered on-line and submit data into the platform provided by QOPI. ECO Foundation offers all centres the support of a CRO. 11 Spanish hospitals have participated in the first round and 6 in the second. 4 of them have participated in both rounds. Core and Lung Cancer modules were completed. Results: For the Fall 2015 round, 686 charts were included. In Spring 2016 334 charts were collected. For the first round, highest scores were: Pathology report confirming malignancy, Plan of care for pain, Effectiveness of narcotic, Patient consent, Tobacco cessation counselling, Patient emotional well-being assessed and in the 9 items of the lung cancer module. Lowest scores were: Pain addressed, Smoking status use, Smoking use cessation counselling, Smoking use cessation administered and Height, Weight, and BSA documented. For the Spring 2016 round, the results were similar, but for the items with the highest scores were now included: Chemotherapy intent discussion, Patient consents for chemotherapy, Smoking status documented, Height, Weight, and BSA documented. In Fall 2015, 7 out of 11 practices obtained a global score of over 70%, and in 2016, 3 out of 6. Regarding the 4 hospitals that repeated in both stages,3 reported an improvement of the global scoring in 2016. Conclusions: These preliminary results are a good starting point for the continued implementation of the QOPI program in Spain. Thus providing a well-structured approach to analyse cancer care in Spain, offering training programs for quality improvement in oncology practices. ECO Foundation will continue pursuing excellence and quality in Spain with future activities like the certification programs and training seminars.
Measurement of person-centered care delivery of adult oncology in Ontario, Canada.
Authors: Moody Lesley , Bridge Erica , Dhanju Suman , Nicholls Brett , Singh Simron 
Published: April 2017

223 Background: In the Ontario, Canada, cancer system, the provincially endorsed Person Centred Care (PCC) Guideline provides recommendations for healthcare providers to implement PCC in the delivery of adult oncology services. However, it is unknown whether healthcare providers have incorporated these recommendations into their daily practice within the Regional Cancer Programs (RCPs). The purpose of this study was to develop an assessment tool to evaluate the implementation of the PCC Guideline in Ontario RCPs. Methods: Tool development consisted of a 3-step process: 1) literature review to identify relevant measures, 2) Modified Delphi with a panel of experts (n = 8), and 3) focus groups with patient/family advisors (n = 5) and RCP PCC leads (i.e., designated individual responsible for PCC deliverables) (n = 7). Results: Through the literature review, two relevant tools were identified ( i.e., Institute for Patient- and Family-Centered Care’s Hospital Assessment Tool and Accreditation Canada’s Cancer Care Standards), resulting in 187 measures deemed appropriate to include in the assessment tool. In round one of the Modified Delphi, each measure was evaluated independently by a panel of experts using a 5-point Likert Scale (1 = strongly disagree to 5 = strongly agree) to assess both the importance and feasibility of each measure. Sixty-seven measures were rated 4 or above by 70% of the experts. Consistent with Modified Delphi best practice, these measures were discussed during the second round with the panel of experts. An additional 33 measures were removed due to similarities/duplications. Nine measures were added. The 42 measures were presented to patient/family advisors and the RCP PCC Leads during focus groups and evaluated based on importance and feasibility of assessing PCC implementation in the RCPs. Wording recommendations were made and two additional measures were added. The final tool includes 44 measures to evaluate PCC implementation within the RCPs. The assessment tool was disseminated to the 14 RCPs in October 2016. Conclusions: The results of this assessment will provide an understanding of the current state of PCC Guideline implementation in Ontario, in order to identify facilitators and barriers to implementation.
Predictors of no-show among international patients with cancer: A 4-year analysis.
Authors: Bhulani Nizar , Xiao Lianchun , Hassan Manal , Lenzi Renato 
Published: April 2017

23 Background: Patient no-show (NSh) for scheduled medical appointments negatively impacts quality of care, impedes optimal use of resources, has significant negative economic consequences secondary to missed appointments, and uncovered referral processing costs. International patients (IntlPts) present challenging financial/travel arrangements and cultural and linguistic needs. There are currently very limited data regarding numbers of IntlPts visiting the United States for medical care and no data regarding NSh rates. The purpose of this study was to quantify costs and identify IntlPts-related variables correlating with NSh to develop interventions aimed at minimizing the associated negative financial consequences. Methods: A retrospective study of IntlPts accepted and scheduled for an appointment at the International Assessment Center at MD Anderson in fiscal years 2010 – 2013 was conducted. Overall 52 variables were evaluated that included socio-demographic and clinical patient characteristics, financial responsibility, and appointment timeline. For univariate analysis, Chi-square test and Wilcoxon rank sum test were applied. For multivariate analysis, a multivariate logistic regression model was fit. The multivariate logistic model with independent covariates was used to construct a nomogram. The Time Driven Activity-Based Cost method was used to assess the cost of processing referral requests. Results: Of 1031 IntlPts scheduled, 311 (30%) were NSh. NSh was significantly associated (p <0.05) with country of origin, payer, diagnosis, referral source, disease stage, patient-delayed appointment date, number of symptoms, pain, bleeding, fatigue, dysphagia, jaundice, neurological symptoms, comorbidities, and appointment lag time. Direct operational costs were calculated using process maps and TDABC. Conclusions: These results provide the groundwork to understand operational costs and predictors of no-show of oncology IntlPts. Having knowledge of predictive factors for NSh in a new patient outpatient setting represents a necessary step towards decreasing its frequency, addressing associated costs, optimizing continuity of care, and ultimately improving outcomes and value of the provided care.
In hindsight if treatment had begun early: A study to determine the OS and PFS in patients with stage III lung carcinoma based on the time elapsed from the diagnosis to start of treatment.
Authors: Seepana Jyothirmai , Haddad Abdo S. , Mohapatra Suryanarayan , Khalid Sidra , Subramaniam Subanandhini , Jia Xuefei 
Published: April 2017

230 Background: Stage III non-small cell lung cancer (NSCLC) is defined as loco-regionally advanced disease due to primary tumor extension into the extra-pulmonary structures (T3 or T4) or mediastinal lymph node involvement (N2 or N3) without evidence of distant metastasis. Patients are concerned about beginning treatment early after diagnosis. The role of the study is to determine the outcome if treatment is started within 8 weeks or after 8 weeks. In a retrospective study, the Cleveland Clinic’s database was used to identify patients treated through 2003 – 2014. Methods: Stage III NSCLC was ascertained as per the pathological or clinical stage. Kaplan-Meier estimate was used to determine the survival of patients. Results: Of the 561 patients patients with stage III NSCLC, 408 had treatment within 8 weeks and 153 after 8 weeks. See table. Treatment within 8 weeks of diagnosis: In total, 105 patients were recorded as having died, the median survival was 55.1 months (95% CI: 48.2, 62.5). The 2-year survival rate was 98% ± 0.9%, and the 5-year survival rate was 44.5% ± 4.7%. The median PFS was 15.3 months (95%Ci 12.0, 23.1). The 2-year PFS was 43% ± 0.28%, and the 5-year PFS was 14.5% ± 2.1%. Treatment after 8 weeks of diagnosis: In total, 34 patients were recorded as having died, the median survival was 60.6 months (95% CI: 50.3, 73.8). The 2-year survival rate was 97.5% ± 1.4%, and the 5-year survival rate was 53.2% ± 8.3%. The median PFS was 12.1 months (95%Ci 9.5, 15.3). The 2-year PFS was 32.8% ± 4.4%, and the 5-year PFS was 12.8% ± 3.2%. Among the following sub-groups: < 65 years, 65-75 years and > 75 years, there was no observable difference whether treatment was begun within eight weeks or after eight weeks. Conclusions: In the combined group and within subgroups, OS and PFS were not significantly different between patients who received treatment within 8 weeks and those who received treatment after 8 weeks. [Table: see text]
Chemotherapy for resected colorectal cancer pulmonary metastases: Utilization and outcomes in routine clinical practice.
Authors: Karim Safiya , Nanji Sulaiman , Brennan Kelly , Pramesh C S. , Booth Christopher M. 
Published: April 2017

236 Background: The role of chemotherapy in the setting of resected colorectal cancer pulmonary metastases (CRCPM) is not well defined. Here we describe utilization of peri-operative chemotherapy and outcomes among patients with resected CRCPM in the general population. Methods: All cases of CRCPM who underwent resection from 2002-2009 were identified using the Ontario Cancer Registry (OCR). Electronic treatment records identified peri-operative chemotherapy delivered within 16 weeks before or after pulmonary metastectomy (PM). Modified Poisson regression was used to evaluate factors associated with chemotherapy delivery. Cox proportional models were used to explore the association between post-operative chemotherapy and cancer-specific (CSS) and overall survival (OS). Results: The study population included 420 patients. Thirty-six percent of patients (151/420) received peri-operative chemotherapy. Among these patients, 75% (113/151) received post-operative chemotherapy. Factors that were independently associated with use of post-operative chemotherapy included higher socioeconomic status (SES) and no prior adjuvant chemotherapy (p < 0.01). In adjusted analyses post-operative chemotherapy was not associated with improved CSS (HR 0.99, 95% CI 0.67-1.47) or OS (HR 0.93 95%CI 0.66-1.31). In exploratory analyses, among those patients who did not receive previous adjuvant therapy for the primary colorectal cancer, post-operative chemotherapy following lung metastatectomy was associated with HR 0.50 (95%CI 0.27-0.95) for OS and HR 0.59 (95%CI 0.27-1.27) for CSS. Conclusions: One third of patients with resected CRCPM in routine practice receive peri-operative chemotherapy. A randomized controlled trial is warranted to evaluate whether chemotherapy following resection of CRCPM is associated with improved survival.
Health utility scores (HUS) and health-related quality of life (HRQoL) in stage 4 lung cancer (S4LC) patients with brain metastases (BM).
Authors: Tam Vivian , Tse Brandon C , Tse Tiffany , Lu Lin , Tam Emily , Borean Michael , Labbé Catherine , Doherty Mark , Bradbury Penelope Ann , Leighl Natasha B. , Brown M Catherine , Xu Wei , Howell Doris , Liu Geoffrey , O'Kane Grainne 
Published: April 2017

24 Background: Novel therapies have improved the survival of S4LC patients, particularly those with EGFR or ALK alterations. As BM are common among such patients, determining whether HUS appropriately capture BM-specific HRQoL is crucial in economic analyses. We evaluated the relationship between the FACT-Brain (Br) HRQoL, presence of BM, and HUS. Methods: This cross-sectional study of S4LC outpatients at a comprehensive cancer centre assessed FACT-Br and EQ-5D-3L-derived HUS. Correlational analyses, stratified by BM status, were performed between HUS and each of FACT-Br and its subscales: FACT-General (G), physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), functional well-being (FWB), and brain cancer (BrC). Linear regression interaction models assessed whether BM modified the associations between FACT-Br or its subscales and HUS. Results: The 65 BM and 42 non-BM patients had similar demographics: median age (range) was 62 (30-83) years, 61% were female, 55% were Caucasian, and 54% were EGFR/ ALK+. Mean± standard error of the mean (SEM) values of HUS were similar between BM and non-BM groups (0.77±0.02 vs. 0.78±0.02; p=0.49). However, 40 BM patients with stable brain disease had higher HUS than the 14 with progressive disease (0.81 vs. 0.69; p=0.007). Mean±SEM values for FACT-Br, FACT-G, and BrC were 148±2.6, 79±1.5, and 69±1.3, respectively, with no differences between BM and non-BM groups. With the exception of SWB, FACT-Br and its subscales were each individually correlated with HUS (all p<0.001 unless specified), including between HUS and PWB (all patients: r=0.58; BM only: r=0.60; non-BM only: r=0.54), FACT-Br (all: r=0.55; BM: r=0.55; non-BM: r=0.54), FACT-G (all: r=0.51; BM: r=0.49; non-BM: r=0.55), and BrC (all: r=0.49; BM: r=0.51; non-BM: r=0.44, p=0.003). Having BM did not modify these relationships (each interaction, p>0.35). Conclusions: The FACT-Br HRQoL measures and the majority of its subcomponents moderately correlate with HUS but are not specific to patients with BM. Progression of CNS disease greatly alters HUS. EQ-5D-3L-derived HUS are a useful index of HRQoL in S4LC.