bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of an algorithm to identify metastatic prostate cancer in electronic medical records using natural language processing.
Authors: Wallner Lauren P. , Dibello Julia R. , Li Bonnie H. , Zheng Chengyi , Yu Wei , Weinmann Sheila , Richert-Boe Kathryn E. , Ritzwoller Debra P. , VanDenEeden Stephen K. , Jacobsen Steven J. 
Published: February 2017

164 Background: Prostate cancer patients who develop metastases are a difficult population to identify through administrative diagnostic codes, due to their protracted time to metastases, limited survival and the inconsistent use of specific codes. As a result, research that is needed to inform the delivery of high-quality care in this setting is limited. Therefore, the goal of this study was to develop an algorithm, which utilizes EMR data to identify men who progress to metastatic prostate cancer after diagnosis using natural language processing (NLP). Methods: An electronic algorithm was developed to search unstructured text using NLP to identify progression to metastases among men with a diagnosis of prostate cancer between 1992 and 2010 in a large, diverse cohort of men who were part of an ongoing study focused on prostate cancer mortality. A training set of 449 men who were diagnosed as early stage prostate cancer was used for development. Pathology, radiology and clinic notes were searched from diagnosis until death or loss to follow-up. Pathology reports were searched for mention of adenocarcinoma in the metastatic lesion, radiology reports were searched for abnormal findings consistent with metastases, and clinic notes were searched for mentions of increasing pain or narcotic use related to metastases. Each NLP component was validated against manual review of the corresponding records. Results: Of the 449 men in the training set, 40 (8.9%) were found to have metastatic prostate cancer. The majority of cases had evidence of metastases in their clinic notes (98%). Radiology reports identified 18% of cases, and pathology reports identified 5%. Of the 40 cases identified, 25% did not have a corresponding ICD-9 codes for metastatic cancer. However, 7.5% used ADT, 37.5% had increasing oncology visits and 22.5% had rapidly rising PSA levels. Conclusions: Our results suggest that NLP can be used to identify men with metastatic prostate cancer in the EMR more accurately than diagnosis codes alone. The automated identification of patients with metastatic cancer facilitates quality of care research in this setting to ensure the delivery of appropriate and high-quality care.
Supportive care plans: Harnessing technology and patient-reported outcomes to drive quality care across the cancer continuum.
Authors: Brant Jeannine , Stricker Carrie Tompkins , Jacobsen Paul B. 
Published: February 2017

167 Background: Cancer care is increasingly complex. Clinicians lack time to stay current on evolving evidence and resources to implement quality standards. Health information technology solutions have proliferated, including electronic patient-reported outcome (ePRO) and care pathway technologies, but adoption has been slow. The goal of this study is to explore feasibility, usability, and acceptability of incorporating a novel supportive care planning technology into clinic workflow. The On Q Care Planning System (CPS) collects ePRO and clinical data to generate a personalized supportive care plan aligned with quality care standards and current evidence. Plans promote self-management and patient-provider communication. Methods: Prospective, multi-center pilot study at 2 NCI-affiliated centers (a comprehensive community cancer program [NCCCP] in the Western U.S., and a NCI-designated comprehensive cancer center [NCCC] in the Southeastern U.S.). 100 patients and their providers will participate; 50 women with gynecological cancers on chemotherapy; 50 women post-active treatment for breast cancer. Patients complete an ePRO assessment and are given an electronically generated, personalized supportive care plan by their providers during office visit(s) over a 3-month period. Study outcomes evaluated at baseline and 6 weeks include feasibility/usability of the platform (patient/provider, post-test only; surveys/platform statistics), patient satisfaction with care (pre/post-test; CG-CAHPS), and adherence to care plan recommendations (post-test survey). Results: To date, 10 patients have enrolled at the NCCCP and 7 completed baseline and 6 week measures; 5 at the NCCC have completed baseline measures. Four providers each at the NCCCP and the NCCC are scheduled for post-test assessments. Updated enrollment and results will be presented at the meeting. Conclusions: The On Q CPS is a novel supportive care planning technology developed to improve care processes and patient outcomes through the delivery of personalized electronic care plans. Feasibility, usability, acceptability, satisfaction and exploratory outcome data will be presented.
Measuring adherence to 2012 Choosing Wisely recommendations: SEER Registry linked with health plan data.
Authors: Kreizenbeck Karma L. , Fedorenko Catherine R. , Hughes Erin E. , Shoemaker Joshua , Lucas Oscar , Chauhan Rakesh T , Ramsey Scott David 
Published: February 2017

178 Background: The ASCO Choosing Wisely campaign aims to reduce the use of interventions that lack evidence of benefit in cancer care. This project characterized adherence to the 2012 ASCO Choosing WiselyRecommendations by linking health plan claims data to a regional cancer registry in order to identify areas for research interventions to improve adherence. Methods: Surveillance, Epidemiology, and End Results (SEER) records for patients diagnosed with cancer in Western Washington state between 2007 and 2013 were linked with enrollment and claims from a large regional commercial insurance plan. Using claims and SEER records, algorithms were developed to characterize each Choosing Wisely measure. Results: For the 5 recommendations measured, adherence rates were as follows: (see Table). Conclusions: Using algorithms involving insurance claims and cancer registry records, we found variable adherence to the 2012 ASCO Choosing Wisely recommendations. While 100% adherence is not expected due to limitations of claims data, such records may be useful to identify areas for intervention and estimating potential savings from improved adherence. [Table: see text]
NCI Community Cancer Centers Program (NCCCP): Percent improvement in guideline-concordant breast and colon cancer care for disparate patient populations.
Authors: Spain Pamela , Teixeira-Poit Stephanie , Halpern Michael T. , Castro Kathleen M. , Prabhu Das Irene , Clauser Steven 
Published: February 2017

182 Background: The NCI Community Cancer Center Program (NCCCP) pilot launched in 2007 to improve quality and reduce disparities in patients receiving care in community hospital-based cancer centers. This study assessed the percent improvement in guideline-concordant cancer care since NCCCP initiation, overall and for disparate patient populations. Methods: We conducted a retrospective analysis of patients diagnosed and receiving treatment at one of 12 NCCCP sites. We compared percent improvement in concordance for NQF-approved quality measures: 3 breast (BCS-radiation following breast conserving surgery; HT-hormonal therapy; and MAC-multi-agent chemotherapy) and 2 colon (12RLN-12 regional lymph nodes examined during surgery; and ACT-adjuvant chemotherapy). Sample included patients diagnosed 2006 to 2007 (baseline, or pre-NCCCP) and 2008 to 2013 (NCCCP). Percent improvement was defined as the difference in concordance between baseline and NCCCP periods divided by baseline concordance. Results: Between baseline and NCCCP periods, improvement was noted for all 5 measures. The HT concordance rate improved by 55.1% (from 58.2% to 90.3%). For all breast measures, Black patients showed significantly larger than average percent improvement (p<.05). For BCS and ACT, Medicaid and uninsured patients showed significantly larger than average percent improvement (p<.05). Larger than average improvement was also noted in hospitals in high-poverty markets and in markets with few physicians. Conclusions: The percent of patients receiving guideline concordant breast or colon cancer care increased significantly since Program initiation, particularly among certain disparate patient subgroups. Future analyses will examine issues of disparities in timeliness of treatment.Funded by NCI Contract HHSN261200800001E. [Table: see text]
Equity of access: Consent interpretation program at Princess Margaret Cancer Centre (PM) in Canada.
Authors: Grant Jasmine , Philip Lindsay , Eagan Grace , Abraham Elizabeth , Degendorfer Pamela , Oza Amit M. 
Published: February 2017

189 Background: Toronto is a multicultural city with over 160 languages spoken by patients. Since 2010, institutional policy requires that professional medical interpreters are used when obtaining informed consent from patients with limited English proficiency (LEP). The availability and cost of these interpreters can be a deterrent for clinical trial participation, particularly when funding is limited. In order to ensure that patients facing language barriers have equitable access to trials, to protect the rights and safety of LEP patients involved in trials, and to improve patient outcomes, adherence to this policy needs to be ensured. Methods: Through a collaboration with the PM Cancer Clinical Research Unit (CCRU) and Interpretation and Translation Services (ITS) supported by the Princess Margaret Cancer Foundation, a 6-month pilot was initiated with full access to interpretation services for all trial patients in November 2012. The CCRU provided training to interpreters on clinical trials and GCP and interpreters reviewed template consent forms provided by ethics boards to cut back on preparation time and costs when delivering a sight translation of study specific consent forms. Trials staff were trained on the process and given badge tags with instructions. Metrics were collected to monitor the use of professional interpreters. Results: Utilization of professional interpreters in trials increased by 16% during the 6-month pilot and 286 requests have been logged to date. Staff were surveyed and indicate this has streamlined the consent process with 83% of respondents saying the new process is easy/very easy. Care providers feel this has allowed them to approach more patients than before this project. Conclusions: This project ensures that accurate information is provided to all patients contemplating participating in or already enrolled in trials, that all patients have the same level of access to treatment, and that there is equity of access for all patients irrespective of their English proficiency. The increased use of professional interpreters in consent discussions indicates better adherence to policy which has allowed the pilot to continue for another year.
The Morbidity and Mortality Conference (MMC) in Oncology: A patient safety and root cause analysis (RCA)-driven approach at the Cleveland Clinic Taussig Cancer Institute (TCI).
Authors: Goodman Lindsey Martin , Moeller Machelle , Guthrie Amy E. , Earl Marc A. , Pennell Nathan A. , Gilligan Timothy D. , Stevenson James 
Published: February 2017

191 Background: MMC has been traditionally viewed as an educational tool. However, negative associations with MMC include emphasis on individual error and assigning blame, with little attention to improving patient safety and quality of care. MMC at the TCI has been designed to provide an opportunity to discuss MMC cases in an open, non-judgmental setting. Methods: Since September 2013, a monthly MMC, open to all caregivers, not just physicians, has been held as part of CME certified oncology grand rounds. Two cases are discussed per session and are obtained from nursing, pharmacy, and physician recommendation through the hospital Safety Event Reporting System or direct communication. Fellows investigate and present cases with patient and provider information de-identified to assure the discussion occurs in a blame-free setting. RCA is performed to determine action items. Process and safety improvements are recommended where applicable. Ongoing follow-up and improvement tracking is reported at future MMCs. The MMC governance committee, composed of the TCI quality officer, quality director, fellow representative, and a multi-disciplinary group of providers, meets quarterly to review cases and follow up action items under the guidance of the TCI MMC charter. The MMC governance committee reports to the TCI Quality Steering Committee. Results: Cases reviewed to date include chemotherapy dosing/administration errors (23%), hospital acquired medical complications (31%), communication breakdown between caregivers (15%), and end of life care (31%). An average of 3.5 action items has resulted from each case with 75% addressed within 90 days. Physician attendance is 59% higher and 23% more physicians report that they are very likely to change their practice behaviors from MMC than other grand rounds presentations. Conclusions: A patient safety driven MMC, delivered in an open setting, can be an effective tool to improve quality of care and caregiver communication in a large academic cancer center. High provider attendance and survey feedback reflects engagement in the process and will be essential to sustaining a meaningful and productive MMC.
Examining health beliefs: Why mastectomies are on the rise.
Authors: Covelli Andrea Marie , Baxter Nancy N. , Fitch Margaret , Wright Frances Catriona 
Published: February 2017

192 Background: Rates of unilateral (UM) and contralateral prophylactic mastectomy (CPM) for early-stage breast cancer (ESBC) have been increasing. To understand this increase we sought the perspectives of patients who chose UM+/-CPM and treating surgeons. Methods: Applying the Health-Belief Model, we completed a qualitative study examining the surgeon’s practice and patient’s decision-making that resulted in the choice for mastectomy. Purposive sampling identified women across Toronto, Canada who were candidates for breast conserving therapy (BCT) but underwent UM+/-CPM. Academic and community breast surgeons from across Ontario, Canada and the United States were also recruited. Data were collected through semi-structured interviews, this continued until data saturation was reached. Constant comparative analysis identified key ideas. Results: 29 patients and 45 surgeons completed interviews. The dominant theme was a ‘misperceived threat’. Despite surgeons describing the high survivability of ESBC, patients greatly overestimated the threat of ESBC and strived to eliminate this threat by choosing mastectomy. Surgeons described BCT and UM as equivalent treatment options for ESBC, and often recommended BCT. In this average-risk population CPM was discouraged by the surgeons describing no survival advantage; despite this, women requested UM+CPM. Personal cancer experiences with family and friends were extremely influential in women’s request for UM+/-CPM. Previous negative experiences translated into an overestimated risk of recurrence, contralateral cancer, metastasisand subsequent death. Despite evidence-based consultations, patients misperceived the risks and severity of ESBC, and believed that by choosing UM+/-CPM they would live longer. Most women did not perceive any risks of undergoing mastectomy, yet many had ongoing issues with disturbed skin sensation, cosmesis and body image. Conclusions: A previous cancer experience was influential in the choice for UM+CPM. Despite surgeons counseling otherwise, women greatly overestimated the risk of ESBC and misperceived the benefits of mastectomy. Improved discussion of patient sources of information and fears around survival would benefit surgical consultations.
Do advance directives predict receipt of palliative care? An evaluation of a single-institution in the Veterans Administration health care system.
Authors: Patel Manali I. , Bhattacharya Jay , Asch Steven M , Kahn James 
Published: February 2017

203 Background: Cancer-related deaths are often preceded by high utilization of non-beneficial care that may contribute to poor quality of life, adverse symptoms, and high costs. Over the past several years, there is increased attention on palliative care to limit these challenges. Yet, rates of palliative care referral at the end of life remain low, and there are few studies that evaluate why. Our objective is to study whether one potentially important factor among patients with advanced cancer, advance directives, influence referral to palliative care among patients with advanced cancer. Methods: We conducted a retrospective chart review of all patients diagnosed with Stage III and IV cancers and treated at the Veterans Administration Palo Alto Healthcare System (VAPAHCS) in Fiscal Year 2012-2013. Chi-squared tests estimated differences in receipt of palliative care by individual- and clinical-factors. Logistic regression models estimated odds of receipt of palliative care after adjustment for individual and clinical factors). Results: There were 276 patients diagnosed with Stage III and IV cancer during the years of study. No records were excluded from analysis. Median age at diagnosis was 68; thoracic cancers were the most common (31%, p = 0.001). A minority of patients (45%) received palliative care or hospice. Rates of referral to palliative care and hospice were highest among patients with stage IV disease (p=0.003). In logistic regression models adjusted for individual and clinical factors only stage of disease predicted increased odds of palliative care and hospice referral. We could not reject the null hypothesis that presence of an advance directive increased palliative care or hospice treatment. Conclusions: Advance directives may be a useful tool to help patients transition to palliative care and hospice, however, we found no influence of advance directives on the receipt of these services in our VA facility. Future studies should evaluate other factors that predict receipt of high quality end-of-life care for patients with cancer.
Patient and physician factors associated with overuse and underuse of cancer screening: A factorial, cluster-randomized trial.
Authors: Talcott James Austin , Cassano Kelly A , Cohen Roy , Herzstein Jessica , Fowler Floyd Jackson , Balakrishnan Aparna , Osborne Michael P. 
Published: February 2017

206 Background: Cancer screening, like other interventions, requires close patient-provider collaboration. By patient recall, key elements are often omitted from informed consent discussions. Most screening guideline compliance efforts focus on reducing underuse, but overuse is also harmful and may be influenced by distinct factors. Therefore, we are performing a prospective randomized trial of educational interventions to improve screening compliance for breast, cervical, colorectal, lung and prostate cancer at an urban academic medical center. Our hypothesis is that gender, age, prior screening experience, provider recommendations, anticipated benefit and distress, communication and informational support will affect compliance. Our primary data collection will be complete before the Symposium. Methods: We will enroll an age- and sex-stratified sample of 216 patients aged 40 to 89 years, 18 each treated by 12 primary care physicians at two affiliated hospitals, undergoing an annual physical examination in a cluster-randomized prospective trial of educational supports for screening. Screening guideline format (color-coding) and academic detailing will be randomly assigned independently. Patients and providers are surveyed immediately after the encounter to record their recollections of screening discussions and recommendations and their plans. Follow-up surveys at 3, 6 and 12 months assess concordance between expressed screening intentions and behaviors. Results: Pilot results indicate patient gender, age, anticipated screening-related distress and benefit, and prior screening experience affect screening recommendations and intentions. These factors vary by cancer. Patients recall less discussion than providers. Reasons not to screen are infrequently discussed. Conclusions: Cancer screening decisions are complex and vary by screening modality, patient and provider factors and communication. Improving underuse and overuse compliance may require distinct strategies. Screening overuse may be a “lower-stakes” environment to develop strategies to reduce overuse of cancer interventions of marginal or negative benefit, including treatment.
An interdisciplinary model of collaboration between medical staff (MS), hospital quality improvement (QI), and continuing medical education (CME) departments to promote education and practice changes in the prevention of venous thromboembolism (VTE) in cancer patients (pts).
Authors: Leong Lucille A. , Mendelsohn Mary , Saavedra Crystal J. , Morgan Robert 
Published: February 2017

215 Background: Venous thromboembolism (VTE) is a leading cause of morbidity/mortality in cancer pts. VTE is increasing and is the second cause of death in cancer pts, behind only cancer itself. In 2010 of the 186 unique hospitalized cancer pts at our institution with VTE, 25% were medical and 75% surgical. Gaps in clinician knowledge/practice of VTE prevention were evident. Methods: A interdisciplinary approach across clinical and administrative specialties was undertaken, with collaboration between: medical/surgical oncologists, MS leaders, pharmacists, nursing, and hospital departments of QI, information technology, and CME, to educate a target group of 120 cancer clinicians in VTE prophylaxis. In 2/2013 - 2/2014 multiplatform educational initiatives were utilized to reach physicians, advance practice/ward nurses and pharmacists: didactic lectures, Key Opinion Leader visiting professorships, online vignettes, VTE FAQ emails from MS QI leaders, small group sessions, e-learning modules. System changes such as standardized VTE prophylaxis order sets tailored for each service and strategically placed visual cues were also used. Results: Almost 3 times as many unique learners participated in these activities as were targeted. Learner satisfaction, knowledge acquisition and competency were high. Compliance with use of standardized order sets improved from 65 to 95% among the MS. Claims by clinicians of pt contraindications to prophylaxis were audited and found valid. Despite these improvements, incidence of VTE has not dropped, reflecting a national trend. Conclusions: With intensive and interdisciplinary effort, progressin clinician knowledge and performance in VTE prophylaxis can be made. This effort required considerable input from physician champions (eg., surgical oncologists with overlapping roles of clinician, QI advocate, and departmental leader, and medical oncologists with roles of clinician, CME and MS leader). This is a promising model for other QI initiatives. Supported by Unihealth educational grant.