bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time-driven activity-based costing and the impact on cost measurement in the face of health reform.
Authors: Albright Heidi Wied , Incalcaterra James , Feeley Thomas W. 
Published: February 2017

262 Background: In 2010, the Institute for Cancer Care Innovation (ICCI) began measuring the true cost of cancer care delivery by following the patient treatment cycle from initial referral to survivorship or supportive care. The project was prompted by both internal and external concerns about the rising costs of health care, the ability to demonstrate value for services provided, and potential changes in reimbursement. Hospital cost accounting systems are historically charge-based and are inherently skewed to shift costs towards procedures or encounters that are higher volume and well-reimbursed. However, these systems do not accurately reflect the actual acquisition costs of the resources providing care. Methods: In order to more accurately and transparently capture costs, the ICCI piloted the use of the time-driven activity-based costing (TDABC) methodology. This methodology allowed the team to map the entire patient experience of care while also capturing costs and capacity associated with each activity in the care delivery cycle. Results: To date, the team has created over 150 maps made up of over 6,500 unique activities with associated cost and capacity rates, which make up various costing equations. Actual clinical volumes are then run through the model to produce cost and capacity results. Initial results provided an unexpected view of the costs of various processes occurring within the care delivery cycle with the ability to rank the processes from most to least costly. This provided a unique opportunity to target specific areas for improvement. Additionally, transparency of the costing equations allows for precise modeling of episode-based bundles of care for different diseases and treatments. Conclusions: TDABC provides a more accurate and transparent approach to developing cost and capacity rates for cancer care delivery to aid in identifying the greatest opportunities for improvement, as well as providing a mechanism for creating episode-based bundles of care that are reflective of actual treatment being provided.
Trends in hospital and office-based chemotherapy administration 2005-2012 for Medicare and commercially insured patients.
Authors: Foley Kathleen A. , Bechhold Rebecca 
Published: February 2017

274 Background: The 2013 Community Oncology Practice Impact Report notes an increase of 20% in the number of community clinics closing since 2011. The objective of this study was to examine trends in location and reimbursement of chemotherapy in office-based (OBS) and outpatient hospital settings (OHS). Methods: Using the MarketScan Research Databases, first administrations of bevacizumab and trastuzumab were identified from 1/1/2005 through 12/31/2012 for patients with commercial or employer-sponsored supplemental Medicare insurance. Bevacizumab claims were excluded if the claim had a diagnosis related to macular degeneration or other eye disease. Claims for both drugs were excluded if the reimbursed amount was less than $100. Chemotherapy administration reimbursements were identified through CPT codes on the same day as the day as the drug charge. All claims were identified as occurring in OB or OHS. Results: The percent of bevacizumab claims occurring in OHS increased from 6 to 34% among Medicare claims, and from 15 to 42% among commercial claims from 2005 to 2012. For trastuzumab, the increases were 4 to 35%, and 10 to 35% in Medicare and commercial claims, respectively. OHS reimbursements were consistently higher than OBS reimbursements for chemotherapy administration and drug for both drugs across both payers. Conclusions: Although the differential in reimbursements between OHS and OBS declined in the most recent two years, OHS reimbursements remained substantially higher while the shift in chemotherapy administration from OBS to OHS has continued through 2012. Continued attention to reimbursement differences between OHS and OBS is warranted and additional research is needed to more fully document the impact on patients, providers, and payers. [Table: see text]
The influence of employer-based health insurance and job support on receipt of adjuvant chemotherapy in stage III colorectal cancer.
Authors: Veenstra Christine Marie , Regenbogen Scott E. , Hawley Sarah T. , Banerjee Mousumi , Kato Ikuko , Ward Kevin C. , Morris Arden M. 
Published: February 2017

278 Background: Approximately 15% of the U.S. population lacks health insurance. Adjuvant chemotherapy confers significant survival benefit in stage III colorectal cancer (CRC), yet many patients fail to receive recommended care. We hypothesized that access to employer-based health insurance (EBHI) and other job-related support programs influences receipt of chemotherapy. Methods: We performed a population-based survey of patients diagnosed with stage III CRC in the state of Georgia and Metropolitan Detroit SEER catchment areas. The primary outcome was receipt of adjuvant chemotherapy. Patients were queried regarding clinical, sociodemographic, and employment characteristics (EBHI and job support - e.g., sick leave, disability, flexible schedule, unpaid time off). We used χ2 analyses to examine associations between health insurance coverage, job support availability and receipt of chemotherapy, adjusting for other characteristics. Results: To date, 630 patients have responded (preliminary response rate=56%). 257 (41%) were working for pay at diagnosis, of whom 46% had EBHI and 9% had no insurance at all. Rates of chemotherapy receipt were higher among those with EBHI than those without (97% vs. 90%, P=0.001). 26% with EBHI reported that they kept their job mainly to keep insurance. 79% of those working for pay reported some form of available job support. Rates of chemotherapy receipt were higher among employed respondents with job support compared to those without (97% vs. 85%, P<0.001). Availability of job support was significantly associated with ability to retain employment; 48% of those without support stopped working altogether because of CRC vs. only 11% of those with support (P<0.001). Conclusions: Patients with EBHI and job support were significantly more likely to receive recommended adjuvant chemotherapy after surgery for stage III CRC. Further, lack of job-related support for medical illness was significantly associated with loss of employment for patients undergoing treatment for CRC. These findings suggest that employer-based health insurance and job support are important contributors to receipt of recommended cancer care.
Midlevel provider utilization within a large community oncology network.
Authors: Mikan Sabrina Q. , Cody Melinda Madison , Lindsey Lori , Carter Patricia , Hoverman J. Russell , Patt Debra A. 
Published: February 2017

282 Background: The Association of American Medical Colleges (AAMC) reports that 56% of Oncologists work with midlevel providers (MLPs). MLPs include physician assistants (PAs) and advanced practice nurses (APNs). Within our large network of community oncology practices,there are 241 MLPs (88 PAs and 153 APNs). The MLP role encompasses the continuum of care beginning with genetic risk assessment throughout treatment, health promotion teaching, survivorship management and advance care planning (ACP) services. Methods: We used an online survey to elicit self-reported proficiency in eight core health care delivery roles. A 52 item, 5-point Likert scale (novice, advanced beginner, competent, proficient, expert) survey was sent in March 2013 to all MLPs. Results: Of all MLPs (n=241) invited to participate, 103 (43.5%) responded anonymously. Over half of all MLPs reported feeling proficient in the areas of collaborating with multi-disciplinary teams to formulate a plan of care (50.4%), facilitating patient and family decision-making in treatments, symptom management and end-of-life care (53.3%), and providing information to patients and families to facilitate adherence to cancer treatments and supportive care (54.2%). Secondly, the MLPs were confident in their ability to provide proficient care in health assessment through physical exam (46.6%), disease progression signs and symptoms (44.7%), and incorporating resources that meet diverse needs of the patients into the planning and delivery of care (52.3%) areas. Finally, the areas where MLPs reported feeling less than proficient were in specialty areas such as survivorship (34.2%) and genetics (34.2%). Also noted, for 45.7% of respondents, ACP was performed only 1-20% of their time. Conclusions: Self-assessment is one form of measurement that allows the individual provider to identify their strengths and weaknesses. It is important so that educational resources can be created, tested, and shared amongst providers to continue to improve their confidence and care delivery. Ongoing work in developing strong tools for survivorship visits, advance care planning, and genetic counseling within our network, is recognized as an imperative part of advancing PA and APN skills and quality patient care.
Use of a video decision tool to improve informed decision making in hospitalized patients considering palliative radiation therapy.
Authors: Dharmarajan Kavita Vyas , McCormick Beryl , Walters Chasity , Monether Christopher , Levin Tomer , Milazzo CarolAnn , Rawlins-Duell Robin , Giannantoni-Ibelli Gina 
Published: February 2017

29 Background: Substantial evidence exists to suggest improved patient outcomes when oncologic patients are involved in making treatment decisions. Tools have been shown to facilitate the decision-making process for patients, yet aids to support decision making in radiation therapy (RT) are scarce. Given RT is one of the more difficult modalities for patients to conceptualize, there is a pressing need to develop and test decision aids, particularly in patients with incurable cancers. Methods: In this study, a video decision tool was developed and tested with 42 inpatients referred for palliative RT. Participants completed questionairres measuring their knowledge regarding palliative RT, treatment preferences and readiness, and decisional uncertainty before and after viewing the video. An additional 5-item tool was administered to participants after watching the video to assess their impression of the tool. Results: The mean percent of patients answering knowledge-assessing questions correctly increased 46.5% after viewing the video. Thirty-three percent (n=13) of patients rated their willingness to start palliative RT as 2 or greater (1= very ready; 10= not ready at all). Of these, 84.6% (n=11) showed improved scores in regard to their willingness to consent to palliative RT. Mean patient willingness scores improved 44% after watching the video. Decisional uncertainty scores changed minimally. Conclusions: Overall, participants' knowledge of palliative RT increased after viewing the video decision aid. With improved knowledge, there was a trend in increased willingness to begin RT. The next phase of this study will be a randomized trial to assess for differences in decisional uncertainty, knowledge of palliative RT, and treatment preferences for palliation. Clinical trial information: NCT01667965.
Operational efficiencies in the infusion center: Improving nursing efficiencies and patient wait times while decreasing costs.
Authors: Garth Alyssa , Schreiner Susan , Jourdan Dawn 
Published: February 2017

56 Background: Decreased nursing efficiency and patient assignments has increased patient wait times and has significant implications on overall patient flow in the infusion center and labor dollars. Historically, staff nurses signed up for their patients, and took an average of 2 patients at one time. This created disparity in patient/staffing ratios, high number of labor dollars per worked infusion and an overall atmosphere of inequity among the nurses. Methods: Patient flow and labor cost were examined. Analysis of the nursing staffing matrix led to the creation of a patient placement nurse, taken from the daily staff allocation, assigning patients based on current patient assignment and acuity of patients. Nurses were identified to learn the patient placement nurse role based on critical thinking and organizational skills. With the assistance of a patient locator system, the patient placement nurse is able to identify when a patient’s wait begins and which nurse is the best choice to be assigned. A system was implemented in which a staff nurse was assigned a patient every 30-40 minutes with a maximum patient assignment of 4 concurrently. A standard 1:3 nurse to patient ratio was established unless a patient’s acuity prohibited this ratio. Results: Nursing ratios stabilized at 1:3. Staff became more efficient and work was reorganized for less subjectivity in patient assignments, producing more equitable workloads. This resulted in an increase in patients seen within 15 minutes improving from 69.8% to 85.3%. In addition, it allowed for the elimination of one nurse per day shift, resulting in a cost savings of approximately a 1.0 FTE/week or average annual salary of $62,129. Conclusions: Development of a standardized patient placement process can increase infusion center efficiencies and stabilize nursing workload, as well as decrease patient wait time and reduce the cost per infusion. This supports a delivery of patient-centered care while utilizing staff efficiently and appropriately and decreasing cost.
Examination of differences in quality of life and use of support services in urban versus rural breast cancer patients.
Authors: Roberts Sarah , Ahmed Shahid 
Published: February 2017

98 Background: Many patients travel great distances, both for testing and for medical care. Previous studies have indicated that there can be significantly poorer quality of life in urban cancer patients. The purpose of this study was to determine any differences in support service use and quality of life in rural versus urban patients in Saskatchewan. Methods: This study is a survey based qualitative and quantitative analysis of women with breast cancer receiving treatment at the Saskatoon Cancer Center (SCC) in Saskatchewan, Canada. Surveys included demographic information, support service utilization and suggestions, as well as the WHO-QOL-bref quality of life assessment. Surveys were collected from 51 women with an age range of 43 to 87 years with a median age of 63. Participants travelled a mean distance of 99.2km to treatment center (range 1.9 – 307.6 km, SD 101 km) with 49% women travelling greater than 100 km (rural group) and 51% travelling less than 100 km (urban group). Results: Only 50% of urban participants and 56% of rural participants reported using support services at the SCC though this was found to be statistically non-significant by Fisher Exact Testing (p= 0.781). The support services reported to be most useful were nursing phone assessments, medication information, pharmacist support and mailing of medications. Further support services that participants would like to have available include: online support groups and blogs, local support groups, physician visits to rural communities and patient liaisons to help navigate the system. Overall, urban participants rated their quality of life on average at 3.96 with rural participants reporting 3.84 on a five-point scale, though non-significant by t-test (p=0.617). The WHO-QOL-bref study examines quality of life in 4 domains: physical health, psychological wellbeing, social and environment. Urban participants scored 68%, 72%, 76% and 77% in the 4 domains respectively while rural participants scored 61%, 73%, 79% and 78% in the 4 domains respectively. Conclusions: Our study did not find any significant difference between urban and rural patients in reported quality of life or support service use.
Incidence of brain metastases following trimodality therapy (TMT) in patients with esophageal and gastroesophageal (E-EGCJ) cancer.
Authors: Wadhwa Roopma , Taketa Takashi , Correa Arlene M. , Sudo Kazuki , Blum Mariela A. , Campagna Maria-Claudia , Komaki Ritsuko , Lee Jeffrey H. , Bhutani Manoop S. , Weston Brian , Liao Zhongxing X. , Rice David C. , Swisher Stephen , Hofstetter Wayne Lewis , Ajani Jaffer A. 
Published: February 2017

108 Background: Brain metastases in E-EGJ cancer patients following TMT are considered rare. We reviewed the cumulative incidence of brain metastases in a large cohort of patients who underwent TMT and had a long follow-up. Methods: Data were analyzedretrospectively for 579 E-EGJ cancer patients who underwent TMT between years 2000 and 2010. None had screening or surveillance brain imaging. Results: Median follow-up time was 57.4 months (95% confidence interval [CI]: 51.5-63.3 months). Common patient characteristics were as follows: median age: 59.5 years (range, 39-74 years), Caucasian ethnicity (90%), male gender (85%), pre-treatment clinical stage III (65%), and adenocarcinoma histology (90%). 197 (34%) of 579 patients developed distant metastases and of these 20 (3% of 579 and 10% of 197) patients developed brain metastases. 18 (90%) patients had brain metastases within the first 24 months (12 in the first 12 months and 6 in the following 12 months) of surgery. 18 (90%) of patients were symptomatic at diagnosis. 15 (75%) of 20 patients had a single metastasis, however, only 4 (25%) patients survived >20 months (overall survival times were [in months]: 20, 30, 92 and 137). The median overall survival time of all 20 patients was 10.8 months (95% CI: 4.7-16.9). Conclusions: 3% of patients with E-EGJ cancer developed brain metastases after TMT and 90% of these occurred within the first 24 months of surgery. A few patients survived ≥20 months. These data rule out the use of screening and surveillance brain imaging for TMT-eligible patients. Supported by UT M. D. Anderson Cancer Center Clinical Research and Generous Donors.
16-covariate propensity score matching between trimodality (TMT)-eligible esophagogastric cancer (EC) patients who had surgery and those who declined surgery after preoperative chemoradiation.
Authors: Taketa Takashi , Xiao Lianchun , Suzuki Akihiro , Blum Mariela A. , Sudo Kazuki , Lee Jeffrey H. , Weston Brian , Bhutani Manoop S. , Lin Steven H. , Wadhwa Roopma , Swisher Stephen , Hofstetter Wayne Lewis , Ajani Jaffer A. 
Published: February 2017

111 Background: Localized EC patients should receive chemoradiation followed by surgery (TMT). Nevertheless, some patients decline surgery after preoperative chemoradiation. Reports on the outcome of such patients are scant. Methods: Between 2002 and 2011, we identified 622 TMT-eligible EC patients in our databases. Of 622 patients, 425 achieved clinical complete response (negative biopsy and PET in the physiologic range) after preoperative chemoradiation. Of 425, 244 patients underwent surgery but 61 patients declined surgery. We were able to matched 16 covariates between 36 patients who declined surgery and 36 patients who had TMT. Results: Baseline characteristics between the two groups were well-balanced (p=NS). Within this matched cohort, the median overall survival (OS) and relapse-free survival were 57.9 months (95% CI, 27.7-NA), and 18.5 (95% CI, 11.5-30.4) for the declined surgery group and those were 50.8 months (95% CI, 30.7-NA), and 26.5 months (95% CI, 15.5-NA) for the TMT group. OS and RFS for both groups were not different (p=0.28, and 0.45, respectively). However, 11 of 36 patients in the declined surgery group had salvage surgery (median OS was 66.1 months). Conclusions: These provocative results are in a small series but need to be interpreted with caution. Nevertheless, the results reinforce a possibility of esophageal preservation strategy that could encompass biomarkers and sophisticated imaging. Currently, however, trimodality remains the gold standard. Supported by UTMDACC and generous donors.
Effectiveness of percutaneous radiofrequency ablation for metachronous liver metastases of gastric cancer.
Authors: Hwang Jun-Eul , Kim Dae-Eun , Shim Hyun-Jeong , Bae Woo Kyun , Cho Sang-Hee , Chung Ik-Joo 
Published: February 2017

136 Background: This study evaluated the efficacy of percutaneous radiofrequency ablation (RFA) for the treatment of metachronous liver metastases of gastric cancer. Methods: We enrolled a total of 44 patients who underwent RFA for the treatment of metachronous liver metastases after resection of a primary gastric adenocarcinoma from January 2002 to November 2011. The primary endpoint of this study was overall survival (OS) and recurrence-free survival (RFS) after RFA. Results: Systemic chemotherapy was combined with RFA in 40 patients.The OS and RFS after RFA for all patients were 14.7 (95% CI, 10.1-19.2) and 6.1 months (95%, CI 4.2-8.1). the OS and RFS of the patients with liver-only metastasis who underwent RFA and chemotherapy were 20.9 months (95% CI 18.4-23.4) and 9.8 months (95% CI 9.2-10.5), respectively. On multivariate analysis, the factors independently, negatively associated with RFS were bilobar intrahepatic distribution (HR 3.9, 95% CI 1.5-9.9, p=0.001), and extrahepatic metastatic lesions (HR 3.6, 95% CI 1.6-7.8, p=0.003). The factors independently, negatively associated with OS were extrahepatic metastatic lesions (HR 12.6, 95% CI 3.7-42.9, p=0.001), no chemotherapy (HR 43.3, 95% CI 7.4-251.3, p=0.001), and tumor number (≥ 2) (HR 2.6, 95% CI 1.2-5.9, p=0.015). Conclusions: The efficacy of RFA for metachronous liver metastases of gastric cancer is limited to patients with a single, unilobar metastasis without extrahepatic metastatic lesions. Combined systemic chemotherapy is very important for the prolongation of overall survival.
Clinical characteristics of recurrent esophageal cancer after definitive chemoradiotherapy for stage II//III (non T4) esophageal squamous cell cancer.
Authors: Nishikawa Akiko , Kato Ken , Honma Yoshitaka , Iwasa Satoru , Takashima Atsuo , Hamaguchi Tetsuya , Yamada Yasuhide , Shimada Yasuhiro 
Published: February 2017

137 Background: Recurrence after definitive chemoradiotherapy (dCRT) for locally advanced esophageal cancer is associated with poor outcome. No standard treatment strategy exist for recurrence after complete response (CR) to dCRT. We examined patterns of recurrence and clinical outcomes in patients with disease recurrence after dCRT. Methods: We retrospectively investigated 197 patients who had achieved initial CR after dCRT for locally advanced esophageal cancer between January 2000 and December 2008. We analyzed data from the 69 patients who had developed disease recurrence after CR, excluding 11 who died of other causes. Time to event was calculated by the Kaplan-Meier method, and the Cox proportional hazard model was used in univariate and multivariate analyses. Results: Characteristics of the 69 patients were as follows: male: female = 61:8; median age = 65 years (range 47 to 82); clinical stage at diagnosis (UICC 6th edition) IIA/IIB/III = 15/22/32; and performance status at recurrence (0/1/2) = (35/32/2). Primary CRT consisted of 5-FU+cisplatin (n = 66), 5-FU+nedaplatin (n = 2), or S-1+cisplatin (n = 1). The pattern of recurrence was locoregional failure (n = 35), or any distant failure (n = 34). Median time to recurrence from the start of dCRT was 13.6 months, and median survival time after recurrence was 17.4 months. Median survival time according to pattern of failure was 27.5 months (locoregional failure), and 17.4 months (any distant failure). In the univariate analysis, locoregional failure (HR 0.51), time to recurrence >13 months (HR0.38), clinical stage II (HR0.48), and any treatment for recurrence (HR: 0.15) were associated with better prognosis after recurrence. In the multivariate analysis, only time to recurrence (>13 months) was associated with better prognosis with HR 0.31(95%CI:0.14-0.66) Conclusions: Our study suggested that patients with early recurrence have a poor prognosis. More intensive treatment is needed to improve survival.