bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of a Pan-Canadian indicator to measure treatment rates relative to evidence-based guidelines for rectal cancer.
Authors: Forte Tonia , Klein-Geltink Julie , Rahal Rami , Lockwood Gina , Bryant Heather E. ,   in collaboration with the System Performance Steering Committee and Technical Working Group
Published: February 2017

177 Background: As part of the Canadian Partnership Against Cancer’s (CPAC) System Performance initiative, indicators measuring treatment practice patterns across the country are now available, offering the ability to compare against evidence-based guidelines. We report on the percentage of patients with stage II and III rectal cancer receiving pre-operative radiation treatment (RT) based on an analysis of Canadian administrative data. A retrospective chart review was conducted to examine reasons for non-treatment with RT, set performance targets, and inform quality improvements. Methods: Data on the percentage of stage II and III rectal cancer cases receiving preoperative RT were obtained from five provincial cancer registries using a standardized methodology for 2,854 cases diagnosed between 2007 and 2008, with 2009 data soon to be available. A retrospective chart review was conducted in five provinces on a random sample of 383 patients diagnosed in 2008 to examine reasons for non-referral and non-treatment. Results: Based on administrative data, an average of 45% of cases received RT preceding surgical resection for stage II or III rectal cancer, ranging from 36% to 48% across provinces. Preoperative RT rates were similar for men and women, but were lower in older patients. From 2007 to 2008, the percentage of patients receiving pre-operative RT increased in all provinces. Results from the chart review showed that, of those who did not receive preoperative RT, 33% were not referred by a surgeon to an oncologist. The most common documented reasons for non-referral were co-morbidities (26%) and patient choice (7%). Among patients referred to an oncologist, 42% were treated with preoperative RT, 30% were treated with post-operative RT and 28% received no treatment. Among those receiving no treatment, 29% were seen only by a medical oncologist, and 18% were not treated due to patient choice. Conclusions: Findings are being used to develop national targets for treatment rates and, working with national oncologist associations, to develop quality improvement strategies, including patient education efforts to promote informed decisions on treatment options.
Chemotherapy safe handling and safe labeling guideline concordance evaluation: A Canadian experience.
Authors: Vu Kathy , Hertz Sherrie , Green Esther , Kaizer Leonard , Trudeau Maureen E. , Simanovski Vicky , Lischka Andrea 
Published: February 2017

179 Background: The safe delivery of chemotherapy is of utmost importance to patients, health care providers and systems administrators. Cancer Care Ontario and the Program for Evidence-Based Care published two guidelines addressing issues of chemotherapy safety: Safe Handling of Parenteral Cytotoxics (Safe Handling) in 2007 and Key Components of Chemotherapy Labeling (Safe Labeling) in 2009. Concordance with the two documents was evaluated across systemic treatment hospitals in Ontario in order to direct quality improvement initiatives. Methods: Since 2009, concordance with Safe Handling has been assessed annually by self-reported questionnaire as part of the regular provincial performance review process. In 2011, concordance with Safe Labeling was assessed by submission and scoring of five standardized chemotherapy labels demonstrating core and additional criteria. Core criteria included patient and drug information, administration information, as well as adherence to other guidelines related to abbreviations and units of measurement. Individualized regional scorecards were compiled highlighting areas of discordance and then used to develop improvement plans. Results: As of October 2011, 98% of Ontario hospitals providing chemotherapy had updated policies and procedures in place for the safe handling of cytotoxics, significantly improved compared to a baseline of 77% in 2009. Baseline evaluation of Safe Labeling performed in 2011 showed a provincial average of 64% concordance for core criteria and 63% for additional criteria. Regionally, concordance scores ranged from 55% to 80% for core criteria and 38% to 75% for additional criteria. Conclusions: Concordance with safety practice guidelines has the potential to improve significantly with continued measurement and performance management. A baseline assessment serves to identify areas for quality and process improvements. Continued evaluation of guideline concordance is necessary in order to achieve the desired target rate for the province.
Implementing patient-centered care: Challenges in community oncology.
Authors: Clifford Kathleen , Tallen Colleen , Davis Mary Helen , Griess Tamara , Zuckerman Dan Sayam , Padgett Lynne 
Published: February 2017

192 Background: The newest Commission on Cancer (CoC) standards focus on patient-centered care across the cancer continuum and include palliative care (PC) and psychosocial care (PS). Little is published regarding the challenges of implementing these standards in community oncology settings. To help examine the integration of PC and PS and to identify barriers and best practices, an assessment was conducted by sites selected to take part in the National Cancer Institutes’ Community Cancer Centers Project (NCCCP). Methods: The NCCCP’s goals to improve quality of care and reduce healthcare disparities included goals for expansion of PC and PS services. Volunteers formed workgroups using monthly teleconferences to share best practices and resources. A questionnaire based on the National Quality Forum (NQF) preferred practices was completed (January-April 2012) by 22 of 29 sites. Results: All respondents have inpatient PC available, 65% in the outpatient setting; 39% described PC as an integral part of their cancer program. All have designated outpatient staff providing symptom management and rehabilitation services. Nurse practitioners and physician assistants are used at 78% of the centers. Interdisciplinary staff includes pharmacists and dietitians; integrative/complementary medicine is found in 57% of the centers. All have integrated PS services: social workers are available in 91% of sites, 30% have psychiatrists, and 30% have psychologists. Most perform psychosocial screening using the NCCN Distress Management tool; 74% have standardized processes. Spiritual support is present in 70% of programs, sexual counseling services in 26%. The majority provides bereavement support. 48% have an outpatient advanced directive program. Inpatient hospice beds are available in 52% of the institutions and 22% own a hospice. Conclusions: Challenges remain with implementation of psychosocial screening and care. Programs to address sexual counseling and advanced directives are lacking. Additional efforts are needed to integrate PC services across the cancer continuum. Project funded with federal funds from the NCI, Contract No. HHSN261200800001E.
Treatment patterns of castration-resistant prostate cancer: A retrospective claims database analysis.
Authors: Burton Tanya , Teitelbaum April H. , Bui Cat N. , Spalding James Robert 
Published: February 2017

198 Background: Prostate cancer is the most commonly diagnosed malignancy among men in the US; mortality rates are highest among those with castration-resistant prostate cancer (CRPC). Observational data on CRPC are limited. This study examined CRPC treatment patterns relative to NCCN guidelines in a large US health plan. Methods: This was a retrospective claims database analysis of commercial and Medicare Advantage enrollees with evidence of prostate cancer (ICD-9: 185.xx) between 07/01/06 – 03/31/11. CRPC patients were then identified based on prostate-specific antigen (PSA) progression (≥2 PSA increases based on ≥3 PSA values) and/or use of chemotherapy: docetaxel (DOC), mitoxantrone (MIT), estramustine (EST), or cabazitaxel (CAB). The CRPC index date was the first date of PSA progression or chemotherapy. Patients were continuously enrolled for 6 months before (baseline) and ≥6 months after the index date until 09/30/2011 or until death, if sooner (follow-up). Results: A total of 1651 patients met the CRPC selection criteria. Mean (SD) age was 70 ± 9 years, 1085 (66%) received DOC on the index date, and 467 (28%) died during follow-up. A third of patients with DOC received additional CRPC therapy during follow-up: 160 (15%) received MIT, EST, or CAB, and 239 (22%) received a secondary hormonal therapy (SHT: antiandrogens, aminoglutethimide, GnRH/LHRH antagonists, estrogen, or abiraterone acetate). Among 566 patients without DOC, 99 (17%) received a different chemotherapy (MIT = 45; EST = 52; CAB = 2), and 178 (31%) received a SHT. More than half 311 (55%) without DOC did not receive any other CRPC therapy during follow-up, of which 40 (13%) received bone-directed therapy (BDT: denosumab = 0; bisphosphonates = 27; radiation = 13). Conclusions: Consistent with NCCN guidelines, DOC was the most commonly used therapy. However, two-thirds of patients with DOC and over half of patients without DOC did not receive additional CRPC therapy after the index date. In addition, only 13% of patients with no CRPC therapy received any follow-up BDT. Additional research is warranted to understand whether clinical rationale, patient preference, or access to care may have resulted in patients not receiving additional therapy.
Chronic hepatitis B virus screening prior to rituximab: A quality improvement project.
Authors: Mahajan Raina , Jang Sekwon 
Published: February 2017

199 Background: Patients’ with chronic hepatitis B (HBV) are at risk for HBV reactivation and liver failure with initiation of rituximab therapy. HBV testing prior to rituximab for patients with non-Hodgkin lymphoma was a quality measure for the American Society of Clinical Oncology’s Quality Oncology Practice Initiative in Spring 2011. Methods: We assessed the pre-intervention HBV screening rate retrospectively from July 2009 to July 2011. Patient demographics, pathology, regimen, and prescriber were abstracted from the electronic medical record. Screening was complete if serum HBVsurface antigen was checked within 3 months prior to rituximab. A quality improvement (QI) intervention was initiated and all prescribers were informed of the screening rate in December 2011. Post-intervention, patients who received rituximab from January 2012 to July 2012 were identified and the same data was abstracted. HBV screening rates across categories pre and post-intervention were analyzed with Fisher’s exact test and multivariate logistic regression analysis. Results: A total of 146 patients (127 pre-intervention, 19 post-intervention) were included. There were more male and rituximab combination therapy in the post-intervention group. The HBV screening rate increased from 59% to 90% (p<0.01) after our QI project. In univariate analysis, factors associated with HBV screening were (1) prior treatment with rituximab (no: 72% vs. yes: 46%, p<0.01), (2) treatment regimen (rituximab alone: 68% vs. combination: 42%, <0.01) and (3) prescriber (full time: 69% vs. part time: 7%, <0.01) In multivariate logistic regression analysis, the odds of HBV screening increased 4.8 times in the post-intervention group compared to pre-intervention group although this was statistically not significant (p=0.07). Prior rituximab (Odds Ratio (OR) 0.4, 95%CI 0.2-0.9), combination regimen (OR 3.2, 95% CI 1.5-7.2), and full-time prescriber (OR 25.1, 95% CI 2.8-255.4) were statistically significant for HBV screening. Conclusions: The HBV screening rate improved after QI intervention although statistically insignificant in multivariate analysis. We identified characteristics associated with low screening rates which will guide future QI strategy.
Predictors of failure to perform pelvic peritoneal cytology in endometrial cancer staging surgery.
Authors: Lopez-Acevedo Micael , Zhang Chelsea , Secord Angeles Alvarez , Lee Paula S. , Havrilesky Laura Jean , Berchuck Andrew 
Published: February 2017

201 Background: The Federation of Gynecology and Obstetrics (FIGO) staging system and the National Comprehensive Cancer Network (NCCN) guidelines for endometrial cancer recommend performing pelvic peritoneal cytology to look for the presence of cancer cells in the peritoneal cavity in patients who are undergoing surgical staging of apparent non-metastatic disease. About 10% of cases have positive cytology and this information is used in formulating plans for adjuvant therapy. However, adherence to the guidelines recommending that cytology be performed is not universal. In this study, we sought to identify factors associated with failure to perform pelvic peritoneal cytology at the time of endometrial cancer staging surgery. Methods: We performed a retrospective study of women with FIGO stage I/II endometrial adenocarcinoma who underwent endometrial cancer staging surgery at our institution from 1993-2007. Predictors of failure to perform cytology that were investigated included: surgeon, presence of adhesions, intraoperative blood loss and conversion from laparoscopy to laparotomy. Results: Among 1,112 cases, peritoneal cytology was not performed in 76 (6.8%). In 30 cases cytology was not performed for valid reasons including 15 in which the surgery was performed vaginally, 10 in which the diagnosis of endometrial cancer was not known prior to surgery and 5 in which gross evidence of stage III/IV disease was found at surgery. Of the remaining 46 cases, 11 (23.9%) had surgery that was converted from laparoscopy to laparotomy, 16 (34.8%) had dense pelvic adhesions and 40 (87.0%) had an estimated blood loss greater than 100 ml. The frequency of these and other risk factors will be compared to that seen in a matched cohort of patients who did have pelvic peritoneal cytology performed. Conclusions: Our analysis will investigate predictors of failure to perform pelvic peritoneal cytology. Increased awareness of these factors has the potential to improve compliance with this accepted procedure that plays a role in planning adjuvant therapy for early stage endometrial cancer.
Driving performance improvement using ASCO’s Quality Oncology Practice Initiative (QOPI).
Authors: Darland Shelby , Burnham Christa , Camilo Nicolas , Beck Thomas M. , Zuckerman Dan Sayam 
Published: February 2017

203 Background: Defining and quantifying quality care is a challenge for cancer care providers. Since 2007 St. Luke’s Mountain States Tumor Institute (MSTI) has been participating in QOPI and was one of 23 practices that received the inaugural QOPI Certification in June 2010. The goal of participation is to benchmark MSTI’s performance with oncology practices across the nation and identify areas for improvement that are recognized as national quality standards. Methods: After each round of QOPI data abstraction, physician and administrative leadership selected measures with the greatest opportunity for improvement. Monthly chart audits for each measure were completed and the results were shared with individual staff to increase education and accountability. In Spring 2010, the education assessment in MSTI’s Electronic Medical Record (EMR) was redesigned to facilitate efficient documentation and data collection of smoking cessation counseling. In July 2011, the performance improvement (PI) team created “Quality Checklists (QCL)” in MSTI’s EMR for three different QOPI measures: i) signed chemotherapy consent, ii) smoking cessation counseling, and iii) assessment of emotional well-being. To ensure signed chemotherapy consent, one QCL included a reminder sent by the primary nurse or secretary to the chemotherapy infusion nurses. To ensure smoking cessation counseling and assessment of emotional well-being by social work, the other QCL included an alert sent by the new patient representative to the primary nurse and social worker. Results: Signed chemotherapy consent improved from 10% (n=229) in 2007 to 100% (n=117) in 2012. Smoking cessation counseling improved from 13% (n=40) in 2007 to 93% (n=272) in 2012. Assessment of emotional well-being improved from 78% (n=302) in 2007 to 95% (n=120) in 2012. Of the patients that had problems with emotional well-being, 73% (n=55) in 2007 had their problems addressed and 95% (n=41) in 2012. Conclusions: QOPI has provided MSTI with the initiatives and benchmarks to quantify quality cancer care. By combining participation in QOPI and ongoing PI data collection, analysis, and action plan implementation MSTI has enjoyed marked improvements in quality.
The effect of care at NCI comprehensive cancer centers on disparities in outcome in adolescents and young adults (AYAs) with cancer.
Authors: Wolfson Julie Anna , Sun Can-Lan , Kim Heeyoung , Kang Tongjun , Bhatia Smita 
Published: February 2017

217 Background: AYAs (15-39y at diagnosis) with cancer have not seen the survival improvement evidenced by younger and older age groups with similar diagnoses, leaving an AYA Gap. While treatment on pediatric protocols is associated with superior survival in 15-21y, impact of site of care on survival for vulnerable AYA subpopulations (race/ethnicity) between 22-39y at diagnosis remains unstudied. Methods: Utilizing a cohort of 10,602 AYAs newly diagnosed between 22-39y with lymphoma, leukemia, brain tumors, melanoma, thyroid and GU cancers, and reported to the Los Angeles County cancer registry between 1998 and 2008, we aimed to determine the impact of receiving care at NCI Comprehensive Cancer Centers (NCICCC) on overall survival for AYAs, and disparities in survival by race/ethnicity. We further aimed to understand the role of SES and insurance status in accessing care at NCICCC. Multivariable analyses included race/ethnicity, age at diagnosis, SES, insurance status, primary cancer diagnosis and diagnosis year in the model. Results: A total of 904 (9%) patients received treatment at the 3 NCICCC (City of Hope, Jonsson Cancer Center, and Norris Cancer Center) in LA County. Ten-year overall survival (10y OS) was significantly worse for patients treated at non-NCICCC (81%) when compared with those treated at NCICCC (83%, p=0.02). Also, 10y OS was worse for African Americans (AA) (68%) vs. non-Hispanic whites (86%, p<0.0001). Multivariable analysis adjusting for SES, insurance status, diagnosis and diagnosis year revealed that AA (HR=1.5, p=0.0001) were at an increased risk of death. Among patients treated at NCICCC, the difference in risk of death due to race (HR=0.9, p=0.84) was abrogated. However, among patients treated at non-NCICCC, these differences in outcome persisted (HR=1.48, p<0.0001). Independent of SES, insurance and tumor factors, AA (OR=0.44, p<0.001) were less likely to use NCICCC. Conclusions: Population-based data reveal that receipt of care at an NCICCC abrogates the inferior outcome observed among AA with cancer. AA are less likely to use NCICCC for treatment. Barriers to accessing care at NCICCC are currently being explored.
Frequency of physician misconceptions that may drive underuse of radiotherapy (RT) in patients with breast cancer.
Authors: Zhou Jessica , Hawley Sarah T. , Zikmund-Fisher Brian , Janz Nancy K. , Griffith Kent A. , Sabel Michael S. , Griggs Jennifer J. , Katz Steven J. , Jagsi Reshma 
Published: February 2017

237 Background: Registry studies suggest underuse of RT for breast cancer, especially after mastectomy. Because radiation oncology is referral-based, knowledge and attitudes of upstream providers may influence patients’ RT decisions, including whether they even consider it. Methods: We surveyed a random sample of 750 medical oncologists (MO) and 750 surgeons (S) drawn from the AMA Masterfile in 2012; 895 responded. We analyzed responses to scenarios in which RT should be considered from the 766 (403 S, 363 MO) who had seen breast cancer patients in the past year. Results: Mean age was 52; 36% worked in a practice with an academic affiliation. 84% of MO and 64% of S saw more than 10 breast cancer patients in the previous year (p<0.001). 44% participated in multidisciplinary breast clinics. In a 45 yo T1cN0 ER+/PR+/HER2- patient receiving lumpectomy and tamoxifen, half of respondents substantially underestimated the 10-year risk of locoregional recurrence without RT. 19% of MO and 38% of S did not know that guidelines recommend RT in that case, but reassuringly, almost all would refer the patient to radiation oncology (97%). Referral to radiation oncology was less common for node-positive patients after mastectomy; however, in a T1cN1 patient with 2/20 nodes s/p mastectomy (in whom guidelines state that RT should be strongly considered), only 53% of MO and 34% of S recommend RT; 29% of MO and 43% of S would not refer to radiation oncology. If 4/20 nodes were involved (where RT is clearly guideline-recommended), 94% of MO but only 79% of S would recommend RT, and 9% of S would not refer to radiation oncology. The majority (53% of MO, 68% of S) substantially underestimated the risk of LRR in a patient with pN2 disease after mastectomy without RT. Fewer than half knew that the EBCTCG meta-analysis revealed a survival benefit from RT after lumpectomy (45%) or mastectomy (47% of MO, 32% of S, p<0.001). Only 66% of MO and 54% of S recognized the 10-year risk of RT-induced second malignancy to be <1%. Conclusions: Many MO and S who treat breast cancer patients have misconceptions relevant to RT decision-making. Educational interventions targeted towards referring providers may improve the quality of care received by breast cancer patients.
Uncertainty in the management of thyroid cancer.
Authors: Haymart Megan , Banerjee Mousumi , Yang Di , Stewart Andrew , Sisson James , Koenig Ronald J. , Doherty Gerard M. , Griggs Jennifer J. 
Published: February 2017

238 Background: Little is known about treatment practices in thyroid cancer, a cancer that is increasing in incidence. We sought to identify aspects of thyroid cancer management that have the greatest variation and thereby uncertainty in management. Methods: We surveyed 944 physicians involved in thyroid cancer care from 251 hospitals affiliated with the U.S. National Cancer Database. Using vignettes and additional survey items, physicians were asked questions in the following four domains: thyroid surgery, radioactive iodine use, thyroid hormone replacement post-surgery, and long-term thyroid cancer management. To identify aspects of thyroid cancer management with the greatest uncertainty, we calculated the ratio of observed variation to hypothetical maximum variation under the assumed distribution of the response. Ratios closer to 1 indicate greater uncertainty. Results: There is large uncertainty in multiple aspects of thyroid cancer management, including the role of central lymph node dissections, the role of pretreatment scans before radioactive iodine treatment, and all aspects of long-term thyroid cancer management, including applications of ultrasound and radioactive iodine scans. For the management of small thyroid cancers, uncertainty exist in all domains, including optimal extent of surgery and the role of both radioactive iodine treatment and suppressive doses of thyroid hormone replacement. Conclusions: We identified areas of uncertainty in thyroid cancer management. Since both a lack of data and a lack of acceptance of the existing data may be contributing to the variation demonstrated, to improve the management of thyroid cancer there is a need for more research and more research dissemination.