bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unwarranted variation in time to initiation of adjuvant chemotherapy in a statewide collaborative.
Authors: Griggs Jennifer J. , Braun Thomas , Dick Andrew W. , Gorski David H. , Bensenhaver Jessica Miley , Breslin Tara M. , Henry Norah Lynn 
Published: February 2017

264 Background: The purpose of this study was to investigate clinical and non-clinical factors associated with time to initiation of breast cancer adjuvant chemotherapy following the final definitive surgery in a state-wide collaborative. Methods: We collected prospective data from all patients who received adjuvant chemotherapy for Stages I - III breast cancer in 25 health systems in the Michigan Breast Oncology Quality Initiative (MiBOQI) between 2006 - 2014. MiBOQI is a Blue Cross Blue Shield of Michigan/Blue Care Network-sponsored quality collaborative. The dependent variable was time to initiation of adjuvant chemotherapy. Time to chemotherapy was examined according to clinical and non-clinical patient and treatment factors and by health system, both with and without adjustment for patient and treatment variables. Results: Complete data were available for 7,513 of 8,236 eligible (91%) patients. The mean time to chemotherapy was 43 days (range 5-390). In multivariate analyses, clinical factors independently associated with longer time to chemotherapy included increasing age, greater comorbidity, and obesity (p value < 0.0001 for all). Higher stage disease was associated with shorter time to chemotherapy (p < 0.0001); there was no association with hormone receptor or HER2 status. Treatment factors associated with longer time to chemotherapy were breast reconstruction, receipt of genomic assays, and receipt of advanced imaging (p value < 0.0001 for all). Non-clinical factors—minority status, higher area-level poverty, and non-private insurance—were also independently associated with longer time to chemotherapy (p value < 0.0001 for all). In addition, time to chemotherapy varied significantly between health system (p < 0.0001); this difference persisted after adjustment for all patient and treatment factors. Conclusions: Clinical and non-clinical factors, including site of care, are associated with variation in time to initiation of chemotherapy. Identifying patient-level factors and processes of care that facilitate or impede timely initiation of chemotherapy may decrease unwarranted variation in care delivery across a collaborative network.
Diffuse large B-cell lymphoma: A single-institution experience of patient outcomes.
Authors: Chan Ryan James , Gupta Rasna , Kanjeekal Sindu Mary , Jarrar Mohammed , Kay Amin , Mathews John , Woldie Indryas Lemma , Hamm Caroline M. 
Published: February 2017

271 Background: The Windsor Regional Cancer Program (WRCP) was determined to have consistently been a top performer in time to treatment of diffuse large B cell lymphoma in this Canadian province (http://www.csqi.on.ca/by_type_of_cancer/lymphoma/lymphoma_treatment/). We endeavored to determine whether faster time to diagnosis and treatment for diffuse large B-cell lymphoma (DLBCL) influenced the IPI score (International Prognostic Score), thereby predicting an improved clinical outcome in these presenting patients. Methods: The WRCP services a catchment area of 650,000 people. A retrospective chart review was conducted for patients diagnosed with DLBCL at the Windsor Regional Cancer Program (WRCP) between 2006-2012. Information collected included the five factors for scoring by the International Prognostic Index (IPI) – age, performance status, LDH, stage, and number of extranodal sites – chemotherapy regimen, relapses, existence of second malignancies, cause of death, and dates of diagnosis, last follow-up, and death. We analyzed the relationship between prognostic factors and these clinical outcomes, and also compared the IPI scores for this cohort of patients against a similar population in another Canadian province, British Columbia. Results: It is established that compared to other cancer centres in Ontario, the WRCP is consistently reporting a shorter diagnosis to treatment metric when compared to their counterparts in Ontario, Canada. When compared to historical Canadian data, presenting IPI scores for DLBCL patients were lower on average for patients treated at the WRCP than those reported in British Columbia, Canada by Sehn et al. [Sehn, L. H., et al. (2007). The revised International Prognostic Index is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood, 109(5), 1857-1861.]. Conclusions: A lower presenting IPI score is known to be correlated improved lymphoma related outcome. With attention to the metric of diagnosis to treatment < 30 days for diffuse large B cell lymphoma, we expect an improved lymphoma related outcome for our patients. We recommend ongoing attention to this metric, in order to improve outcomes for our patients.
Current landscape of prostate cancer quality measures in the United States.
Authors: Flanders Scott C , Fitall Eleanor , Jagun Dayo , Mitchell Kristi , Francis Peter St. John , Tang Hong , Song Kyung Min 
Published: February 2017

273 Background: Prostate cancer (PCa) is the leading cancer for men in the United States (US) and identified by the Centers for Medicare & Medicaid Services (CMS) as one of the top 20 high-impact Medicare conditions experienced by beneficiaries. Thus, there is increasing focus by stakeholders to measure and achieve high-value, quality care in PCa. However, quality measurement is particularly difficult in oncology. Our aim was to assess the current landscape of PCa quality measures (QMs) in the US. Methods: Published literature and online resources from the past 5 years were reviewed to identify PCa QMs and general oncology QMs relevant to PCa. PCa QMs were categorized using a “continuum of care” framework across 5 stages: 1) symptom assessment and screening; 2) diagnosis and risk stratification; 3) initial treatment; 4) monitoring and additional treatment; and 5) advanced- or late-stage care. Finally, PCa QMs were evaluated for their type (eg. process, outcomes), and use by CMS. Results: We identified 16 PCa-specific QMs and 20 general oncology QMs relevant to PCa. The majority of PCa QMs were developed by the American Medical Association–Physician Consortium for Performance Improvements (6 measures) and the Michigan Urological Surgery Improvement Collaborative (6 measures). There are 3 QMs for symptom assessment and screening, 5 QMs for diagnosis and risk stratification, 6 QMs for initial treatment, 2 QMs for monitoring and additional treatment, and 0 QMs for advanced- or late-stage care. Fourteen PCa QMs focus on process of care, but only 2 PCa QMs address outcomes. Nine PCa QMs are part of CMS quality improvement programs, 6 of which are reportable through the Michigan Urological Surgery Improvement Collaborative. Three new PCa QMs are under consideration by CMS. Conclusions: We found few PCa QMs that capture outcomes of patient experience or care, and no PCa-specific QMs available for advanced disease and late-stage care, demonstrating a need to better define quality in this setting. Opportunities to increase the focus on innovative, real-world data-generation strategies, such as PCa disease registries that collect clinical outcomes, patient preferences, and comorbidities, may inform stakeholder development and adoption of new QMs in the US.
Regional engagement to define, report, and use quality metrics to improve palliative care in oncology.
Authors: Stickney Kristine , Kreizenbeck Karma , Fedorenko Catherine R. , Goulart Bernardo , Shankaran Veena , Curtis J. Randall , Lyman Gary H. , Mera Csaba , Smith Bruce , Ramsey Scott David 
Published: February 2017

282 Background: Palliative care in oncology encompasses a wide array of care, and optimal performance metrics remain uncertain. To address this issue we held a regional meeting that included patient advocates, clinicians, private and public payers and researchers to identify quality indicators for palliative care, discuss palliative care (PC) quality measurement in the region, review preliminary results and metrics for PC, and identify opportunities to improve care. Methods: Regional experts facilitated discussions. Data was presented from a regional insurance claims-cancer registry linked database. Participants were asked to: discuss and prioritize interventions to improve palliative care in oncology and create metric dashboards for healthcare providers. Results: Oncology-specific recommendations for interventions: early and continuous palliative care discussions from diagnosis through EOL; training existing care team on palliative care conversations, through standard certification programs; pair patients with an experienced patient/patient advocate; educate caregivers, patients and providers respectively on how to communicate about PC and care choices; and patient navigation to manage symptoms of advanced cancer. Feedback on prioritization of palliative care/EOL metrics: see Table. Conclusions: A multi-stakeholder approach can be effective for developing metrics and interventions to improve palliative care by providing an understanding of the information needs of the community. [Table: see text]
The impact of immigration status on cancer outcomes in Ontario, Canada.
Authors: Cheung Matthew C. , Earle Craig , Fischer Hadas , Camacho Ximena , Saskin Refik , Shah Baiju , Austin Peter , Singh Simron 
Published: February 2017

285 Background: In the delivery of cancer care, barriers to access could potentially result in inferior outcomes and survival. Although a relationship has been demonstrated between disadvantaged socio-economic status and mortality, the impact of immigration on outcomes is less clear. Methods: Administrative databases were linked to create a cohort of all incident cases of colorectal, lung, prostate, head/neck, breast and hematologic malignancies from Jan 2000 to Dec 2012 in Ontario, Canada. Cases were defined according to immigration status and followed from diagnosis until death (or cancer-specific death). Cox proportional hazards models were constructed to study the impact of immigration status on survival after adjusting for relevant variables. Additional adjusted models studied the relationship of time since immigration on mortality. Results: During the study period, 11,485 cancer cases were diagnosed in recent immigrants (0-10 years in Canada), 17,844 cases in non-recent immigrants (11-25 years), and 416,118 cases in non-immigrants. Following adjustment for relevant predictors by Cox regression, survival was improved for recent immigrants (HR 0.843; 95% CI 0.814-0.873) and non-recent immigrants (HR 0.902; 95% CI 0.876-0.928) compared to non-immigrants. Cancer-specific survival was also better for recent immigrants (HR 0.857; 95% CI 0.823-0.893) and non-recent immigrants (HR 0.907; 95% CI 0.875-0.94) compared to non-immigrants. Amongst immigrants, each year from the original landing in Canada was associated with increased mortality (HR 1.004; 1.000-1.009) and a trend to increased cancer-specific mortality (HR 1.005; 0.999-1.010) that was not statistically significant. Immigrants from all WHO world regions were found to have similar reductions in mortality and cancer-specific mortality. Conclusions: Immigrants to Canada demonstrate a “healthy immigrant” effect, with lower mortality compared to Canadian-born individuals. This benefit appears to diminish over time, as the health of immigrants potentially converges with the Canadian norm. Potential contributors to the benefit include self-selection for immigration, health requirements for entrance, and differences in disease distribution related to ethnicity.
Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among breast cancer patients.
Authors: Check Devon , Reeder-Hayes Katherine Elizabeth , Basch Ethan M. , Zullig Leah L. , Weinberger Morris , Dusetzina Stacie 
Published: February 2017

292 Background: Chemotherapy-induced nausea and vomiting (CINV) is a major concern for cancer patients and, if uncontrolled, it can have serious implications for patients’ treatment outcomes, including quality of life. Guidelines recommend the use of an NK1 receptor antagonist to prevent CINV among patients beginning chemotherapy with a high risk of causing the side effect. However, barriers to use of oral NK1s (i.e., aprepitant) exist. In many cases, patients are required to fill a prescription for aprepitant at their home pharmacy. As well, the drug is expensive, costing over $500 under Medicare Part D, and patients may be responsible for a large portion of that cost. These barriers may contribute to racial disparities as they disproportionately affect minority patients. Methods: We used 2006-2012 SEER-Medicare data to evaluate the use of NK1s among black and white women initiating adjuvant chemotherapy with an anthracylcline and cyclophosphamide for early-stage breast cancer. NK1 use during the first chemotherapy cycle was measured using Medicare Part D and Part B claims. We used modified Poisson regression to assess the relationship between race and (1) any NK1 use, (2) oral NK1 (aprepitant) use, and (3) intravenous NK1 (fosaprepitant) use. We report adjusted risk ratios (aRR) and 95% confidence intervals (CI). Results: Of 1,015 eligible women (911 white; 104 black), 38% of white and 28% of black women received any NK1 at the start of their chemotherapy regimen. In adjusted analyses, black women were 30% less likely than white women to receive any NK1 (aRR black vs. white: 0.70, 95% CI: 0.52-0.94). This disparity was driven by a 44% gap in orally administered NK1s (aprepitant) (aRR: 0.56 95% CI: 0.35-0.89). We did not observe disparities in intravenous fosaprepitant use (aRR: 0.77, 95% CI: 0.46-1.28, NS). After controlling for variables related to socioeconomic status, disparities in NK1 and aprepitant use were reduced but not eliminated. Conclusions: Our study found racial disparities in women’s use of oral NK1s for the prevention of CINV. These disparities may be partly explained by racial differences in women’s ability to afford the medication.
Comparative effectiveness of early-line nab-paclitaxel (nab-P) versus eribulin in patients (pts) with metastatic breast cancer (MBC): A U.S. real-world analysis.
Authors: Braiteh Fadi S. , Parisi Monika , Ni Quanhong , Park Si yeon , Faria Claudio 
Published: February 2017

293 Background: In a phase III study in MBC, nab-P demonstrated anti-tumor activity across lines of therapy. Eribulin is indicated for the treatment (Tx) of MBC in pts who have previously received ≥ 2 chemotherapeutic regimens. This analysis evaluated Tx patterns and effectiveness of nab-P and eribulin in pts with MBC in a real-world community-based setting. Methods: A retrospective cohort study was performed using fully de-identified data from a US electronic medical record platform of 1300 community oncology physicians. The analysis included women aged ≥ 18 years with MBC who started on nab-P or eribulin monotherapy as 1L or 2L Tx from 12/4/10 to 10/6/14 (≥ 1 cycle of nab-P or eribulin required). The primary objective was to examine duration of Tx (DOT, including time to Tx discontinuation [TTD]; censored if last administration > 30 days from the last date in the database) and time to next Tx (TTNT; day 1 from drug 1 to drug 2). Incidence of adverse events (AEs) and supportive care used during Tx were also examined. Results: Pt characteristics were similar between groups. Mean age was 59 years. Most pts had hormone receptor + (62%), HER2− (82%) disease, and 1L therapy (60%). More pts received nab-P vs eribulin. Slightly more pts receiving nab-P vs eribulin were treated in 1L (63% vs 55%). DOT, TTNT, and TTD were significantly longer in the nab-P vs eribulin group (Table). Thrombocytopenia and anemia were numerically lower in the nab-P vs eribulin group (P = 0.11 for each). Nausea/vomiting was less common with eribulin vs nab-P (P = 0.009). Granulocyte-colony stimulating factor, hydrating agents, and antiemetics were used less often in pts receiving nab-P (P < 0.01 for each). Conclusions: DOT, TTNT, and TTD were significantly longer for pts treated with nab-P vs eribulin. Moreover, pts receiving nab-P experienced fewer hematologic AEs and utilized fewer doses of supportive care. [Table: see text]
Choosing Wisely in oncology: Screening for a new primary cancer in patients with metastatic disease.
Authors: Singh Simron , Lipscombe Lorraine , Fischer Hadas , Tinmouth Jill , Austin Peter , Fung Kinwah , Cheung Matthew C. 
Published: February 2017

295 Background: The Choosing Wisely Canada (CWC) campaign aims to start conversations about unnecessary treatments and procedures in order to improve quality of care. In particular, the CWC campaign in cancer seeks to reduce interventions that are not supported by evidence and contribute to unnecessary rising costs of cancer care. We sought to document the performance of cancer screening for a new primary cancer in patients with existing metastatic cancer (CWC statement #2). Methods: We used population-based administrative health care databases from Ontario, Canada held at the Institute for Clinical Evaluative Sciences (ICES). The cohort included all adult residents of Ontario of eligible screening age (age 50 or older) diagnosed with incident, stage 4 (metastatic) colorectal cancer (CRC), lung, breast, or prostate cancer between January 1, 2007 and December 31, 2012. We examined screening tests for CRC and breast cancer in the first 1 and 3 years after diagnosis of an unrelated cancer. Given the high mortality rate in this population, screening rates were calculated using the cumulative incidence function which takes into account the competing risk of death or the occurrence of the cancer for which the patient was being screened (prior to being screened). Results: Among the 20,992 patients with stage 4 lung, breast, or prostate cancer, CRC screening within 1 year of cancer diagnosis occurred in 2.8%, 6.1%, and 13.0%, respectively. Within 3 years of diagnosis, screening rates were 3.9%, 11.9%, and 26.9%, respectively. Among the 10,034 women with metastatic CRC or lung cancer, breast cancer screening within 1 year of cancer diagnosis occurred in 8.0% and 8.7% of women, respectively. Within 3 years of diagnosis, screening rates were13.1% and 10.2%, respectively. Screening rates were higher in patients age 50-74 than those ≥75 years. Conclusions: Our findings indicate that up to one quarter of patients with metastatic cancer receive subsequent screening tests for other cancers, which are unnecessary as these patients are unlikely to benefit. Further studies are warranted to examine resource implications, potential patient and societal harms, and the future impact of the CWC campaign on this practice.
Breast cancer patient functional status and comorbidities and their impact on treatment aggressiveness: A population-based study.
Authors: Pearlstein Kevin A. , Basak Ramsankar , Chen Ronald C. 
Published: February 2017

306 Background: The ASCO Choosing Wisely Campaign and other published guidelines recommend avoidance of aggressive treatments in early-stage cancer patients with limited life expectancy. However, patients with more advanced cancers are likely to benefit from aggressive treatment. The population-based SEER-MHOS (Medicare Health Outcomes Survey) provides unique data to allow assessment of aggressiveness of cancer treatment by cancer stage and patient frailty. Methods: MHOS includes patient-reported functional deficits in a sample of Medicare beneficiaries, and has been linked with SEER data which provide diagnostic and treatment data. This analysis included 2605 patients diagnosed with non-metastatic breast cancer from 1999-2006 who had pretreatment frailty data  which was calculated using a validated index based on age, comorbidity, and functional deficit. Each patient was classified as healthy, intermediate, or frail. Treatment aggressiveness was examined for each group. Results: Comorbidity and functional deficits were very common. For example, 11% had chronic lung disease, 17% diabetes, 52% low back pain, 50% reported difficulty walking several blocks, and 11% difficulty bathing. Almost all individuals with localized and regional breast cancers had surgery (Table 1). However, frail patients with localized cancers were less likely to receive post-lumpectomy radiotherapy (RT, p < .001); frail patients with regional cancers were less likely to receive post-mastectomy RT (p = .02). A sizable proportion of healthy patients (25-32%) do not receive post-lumpectomy RT. Conclusions: Comorbidities and functional status limitations are common in Medicare breast cancer patients. There appears to be an underutilization of adjuvant RT in healthy breast cancer patients, and use is less in frail patients. [Table: see text]
Disparity in early mortality among racial groups with multiple myeloma in the United States: A National Cancer Data Base study of 108,352 patients.
Authors: Gonsalves Wilson I. , Bartley Adam C , Go Ronald S. 
Published: February 2017

311 Background: Previous population-based studies have shown variations in disease incidence and overall survival (OS) among multiple myeloma (MM) patients (pts) from different ethnic and racial backgrounds. However, the impact of race and ethnicity on early mortality (EM) or death in the first year after the diagnosis of MM is less well known. Methods: Pts with MM diagnosed from 2000-2011 were identified in the NCDB. We obtained data associated with socio-demographics, type and location of care facility, as well as the use of autologous stem cell transplant (ASCT) as an initial treatment option. Two cohorts were created based on the use of ASCT: 1) The group who received an upfront ASCT and 2) Pts who were 75 years or older who are unlikely to have ever received an ASCT. The rate of early mortality (EM) was estimated using the 1-year OS and assessed for all pts based on racial/ethnic background and the use of ASCT in their therapy. Results: There were a total of 108,352 pts who were included in this analysis. The median age of this cohort was 65 years (Range: 20 – 90). Of these 58,223 (54%) were male. The racial distributions of these cohorts were as follows: 78,589 (73%) White non-Hispanic (WNH), 21,292 (20%) Black non-Hispanic (BNH), 1,943 (2%) Asian Pacific-Islander (API), 293 (< 1%) Native-American (NA) and 6,235 (5%) Hispanics-any race (HIS). The estimated 1-yr OS (95% CI) was 71% (71 – 72) for WNH, 74% (73 – 74) for BNH, 77% (75 – 79) for API, 73% (68 – 78) for NA and 75% (74 – 76) for HIS. Amongst patients who received an upfront ASCT, the estimated 1-yr OS (95% CI) was 97% (97 – 98) for WNH (Reference), 98% (97 – 98) for BNH (P = 0.99), 99% (99 – 100) for API (P = 0.96) and 98% (97 – 99) for HIS (P = 0.99). Whereas amongst pts who likely never received an ASCT (75 years or older), the estimated 1-yr OS (95% CI) was 55% (54 – 56) WNH (Reference), 57% (56 – 59) for BNH (P = 0.03), 62% (58 – 67) for API (P = 0.02), 55% (43 – 72) for NA (P = 0.99) and 55% (52 – 58) for HIS (P = 0.99). Conclusions: In general, WNHs have a worse 1-yr OS compared to BNH and API. However, this disparity appears significant only among pts unlikely to get an ASCT. Further studies are required to identify explanations for such disparate outcomes based on race and use of ASCT.