bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breast cancer: Does where you get treated affect survival?
Authors: Bickell Nina A. , Lin Jenny J , Franco Rebeca , Egorova Natalia 
Published: February 2017

28 Background: Under the ACA, more women are insured with Medicaid which should improve access to cancer care. However, Disproportionate Share Hospitals (DSH) are due to receive reduced subsidies thereby threatening resource stressed facilities and poorer hospitals are experiencing greater financial penalties due to higher readmission rates. In NYS, 83% of Medicaid breast cancer patients got their cancer surgery at DSH hospitals. As women gain more choice and access, they will require information about hospitals’ quality and outcomes of cancer care. We sought to determine whether there are survival advantages among breast cancer patients treated at hospitals with varying proportions of Medicaid patients. Methods: We used non-obstetric delivery Medicaid discharges from NYS hospitals in 2005-13 to create quintiles of hospitalized patients with Medicaid. Women treated for breast cancer were identified with a diagnostic and procedure code for breast cancer. Based on NYS hospital discharge database linked with vital statistics death records, we calculated hazard ratios using marginal Cox model with a robust sandwich variance estimator controlling for clustering of patients within the hospital, age and comorbidity. Results: Quintiles of Medicaid hospitals ranged from low (0-15%), to low medium (15-22%), medium (22-29%), medium-high (29-50%), to high ( > 50%). 26% of breast cancer patients were treated at the low; 22% at the low medium; 20% at the medium; 21% at the medium-high and 11% at high quintile hospitals. Patients treated in hospitals with > 50% Medicaid patients had a higher long-term mortality (HR = 1.51; 95%CI: 1.19-1.93) compared to those treated at the lowest quintile hospitals. Sensitivity analyses to adjust for stage are underway. Conclusions: While the ACA may improve access to breast cancer treatment, the long term impact on survival remains questionable as women with breast cancer treated at hospitals with high proportions of Medicaid patients may have worse survival. Analyses to control for stage are underway. Pending these results, hospitals with high proportions of Medicaid patients may need to target cancer quality improvement efforts to assure equitable outcomes.
Caring for adult survivors of childhood cancer: A primary care based adult transition clinic.
Authors: Lowry Becky N. , Alsman Kyla , McClellan Wendy , Klemp Jennifer R. , Krebill Hope , Al-hihi Eyad , Doolittle Gary C. , Fulbright Joy M. 
Published: February 2017

40 Background: Long-term survival is an expected outcome for childhood cancer patients. Caring for adults who are childhood cancer survivors requires dedicated late effects monitoring. Recognizing transition challenges from pediatric to adult and oncologic to primary care settings, we developed a dedicated monthly survivorship transition clinic (STC) in an internal medicine office at the University of Kansas Medical Center. We describe the first year practice experience (2014-2015). Methods: Retrospective chart review was completed on 41 STC patients - age 20 to 52 years. Each survivor self-selected to establish in STC, with either consultative survivorship care (correspondence sent to existing primary care physician (PCP)) or combined primary and survivorship care (if no established PCP). Selections were recorded. Two oncology providers performed blinded independent reviews of treatment summaries and scored these using Children’s Hospital of Philadelphia Intensity of Treatment Rating scale (ITR-3). If scores differed, discussion determined consensus. Scores were provided to the STC and unblinded. ITR-3 scores were matched with data on subspecialty referral patterns for each survivor to determine if ITR-3 scores correlated with referral needs. Results: Of 41 patients, 26 (63%) requested PCP and survivorship care. Only 15 (37%) had an established PCP. Survivors were grouped by ITR-3 into low (1 or 2) or high (3 or 4) intensity scores. Subspecialty referrals in each group were analyzed as follows: total number of referrals / average referrals per survivor / median referral number. Referral data: low intensity group 14 / 1.27 / 1, high intensity group 96 / 3.56 / 3. Conclusions: Despite complex medical histories and long term follow-up needs, a high percentage of Midwest cancer survivors were in need of survivorship, PCP and subspecialty care emphasizing the importance of intentional transition efforts. ITR-3 scores correlated with subspecialty referral needs. Future research will include an increased number of survivors to determine further predicative value of this scale in estimating survivor needs complexity.
A clinical placement program for primary care professionals at a comprehensive cancer centre.
Authors: Jefford Michael , Evans Judy , Nolte Linda , Piper Amanda , Simkiss Liz , Whitfield Kathryn 
Published: February 2017

44 Background: Primary care physicians (PCPs) and primary care nurses (PCNs) are likely to have a critical role in providing care for cancer survivors, especially following the end of cancer treatments. Generalists (PCPs and PCNs) express a need for information and training in post-treatment care. Based on models in other contexts a clinical placement program was developed at a comprehensive cancer centre to determine (1) its feasibility and acceptability, and (2) whether learning needs were met. Methods: Five clinical services (breast, lower gastro-intestinal, urology, skin and melanoma, late effects) participated. The program was advertised to generalists, intending to recruit 5 PCPs and 10 PCNs. Generalists received professional development points and partial reimbursement for lost income through a stipend. Pre-placement educational materials were provided. Participants were interviewed one-on-one pre and post-placement. The relevant human research ethics committee approved all aspects of the project. Results: The program exceeded recruitment goals: 16 PCPs, 12 PCNs and 9 oncologists participated. Generalists rated the placement highly: program learning outcomes entirely (63%) or partially (37%) met; personal learning needs entirely (70%) or partially met (30%); relevance to practice entirely (89%), partially (11%). Consistent themes from interviews: generalists would recommend the program to colleagues and could identify knowledge and skills transfer, however learning was largely by observation, rather than participation. Learning opportunities were skewed toward generalists, rather than oncologists. All participants showed enthusiasm to address the challenges of providing shared care for survivors. Conclusions: A clinical placement program for generalists is feasible and highly regarded. Participants described challenges to providing quality post-treatment shared care, but a willingness to address these. Future programs should consider the learning needs of cancer centre professionals.
Developing electronic health record (EHR)-based program to deliver survivorship care plans (SCPs) and visits at the UW Breast Center.
Authors: Seaborne Lori A. , Hueneberg Karol , Bohler Aaron , Schroeder Gillian , White Terri , Sesto Mary E , Haine James Edward , Wilke Lee G. , Neuman Heather B. , Tevaarwerk Amye 
Published: February 2017

56 Background: Accreditation guidelines require all breast cancer patients receive SCPs within 6 months of end of treatment (EOT) in 2016. SCPs require significant resources to provide, which EHR assistance might decrease. Our objective was to develop a standardized program for creating, providing, and tracking SCPs using an EHR. Methods: Clinicians and EHR analysts developed processes for implementing an EHR-based program, using our existing SCP to guide overall structure. We piloted this program 5/2015-6/2015 to identify barriers & facilitators to creating EHR-based SCPs, providing EHR-based visits and EHR-based tracking of both. Results: The pilot included 24 patients (2% of annual volume). Facilitators were: 1) pre-entry of cancer history, 2) clearly defined responsibilities for SCP & visit; barriers were: 3) no identified method to assess concerns or track referrals, 4) variability in EOT due to treatment heterogeneity, 5) limited time during routine follow up for SCP provision. The following changes were implemented: 1) SCP auto-population, requiring consensus on essential clinical data, 2) assigning staff roles (MD, NP/PA, RN) for all aspects of SCP creation & visit provision; 3) creating 1-page survey addressing NCCN recommended topics to pre-screen for concerns discussed at SCP visit and using a visit template to track topics covered plus information and referrals provided, 4) establishing processes and delivery dates for SCP & visit to newly diagnosed patients and 5) developing algorithms for referral for SCP & visit (4-8 weeks from EOT) including adding “SCP visits” to EHR-chemotherapy plans and other auto-reminders. Clinic-wide implementation began 7/2015; updated results will include: EHR-tracked, provision rate, type and frequency of survivor concerns and referral patterns and time for SCP creation and visits. Survivor/clinician satisfaction with EHR-based program will also be included. Conclusions: EHR-based SCP creation, provision and tracking is feasible. Future plans include assessing time and personnel resources required, and comparing the accuracy of EHR-tracking with cancer registry data or other standards used to address guideline compliance.
Challenges in the implementation of survivorship care plans in an NCI-designated cancer center.
Authors: Mendelsohn Mary , Mortimer Joanne E. , Popplewell Leslie , Lai Lily L. , Maghami Ellie , Economou Denice 
Published: February 2017

68 Background: The development and initiation of Survivorship Care Plans (SCPs) across all disease sites was identified as a Strategic Initiative Goals for 2015 by the Clinical Cancer Committee. The 2012 Commission on Cancer requirements for certification provided an additional incentive to meet this goal. Establishing a process that includes the development and distribution of a SCP’s within the electronic medical record (EMR) is necessary to improve on the completion of SCP’s and to improve the utilization of surveillance tests in cancer survivors. We describe the process developed at a free-standing NCI cancer center to meet the standard of SCP provision to all cancer patients. Methods: A multi-disciplinary subcommittee of the Cancer Committee was designated to develop the overall strategic plan for the implementation of this standard. It met with disease teams to facilitate a treatment summary from Cancer Registry data, identify patient reported symptoms using a self report tablet (SupportScreen). Electronic care plans were created using survivorship research program templates and ASCO framework for each disease site team. The disease team Nurse Care Coordinator inputs information into the eSCP. Results: Templates have been established within the EMR in the documents section under survivorship care plan title. These can be initiated and modified when the Nurse Care Coordinator chooses to start them. The disease teams have established their time points for SCP presentation to their patients. Using the cancer registry to provide data related to staging, treatments and genetic testing has helped minimize development time. Individual survivor’s concerns will be reflected in patient reports and physician symptom documentation. This eSCP completion process is a pilot program within the breast cancer disease team and will be expanded to include patients with head & neck and hematologic malignancies with a goal of including all patients by mid 2016. Conclusions: The goal of improving survivorship care coordination and compliance with surveillance guidelines is challenging. Maximizing available interdisciplinary resources has helped to create a viable Survivorship Care plan at our institution.
Continuum of care: Establishment of a comprehensive cardio-oncology program.
Authors: Aseyev Olexiy , Gosh Nina , Sulpher Jeffrey Allen , Johnson Christopher , Stadnick Ellamae , Turek Michele , Dent Susan Faye 
Published: February 2017

74 Background: Cardiac disease in individuals with cancer is common, impacts survival, the ability to tolerate cancer treatments and quality of life. Cardio-oncology is a novel interdisciplinary approach to the management of cancer patients with treatment-induced cardiotoxicity. The goal of our program is two-fold: a) establishment of a hospital based cardio-oncology clinic to rapidly assess and manage cancer patients with cardiotoxicity related to their cancer treatment and b) provide continuum of care for these patients with the establishment of a cardiovascular survivorship program. Methods: In 2008, in collaboration with oncologists, cardiologists, pharmacy and nursing we established a multidisciplinary cardio-oncology clinic at The Ottawa Hospital. Referrals are primarily form treating oncologists. The clinics take place 3-4 half days per month and are conducted by 3 dedicated cardiologists. Patient data including demographics, cancer type and treatment, cardiovascular risk factors, treatment and clinical outcomes of each patient are being collected. Results: We have seen over 800 patients with solid and hematological malignancies. Clinical outcomes of patients referred from 10/2008 to 01/2013 have previously been reported (Sulpher J. et al 2014). The majority of patients referred were able to successfully complete their cancer therapy (79.7%), reflective of the large breast cancer population seen in this clinic. A third of patients achieved stable left ventricular ejection fractions with cardiac intervention and 41% received cardiac medications. Overall survival and long term cardiac outcomes will be reported. Conclusions: While these initial results are encouraging the impact of cardiotoxicity experienced by cancer patients and long term cardiac outcomes are unknown. In an effort to improve the cardiovascular care of cancer survivors we are currently developing a Cardiovascular Survivorship Program; patients will be referred from our hospital based cardio-oncology clinic to a specialized community clinic, for long-term surveillance and optimization of cardiovascular health. This initiative represents a continuum of care from hospital to community and is the first such program in Canada.
Implementation of survivorship care plans: Lessons learned at the Kaiser Permanente Oakland Medical Center.
Authors: Washington Pamela Kim , Li Yan , Durzinsky Dennis S , Duffy James , Shim Veronica , Barnett Nicole M , Warren Nakeia , Stodd Kay 
Published: February 2017

75 Background: Beginning in 2015, the Commission on Cancer (CoC) requires accredited facilities to provide eligible patients with a Survivorship Care Plan (SCP). While the benefits of SCPs in the quality and continuity of care are well documented in the literature, there is a dearth of information regarding best practices for implementation. Here we describe lessons learned in the development of a SCP at the Kaiser Permanente Oakland Medical Center (OMC). Methods: Adult patients with a diagnosis of stage 1-3 cancer who received curative treatment were identified by the Northern California Kaiser Permanente Cancer Registrar. Consistent with CoC guidelines for 2015, 10% of all eligible patients (n = 1160) are required to receive a SCP 3-6 months following active treatment. Thus, a total of 116 patients with a diagnosis of breast, colon, lung/bronchus, prostate, or melanoma of the skin at OMC were given a SCP. The implementation timeframe was July to December 2015. Use of a modified ASCO template was recommended for its rigor across the required domains. Following template approval by the Comprehensive Cancer Committee (CCC), a workflow consisting of identifying patients’ last treatment and manual data entry by a Physician Assistant (PA) as well as automated data population in the Kaiser Permanente electronic medical record system was developed. Completed SCPs were then provided to patients during a clinic visit. The workflow process was refined as appropriate based on feedback from staff & physicians. Results: Depending on the scope of treatment, mean preparation time is 10 minutes per plan using specific diagnosis codes via an electronic medical record system. Further, it takes 30 minutes for a PA or other Ancillary personnel to discuss the plan with a patient. Patient response was generally positive upon receipt of the plan. Conclusions: Successful SCP implementation is contingent upon engagement from multiple stakeholders. Per standard CoC 3.3, the implementation rate will increase annually from 10% in 2015 to 100% by 2019. Careful consideration to workflow processes and resources planning be must factored into achieving 100% compliance across all disease sites by 2019.
Measuring and understanding quality of survival in oncology.
Authors: Hudgens Stacie , Forsythe Anna , Lloyd Andrew , Lapuerta Pablo 
Published: February 2017

e291 Background: Health status, burden of illness, and quality of life (QOL) are considered crucial for clinical decision making in cancer. More specifically, quality of survival (QOS) in patients with cancer must be paramount in treatment considerations from early stage disease to palliative care. Measuring QOL provides information beyond biomedical outcomes, offers a unique understanding from the patient's perspective, and has demonstrated influence over study conclusions where differences in QOL are more often detected in studies comparing intervention to no intervention rather than comparative studies with systemic therapies. Methods: This panel presentation is focused on the crossfunctional perspectives of critical research areas for understanding QOS in oncology. As such, this presentation seeks to address the need for patient-focused research in oncology including: 1) the importance of the patient's voice in early and metastatic disease, 2) what endpoints should we consider in oncology trials for understanding the impact on patients, 3) modeling time to patient reported decline as a critical endpoint in understanding survival, 4) quality of life as a story rather than a statistic, 5) understanding health states for response and progression. Results: The authors of this panel seek to present real world examples for each of the above topics as well as introduce methodologies for improving QOS value messaging in oncology. Conclusions: In cancer studies, the primary response is measured as survival benefit with the ability to measure biomarkers such as tumor response, blood levels, etc. However, measureable endpoints in oncology from patient report contribute to the understanding of symptom improvement or decline (change over the course of treatment), change in function (e.g., physical functioning), side effects (treatment toxicity; e.g., patient reported potential with the PRO common terminology criteria for adverse events), economic aspects, interaction between biomarkers of progression or response and patient-reported symptoms, function, and QOL should be carefully estimated to fully understand treatment efficacy and safety, and inform patients of duration and cycle of toxicity onset; disease symptoms and changes.
Chemoprevention and epigenetic multitargeted approach.
Authors: Nezami M. A. 
Published: February 2017

e297 Background: In 2012 there were 11,957,599 advanced cancer cases in the US reported by CDC and the incidence has been almost unchanged over the previous 8 years (482,000 cases in 2000 versus 456,000 cases in 2008). There has been an annual percentage change of only (-0.6) between years 1999 to 2008 in cancer incidence. It is described in recent literature that epigenetic alterations are at least if not more important than genetic defects for the development and progression of malignant diseases. Transcriptional therapy is a very promising form of cancer treatment that is being extensively evaluated. It is speculated that inhibitors of DNA methylation and histone deacetylases can reactivate expression of tumor suppressor genes. Hypermethylation and transcription silencing of suppressor genes has been shown in 33% of breast cancers, 60% of prostate CA and 92% of colon CA. The value of combination therapy both in chemoprevention, as well as treatment in patients with cancer is extremely important and can cause a significant shift in the current practice of oncology and cancer prevention, the results in clinical studies have been poor as the target histone hyperacetylation does not correlate with survival (possibly due to P 16/21 resistance and unselectiveness of the conventional therapies/targets). Methods: In vitro application of epigenetic modifiers, consisting of nontoxic natural substances tested in cell cultures showed preliminary results confirming apoptosis. Application of the relevant scientific merits described above, using combination of epigenetic modifiers, and natural compounds in a protocol called Multi targeted epigenetic therapy (MTET) in a set of advanced patients showed synergistic effect which was clinically relevant. Results: Clinical application of this method of treating cancer has caused promising preliminary results. We present the summary of outcomes in one hundred cases of advanced cancer (refractory solid tumors) with thirteen cases, described in detail. Conclusions: Our preliminary findings were encouraging and supports further research in a large randomized trial to evaluate the efficacy of such method, in refractory and advanced solid tumors.
Transrectal MR-guided laser focal therapy of recurrent prostate cancer in a patient post-proton therapy: A case study.
Authors: Greenwood Bernadette Marie , May Stuart , Feller John Francis 
Published: February 2017

e298 Background: Prostate cancer is commonly managed with radical prostatectomy (RP) or radiation therapy (RT). 20-40% of men undergoing RP experience biochemical recurrence (BCR) before 10 years. 30-50% or those receiving RT experience BCR. Treatment options for these men are limited and include: salvage radiation, close surveillance, androgen deprivation therapy (ADT), or participation in a clinical trial. Our IRB-approved study evaluated the use of transrectally delivered, MR-guided laser focal therapy with real-time MR thermometry for the treatment of recurrent prostate cancer. Methods: 63 y.o. patient treated September, 2014 with MR-guided laser focal salvage therapy for locally recurrent prostate cancer, Gleason score 4+5 involving the transition zone far anteriorly at the base level measuring 1.4 x 1.1 x 1.3 cm. The patient was originally diagnosed with Gleason score 4+3 adenocarcinoma of the prostate by MR ultrasound fusion biopsy in 2012 and subsequently underwent treatment with proton beam radiation therapy. Results: MR-guided biopsy of the prostate August, 2014 confirmed the presence of locally recurrent PCa. Before MR-guided laser focal therapy, the biochemical recurrence was documented with an elevated serum PSA equal to 5.7. The 3- and 6-month post laser focal therapy serum PSA levels were 0.5. It reached a nadir of 0.3 at one year following the laser ablation. Patient had negative 6-month follow-up MR-guided biopsy of treatment region and remains on active surveillance Conclusions: Following proton beam radiation therapy, transrectal MR-guided laser focal therapy achieved oncologic control at 12 months post-treatment. Clinical trial information: 02243033.