bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nomogram predicting treatment-related sexual dysfunction for men with localized prostate cancer treated by radical prostatectomy (RP), external-beam radiotherapy (EBRT), and brachytherapy (PI).
Authors: Klink Joseph C. , Sanda Martin G. , Litwin Mark S. , Ferrer Montserrat , Regan Meredith M. , Saigal Christopher , Kwan Lorna , Gao Tianming , Klein Eric A. , Kattan Michael W. , Stephenson Andrew J. 
Published: February 2017

51 Background: RP, EBRT, and PI for the treatment of clinically localized prostate cancer may negatively impact sexual function. Predictions of treatment-related sexual problems from patient-reported, prospective data may be useful in decision-making. Methods: Patient-reported data on treatment-related sexual problems was obtained from 4 prospective, longitudinal, health-related quality-of-life (HRQOL) protocols comprising 2,668 patients treated between 1999 and 2011 by RP (n = 1,294), EBRT (n = 630), and PI (n = 744). A single HRQOL instrument was not uniformly used for each study, although questions pertaining to the quality and frequency of erections were identical among the studies. Only those patients with quality of erections sufficient for intercourse were included in the model. The endpoint of the model was erections suitable for intercourse on at least half of attempts at 2 years after treatment, with or without the use of oral medications. Cox proportional hazards regression analysis was used to model the clinical information and follow-up data. Internal validation was performed using bootstrapping. Results: Overall, 931 (74%), 249 (42%), and 323 (45%) patients treated by RP, EBRT, and PI were considered to be potent at baseline. Significant differences in baseline characteristics such as patient age, ethnicity, and disease severity existed between the treatment groups. The potency rate at 2 years for 1,215 patients who were potent at baseline and had complete follow-up data was 38%, 51%, and 61% for patients treated by RP, EBRT, and PI, respectively (p < 0.001). In multivariable analysis, age (p < 0.001), baseline frequency of erections (p < 0.001), EBRT (p < 0.001), PI (p < 0.001), PSA (p = 0.001), and institution (p = 0.006), were associated with potency. A nomogram based on the predictive parameters had a concordance index of 0.72 and predictions were well-calibrated with observed outcome. Conclusions: An externally-validated nomogram that predicts 2-year potency after treatment for localized prostate cancer has been developed and may be useful for patient counseling regarding treatment options.
Associations between receipt of a treatment summary, emotional concerns, and patterns of care among post-treatment cancer survivors.
Authors: Rechis Ruth , Nutt Stephanie , Beckjord Ellen Burke 
Published: February 2017

52 Background: Treatment summaries (TS), a critical component of survivorship care plans, were identified as a tool to improve long-term outcomes for the 12 million cancer survivors alive in the United States. Methods: In 2010, the Lance Armstrong Foundation fielded the LIVESTRONG Survey for People Affected by Cancer. Respondents were recruited through several channels including partnerships with national organizations such as ASCO. Over a 9-month period, 12,682 people completed the survey, including 3,682 post-treatment cancer survivors (PTCS). The survey addressed post-treatment concerns including receipt of TS. Full survey results were presented at the 2011 ASCO Annual Meeting. Results: Receipt of TS data was available for 3,042 PTCS: average age (50); female (65%); average time since diagnosis (6 years); received a TS (34%). PTCS who received TS reported that they were closer to time since diagnosis or since treatment ended (p < 0.01); more likely to have received chemotherapy (p < 0.01); more often receiving the majority of their health care from a medical oncologist (p < 0.05); experiencing significantly fewer (p < 0.05) post-treatment emotional concerns (including emotional distress; fears of recurrence; concerns about family risk; and appearance concerns) and were more likely to have received care; significantly less likely to say that they had “learned to live with” their concerns (p <0.05)—the most common reason among participants for not receiving care. Finally, receipt of a TS was related to higher information efficacy (p < 0.01; which appeared to mediate the relationship between receipt of a TS and fewer emotional concerns). PTCS who received a TS more often reported that their needs were met including information received about possible late-effects; care they got during treatment; and care they received after treatment. Conclusions: These results support the provision of TS to PTCS. Receipt of TS was associated with a variety of positive outcomes; however, only about one-third of PTCS received one. Future studies focused on patient perspectives on care planning tools, such as treatment summaries and care plans, can help to improve optimal survivorship care delivery.
Patient-reported outcomes from POINTBREAK: The randomized, open-label, phase III study of pemetrexed (pem) + carboplatin (cb) + bevacizumab (bev) followed by maintenance pem + bev versus paclitaxel (pac) + cb + bev followed by maintenance bev in patients with stage IIIb or IV nonsquamous non-small cell lung cancer (NS-NSCLC).
Authors: Spigel David R. , Patel Jyoti D. , Reynolds Craig H. , Garon Edward B. , Hermann Robert C. , Govindan Ramaswamy , Olsen Mark , Winfree Katherine B. , Liu Jingyi , Guba Susan C. , Socinski Mark A. , Bonomi Philip 
Published: February 2017

53 Background: Treatment (tx) impact on pt quality of life (QoL) informs pt and physician choices in the management of NSCLC. QoL, a secondary endpoint of POINTBREAK, was assessed using the patient-reported Functional Assessment of Cancer Therapy General (FACT-G), Lung (FACT-L), and Neurotoxicity (FACT&GOG-Ntx). Methods: Pts with previously untreated stage IIIB/IV NS-NSCLC and ECOG performance status 0-1 were randomized to receive induction Pem+Cb+Bev or Pac+Cb+Bev for up to 4 cycles. Pts without progressive disease received maintenance Pem+Bev (Pem Arm) or Bev (Pac Arm). Pts completed the FACT-G [physical, emotional, functional, and social well-being subscales (SS)], FACT-L (FACT-G + lung cancer SS), and FACT&GOG-Ntx (FACT-G + Ntx SS) at each visit. SS score and total score (TS) were calculated for each instrument. Tx group differences were analyzed using Linear Mixed Effects model. Toxicity was investigator assessed using CTCAE and was compared with Fisher’s exact test. Results: The primary endpoint of superior OS for the Pem arm was not met and is reported elsewhere. Pt overall compliance on the FACT was 91.2% (Pem Arm) and 90.0% (Pac Arm). For both the FACT-G and FACT-L TS, no overall significant change from baseline difference was observed between the Pem and Pac Arms. No overall differences were seen in SS scores except for Ntx. Pts on the Pem Arm had significantly less change from baseline in Ntx SS score and Ntx TS than pts in the Pac Arm at cycle 2 (p<0.001), and this significant tx effect persisted through induction and the six cycles of maintenance considered in the analysis. Significantly fewer pts on the Pem Arm experienced investigator assessed Grade 3/4 sensory neuropathy compared to the Pac Arm (0.0% vs. 4.1%, p<.00001). Conclusions: Based on the FACT results, pts on the Pem and Pac Arms reported similar changes in QoL except for less change from baseline in Ntx on the Pem Arm. Patient-reported Ntx is consistent with the clinically-measured drug-related Grade 3/4 sensory neuropathy.
High-quality basic care and support needed in lung cancer survivors.
Authors: Yang Ping , Benzo Roberto P. , Cassivi Stephen D. , Cheville Andrea L. , Clark Matthew M. , de Andrade Mariza , Ebbert Jon , Fortner Connie , Garces Yolanda I. , Jatoi Aminah , Marks Randolph , Midthun David E. , Petterson Tanya , Piderman Katherine M. , Sloan Jeff A. , Stoddard Shawn , Wampfler Jason A. , Yost Kathleen J. 
Published: February 2017

54 Background: After diagnosis and treatment, lung cancer survivors do not return to a health-related quality of life (QOL) and function comparable to pre-diagnosis levels as observed in other adult cancer survivors. We hypothesize that inadequate attention has been paid to addressing and improving QOL and function among lung cancer survivors. Our primary goal is to evaluate existing symptoms and QOL deficits among lung cancer survivors. Methods: We are evaluating patterns of QOL deficits (scored 5 or less on the scale from 0 [worst] to 10 [best]) in relation to time of lung cancer diagnosis, treatments, progression and/or recurrence, and health-related conditions. We are collecting and analyzing relevant health care utilization for selected QOL deficits, and identifying availability, accessibility, and effectiveness of evidence-based interventions. The expected outcomes will be new knowledge on patterns of QOL deficits, quality-adjusted life years in relation to the availability, accessibility, and adequacy of needed care and the effectiveness of interventions targeting improvement in QOL and symptoms. Results: In our initial analysis, among 3,707 lung cancer survivors who were diagnosed in 1999 to 2010, post-cancer treatment, and followed through 2011, 39% (1,442) reported deficits in overall QOL, 71% fatigue, 60% dyspnea, 41% being sedentary, 17% low spiritual well-being (SWB), and 10% currently smoking cigarettes. Among the 1,442 lung cancer survivors with a deficit in overall QOL, 97.5% reported severe fatigue or dyspnea, being sedentary or smoking, or having low SWB. In the remaining 36 of the 1,442, 24 had pain, cough, poor appetite, or other symptoms; only 12 (<1%) did not report deficit in any of the measured QOL domains. Analyses are ongoing. Conclusions: Based on evidence gained to date, we are developing and testing interventions targeting symptoms and QOL deficits. We expect to gain strong evidence for recommendations in redefining and delivering care and support that are necessary for improving the health and QOL of lung cancer survivors.
Nomogram predicting treatment-related bowel dysfunction for men with localized prostate cancer treated by radical prostatectomy (RP), external-beam radiotherapy (EBRT), and brachytherapy (PI).
Authors: Klink Joseph C. , Michalski Jeff M. , Sanda Martin G. , Litwin Mark S. , Ferrer Montserrat , Hamstra Daniel A. , Regan Meredith M. , Saigal Christopher , Kwan Lorna , Gao Tianming , Klein Eric A. , Kattan Michael W. , Stephenson Andrew J. 
Published: February 2017

55 Background: RP, EBRT, and PI for treatment of clinically localized prostate cancer may negatively impact bowel function. Predictions of treatment-related bowel problems from patient-reported, prospective data may be useful in treatment decision-making. Methods: Patient-reported data on treatment-related bowel problems was obtained from 4 prospective, longitudinal, health-related quality-of-life (HRQOL) protocols comprising 2,668 patients treated between 1999 and 2011 by RP (n=1294), EBRT (n=630), and PI (n=744). A single HRQOL instrument was not uniformly used for each study, though all patients were asked if they experienced bother related to bowel problems using a similar 5-point scale. Patient responses were obtained at baseline and at 2 years after treatment. The endpoint of the model was bowel dysfunction, defined as bowel symptoms that were identified as a moderate-to-big problem. Cox proportional hazards regression analysis was used to model the clinical information and follow-up data. Internal validation was performed using bootstrapping. Results: Significant differences in baseline characteristics such as patient age, ethnicity, and disease severity existed between the treatment groups. Overall, 46 patients (2%) with complete data available had bowel dysfunction at baseline, including 11 (1%), 19 (4%), and 16 (3%) patients treated by RP, EBRT, and PI, respectively (p = 0.001). The overall rate of bowel dysfunction at 2 years in those patients with no bowel dysfunction at baseline was 2%, 10%, and 4% for patients treated by RP, EBRT, and PI, respectively (p < 0.001). In multivariable analysis, EBRT (p < 0.001), PI (p < 0.001), baseline bowel symptoms (p < 0.001), and institution (p = 0.04) were associated with bowel dysfunction. A nomogram based on the predictive parameters had a concordance index of 0.73 and predictions were well-calibrated with observed outcome. Conclusions: An externally validated nomogram that predicts 2-year incidence of bowel dysfunction after treatment for localized prostate cancer has been developed and may be useful for patient counseling regarding treatment options.
Qualitative analysis of practicing oncologists’ attitudes and experiences regarding HIT-facilitated collection of patient-reported outcomes.
Authors: Jagsi Reshma , Chiang Anne C. , Medeiros Bruno C. , Polite Blase N. , McNiff Kristen , Zon Robin , Loehrer Patrick J. 
Published: February 2017

56 Background: Growing interest in incorporating widespread and routine collection of patient-reported outcomes (PROs) into a rapid-learning system for cancer care motivates consideration of stakeholder attitudes and experiences with PRO collection. Practicing oncologists are stakeholders whose views are not well characterized to date. Methods: We developed an interview guide after literature review and 6 in-depth interviews with leaders in the field. With IRB approval, we conducted 45-minute semi-structured interviews with medical oncologists identified through affiliation with QOPI or a minority-based CCOP. Purposive sampling ensured a diverse range of viewpoints. Interviews were conducted until thematic saturation. Multiple analysts independently reviewed and thematically coded verbatim transcripts. Results: 17 interviews were conducted with oncologists from diverse practice settings and types. Emergent themes included variability in understanding and experience with PRO collection; general enthusiasm for the potential value of PROs (with subthemes focused on impact on thoroughness and efficiency, and potential for coordination with quality measurement processes); and fundamental concerns (including information overload, the possibility of identifying problems for which no good interventions exist, depersonalization of the physician-patient encounter, cost, and inefficiency). Several potential barriers to the widespread implementation of PROs were identified, including need for buy-in from other stakeholders in the practice, lack of appropriate referral resources, staffing needs, and technology concerns. Respondents generally favored simple tools, format allowing for time-trending and visualization of the impact of interventions, and tailoring to the individual patient’s disease site, stage, and point in treatment trajectory. Very few identified patient compliance, data sharing/privacy, or medical liability as major barriers to implementation. Conclusions: Widespread inclusion of PROs in a rapid-learning system of oncology care will require careful consideration of the insights provided by practicing oncologists.
Patient-reported outcomes on integrative therapies for pain, tension, and level of comfort.
Authors: Keep Kamron , Shaw Alan , Leavell Stephanie , Wimmer Paige , Bartholomeus Amie , Furniss Shelli , Haney Cheary , Condit George , Milburn Belen , Doshier MaryAnn , Zuckerman Norman , Beck Thomas M. , Zuckerman Dan Sayam 
Published: February 2017

58 Background: The 2007 National Health Interview Survey (NHIS) reported more than one-third of adults used some form of complementary and alternative medicine (CAM). An analysis of 2002 NHIS data found CAM use to be more prevalent among people with a prior diagnosis of cancer. In 1999, St. Luke’s Mountain States Tumor Institute (MSTI) began an integrative therapies program to meet this growing interest and provide evidence-based, safe CAM modalities for patients. The program continues to grow and offers programs such as massage, acupuncture, and pediatric music therapy. Methods: Patient reported outcomes are collected from patients using pre/post treatment assessments. Outpatient massage and acupuncture programs measure comfort levels pre/post treatment using a 0-10 scale (0 = very comfortable; 10 = worst discomfort). The inpatient massage program measures pre/post treatment pain and tension using a 0-10 scale (0 = no pain/tension; 10 = worst pain/tension). Finally, the MSTI pediatric music therapy program collects pre/post treatment pain outcomes using a FLACC scale, where each of the five categories Face (F), Legs (L), Activity (A), Cry (C) and Consolability (C) are scored from 0-2, which results in a total score 0-10. Results: Assessments from outpatient acupuncture and massage collected between July 1, 2011 to July 1, 2012 showed that patients had an average comfort score of 3.6 before acupuncture and 2.0 after acupuncture and an average comfort score of 3.4 before massage and 0.77 after massage (n=1300 estimate). Inpatient massage outcomes collected between Dec. 2011 – June 2012 showed an average pain score of 2.53 before massage and 0.41 after massage and an average tension score of 4.73 before massage and 0.52 after massage (n=52). MSTI pediatric music therapy outcomes collected from January-April 2012 showed an average FLACC score of 3.0 before music therapy and 0.72 after music therapy (n=68). Conclusions: Integrative therapies such as massage, acupuncture and pediatric music therapy show significant benefits in providing comfort and decreasing pain and tension in MSTI cancer patients. Opportunities remain to conduct research and set a standard of practice with integrative therapies.
Colorectal cancer screening discussions: Maybe 3As is enough?
Authors: Elston-Lafata Jennifer , Cooper Gregory , Divine George , Flocke Susan 
Published: February 2017

7 Background: We evaluate the association of the 5A steps as recommended by the US Preventive Services Task Force (i.e., assess, advise, agree, assist and arrange) with adherence to physician-recommended colorectal cancer (CRC) screening. Methods: Audio-recordings of periodic health exams (PHEs) were joined with electronic medical record data and pre-visit patient surveys. Association of the 5A steps, as coded from audio-recordings, with CRC screening use was assessed using generalized estimating equation approaches. Results: Physician participants (n=64) were salaried primary care physicians. Patient participants (n=444) were insured, aged 50-80 years and due for CRC screening. Virtually all visits (n=415) included a discussion of CRC screening. When CRC screening was discussed, patients almost always (99%) received a physician recommendation for screening (advise). Over half were given assistance in obtaining screening (assist, 59%) and told why they were eligible for screening (assess, 56%). Few negotiated a plan (agree, 16%) or discussed follow up (arrange, 3%). Just over half (56%) of patients adhered to physician screening recommendations. Multivariable model results illustrate the importance of the assess and assist steps combined (OR=1.92 [95%CI 1.03-3.57]) for patient adherence to recommended CRC screening. Other variables significantly associated with screening use included discussion of CRC screening during history taking, and decreasing patient age and body mass index. Conclusions: A relatively simple discussion at the time of a CRC screening recommendation (Advise)—one that both describes the patient’s eligibility for screening (Assess) and provides verbal help regarding how to obtain screening (Assist)—may lead to improved adherence to CRC screening.
Improving infusion therapy efficiency at the Woodlands Regional Care Center (RCC).
Authors: Meade Jeremy 
Published: February 2017

84 Background: The Woodlands RCC opened the Ambulatory Treatment Center in September 2010. The center houses 14 infusion units. Within 1 year, the demand for its infusion therapy services had more than doubled with continued rapid growth expected. The perception was that more patients could not be accommodated without additional space and staff. Therefore, a performance improvement team was formed in August 2011 with the goal to increase operational efficiency to satisfy patient demand, while maintaining the highest level of quality care. The increased access for patients allows for treatment to start sooner. Methods: The six sigma Define-Measure-Analyze-Improve-Control methodology was used to manage the project, and several lean and six sigma tools were utilized. The project commenced with a project charter with a measureable AIM statement to increase infusion volumes from 1.7 to 2.4 patients/unit per 9 hour day. Historical data was extracted, and all patients’ movements were timed for 3 weeks. Benchmarking, observations, and process mapping were also performed. Baseline performance was measured using SPC charts. Sources of variation were uncovered using statistical quality tools, brainstorming techniques, and cause/effect analysis. Key interventions consisted of standardized scheduling practices, development of a scheduling template, creation of a fast track room, new processes for overbooks and preschedules, and work balancing of nursing staff using an acuity rating system. In addition, staff workload was redistributed, and the lab was reorganized. Results: Within 3 months, the center met targeted capacity and provided regional care access to 41% more patients without additional staff, space, or working hours. By March 2012, the center accommodated 67% more patients (2.9/unit or 40/day) without adversely affecting patient wait time. Infusion room utilization increased by 15%. Conclusions: Although space constrained, The Woodlands RCC was presented with the challenge to provide patients’ open access to infusion therapy services. The team successfully applied lean and six sigma principles to evaluate the current state, perform a gap analysis, and deploy interventions to support quality and operate more efficiently.
Prospective quality review of breast care navigation and treatment: Fox Chase Cancer Center Partners’ (FCCCP) initiative.
Authors: Goldstein Lori J. , Bleicher Richard J. , Cohen Steven J. , Sein Elaine , O’Grady Margaret Anne , Keeley Patricia A. , Miller Bonnie J. , Slater Elyse , Li Tianyu 
Published: February 2017

85 Background: There is increasing emphasis on quality metrics and process improvement for breast cancer treatment. FCCC designed a study to measure compliance with NCCN breast cancer guidelines at 11 FCCCP institutions. Methods: A relational data base was created to track indicators for operational timing, access, treatment modalities, and variance data in a population of breast cancer patients diagnosed and receiving first course of treatment at participating FCCCP institutions for 2009 calendar year. Pilot was conducted to ensure integrity of data collection tool in the previous year. Activation workshop, quarterly on site quality monitoring plan, real time quarterly reports to cancer committee, and benchmarking data were embedded in study. The primary objective was to benchmark participating institutions against each other and national benchmarks. Secondary objectives were to assess causes for variance and explore the role nurse navigation plays in real time quality metrics. Results: See Table. Conclusions: This novel prospective quality study demonstrated significant compliance with established breast cancer metrics across a large community hospital affiliate program. The impact of navigation appears greatest in reducing time between screening and diagnostic testing, demonstrating that navigation’s benefits extend beyond patient satisfaction to improvement of quality metrics. [Table: see text]