bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regorafenib in metastatic colorectal cancer: An exploratory biomarker trial.
Authors: Salem Mohamed E. , Petricoin Emanuel , Wellstein Anton , Pierobon Mariaelena , Wang Hongkun , Mikhail Sameh , Hartley Marion L. , Smaglo Brandon George , Lou Emil , Alistar Angela Tatiana , Dorsch-Vogel Karen , Pishvaian Michael J. , He Aiwu Ruth , Kim Alexander Y. , Shivapurkar Narayan , Reddy Sandeep K. , Marshall John 
Published: February 2017

TPS773 Background: Treatment with Regorafenib (REGO) has shown significant clinical benefits in metastatic colorectal cancer (mCRC) patients (pts) as demonstrated in the CORRECT and CONCUR trials. Results from both studies suggest that subgroups have differential responses. Further research to identify these subgroups through the identification of molecular biomarkers is needed. Methods: Forty pts with refractory mCRC are being enrolled in this study. The primary objective is to prospectively identify tissue and serum-based biomarkers that can predict response to REGO. Secondary objectives are to determine molecular mechanisms by which REGO controls refractory mCRC, as well as molecular pathways involved in the acquisition of resistance. Tumor and blood samples are obtained prior to and 2 weeks after starting REGO. Blood samples are collected on day 1 of each cycle thereafter. Pts will receive 160 mg REGO daily for 3 weeks of each 4-week cycle until disease progression or unacceptable toxicity. Multi-omic based biomarker discovery approaches will be used to uncover predictive marker candidates with special attention to the tumor microenvironment. Laser capture microdissection will be used on tumor tissue to procure highly enriched populations of pt-matched epithelial and stromal/immune cell infiltrates. Each of these entities will be analyzed for RNA expression changes and protein signaling/drug target activation mapping. Protein signaling analysis will be performed by reverse phase protein array of key REGO-related proteins and phosphoproteins (e.g. phosphoVEGFR, Tie2, phosphoRET), as well as broad-scale mapping of mitogenic, survival, autophagy, inflammatory, motility, and signaling networks. Tumor profiling will include next-generation sequencing for 592 genes with 53 selected gene fusions, and IHC and FISH/CISH for selected biomarkers, including PDL1, HER2, MSI, TS, ERCC1, and TOPO1. Blood samples will undergo protein, miRNA, and mutated DNA analysis, as well as exosomal signature study via a proprietary synthetic polyligand multiplexed aptamer-based assay. Exploratory analysis of biomarkers will be used to determine correlations between the presence of, or change in, biomarker levels and clinical response. Clinical trial information: NCT01949194.
Capecitabine maintenance therapy after adjuvant chemotherapy of FOLFOX (or XELOX) in patients with stage IIIC or R0 resected stage IV colorectal cancer (CAMCO study).
Authors: Ling Jiayu , Wang Wenjing , Li Shanshan , Cai Yue , Hu Huabin , Deng Yanhong 
Published: February 2017

TPS781 Background: Surgical resection and adjuvant therapy has become the main treatment for resectable colorectal cancer (CRC). Treatment with current strategies, however, recurrent rate is high for stage IIIc or R0 resected stage IV CRC (high risk-CRC). For some other maglinancies with high risk of recurrence, such as gastric cancer or high-risk gastrointestinal stromal tumor, longer period of postoperative chemotherapy was applied. The effectiveness of maintenance therapy following standard adjuvant chemotherapy in high risk-CRC has not been verified in clinical trial. Capecitabine is is an orally-administered chemotherapeutic agent used in the treatment of CRC, either as neoadjuvant therapy with radiation, adjuvant therapy or for metastatic cases. This study is exploring the efficacy and safety of strategy of surgical resection and adjuvant chemotherapy followed by maintenance capecitabine for stage IIIC or R0 resected stage IV CRC. Methods: The study was designed as an open-label phase II trial with 200 patients assigned to two thearapy group: experimental arm A (Adjuvant chemotherapy with mFOLFOX6 or XELOX for more than four months + oral capecitabine 1000mg/m2 twice daily days1-14 every 3 weeks for 12 months maintenance) or standard arm B (Adjuvant chemotherapy with mFOLFOX6 or XELOX for more than four months + observation). Eligibility included patients of 18-80 years of age, diagnosis of adenocarcinoma of the colon or rectum, received curative resection when diagnosed, with postoperative stage of IIIC OR IV(R0 resected), PS 0-1 and adequate organ function. Doses were modified for hand-foot syndrome, diarrhea and other grade 3 toxicities. The primary aim is to evaluate the 3 year disease free survival of the patients. Secondary aims inclued overall survival, safety, quality of life and an assessment of predictive molecular markers of maintenance strategy. After completion of adjuvant treatment, patients are followed every 3 months for 2 years, and then every 6 months for 3rd-5th years. This study is now open to accrual in The Sixth Affiliated Hospital of Sun Yat-sen University. Clinical trial information: NCT01880658. Clinical trial information: NCT01880658.
Addressing patient needs through compilation of self-reported verbatim comments.
Authors: Hartman Scott , Denny Diane , Hizon Sarah , Kendrick Danielle , Markman Maurie 
Published: February 2017

111 Background: Cancer Treatment Centers of America, Inc. (CTCA) is a national network of five hospitals that specialize in the treatment of patients fighting complex or advanced-stage cancer. The Symptom Inventory Tool (SIT) is an assessment that captures the patients’ perceived symptom burden, from baseline and every 21 days thereafter. The SIT is comprised of questions utilizing the M.D. Anderson Symptom Inventory tool, with eight questions and a free text box added by CTCA. Patient comments are provided in approximately 5% of all assessments (representing 3,700 comments) since initiation of the SIT. Methods: Patients answer the question, “Is there anything else that you would like to tell us or are there additional concerns you would like addressed?” within a free text field. In addition to availability to the care team to address any identified urgent need, each comment is classified into 15 defined categories to allow trending. The report is disseminated monthly to a multi-disciplinary team for follow-up on service delivery and consideration in program development. Results: The table represents the top five patient comment categories along with “other”. In addition, a sample of last quarter's data revealed that 84% of comments required immediate follow-up that may have otherwise been missed without text data mining. Conclusions: Verbatim comments are of significant value and can be best managed via dual processes to ensure timely follow-up and to support programmatic alignment, continuously analyzing data for areas of improvement. [Table: see text]
An approach to implementing meaningful change in a provincial health care system.
Authors: Ang Michelle , Lockhart Elizabeth , Brundage Michael Donald , Hart Margaret , Hartman Mark , Foxcroft Sophie , Reddeman Lindsay Elizabeth , Simniceanu Carina , Mendelsohn Marissa , Favell Lisa , Wang Jonathan , Meertens Elaine , Gutierrez Eric , Warde Padraig Richard 
Published: February 2017

120 Background: Radiation treatment (RT) is essential to cancer management, contributing to cure and symptom control. With increasing cancer incidence and treatment complexity, health systems must adapt to ensure patients (pts) receive the highest quality of care. Methods: With the objective of ensuring equitable access to high-quality, safe care, Cancer Care Ontario (CCO), a provincial government agency, identified provincial variability in RT activities. As a result, CCO prioritized 3 quality initiatives over the past 7 years: 1) Access to Intensity Modulated RT (IMRT) (2008-2013); 2) Peer Review of RT plans due to increasing RT planning complexity and the existence of high-profile RT errors (2012-present); and 3) Ensuring equitable access to RT (RT Utilization) (2014-present). Strategic plans were developed using change management framework adapted from the Kotter process for leading change (Kotter, JP. Harvard Bus Rev 73:59-67, 1995). In each initiative, CCO created a climate for change, engaged the provincial RT community to move priorities forward, and worked to sustain achieved gains. Results: CCO found that building a project team, communicating a clear understanding of goals and objectives, providing sufficient resources to cancer centres, and public reporting of results were key contributing success factors. IMRT project: Currently in sustainability phase. IMRT rates increased from 20% in 2008/09 - full implementation and target attainment in 2012/13. Public reporting continues. Peer Review of RT plans: Currently moving from engagement to implementation phase. Increase from 44% of RT cases undergoing peer review in 2013/14 to 68% in 2014/15. RT Utilization Project: Currently in engagement phase. Provincial shortfall of 11% in annual RT rates correlates to roughly 2500 pts who do not receive RT as needed. Engaging data experts and consulting with regional administrators, RT utilization is the current change priority for CCO’s RT program. Conclusions: These projects demonstrate the possibility of using change management practices to achieve quality improvement in healthcare. Ongoing work continues to ensure that pts in Ontario receive the highest quality cancer care.
Choosing Wisely: Opportunities for improving value of cancer care in the Deep South.
Authors: Pisu Maria , Rocque Gabrielle Betty , Kenzik Kelly , Jackson Bradford E. , Li Yufeng , Acemgil Aras , Taylor Richard A. , Salter Terri , Partridge Edward E. 
Published: February 2017

13 Background: Under the Choosing Wisely (CW) Campaign, the American Society of Clinical Oncology (ASCO) and the American Society of Therapeutic Radiology and Oncology (ASTRO) recommend against non-evidence-based costly medications, tests, and procedures. CW recommendation adherence in the Deep South is largely unknown, and opportunities to reduce overuse and costs may exist. Methods: Analysis of administrative claims and tumor registry data from 12 cancer centers of the University of Alabama Health System Cancer Community Network, for Medicare beneficiaries ≥65 years old with cancer. Main outcome: percent of beneficiaries adhering to 9 CW recommendations. Results: 2012-2015 (Q1) adherence varied across CW recommendations and cancer centers, and increased over time for CW 2 and 7, decreased for 3, 5, and 6, and did not change for others. Conclusions: Opportunities to improve quality and value of cancer care exist in the Deep South. Research should understand how to minimize use of non-evidence based medications, tests, and procedures. [Table: see text]
With quality and safety for all: Risking optimal care with VIP patients.
Authors: Blackburn Sandra 
Published: February 2017

142 Background: The person deemed a VIP is generally considered differentiated from the average person by virtue of fame, notoriety (positive or negative), or success through talent, tenacity or simple luck. Because society often views VIPs as special, this can generate strong feelings ranging from excitement and awe to resentment in those who encounter a VIP. VIPs and/or their entourage may request or demand special attention. The unique factors associated with caring for a VIP can jeopardize patient safety and optimal care of the VIP patient. Methods: Typology associated with the labeling of VIP patients will be used as a framework. For example, an objective VIP patient is someone who is indisputably famous or notorious. These individuals are typically in the public eye such as a famous actress, professional athlete, elected official or rock star. Persons who are subjectively designated as a VIP are usually labeled by a person of power or authority such as a hospital administrator or the Development office and they are largely unknown until they are so designed as a VIP in a specific facility. They may be the brother-in-law of the hospital CEO or a major benefactor who has a low or unknown public profile. Both objective and subjective VIPs pose problems because of the expectations placed on staff whether implied or explicit. Results: This presentation will review typical operational problems and named syndromes that are associated with the medical care of the VIP patient. These syndromes typically outline how the whirlwind of activity and expectations surrounding a VIP patient can cause a flummoxed staff to make decisions that can lead to worse care for the patient. Conclusions: For example, ‘Chief Syndrome’ is a demand, request, or intentional substitution for the “top person” in a department to provide care to the VIP patient. Problems can result if the top person, or chief, has been behind an administrative desk for the past five years and they are not as practiced as a usual provider who sees patients daily. Other cautionary notes and preventable actions that can lead to sub-optimal care of the VIP patient will be presented.
Hardwiring advance directives into an electronic medical record.
Authors: Childress Susan B. , Buckley Tyler , Badke Andrew , Horyna Amy , Howell Julie , Gren Lisa , Beck Anna Catherine 
Published: February 2017

146 Background: Patient preference at the end of life has been extensively researched and documented. Advance Directives (AD) have been shown to make a difference for patients in the areas of quality, cost, and patient satisfaction. Organizations struggle with meeting federal laws and accreditation expectations due to our complex systems. Literature supports “hardwiring” AD documentation into the EMR and providing “one click” accessibility to AD’s. Changing EMR vendors provides a unique opportunity to optimize access to AD’s, both through patient education /endorsement, review of providers’ role, and engagement of IT. Methods: Huntsman Cancer Institute at the University of Utah identified an opportunity to improve the process of obtaining AD's during a change to Epic as an EMR. MD/RN champions brought a team together that included pastoral care, social work, medical records, and IT. The group used national "Decision Day" efforts as a platform for kicking off the project. Notable barriers to implementation included AD’s from previous EMR not migrating, inadequate systems for RN and SW consultation, lack of triggers to engage provider support, and MD order sets requiring major revisions Accessibility on the banner from any view was deemed best practice. Audits were created to give feedback to hospital staff and the quality department. This effort was also identified as a priority quality goal for the entire institution. Results: There have been significant improvements in assessing patients, obtaining AD's, and providing easy access to these records. Conclusions: EMR systems do not always come with processes in place to address the need to obtain AD's, scan or enter them into the EMR, and provide easy access during critical decision points in patient care. Collaboration with the IT team in identifying institutional requirements and workflow is critical as an organization identifies the need to improve AD system flow or begins planning for transition to a new EMR.
Meeting patient and provider eTechnology needs: A provincial approach.
Authors: Redwood Erin , Smith Richard , Garay Chanson Robert , Truscott Rebecca , Umar Shama , Kaan Melissa , Kraetschmer Nancy , Lee Gemma , Kukreti Vishal 
Published: February 2017

153 Background: Cancer Care Ontario is the government agency responsible for improving cancer services across Ontario, and for implementing standards such as quality care, benchmarking and system navigation. In this role, a provincial information management and information technology (IM/IT) strategy across the patient continuum of care is essential to achieve the goal of improving the performance of the healthcare system and enhancing quality of care. Methods: Cancer Care Ontario developed a standardized approach for an IM/IT strategy through clinical engagement, needs assessment, gap analysis, clinical standardization influencing product build, usability testing, change management and post-implementation evaluation. Results: See table below. Conclusions: Ontario’s strategy for IM/IT initiatives includes a repertoire of eTools for system, patient and clinician level end user needs. An ongoing evaluation strategy including real-time patient experience measures will further strengthen the approach. [Table: see text]
Use of an automated notification tool to drive real-time patient symptom intervention.
Authors: Hartman Scott , Bosch Brandon , Denny Diane , Markman Maurie 
Published: February 2017

160 Background: Cancer Treatment Centers of America, Inc. (CTCA) is a national network of hospitals that specialize in the treatment of patients fighting complex or advanced-stage cancer. The Symptom Inventory Tool (SIT) is an assessment tool that captures the patients’ perceived symptom burden for real-time clinical intervention, from baseline and every 21 days thereafter. The SIT is comprised of questions utilizing the M.D. Anderson Symptom Inventory tool, a validated assessment instrument with questions added and a free text box by CTCA. Methods: An e-mail notification system associated with the SIT was established to allow efficient communication with specialists and support team members who would not traditionally see the patient without such a trigger signifying a need. While the SIT report is housed within the EHR, an automated e-mail profile may be established for each clinician and or team, tailored to the clinical specialty, based on symptom(s) of interest. Patients completing the SIT and scoring a particular symptom(s) at or above a threshold will “trigger” notification of that their score along with information allowing follow-up. Notifications can be set at 15 minute intervals, hourly, daily, etc. Results: 31 users/groups, representing a wide variety of disciplines and multiple care teams, currently utilize the SIT e-mail functionality including: Pain, Distress, Mind Body Medicine, Survivorship, Physical Therapy, and Sleep. The content of the e-mail consists of the patient name, medical record number, and (self-defined) symptom scores of interest. These same patients triggering a notification may be readily tracked for follow-up by the support team throughout their course of treatment or seen only once depending upon patient preference and identified need. Conclusions: The e-mail notification process has promoted communication with specialists and other support team members outside of the core team, cognizant of their different communication needs. Moreover, it allows for effective alignment of resources based on clinician expertise.
The radiation oncology EMR as a quality and outcomes-based informatics platform: A multicenter pilot study.
Authors: Pawlowski Jason Mark , Wotring Tammy , Kennedy Andrew S. 
Published: February 2017

168 Background: Radiation oncology specific oncology information systems (OIS) are highly specialized and capture large amounts of rich data related to patient care. There is great potential to expand the utility of these systems from data collection and point-of-care documentation to platforms for radiation oncology informatics. To this end, we have begun an effort to consolidate and standardize the OIS within a large network of radiation oncology clinics. We report initial findings from a multi-center OIS standardization pilot involving five clinics. Methods: Five radiation oncology clinics were converted from a paper-based medical record to an electronic medical record (EMR) on a single instance of the OIS. Clinician-led workgroups developed best-practice EMR workflows to ensure high-quality data were input into the OIS. Database configuration, clinical workflows, and documentation were standardized to enable consortium-wide reporting and dashboarding. Results: Standardization for the five radiation oncology centers was completed in September 2014. Clinical and operational dashboards were generated including dashboards to study radiation toxicity, treatment modality utilization, time studies for each task from referral to treatment, SRS/SBRT utilization, follow-up rates, and referral patterns. Consortium-wide analysis revealed substantive differences in operational and clinical practices. For example: IMRT utilization for prostate cancer patients treated with external beam radiotherapy ranged from 83% to 100% amongst facilities; the time required to contour target volumes on 80% of patients ranged from 2 to 10 days amongst physicians; and follow-up rates ranged from 50% to 83% amongst physicians. Conclusions: Standardization and consolidation of the radiation oncology OIS significantly increased reporting capabilities to include measures based on quality, safety, and patient outcomes. Disparate practices amongst radiation oncology clinics were observed and best practices discovered. OIS consolidation and standardization was essential to develop a consortium-wide understanding of clinical and operational quality.
Faster ways of pursuing quality control using EHR (Electronic Health Record).
Authors: Dwary Ashish Dutta , Master Samip R. , Mills Glenn Morris , Mansour Richard P. 
Published: February 2017

169 Background: In this era of electronic health records (EHR), quality monitoring can be a fast repetitive process. Having access to the relational database of the EHR permits rapid case identification and quality indicator determination. We hereby describe evaluation of hepatitis B testing prior to rituximab administration, a quality measure as per ASCO guidelines. Methods: We connected SQL Query Manager with EPIC Clarity database. Using the object model for medication orders, location and department, we used SQL language to build a temporary dataset of all patients who have a completed order for a Rituximab infusion at a specific department location within the past 6 months. Using the dataset obtained in step 2, we created a smaller dataset with one row for each patient. We updated each unique patient row by updating columns for the count of completed Rituximab infusions, the first infusion date and the last infusion date. We then updated each row from a query of the order procedure and results object model. The unique patient id and component id are the key fields for this query. The Hepatitis B surface antigen and core antibody results were queried from up to 6 months prior to the initial rituximab dose. We looped through the dataset and compared the first Rituximab start date with the Hepatitis B testing date. If the testing date is before the drug administration date, a Boolean column was updated to indicate a 1 for passing the quality measure and a 0 for not passing. Finally, we reviewed that chart of any patients who fail the electronic quality measure check as some Hepatitis B testing may be represented in scanned results and these scanned results cannot be queried. Results: When the final SQL query runs, it takes less than a minute to see the result set. The query can be run at any interval or date range. Once the SQL procedure is created, there is essentially no labor and very low costs to run procedure at specific time intervals. Conclusions: Quality control is integral for improvement in patient care. Doing quality monitoring can be labor intensive, expensive, repetitive and time consuming. By using the relational database created and maintained by the EHR we can accomplish the quality control in faster way that is time and cost effective.