bluuebunny/crossref_metadata_2025_split huggingface dataset:
End-of-life healthcare utilization among Medicare beneficiaries with malignant brain tumors.
Authors: Dulaney Caleb , Dover Laura L , Williams Courtney , Jackson Bradford E. , Warren Paula , Fiveash John B. , Rocque Gabrielle Betty 
Published: April 2017

244 Background: Patterns of end-of-life healthcare utilization for patients with primary and secondary malignant brain tumors (PMBT, SMBT) are poorly understood. The primary objective of this study was to compare end-of-life healthcare utilization and expenditures between patients with PMBT and SMBT. The secondary objective was to determine risk factors for low-quality healthcare utilization at the end-of-life. Methods: We analyzed Medicare administrative claims data for decedents with a diagnosis of PMBT or SMBT within a community cancer network in the southeastern US from 2012-2015. Outcomes included hospital-based care (ED visit, hospitalization, and ICU admission), cancer therapy (chemo- or radiotherapy), hospice care, and total cost to Medicare in the last 30 days of life. We performed regression analyses to determine risk factors for each of the outcomes. Results: 1323 patients had a diagnosis of PMBT (383) or SMBT (940). Patients with SMBT received more hospital-based care (57% v 49%, p < 0.01) and more cancer therapy (25% v 18%, p < 0.01) than those with PMBT. Male gender (RR 1.28, p = 0.03) and decreasing age (RR 1.09, p = 0.02) were risk factors for PMBT and SMBT hospital-based care, respectively. While the majority of PMBT (81%) and SMBT patients (78%) utilized hospice care, those with SMBT were more likely to enroll ≤ 3 days prior to death (10% v 5%, p < 0.01). Hospital-based care (RR 5.22, p < 0.01 (PMBT); RR 5.24, p < 0.01 (SMBT)), and non-white race (RR 1.59, p = 0.04 (PMBT); RR 1.56, p < 0.01 (SMBT)) were risk factors for no hospice utilization. Mean expenditures in the last 30 days of life were similar between PMBT and SMBT ($8592 v $9964). Hospital-based care increased the average cost by $16,303 (PMBT, p<0.001) and $13,132 (SMBT, p<0.001). Conclusions: Hospitalization at the end-of-life is common in patients with PMBT or SMBT and is associated with lower rates of hospice care and increased expenditure.
Uptake and effectiveness of FOLFIRINOX for advanced pancreas cancer: A population-based study.
Authors: Karim Safiya , Zhang-Salomons Jina , Biagi James Joseph , Asmis Tim , Booth Christopher M. 
Published: April 2017

245 Background: While FOLFIRINOX is a standard treatment option for advanced pancreas cancer there is little data describing utilization and effectiveness in routine clinical practice. Here we report practice patterns and outcomes in the general population of Ontario, Canada. Methods: Using the Ontario Cancer Registry and New Drug Funding Program we identified all patients with pancreas cancer treated with palliative intent gemcitabine or FOLFIRINOX in Ontario during 2006-2014. FOLFIRINOX became available in Ontario’s single-payer health system in November 2011. Gemcitabine cases were classified as pre-FOLFIRINOX era (2006-2010) or post-FOLFIRINOX era (2011-2014). Cases treated with peri-operative chemotherapy were excluded. Comparisons of proportions between study groups were made using the chi-square test. Overall survival (OS) was measured from date of chemotherapy initiation. Results: During 2006-2014, 3826 patients in Ontario were treated with Gemcitabine (n=3042) or FOLFIRINOX (n=784) chemotherapy for advanced pancreas cancer. Uptake of FOLFIRINOX increased from 41% (206/505) of treated cases in 2012 to 56% (274/486) of treated cases in 2014. Among patients treated after 2011, median age was 69 and 63 years for Gemcitabine and FOLFIRINOX respectively (p<0.001). The proportion of treated cases who received FOLFIRINOX varied considerably across geographic regions (from 26% to 58%, p<0.001). Median number of FOLFIRINOX cycles delivered was 6 (median 10 cycles in pivotal RCT). Median OS of patients treated with Gemcitabine was 5.0 months in 2006-2010 and 4.8 months in 2011-2014. Median OS of FOLFIRINOX patients treated in 2011-2014 was 8.2 months (median 11.1 months in pivotal RCT). Conclusions: Use of FOLFIRINOX in the general population has increased since 2011 with a resulting decrease in use of Gemcitabine. However, outcomes achieved with FOLFIRINOX in Ontario demonstrate a substantial efficacy-effectiveness gap between survival in the pivotal clinical trial and survival in routine practice.
Disease complexity and economic burden on patients with colon cancer in the SEER-Medicare population.
Authors: Rodriguez Maria Alma , Cheng Lee , DeJesus Alma Yvette , Zhao Hui , Giordano Sharon Hermes 
Published: April 2017

30 Background: The relatively high cost of cancer care is receiving national attention. Treating cancer includes not only managing this illness, but also the complications and exacerbation of the patients’ underlying comorbid conditions. The purpose of this study was to analyze how the charges for colon cancer care are affected by the complexity of the patients’ underlying health problems. Methods: We searched the Surveillance, Epidemiology, and End Results-Medicare database to identify patients diagnosed with colon cancer from 2009 through 2011. The estimated charges of the patients’ Medicare claims were stratified by survival time, disease stage, patient age, and comorbidity number. We defined patients’ 12 months of care as the 1 month immediately preceding cancer diagnosis plus the 11 months immediately following diagnosis. Results: We identified 10,822 patients newly diagnosed with colon cancer during the study period. Of those patients, one quarter died within 11 months after diagnosis. Treatment for early-stage cancer was significantly less expensive than treatment for advanced disease. For patients with early-stage disease, the charges for surgery, chemotherapy, and/or radiation therapy constituted a smaller contribution to the overall care charges. For patients with advanced-stage disease, the substantially higher overall care charges were largely due to charges for chemotherapy and/or biotherapy. Among patients with the same disease stage at diagnosis (except for patients stage IV disease), those with a survival time of less than 12 months incurred higher charges than those with a survival time of 12 months or more did. Regardless of disease stage, survival time, or age, patients with one and two or more comorbid conditions incurred statistically significant higher charges (7.0% and 29.7%, respectively) than those with no comorbid conditions. Conclusions: These findings demonstrate the important contribution of disease complexity among patients with cancer to the analysis of resource utilization. Using overall cancer care cost or reimbursement models that do not incorporate disease complexity may negatively affect hospitals that care for a high proportion of patients with complex conditions.
Establishing best practice recommendations for systemic treatment regimen development and maintenance.
Authors: Crespo Andrea , Redwood Erin , Vu Kathy , Kukreti Vishal 
Published: April 2017

40 Background: A province-wide review of oncology regimens identified discrepancies in a number of regimens in systemic treatment computerized prescriber order entry (ST CPOE) systems. The potential patient harm from such discrepancies includes unnecessary toxicities and reduced treatment efficacy. The regimen review highlighted the need for a high-quality process to improve the safety of systemic treatment prescribing in Ontario. The objective of this work was to develop recommendations on best practices for the development and maintenance of oncology regimens. Methods: An expert multidisciplinary group of oncology clinicians and administrators was formed to review available literature and leverage their expertise to establish oncology-specific recommendations. These were then circulated to broader stakeholder groups for feedback and consensus. Results: Practical, consensus-based best practice recommendations for ST CPOE and pre-printed order regimen development and maintenance were created. Detailed processes for new regimen development are outlined in the table below. Moreover, broad areas of roles and responsibility, frequency of review, and sign-off were highlighted. This was repeated for regimen changes (not shown). Conclusions: There is a lack of guidance in the literature on best practices for oncology regimen development and maintenance. Careful analysis and application of the expertise of oncology professionals resulted in consensus-based best practice recommendations that will enable the advancement of safe, standardized, systemic treatment prescribing.[Table: see text]
Reducing overuse of colony-stimulating factors without compromising patient safety: Evidence from a decision-support enabled utilization management in patients with lung cancer receiving chemotherapy.
Authors: Adeboyeje Gboyega , Agiro Abiy , DeVries Andrea , Fisch Michael , Malin Jennifer L. 
Published: April 2017

52 Background: Recent studies suggest significant overuse of colony-stimulating factors (CSFs) for the primary prevention of febrile neutropenia (FN) in patients with cancer receiving chemotherapy. Overtreatment with CSF increases costs without evidence of clinical benefit. We examined the impact of a decision-support tool to promote risk-appropriate CSF use in lung cancer. Methods: A retrospective cohort study design was used to analyze commercial claims data on lung cancer patients. The decision-support tool was implemented at participating oncology practices in staggered phases across 14 U.S states (from July 1, 2014 - November 1, 2014). Study population included adults with lung cancer who initiated chemotherapy from July 1, 2014 through March 30, 2015. Patients were assigned to case and control cohorts according to whether or not they resided in service areas where the tool had been implemented. Patients were followed up to 6 months after initiating chemotherapy in the pre- and post-implementation periods. The primary outcomes: CSF use and FN incidence rates were compared using difference-in-differences (DID) models; adjusting for baseline FN risk factors with generalized estimating equations. Results: The final study population included 3,470 patients (case: 1,857 and control: 1,613; overall mean age (SD), years: 65 (10)). There were no meaningful differences in FN risk factors at baseline between the cohorts. In adjusted results, CSF use decreased from 48.4% to 35.6% in the case compared to a change from 43.2% to 44.4% in control cohort (DID: -8.7% (95% CI: -14.65% to -2.67%), p - < 0.001) in the pre- and post-implementation periods. The rates of FN were consistent for both cohorts in each time period, with no statistical difference in trend for the case (2.8% to 4.3%) as compared with the control (3.1% to 5.1%) cohort (DID: -0.2% (95% CI: -0.63% to -0.33%), p – 0.953). Conclusions: These findings demonstrate the potential for decision-support tools to improve evidence-based guideline adherence and promote risk-appropriate CSF use in patients with lung cancer without adversely impacting patient safety.
Patient-reported outcomes (PROs) in testicular cancer survivors (TCS): Do unmet needs resolve with routine care?
Authors: Palmer Steven C , Vaughn David J. , Blauch Abigail N. , Pucci Donna A. , Jacobs Linda A. 
Published: April 2017

56 Background: Unmet needs for intervention are common among cancer survivors, but may go unidentified and unaddressed in routine care, leading to poorer outcomes. PROs are becoming the standard of care at many treatment facilities and have been shown to be feasible and to potentially improve outcomes. However, communication of PROs to providers may be a necessary step in this process. We examined the prevalence and stability of unmet needs over a one-year time period in a sample of TCS to determine whether these resolve over time in routine care. As well, we examined the relationship of unmet needs to symptoms of anxiety and depression. Methods: Ninety-nine consecutive TCS were recruited from an ongoing survivorship clinic. Participants completed assessments of demographics, unmet needs, and anxiety and depression (HADS) prior to their visit and at a one year interval. To ensure routine care, providers were unaware of the results of unmet need screening. Results: Participants were primarily white (94%), early middle aged (M = 40 yrs), married (71%), and college educated (79%). Most participants were diagnosed with Stage I disease (73%) an average of 7 years previously. The number of unmet needs was generally low (M < 0.89) at both time points, but varied from 0-10 (SD = 1.8 over both time points). The number of unmet needs was significantly associated over the one year time period (r = 0.65), and unmet need for specific symptoms at time one was associated with unmet need at time two for fatigue, pain, insomnia, numbness, aching joints, difficulty with concentration, memory, anxiety, decreased sexual interest, and weight gain (all X2 > 8.12, all p < 0.05). Only muscle aches, depression, and body image were unstable over the one year period (all p > 0.05). Number of unmet needs was associated with increased symptoms of depression and anxiety at both time points (all r > 0.23 and < 0.50, all p < 05). Conclusions: Although unmet needs were fairly low, most failed to resolve over the one year time period in routine care, and greater unmet need was associated with more symptoms of depression and anxiety at both time points. The use of PROs may improve outcomes, but only if communicated to providers and acted upon in enhanced care.
Value of central line care teaching for families of pediatric oncology patients.
Authors: Wong Quiles Chris Ivette , Schwartz Marc A , Mahan Riley M , Billett Amy 
Published: April 2017

60 Background: Pediatric oncology care depends on central lines (CLs) in both outpatient and inpatient settings. Although inpatient implementation of CL maintenance bundles has been achieved, little attention has focused on families who care for CLs at home. Families are expected to follow best practice, but most have no prior experience or medical background. We sought to understand the comfort level and knowledge of families caring for external CLs at home and the value of our program’s existing teaching strategies, prior to an improvement initiative. Methods: Families caring for children with new and existing external CLs at home from May 2015-May 2016 were eligible for a survey and approached during outpatient visits if their primary team agreed. Using Likert scales, families were asked to assess their current comfort level with CL care, evaluate existing teaching strategies (instructional sheets; hands-on teaching by program nurses, and by home health nurses), and comment on other potentially helpful strategies. Five content questions regarding CL care were included to evaluate knowledge. Results: 80 of 82 (97.6%) families approached completed the survey. 70% had a CL in place for > 60 days. 46.3% felt "very comfortable" performing CL care, 42.5% were "comfortable", and 11.2% were "sort of or not comfortable". Only 17.5% of families found instruction sheets indispensable. Hands-on teaching was indispensable for 51.3% of families; 1.3% responded that teaching was not performed. 27.5% of families found hands-on teaching by home health nurses indispensable, but 22.5% had not received this. 98% of content questions were answered correctly. Other helpful strategies concentrated on 3 themes: standardization of educational content, increased opportunity for hands-on practice, and cognitive aids (e.g. a checklist) for CL care. Conclusions: A minority of families feel the highest level of comfort with CL care at home even after months of experience. Improvement opportunities and gaps in CL care teaching strategies are prevalent. To help support families caring for CLs at home and ensure adherence to best practice, programs should engage families to better understand their needs and develop solutions to meet them.
Identifying cancer quality measurement gaps in the Choosing Wisely Initiative.
Authors: Corrigan Kelsey , Agarwal Sarvesh , Aksenov Leonid , Paul Alexandra , Sharif-Askary Banafsheh , Kamal Arif 
Published: April 2017

7 Background: Cancer is a leading cause of morbidity in the US. Improvements in treatment strategies are rapidly transitioning many cancers into long-term, chronic illnesses, similar to heart failure, COPD, and diabetes. We compared the prevalence and focus of cancer and non-cancer quality measures within the Choosing Wisely Initiative to assess possible measure gaps. Methods: The Choosing Wisely Initiative is the most recognized public campaign to reduce low value services in health care. We identified all published Choosing Wisely measures from April 2012 to May 2016 and abstracted for target disease, care setting, type of care, and patient age. We calculated descriptive statistics and chi-squares for analysis. Results: 75 healthcare organizations submitted 461 total Choosing Wisely measures. Of these, 15% (71/461) involved cancer and 15% (68/461) involved non-cancer chronic illnesses, including heart disease, diabetes, COPD, asthma, stroke, and Alzheimer’s Disease; 70% (322/461) were “other”. Among measures, 30% (139/461) overlapped between cancer and non-cancer chronic illnesses. Among cancer measures, a minority (10/71; 14%) were submitted by ASCO. Prostate cancer (28%) and breast cancer (23%) were the two most addressed cancer diagnoses. Among cancer guidelines, 79% (66/84) targeted imaging, tests, and/or procedures, 12% (10/84) addressed treatment, 5% (4/84) addressed medications, and 5% (4/84) targeted prevention. This is similar to non-cancer chronic illnesses, which had 72% (60/83) of guidelines targeting imaging, tests, and/or procedures, 13% (11/83) of guidelines addressing treatment, 8% (7/83) addressed medications, and 6% (5/83) targeted prevention. In examining numbers of measures per prevalence of the diseases addressed, we found 71 guidelines for 14.4 million people for cancer and 68 guidelines for 152 million people with non-cancer chronic illnesses (p<0.001). Conclusions: Quality measures involving serious illness, including cancer, represent a minority of the Choosing Wisely measures. Existing quality measures emphasize diagnostics and procedures. Future measures should target the chronic illness aspects of cancer care, including prevention, survivorship, and palliative care.
Addressing the risk of infertility in young women with breast cancer (BC): A quality improvement (QI) intervention.
Authors: Smith Karen L. , Cheung Enoch , Thompson Beth , Jeter Stacie , Mull Jill , Ensminger Jennifer , Capano Mary , Klein Catherine , McTague Meghan , Christianson Mindy , Stearns Vered 
Published: April 2017

72 Background: Many young women with early BC require systemic therapy (ST) which can result in ovarian damage leading to infertility. Fertility preservation (FP) can be performed prior to ST, however uptake is low. Data suggest oncology providers do not routinely discuss the risk of treatment related infertility (TRI) or FP with young women with BC. Methods: We created a QI protocol to ensure providers address fertility needs of young women with early BC. Non-pregnant women age 18-44 years with stage I-III BC who have not initiated ST are identified by screening clinic schedules. Clinicians are asked to follow a QI protocol requiring assessment of patients’ childbearing potential (CBP), risk for TRI and fertility goals (FG). If appropriate, FP is discussed and consultation with a fertility specialist arranged. A clinical team member completes a provider documentation form (PDF) summarizing the QI protocol steps accomplished. Results: Since implementation of the QI protocol, there have been 80 eligible women (mean age 38.6). At least one PDF was completed for 56 (70%), with the majority completed by breast surgeons. Among those with a completed PDF, 48 (86%) were of CBP, all but one of whom planned ST associated with a risk of infertility. According to the PDF, the risk of TRI was discussed in 34 (72%) while FG were assessed in 44 (94%), with 8 (18%) desiring fertility and 8 (18%) undecided about FG. Discussion of FP by the provider and/or a fertility specialist was documented in the PDF for 85% of those who desired fertility or who were undecided. In comparison to the PDF, discussion of FG was recorded in provider notes in 36 (45%) women with documentation in both provider notes and the PDF for 29 (36%). Provider notes documented discussion of FG in 94% of the women who desired fertility or who were undecided according to the PDF. Conclusions: Implementation of a QI protocol with required documentation ensures providers address fertility needs of young women with BC. Providers do not discuss the risk of TRI as frequently as assessing FG. Efforts are ongoing to increase completion rate of our PDF and to incorporate it into the electronic medical record. Follow-up regarding ST and uptake of FP in our cohort is ongoing.
Oncology beyond the hospital: 7 years taking care of cancer patients from the very begining until the last consequences.
Authors: Cunquero Tomas Alberto Jacobo , Avila Andrade Claudio Dario , Pep Ferri , Condori Farfan Lauren , Fernandez Diaz Amaya Belen , Shaheen Ihsan , Meri Abad Marina , Fernandez Adriana , Blasco Ana , Berrocal Alfonso , Safont Maria Jose , Caballero Cristina , Iranzo Vega , Godes Maria Jose , Camps Carlos 
Published: April 2017

75 Background: Comprehensive and continuous care is esential for the correct management of cancer patients. To achieve this, specific programs for early diagnosis and long survivor care are needed. Since 2007, within the project “Oncology beyond the Hospital: Oncologic assistance at the Universitary General Hospital of Valencia”, the Oncologist Liaison was created. Methods: Two tracks were designed: High-resolution track for patients with suspicion of non-diagnosed cáncer; and Oncologist Liaison track, to organize the follow-up of cáncer long survivors. We present a descriptive and retrospective study by reviewing medical records of patients referred to the high-resolution diagnostic consultation; and long survivors followed up by the Oncologist Liaison from May 2007 to September 2015 (2016 data under review). Results: High-resolution track: 1,596 patients with suspected cancer were visited. The mean time between the primary care physician consultation and the oncologist visit was 4.32 days. Main reasons for consultation were: breast disease (25.4%), blood test disorders (16.4%), enlarged lymph nodes (11.1%) and radiological suspicion of tumor (12%). 424 cancers were diagnosed (26.5%) all having been studied in Oncologic Committee: 22.6% lung; 17% lung; 16.2% breast; 11.8% lymphomas; 12.5% superior dighestive tract; and19.8% miscelanea. Long-survivors track: 1406 patienst free from disease were referred for surveillance of recurrence and treatment sequelae: 44% breast; 20% gastrointestinal; 17% gynecological; 7% double neoplasia; 4% of lung cancer and other tumors, 8%. Conclusions: With the integration of the Oncologist Liaison in the continuum of care, we have achieved: Normalization of oncologic approach among patients and primary care physicians; implementation of a fast-track for patients with cancer suspicion: access to the oncologist in less tan a week; case study in the Oncologic Comittee in the following week; and consensus in diagnosis and treatment plan in each case. Ensure control over long-survivors.