bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality care and patient involvement in their care: Preferences for transitioning cancer follow-up care to the community.
Authors: Herzog Lindsay , Howell Doris , Moura Shari , Qiu Xin , Brown Catherine , Vennettilli Ashlee , Eng Lawson , Chen Linda , Malik Noor , Zvetkova Svetlana , Zarrin Aein , Dobriya Aditi , Patel Devalben , Xu Wei , Townsley Carol , Liu Geoffrey 
Published: February 2017

75 Background: The cancer survivor rate is rising and a new focus has turned to the appropriate survivorship care for this new population. Although several models of survivorship care are currently present in Canada, few studies have examined cancer patient preferences. This study compared patient preferences for direct referral back to one’s primary care practitioner (PCP) after 2-3 years of oncology specialist care versustransition through a specialized transitional clinic before exclusive follow-up by one’s PCP. The main objectives were to: (1) assess patient interest in a specialized cancer transitional clinic model, and (2) compare patient and demographic characteristics by such preferences. Methods: A cross-sectional scenario-based survey of cancer survivors who had undergone curative therapy at the Princess Margaret Cancer Centre assessed patient preferences for the transitioning of their post-treatment cancer care. Regression models compared clinico-demographic and psychosocial variables (anxiety, depression, distress) to one’s preference for transition of care. Results: Among 242 cancer survivors, 54% were male, 78% Caucasian, 43% with a college degree, median household income between 60-75K, 71% married, with a wide distribution of curable cancer sites (anal, colorectal, breast, testicular, lymphoma, head/neck, lung). 77% preferred transition through a specialized transitional clinic versus direct referral back to their family doctor. No factors were found to be related to preference for transition of care, except individuals who scored high on anxiety using the ESAS scale were significantly more likely to prefer referral to the specialized transitional clinic (p<0.05). No differences in preference were found by other clinico-demographic factors. Conclusions: A specialized transitional clinic is a preferred survivorship option in three-quarters of cancer patients. Anxiety, but not other variables, was associated with preference for the specialized clinic. This study highlights the need for individual decision-making regarding survivorship options. This individualization of transitioning may help improve patient’s perception of quality cancer care.
A standardized approach for managing chemotherapy-induced rash.
Authors: Poggi Laura , Godden Jennifer , Yoder Sol 
Published: February 2017

86 Background: Chemotherapy-induced rash can lead to disruptions or discontinuation of therapy, potentially leading to a poorer prognosis for patients. Methods: A retrospective chart review was performed at selected clinics to determine rash incidence, current rash management, and dose reductions, disruptions, and discontinuation of therapy due to rash for epidermal growth factor receptor-inhibitors (EGFR-I) during August and September 2013. A rash management algorithm containing preventative and treatment recommendations was created for selected EGFR-I (cetuximab, panitumumab, erlotinib) and implemented in the clinics’ electronic medical record as part of a pilot study from February through May 2014. When the EGFR-I were ordered, electronic alerts reminded providers of the algorithm. Pharmacists received electronic messages to ensure algorithm compliance. Nurses provided patients with a rash information sheet and preventative prescriptions. Providers assessed patients for rash during follow-up and instituted the rash treatment algorithm, if indicated. Through a chart review, rash incidence, and dose reductions, disruptions, and discontinuation of therapy due to rash were determined. Results: The retrospective chart review revealed 7 of 9 (78%) patients, in whom preventive medications were not utilized, developed rash with the selected EGFR-I. Treatment medications were required in 6 of 7 (86%) patients with rash. Even with treatment, 3 of 7 (43%) patients had a severe rash, making therapy modification necessary. A dose reduction was ordered for 1 patient, a disruption for another, and discontinuation of therapy for a third. During the pilot period, 6 of 7 (86%) patients developed rash, but none required dose reductions or discontinuation of therapy. Of the 6 patients who developed rash, 4 were adequately managed with preventive measures alone. Of the 2 patients who started rash treatment, 1 patient had rash resolution and the other patient continued treatment without any therapy modifications. Conclusions: An algorithm containing preventive and treatment recommendations for EGFR-I-induced rash may be more beneficial than reactive therapy alone in attenuation of dose reductions, disruptions, and discontinuation of therapy.
Comparative effectiveness of antiangiogenesis inhibitors for second-line therapy of metastatic colorectal cancer.
Authors: Chen Christina Xiaoyue , Sadeghi Sarmad , Lenz Heinz-Josef , Barzi Afsaneh 
Published: February 2017

9 Background: Treatment guidelines for second-line therapy of metastatic colorectal cancer (mCRC) suggest that addition of an anti-angiogenesis inhibitor to standard chemotherapy will prolong survival. Bevacizumab and aflibercept are two inhibitors that have increased survival in randomized clinical trials, but their cost-effectiveness is unclear. This study uses clinical trial data to compare the addition of aflibercept versus bevacizumab to a chemotherapy regimen in terms of incremental cost-effectiveness ratios (ICERs) in cost per month gained and treatment-related toxicities. Methods: A Markov model was used to simulate survival, toxicities, and costs for each treatment arm. Survival and adverse event probabilities were derived from published clinical trial data, and costs were estimated from the literature and the 2013 Veterans Affairs Federal Supply Schedule. Results: Aflibercept dominates bevacizumab by increasing survival by 1.06 months, while saving $3,526 in total treatment and adverse event costs combined (Table). When evaluating only adverse event-associated costs, the ICER between aflibercept and bevacizumab is $3,675 per month gained. One-way sensitivity analysis of the total cost ICER shows that aflibercept cost-savings are robust to almost all parameters varied, while similar analysis of the adverse event ICER suggests that aflibercept-associated toxicities would cost less than bevacizumab-associated toxicities in the case of a 20% decrease or increase in aflibercept or bevacizumab toxicity costs, respectively. Conclusions: Aflibercept plus chemotherapy is cost saving overall and improves survival compared with bevacizumab plus chemotherapy but results in more adverse events and associated costs. Practitioners treating mCRC patients should weigh survival outcomes against potential increased toxicity between different treatments, especially when evaluating limited survival gains. [Table: see text]
Barriers to clinical trial accrual in a community cancer clinic.
Authors: Santhosh-Kumar Cheruppolil R. 
Published: February 2017

91 Background: The availability of and enrollment in clinical trials at an institution may be considered cancer care quality measures. Nationally, most cancer patients are initially diagnosed and treated in the community setting. Data regarding clinical trial accrual of new cancer patients from community-based cancer centers and the barriers they encounter are limited. We sought to identify potential barriers to enrollment in clinical trials at a community cancer clinic. Methods: Data on new cancer patients seen at our comprehensive community cancer clinic were prospectively collected from 2007 through 2010. Factors that potentially affected patient accrual in clinical studies were tracked. Results: During the four-year study period, a total of 662 patients were diagnosed with breast, prostate, colon, lung, gynecological, melanoma and renal cell cancers. No studies were available for 42% of the patients (n=278). Of the remaining patients, 49% (190/384) met protocol eligibility. Of the eligible study patients, 45% (85/190) enrolled, for an overall accrual rate of 13% (85/662), and 55% (105/190) declined participation. Patients declined to participate due to stress of diagnosis, refusal of treatment entirely, issues with randomization and placebo, concerns with side effects of the medications, delay of treatment while awaiting the clinical trial process, patient refusal, transportation concerns and length of treatment. Conclusions: This study demonstrates that above average clinical trial participation can be achieved in community cancer clinics in the rural setting. There are modifiable barriers to clinical trial accrual including study availability, patient eligibility and other patient factors. Improvement of patients’ perceptions and perspectives regarding the clinical trial process could be achieved through patient education. Elimination of barriers to trial accrual could be studied as a quality metric.
Challenges of implementing the ASCO/ONS oral chemotherapy standards in a community practice network.
Authors: Dalby Carole Kathleen , Thiele Jodi , Walsh Jeanna Hamilton , Fuller Frances , Constantine Michael , Burke Reanne , Faggen Meredith , Gilchrist Heather , Norden Andrew David , Kostka Judith , Jacobson Joseph O. 
Published: February 2017

93 Background: In March 2013, The American Society of Clinical Oncologists and the Oncology Nursing Society published standards for the safe administration of oral chemotherapy. Gap analysis at Dana-Farber Cancer Institute (DFCI) Satellites revealed opportunities in planning, education, and monitoring of patients prescribed oral chemotherapy. As a quality improvement initiative, the DFCI Satellites designed and implemented a multidisciplinary approach to oral chemotherapy administration. Methods: The Model for Improvement was employed. A process map highlighted gaps in oral chemotherapy. Several improvement opportunities were identified. 1) Pharmacists developed oral chemotherapy treatment algorithms in the EMR. 2) Providers adapted the parenteral chemotherapy treatment plan (CTP) for use with oral chemotherapy. 3) A nursing education program was created, and implemented following completion of the CTP and consent. 4) Continuous monitoring for toxicity and adherence was initiated by providers via clinic visits and telephone screening. Results: Monthly compliance reports measured CTP completion, consent, initial education, and monitoring for adherence. Aggregated rates indicate practice variability. Some sites perform well, while others continue to show room for improvement. Conclusions: Developing a process for oral chemotherapy is challenging. Systems are not set up for oral drug safety. Although we had success with introduction of the intervention, results have not yet demonstrated sufficient reliability. System limitations and human factor challenges have impeded progress. Given the risk potential of oral chemotherapy, adopting a robust process to deliver oral chemotherapy is essential for safe patient care. Oral chemotherapy administration is a work in progress that must be refined to achieve high reliability. [Table: see text]
Timing of access to outpatient palliative care services: What’s in a name?
Authors: Dalal Shalini , Bruera Sebastian , Masino Charles , Williams Janet L. , Zhang Yi , Obasi Emmanuel , Schuren Natalie , Bruera Eduardo 
Published: February 2017

10 Background: We have previously shown the name “palliative” to be a barrier to early palliative care (PC) referral. Further, following service name change to supportive care (SC) in late 2007, we immediately observed an increased survival time of about 1.5 months from PC consultation suggesting earlier referral following the name change. This study was conducted to determine the timing of patient access to outpatient PC services over several years period after the name change. Methods: Records of consecutive outpatient referrals in fiscal years (FY) 2007 (pre-name change), 2008 (transition period), 2009-2013 (post-name change) were reviewed. Timing of PC access was determined by 3 time intervals: (a) survival from PC consultation; (b) advanced cancer diagnosis to PC (c) hospital registration to PC; Kruskal-Wallis, Kaplan Meir and Cox regression models were used. Results: 6,624 patients had their first outpatient PC consultation during FY 2007 to 2013. Each year we observed a consistent increase in new patient referrals, as well as a longer median survival time from PC consultation (logrank <0.0001). The table below shows median survival and hazard ratio (HR) for FYs 2008-2013 as compared to FY 2007. In FY 2013 there were 63% greater number of outpatient referrals as compared to FY 2007 (p <0.0001), longer median survival (months) (7.9 vs 4.8; p <0.001), and shorter median interval (months) from advanced cancer diagnosis (5.9 vs 7.8; p< 0.002) and from hospital registration (6.6 vs 14.8; p< 0.0001) to PC consultation. Conclusions: Following the name change of service from PC to SC, there has been consistent annual increase in new patient referrals as well as earlier access to outpatient PC services. The outpatient setting facilitates earlier patient access to SC/PC services and should be established in more centers. [Table: see text]
Trajectories of performance status decline in advanced cancer.
Authors: Ritchie Christine , Abernethy Amy Pickar , Kutner Jean , Levy Cari , O'Mahony Sean , Rhodes Ramona , Roshal Anna , Wiebe Lauren Allison , Blatchford Patrick Jud 
Published: February 2017

100 Background: Historically, functional decline is considered to occur steadily and inexorably in the last months of life, with a relatively steep trajectory compared to non-cancer patients (pts). As part of a trial evaluating the safety and clinical impact of discontinuing statin medications for patients in the palliative care setting, we recorded the performance status (PS) in 186 cancer patients regularly during their time on study and compared changes among those with differing baseline PS levels and between those with and without cancer. Methods: This was a multi-center, parallel-group, unblinded pragmatic trial. Eligibility included: age > 18; life expectancy between 1 month and 1 year, on a statin for ≥ 3 months for primary or secondary prevention, recent deterioration in PS and no recent active cardiovascular disease. Participants, randomized to either discontinue or continue statins, were followed monthly for up to 1 year. Outcomes included survival, cardiovascular events, and PS. PS was measured using the Australia-modified Karnofsky Performance Status (AKPS) scale and grouped into 4 categories: AKPS=70, 60; 50 and 0-40. The trajectory of PS decline for each group was modeled using a piecewise-linear function allowing for knots at 4, 8, and 12 weeks and separated out between those participants who died and did not die during their time on study. A mixed model was used allowing for a random intercept for each participant. Results: Among the 186 subjects whose primary diagnosis was cancer, 111 died; among 195 without cancer, 75 died. Those who did not die maintained a relatively flat trajectory of AKPS across 20 weeks; for those who did die, AKPS scores declined somewhat over 20 weeks but this decline was most remarkable among those with a starting AKPS of 0-40. Compared to noncancer patients who died during the study period, PS levels were higher at baseline and had initially greater rates of decline. Conclusions: For advanced cancer patients, PS declines are less dramatic than previous estimates have suggested except for those with AKPS 0-40, suggesting precipitous declines at the very end of life for those with higher initial AKPS. Compared to noncancer patients, PS decline is slightly steeper among cancer pts.
A prognostic model for survival after urinary diversion for malignant ureteral obstruction: A prospective study of 208 patients.
Authors: Cordeiro Mauricio , Coelho Rafael , Pessoa Rodrigo Rodrigues , Chade Daher Cesar , Guglielmetti Giuliano Betuni , Junior Jose Roberto , Chaib Matheus , Srougi Miguel 
Published: February 2017

102 Background: To determine prognostic factors and create a model for risk stratification in patients with malignant obstructive uropathy. Methods: We prospectively collected clinical and laboratory variables of 208 patients who underwent palliative urinary diversion by ureteral stenting or percutaneous nephrostomy between January 2009 and November 2011 in two tertiary care university hospitals, with minimum 6 months follow-up. Inclusion criteria were age>18yr and malignant urinary obstruction confirmed by computed tomography, ultrasound or magnetic resonance imaging. Results: Median survival after urinary diversion was 144 days. At the end of the study 164 patients died, 44 (21.2%) during the urinary diversion hospitalization. There was no difference in overall survival between the 2 types of diversion (p=0.216). The number of events related to malignant dissemination (≥4) and ECOG index≥2 were associated with shorter survival in multivariable analysis. Using these 2 risk factors (RF), patients were divided into 3 groups: favorable(no RF), intermediate(1RF) and unfavorable(2RF). The median survival at 1, 6, and 12 months was 94.4%, 57.3% and 44.9% in the favorable group, 78.0%, 36.3%, and 15.5% in the intermediate, and 46.4%, 14.3%, and 7.1% in the unfavorable. There were differences in survival profiles of the 3 groups (p<0.001). Conclusions: Our stratification model may be useful tool to determine whether urinary diversion procedures are indicated in patients with malignant urinary obstruction.
Five-year retrospective review of end-of-life care quality metrics in a large, multidisciplinary community oncology practice.
Authors: Kalisiak Angela , Gandara Elizabeth Ann , Hedlund Susan C , Gress Justin K 
Published: February 2017

108 Background: It is increasingly recognized that earlier integration of palliative care for patients with advanced cancers positively impacts both cost and quality of oncology care. Compass Oncology (CO) is a multidisciplinary community oncology practice and a member of The US Oncology Network; 39 medical, gynecologic, and radiation oncologists and 18 advance practice providers serve patients at 6 sites in Oregon and Washington. In 2008, CO prioritized practice improvement in end of life care, identifying metrics for ongoing assessment. Between 2009 and 2014, quality improvement (QI) projects focused on communication skills; whole-staff palliative care education; integration of social workers; initiation of embedded palliative care at 2 sites; and development of a more standardized approach to Advance Care Planning (ACP). Methods: Systematic retrospective record review of patient deaths from January 2009 to December 2013, targeting analysis of hospice utilization, chemotherapy use at end of life, and ACP. Results: Among patients with a CO visit within 6 months of a documented date of death (n= 783 in 2009; n= 909 in 2013), both hospice utilization and ACP participation improved significantly. Percent of patients with evidence for Advance Directive (AD), POLST or code status documented in the electronic medical record (EMR) improved from 36% in 2009 to 50 % in 2013 (p<0.001). Percent of patients enrolled in hospice at the time of death improved from 56% in 2009 to 63% in 2013 (p= 0.003). No statistically significant change was noted in % patients receiving chemotherapy in the last 14 days of life. Conclusions: Focused implementation of end of life care QI strategies in a large multidisciplinary community oncology practice appears to result in both improved hospice utilization and ACP. Chemotherapy usage in the last 14 days of life remains a meaningful target for intervention. Future QI efforts will focus on ongoing, scalable improvement in these metrics. [Table: see text]
Concurrent urologic and palliative care after cystectomy for treatment of muscle-invasive bladder cancer.
Authors: Rabow Michael W. , Benner Carly , Shepard Nancy , Meng Maxwell V. 
Published: February 2017

11 Background: To characterize the impact of palliative care concurrent with usual urologic care for bladder cancer patients undergoing cystectomy. Methods: Prospective, 6 month, serial cohort study comparing 33 participants receiving usual care with cystectomy for muscle invasive bladder cancer with 30 participants also receiving concurrent palliative care. Patients and family caregivers completed validated symptom assessment and satisfaction surveys pre-operatively and two, four, and six months post-operatively. Results: The intervention group saw improvements in most symptom measures over the six months following cystectomy compared to the control group. Depression and anxiety decreased over the six-month period for intervention patients, but increased over this time among controls (p=0.01). Fatigue fell to a minimum for intervention group participants at four months, while it peaked at this time for control participants (0.002). Quality of life and post-traumatic growth scores followed a similar pattern, with scores peaking at four months for the intervention group while controls reported their lowest scores at this time (p=0.01 and p=0.03, respectively). Changes in pain scores did not reach statistical significance. Neither family caregiver burden nor patient satisfaction showed statistically significant changes over time. Conclusions: Patients who received concurrent palliative care in addition to usual urologic care following radical cystectomy for muscle-invasive bladder had better outcomes, including improved fatigue, depression, quality of life, and post-traumatic growth. While further research on this topic is needed, our results suggest that providing palliative care services in addition to usual urologic care for bladder cancer patients may significantly reduce post-operative symptoms.
Palliative radiotherapy (PRT) at end of life (EOL): Benchmarks for a proposed metric.
Authors: Yu Hsiang-Hsuan Michael , Lutz Stephen T. , Johnstone Peter Anthony 
Published: February 2017

119 Background: The initiation of chemotherapy within 30 days of death is considered a marker of chemotherapy overuse by Quality Oncology Practice Initiative (QOPI). We have previously proposed that the same be considered for RT. However, existing data for PRT delivered at EOL are limited. Methods: We reviewed the published literature for articles reporting PRT at EOL, defined as being within 30 days of death. These articles may be considered as benchmarks for current practice. Results: Published data revealed that frequency of PRT at EOL ranges from 6.2% to 28.6% for adult patients, and an order of magnitude lower in pediatric patients. Many patients received prolonged treatment course, did not complete PRT, and several studies reported median time from PRT to death was less than 2 weeks. A single study reported that only 26% of the patients reported benefit of palliation. The table summarizes published data. Conclusions: Substantial variability exists in published rates and completion of PRT delivery at EOL. Future studies may improve therapy choices at EOL by focusing on efficacy of PRT in this cohort, various PRT techniques including hypofractionation, and clinical variables that predict RT palliation at EOL. [Table: see text]