bluuebunny/crossref_metadata_2025_split huggingface dataset:
Embedded palliative medicine model for inpatient solid tumor oncology patients utilizing corounding and consultation criteria: A quality improvement pilot.
Authors: McInnes Susan , Estfan Bassam N. , Montero Alberto J. 
Published: February 2017

148 Background: Hospitalized patients (pts) on solid tumor oncology (STO) services have palliative needs including pain management. This quality improvement project sought to establish a new STO-specific co-rounding PM consult service, evaluate the use of consult criteria for STO inpatients, assess the impact/interest in an embedded service, improve access to PM for STO pts and improve palliative education to STO teams. Methods: During October 2015 to January 2016, a new PM consult service was established for the 2 STO inpatient services at Cleveland Clinic. The PM attending physician (MD) rounded with each of the STO teams twice a week. On weekdays, the PM MD chart-screened all STO pts for palliative needs such as uncontrolled pain (2 pain scores ≥ 6 out of 10 in 24 hours), unplanned readmission within 30 days or contact with a PM MD as an outpatient. Other PM needs were assessed on rounds. PM consults were offered for pts who screened positive and were performed if approved by the STO team. STO MDs were surveyed anonymously regarding acceptance of the embedded service. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data regarding pain management during the pilot period was reviewed. Results: Average daily census for the 2 STO teams was 28 pts. There were 282 positive palliative screens in 4 months, 119 of whom were seen in consultation (42%.) The embedded service saw 42-45 new consults per month. The PM team followed 22-35% of all STO inpatients. 14-18 pts/month new to PM were referred to the outpatient PM clinic after discharge. STO MDs indicated strong acceptance of the embedded PM team for pain management, STO team education and coordination of care. All STO MDs wanted the service to continue. HCAHPS pain scores for the entire STO floor improved from a baseline 39th percentile to 98thpercentile. Conclusions: PM was integrated successfully into daily hospital care of STO pts at our institution using a co-rounding model and consult criteria. The service was busy and well received by STO MDs. Continuity with outpatient PM was provided. HCAHPS pain scores improved for the entire STO floor, including pts not directly seen by PM.
Food as medicine: A randomized controlled trial (RCT) of home delivered, medically tailored meals (HDMTM) on quality of life (QoL) in metastatic lung and non-colorectal GI cancer patients.
Authors: Ishaq Omar , Mailhot Vega Raymond , Zullig Lisa , Wassung Alissa , Walters Dorella , Berland Noah , Du Kevin Lee , Ahn Jiyoung , Leichman Cynthia G. , Jill Cohen Deirdre , Gu Ping , Chachoua Abraham , Leichman Lawrence P. , Pearl Karen , Schiff Peter B. 
Published: February 2017

155 Background: Malnutrition incidence in cancer approaches 85%, disproportionately burdening those with lung, GI, and advanced stage cancers. Malnourished patients have impaired chemotherapy response, shorter survival, longer hospital stays, and decreased QoL. Home delivered meals are nutritional interventions that improve patient well-being, nutrition, and lower healthcare costs in the elderly but have not been studied as an intervention in cancer patients. HDMTM are nutritionist prescribed home delivered meals tailored to patient’s symptoms, co-morbidities, and health needs. Preliminary data in 211 cancer patients showed with HDMTM 87% ate more than half of meals, 91% lived more independently, 89% ate more nutritiously, and 70% had less fatigue. HDMTM may be a strategy to reduce financial toxicity and healthcare utilization and improve QoL in cancer patients, but no primary data exists evaluating its efficacy. Methods: We sought to develop the first RCT evaluating patient-centered QoL improvement from nutritional intervention with HDMTM in those with metastatic lung and non-colorectal GI cancer. We established a partnership with God’s Love We Deliver, a 501c3 non-profit specializing in HDMTM. Results: We developed a protocol for a single-institution RCT of standard of care (SoC) versus SoC and HDMTM in metastatic lung and non-colorectal GI cancer patients with primary aim comparing QoL between arms at 12 weeks using the FACT-G questionnaire. Sample size is 180. Secondary aims assess HDMTM’s impact on nutritional status, weight, mood, survival, food security, financial toxicity, healthcare utilization, and cost effectiveness. Eligible patients tolerate oral alimentation, have PS 0-3, and newly diagnosed (< 6 weeks) metastatic cancer. All patients have pre-randomization nutritional evaluation by an oncologic dietician. Conclusions: We present the first PRMC reviewed and IRB approved RCT evaluating the efficacy of HDMTM in metastatic cancer patients with primary endpoint of patient reported QoL. Investigating HDMTM expands our knowledge of nutrition as an effective arm of palliative oncology.
Molecular tumor profiling ordering trends in cancer patients.
Authors: Ma Joseph D. , Wang Winnie S , Yau Warren , Hagmann Chelsea , Revta Carolyn , Armstrong Janet M , Roeland Eric 
Published: February 2017

165 Background: Molecular tumor profiling may provide information as to whether to initiate or not initiate a targeted therapy. As to the timing of when the tumor profiling is ordered relative to date of diagnosis, date of death, and palliative care (PC) consultations are unknown. The primary objective of this study was to examine molecular tumor profiling ordering trends in the course of cancer illness. Methods: A preliminary, retrospective chart review was conducted in a cohort of patients with a confirmed diagnosis of cancer at an academic, NCI-designated comprehensive cancer center. Patients were identified from a tumor registry and then matched to a next generation sequencing molecular tumor profiling database. The date of palliative care consultation was collected from the electronic medical record. Differences in the date of when tumor profiling was ordered and date of diagnosis, date of PC consultation, and/or date of death were determined. Data were compiled into a single database and descriptive statistical analyses were performed. Results: A cohort of 397 (205 women) cancer patients was included. Metastatic disease was present in 108 (27.2%) patients, with mean±SD age of 58.7 ± 13.5 yrs. One-hundred and nine (27.6%) patients received a PC consultation (n=60 inpatient, n = 49 outpatient). As of February 2016, 119 (30%) patients died, with 58 (48.7%) out of 119 receiving a PC consultation. The difference between date of cancer diagnosis and date of tumor profiling ordered was 2467.4 ± 6865.7 days (n = 376), while the difference between date of tumor profiling ordered and date of death was 229.1 ± 185.7 days (n = 111). The difference between date of cancer diagnosis and date of death was 1507.5 ± 2002.1 days (n = 119). In patients were the tumor profiling was ordered before the PC consultation (n = 29), the difference between date of PC consultation and date tumor profiling ordered was 157.3 ± 258.1 days. In contrast, in patients were the tumor profiling was ordered after the PC consultation (n = 76), the difference was 194.6 ± 168 days. Conclusions: This analysis suggests that molecular tumor profiling is ordered at the end and not at the beginning of a cancer illness. PC consultations are not routinely performed in patients who participate in tumor profiling.
The estimated hospital-wide financial impact of a comprehensive inpatient palliative care (PC) program.
Authors: Isenberg Sarina , Lu Chunhua , McQuade John P , Razzak A. Rab , Gill Natasha , Cardamone Michael A , Torto Deirdre , Langbaum Terry , Holtgrave David R , Smith Thomas J. 
Published: February 2017

173 Background: Inpatient PC improves quality of care, patient and family satisfaction, and lowers costs. PC consultation during a cancer hospital stay led to a 14 (if by day 6) to 24% (by day 2) reduction in direct cost, and especially when people had comorbidities. (May, JCO 2015; Health Affairs 2016). We attempted to discern the financial impact of both a PC inpatient unit (PCU) and PC consultations on patients in other inpatient units for a large academic medical center, the Johns Hopkins Hospital (JHH), as we prepared to expand the PCU from 6 to11 beds and increased inpatient PC consultation capacity. Methods: We estimated the savings for an 11 bed PCU based on cost per day from FY 2015 with a 6 bed unit ($444 lower costs per PCU day compared to inpatient stay prior to transfer to the PCU). We then calculated the cost savings for an 11 bed unit operating at 80% occupancy. We estimated the direct cost savings of consultations by adjusting the $/discharge saved (Morrison, Arch Int Med 2008) to 2014 $ (by multiplying the $/discharge saved by 1.4 to adjust for medical inflation). Results: The PCU inpatient stays resulted in projected lower costs of $6.7M over 5 years ($444/day x 3009 days/year, or $~1.3M yearly). IP revenue and margins were small (data not shown). For PC consults of 785 alive discharges ($2197/case) and 97 decedent discharges ($6357/case), total estimated savings in direct costs per case are $2,530,000/year. The PCU allows for additional benefits not calculated in this analysis, including inpatient backfill opportunities, more appropriate ICU bed use, savings from increased referral to hospice (hospice referrals increased 340% in 3 years), and reduced readmission rates from increased PC and hospice use. Conclusions: In addition to improving quality of care and patient satisfaction, the combined IP and consult PC programs contribute to substantially lower charges and costs per day. Backfill revenue, the opportunity for increased revenue from improved patient satisfaction (HCAHPS) scores, and reduced readmission rates will increase this financial impact. [Table: see text]
Template-based high dose rate endobronchial brachytherapy for palliation of previously irradiated obstructive lung lesions.
Authors: Hrycushko Brian A , Chiu Hsienchang , Folkert Michael Ryan 
Published: February 2017

174 Background: Local progression after external beam radiation therapy (RT) for lung cancer may result in clinical compromise from bleeding and/or airway obstruction, and additional RT may be precluded by radiation tolerance. High-dose-rate (HDR) endobronchial brachytherapy (EBT) is an effective salvage treatment for airway obstruction and/or bleeding, but requires significant time and resources; planning and treatment are performed bronchoscopically under anesthesia. We sought to reduce procedure and anesthesia time for EBT through template-based planning. Methods: EBT templates were created using the Brachyvision version 11.0.47 treatment planning system for the Varisource iX Ir-192 afterloader. Plans were optimized for dose uniformity at distance from the source following planning criteria of published works. Nine endobronchial centering tube templates were created for treatment lengths from 2-10 cm (1cm intervals) prescribed to 0.5cm distance from the applicator surface. Results: Standard EBT treatment requires a median of 47 minutes (range 44-49 minutes); 5 minutes for applicator placement and fluoroscopic confirmation, 15-17 minutes for plan design and optimization, 20 minutes for quality assurance and plan check, 2-5 minutes for radiation delivery, and 2 minutes for room clearance and applicator removal. Pre-planned templates were evaluated for plan quality, and achieved >90% of the prescription dose for the entire treatment length at the respective treatment depth. Changes to the prescription dose could be achieved through dwell time scaling. Changes to the prescription depth require re-optimization of the plan with the current templates as a base. Use of template-based planning was expected to reduce overall treatment time by 8-9 minutes (16-20% reduction in overall procedure time, 50-56% reduction in treatment planning time); median observed treatment time was 35 minutes (range 32-38 minutes). Conclusions: Template-based HDR EBT treatment plans were developed for the palliative lung cancer program at our institution. Implementation of template-based plans resulted in reduced procedure and operative time, and are now our standard technique.
A provider-based quality improvement intervention aimed at improving appropriateness of radiation therapy regimens for patients with advanced cancer and painful bone metastases.
Authors: Walling Anne M. , Beron Phillip , Wenger Neil , Kupelian Patrick , Kaprealian Tania Betty , McCloskey Susan Ann , King Christopher R. , Steinberg Michael L. 
Published: February 2017

176 Background: Although guidelines suggest that shorter course radiation treatments for patients with advanced cancer and painful bone metastases are most appropriate, treatment patterns in the United States are inconsistent with this approach. Methods: We implemented a provider-focused intervention at a university-based radiation oncology practice aimed at improving rates of shorter-course radiation treatments for patients with advanced cancer and painful bone metastases. The intervention involved key leaders of the practice participating in a RAND/UCLA Appropriateness Panel to review the latest guidelines and evidence and judge appropriateness of various treatment regimens as it pertained to their practice. These results were compared to current (7/2012-6/2013) practice patterns and presented to the faculty group. This exercise informed a template-based point of care intervention led by a clinical champion and leadership that focused on key aspects of clinical and patient-centered care including whether the bone metastases were complicated or uncomplicated, patient prognosis, extent of disease, and travel distance for the patient to the treatment site. We compared rates of lower burden treatment regimens (less than 10 fractions) for 81 pre-intervention patients with 107 metastases treated between 7/2012-6/2013 and 75 post-intervention patients with 94 metastases treated between 5/2015-1/2016. Results: Overall, painful bone metastases were treated with less than 10 fractions more often in the post-intervention period (38% v. 63%, p < 0.001). Uncomplicated bone metastases treated with conformal radiation were also more likely to be treated with less than 10 fractions in the post intervention period (19% v. 52%, p < 0.001). One quarter of metastases were treated with SBRT during both the pre and post-intervention periods. Conclusions: Leadership support, provider engagement in integrating guidelines into practice, and a note template with point of care clinical reminders can improve rates of appropriate, low-burden radiation oncology treatments for patients with advanced cancer.
Supportive Oncology Collaborative: Initial impact of supportive oncology screening and care.
Authors: Lo Shelly S. , Wiebe Lauren Allison , Deamant Catherine , Scheu Amy , Roggenkamp Betty , Patel Urjeet , Khosla Pam , Robinson Patricia A. , Penedo Frank J. , Gerhart James , Dale William , Danciu Oana Cristina , Berardi Rosa , Weldon Christine B. , Trosman Julia Rachel 
Published: February 2017

180 Background: The Institute of Medicine (IOM) 2013 report recommends supportive oncology care from diagnosis through survivorship, to end of life. The Coleman Supportive Oncology Collaborative (CSOC) developed a city-wide plan to improve supportive oncology. Metrics derived from the Commission on Cancer (CoC), ASCO Quality Oncology Practice Initiative (ASCO-QOPI) and National Quality Forum (NQF) were used to assess the CSOC impact. Methods: Medical records of consecutive cancer patients from 6 practice improvement cancer centers in Chicago (3 academic, 2 safety-net, 1 public) were reviewed for 2 periods: 2014 (n = 843) and Q1 of 2015 (n = 313). Descriptive statistics assessed differences in quality metrics. Results: Significant improvement was achieved in 6 of 8 core supportive oncology metrics (see table). Conclusions: Consolidated metrics are feasible to assess supportive oncology quality. Early data indicate improvement and effectiveness of the collaborative approach. [Table: see text]
How can palliative care specialists best integrate into multidisciplinary oncology care for patients with metastatic breast cancer?
Authors: Kaufmann Tara Laura , Miller Melissa F , Buzaglo Joanne S. , Kamal Arif 
Published: February 2017

182 Background: Current evidence for palliative care/oncology integration derives from cancers with either very short prognoses or relatively limited treatment options (e.g. pancreas). Little is know about the role of palliative care in metastatic breast cancer, where prognosis may be measured in years and the treatment option portfolio is continuously expanding. Methods: The Cancer Support Community Metastatic Breast Cancer Experience Registry is a voluntary, patient-reported, online registry of patient experiences with cancer. We evaluated data reported by patients from March 2013 to March 2014. The registry includes demographic information and data regarding physical, emotional, social, and financial distress measured using Likert scales. We calculated descriptive statistics and Pearson’s chi-squared. Results: We evaluated 599 patients. The sample median age was 56; 93% were White; 61% had a bachelor’s degree or higher Median time from diagnosis of metastatic cancer was 3 years. Regarding physical distress, over 50% reported “moderate” or higher issues with sleep, nutrition and eating, and fatigue. Depression and anxiety prevalence increased by 15% and 20%, respectively, from pre-treatment to post-treatment. Among social distress, 25% felt alone, 62% worried about burdening their family, and over 50% limited contact with others. 30% or higher desired more assistance with: diagnostic and treatment information, making decisions, managing symptoms and emotions, and managing disruptions to family and work life. Respondents were more likely to have been asked about distress if they received part or all of their care at an academic or comprehensive cancer center (p < 0.001) or treatment through a clinical trial (p = 0.012). Conclusions: We identified a high prevalence of unmet needs across several supportive care domains. These areas of distress should be a targeted focus of palliative care and oncology integration to improve the care of patients with metastatic breast cancer.
Health care utilization and costs at end of life among patients with leukemia or lymphoma in a regional cancer registry-insurance claims linked database.
Authors: McDermott Cara L , Fedorenko Catherine R. , Kreizenbeck Karma L. , Conklin Ted , Smith Bruce , Lyman Gary H. , Ramsey Scott David 
Published: February 2017

184 Background: End-of-life (EOL) care for persons with hematologic malignancies is variable and often involves high-intensity services at death approaches, which may not reflect patient or family preferences. We characterized healthcare utilization and associated costs in the last 30 days of life among subjects with leukemia or lymphoma to better understand patterns of care in this population. Methods: We linked enrollment and claims records from two regional commercial insurers to Surveillance, Epidemiology, and End Results (SEER) records for patients diagnosed with leukemia or lymphoma in Western Washington state between January 1, 2007 and December 31, 2015. We developed algorithms to characterize EOL care and calculate costs from both the payer and patient perspective for the last 30 days of life. Costs are derived from paid claims for inpatient, outpatient, and pharmacy utilization. Patient out-of-pocket costs are calculated as the difference between allowed and paid claim amounts. Results: See Table. Conclusions: In this analysis, a majority of subjects usedat least one form of high intensity care in the last 30 days of life, and average out-of-pocket costs were considerable. Future research will focus on developing interventions to assess patient and family preferences for intensity of care to better inform the provision of high-value care in this population. [Table: see text]
Prevention of everolimus/exemestane (EVE/EXE) stomatitis in postmenopausal (PM) women with hormone receptor-positive (HR+) metastatic breast cancer (MBC) using a dexamethasone-based mouthwash (MW): Results of the SWISH trial.
Authors: Rugo Hope S. , Beck J. Thaddeus , Glaspy John A. , Peguero Julio Antonio , Pluard Timothy J. , Dhillon Navneet , Hwang Leon C. , Nangia Chaitali Singh , Mayer Ingrid A. , Meiller Timothy F. , Chambers Mark Steven , Warsi Ghulam , Sweetman Robert William , Sabo J. Randy , Seneviratne Lasikas 
Published: February 2017

189 Background: Stomatitis is a frequent adverse event (AE) associated with mTOR inhibition. In BOLERO-2 patients (pts) receiving EVE/EXE, all grade (Gr) stomatitis was 67%; 33% had Gr ≥ 2 and 8% Gr 3. Median time to ≥ Gr 2 onset was 15.5 days; incidence of new stomatitis (Gr ≥ 2) plateaued at 6 wks. In a meta-analysis, 89% of first stomatitis events occurred within 8 wks. Topical steroids are used to treat aphthous ulcers; anecdotal use as prophylaxis has been reported. Methods: Eligibility included PM women with HR+ MBC prescribed EVE/EXE. Treatment included EVE 10 mg and EXE 25 mg QD, with 10 mL of commercially available 0.5 mg/5 mL dexamethasone oral solution to swish x 2 min and spit QID for 8 wks starting day 1. Pts completed a daily adherence log, including an oral pain (range 0-10) and normalcy of diet score. The primary endpoint was to compare the incidence of Gr ≥ 2 stomatitis at 8 wks with BOLERO-2 results. Secondary endpoints included MW use by average times/day, EVE/EXE dose intensity, incidence of all Gr stomatitis and time to resolution to Gr ≤ 1. Results: 92 women were enrolled; 86 were evaluable for efficacy. Median age was 61 yrs (range 34-87); median dose intensity was 10 (range 3-10) and 25 mg (range 8-25) for EVE and EXE, respectively. 95% of pts used the MW 3-4 times/day (median MW use/day = 3.95, range 1.9-4). At 8 wks, the rate of ≥ Gr 2 stomatitis was 2.4% (2 pts) with a Gr 1 rate of 18.8%. A comparison of stomatitis incidence by grade between BOLERO-2 and SWISH is shown in the table. In the 75 patients with complete ECOG scores, 88% maintained/improved ECOG status. Mean pain scale score was < 1 at all visits; 88% of pts reported a normal diet at 8 wks. 13% discontinued EVE/EXE due to suspected related AEs (most common: rash, 2%; hyperglycemia, 2%; stomatitis, 2%; and pneumonitis, 1%). Conclusions: Prophylactic use of 0.5 mg/5 mL dexamethasone oral solution markedly decreases the incidence and severity of stomatitis in patients receiving EVE/EXE for MBC and should be considered a new standard of oral care in this setting. Clinical trial information: NCT02069093. [Table: see text]