bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of very early referral on the effectiveness of specialty cancer care management services for oncology patients in active treatment.
Authors: Gratias Eric J. , Lindholm Melissa , Rossof Arthur H. , Weininger Richard B. , Rausa Margaret , Schumacker Pamela , Hartley Steven , Richards Diane , Spangler David , Stern Debra , Reid J. Scott 
Published: February 2017

157 Background: Many patients receiving treatment for cancer experience high levels of morbidity and reduction in quality of life. Proactive specialty cancer care management programs can be offered to patients experiencing these challenges. These patients are most often self-identified, referred by a physician, or identified by claims from a commercial or government insurer or vendor. While earlier intervention of case management or palliative care services has been shown to improve outcomes for cancer patients, a variety of logistic challenges frequently interfere with early referral. Methods: All oncology patients obtaining regimen-based chemotherapy prior authorizations were referred for specialty cancer care management via the prior authorization process. Additionally, all oncology patients in active treatment or with active disease whose benefits included care management were eligible through standard referral mechanisms. Patient satisfaction scores were measured every 3 months for all patients enrolled in the program. The medical cost savings value of referral to the specialty cancer care management program was evaluated by comparing patients referred to the program within 30 days of diagnosis (very early referrals) against patients found between 30 and 120 days from the time of diagnosis. Results: Compared with patients referred through standard methods, patients referred to the specialty cancer care management team at the time of chemotherapy authorization resulted in a high percentage of very early referrals. Patients enrolled in specialty cancer case management within 30 days of diagnosis saved an average of $16,000 per surviving participant, or 30% more than patients referred between 30 and 120 days from diagnosis. Overall, patients engaged in specialty cancer case management are highly satisfied. Overall satisfaction with the nurse/case manager was 98%. Conclusions: Early referral of high risk oncology patients to patient-centered care management programs improves the overall patient experience while simultaneously reducing health care costs, and should be strongly considered for all oncology patients with high morbidity or mortality risk.
New primary palliative care (PC) model for community cancer clinics (CCC).
Authors: Santhosh-Kumar Cheruppolil R. , Gray Deborah , Struve Stephanie , Huibregtse Carol , Chen Qiaofang 
Published: February 2017

159 Background: Our CCC serving a mixed rural/urban population is part of a large integrated healthcare system in Eastern WI. The closest PC specialist/team is 45 miles away at one of the tertiary care facilities. To fill this service gap we implemented a primary PC model. An initial outpatient palliative care family conference (OFC) and use of cancer nurse navigators (CNN)are hallmarks of this program. Methods: The VLCC, housed in a standalone facility is staffed by two medical oncologists and one radiation oncologist and has an infusion center and a full-fledged radiation oncology unit with support staff, including cancer nurse navigators, research nurses, social workers, a clinical psychologist, a pharmacist, a nutritionist, a therapy dog and a chaplain. Specialized pain management teams and services like acupuncture and hypnotherapy are readily available in the community. The patients have had access to multiple clinical trials since 2004. A team of a physician champion, a CNN and a social worker prioritized the needs and designed a program with support from system leadership. A CNN took additional training in PC. Funding from a research grant provided support for an occupational therapist (OT). Difficulties in communication was identified early as a barrier to integration of PC. OFCs were designed and conducted to discuss multiple domains of palliative care and referrals were made to different services. Pre and post enrollment surveys were administered. The following flow diagram was used (see Table). Results: In 2015, of 334 new patient visits for all stages of cancer, 32 were managed through the new PC model. Patient satisfaction scores were near 100%. Detailed methodology and data analyses will be presented. Conclusions: A successful new model of early integration of PC that is easily replicable in communities without access to specialist PC services is presented. [Table: see text]
Addressing resource allocation for advance care planning discussions in hospital.
Authors: Wong Aaron Kee Yee 
Published: February 2017

16 Background: Advance care planning (ACP) is fundamental in quality palliative care. There is no data detailing the demand for ACP discussions in hospitals, nor any standard objective criteria to decide urgency of such discussions. This cross-sectional study addresses this by comparing the ability of two commonly used instruments to detect palliative patients, and to predict death in the current admission. Methods: All inpatients were censored from the largest tertiary hospital in the state on a single inpatient day. 475 patients were followed for 3 months or until discharge or death, whichever earlier. Quan-modified Charlson score (QCS) and the Palliative Prognostic Score (PaP) was identified for each patient. These instruments were chosen based on external validity and ease of scoring. Results: See Table. 134 patients were identified as palliative (using Gold Standards Framework Indicators). 40 patients died. Both instruments were highly specific in detecting palliative patients and deaths but not sensitive, meaning they predicted patients who were palliative or died that admission. PaP>5.6 was most sensitive test to detect death in current admission. Conclusions: Despite poor sensitivity, the most sensitive instrument (QCS) detected many patients requiring ACP discussion on a single day in hospital, highlighting the demand for ACP-trained staff. Secondly, streamlined usage of these instruments may assist in prioritising resource allocation. The QCS could identify patients needing ACP discussions (despite poor sensitivity, still identified many patients), whereas the PaP > 5.6 could refine the prioritisation of such discussions. This strategy could assist in reaching as many patients as possible using current staffing levels. [Table: see text]
PathWell: The development of a triage center and access hub for comprehensive palliative care in oncology.
Authors: Ramchandran Kavitha , Tribett Erika Lauren , Winget Marcy , Webster LaTisha , Valmayor Dorothy , Lunger Jenna , Falconer Patricia 
Published: February 2017

162 Background: Routine screening to identify palliative care (PC) needs, followed by assessment and management of needs is critical for high-quality cancer care. Our current healthcare system there is poor screening for PC needs, low referral rates to PC services, and unmet needs. In response to these gaps, we developed a dedicated triage center to streamline the assessment of PC needs and better connect patients with appropriate supportive care services. Methods: We identified 24 services at our academic cancer center that provide PC and supportive services. Examples include PC, psycho-oncology, survivorship, nutrition, and social work. Representatives from these groups convened to map service overlap and develop referral structures based on patient need and acuity. A triage hub (PathWell) was established to complete uniform assessments of patient needs and determine appropriate referrals. The hub utilized a centralized scheduling platform, new patient coordinators, and an oncology nurse for assessment and triage. Referrals to the hub were made via EHR, direct patient contact, or prompted by routine distress screening. Results: PathWell launched on February 1, 2016. Referral volume to the hub was 54 in February, 91 in March and 74 in April. Referrals from PathWell were distributed amongst the 24 services, the majority of referrals going to PC, psycho-oncology and nutrition. All programs that were part of the triage center experienced growth in volume; PC 41%, psycho-oncology 14%, nutrition 16%. Conclusions: Partnerships between specialist services and dedicated triage staff can improve early access to resources for PC needs. Early data from PathWell reveals improved assessment and management of patient needs via referrals to appropriate services. The hub has also unveiled important resource gaps (e.g. physical therapy, integrative medicine). These gaps were not previously quantified, and thus not prioritized by leadership. Future state for PathWell includes reporting operational and health-related outcomes, optimizing distress screening, establishing care pathways for patient subtypes (e.g., metastatic disease), and hosting interdisciplinary tumor boards for complex distress management.
Palliative care interventions and end-of-life care outcomes for hepatocellular patients (pts) at two Veterans Affairs (VA) medical centers.
Authors: Wang Zhen , Lee Sarah , Kothadia Sejal , Wang Yucai , Chang Victor Tsu-Shih , Park Yeun-Hee Anna , Olson Ellen , Klein David , Zhong Fengming 
Published: February 2017

164 Background: Palliative care interventions and their effect on EOL outcomes for liver cancer pts have not been described. We investigated the association between palliative care intervention and EOL care outcomes. Methods: We reviewed the charts of pts with hepatocellular carcinoma and who were seen by palliative care at 2 VA medical centers from 2006 to 2012. We investigated the association between EOL outcomes (number of ER visits, ICU visits, chemotherapy, place of death, number of hospitalizations during their last 30 days), and interventions such as early referral (within 30 days of diagnosis), defined goals of care, holding a family meeting, and symptom assessment and management. The protocol was reviewed by the IRB of both VAs and analyses were done with SAS Studio v3.4. Results: 82 charts were reviewed (30 from EOVA and 52 from BVA). All Pts were men; 30 (39%) were white and 47(61%) African American. Interval from diagnosis to palliative care consult was 68 days (median). 72 (90%) pts were not aware of their diagnosis. 48 (65%) were not aware of prognosis. 65 (88%) had decision making capacity. 32 (39%) pts were DNR/DNI. 60 (86%) pts chose symptom management and 10 (14%) life prolongation. 47 pts (50%) had family meeting. In the last month, 35 pts (48%) had ER visit. 9 pts (12%) had ICU visits, 4 pts (5%) had chemotherapy and 48 pts (71%) had at least 1 hospitalization. 68 (85%) underwent symptom assessment. Most frequently treated symptoms were pain (78%), nausea (27%), constipation (46%), dyspnea (34%). Significant associations were found for early referral and ER admissions (OR = 3.2, p = 0.0178), family meeting and site of death (OR = 0.136 p = 0.0037), family meeting and number of hospitalizations (OR = 0.2652, p = 0.0169). Pts choosing symptom management and who had family meetings associated with hospice/home as place of death (chisq = 5.7368, p = 0.016). Knowledge of prognosis was not associated with site of death. Conclusions: In this population, many palliative care interventions were performed. Early referral, family meetings were significantly associated with site of death, ER admissions, and number of hospitalizations. These results should be replicated in larger studies.
Impact of financial burden on information and opportunity for cancer (ca) patients' (pts) participation (par) in clinical trials (cts).
Authors: Mitchell Edith P. , Dornsife Dana 
Published: February 2017

166 Background: The degree to which cancer caused financial problems may influence ca pts par in cts and negatively impact quality of life (QoL). Financial burden of cts par, may include finding an appropriate trial, traveling to the trial site, paying for travel, lodging and some medical expenses. The Lazarex Cancer Foundation (LCF) was founded in 2006 with mission to improve care, giving hope, dignity, and life to advanced ca pts by providing assistance with options and costs to cts par, community outreach, and education. LCF developed processes to removing the barriers to cts par by improving equitable access to cancer care, increasing cts enrollment, retention and minority par, and increasing cts referrals. Methods: To determine the extent of benefit of LCF, we conducted a retrospective analysis of LCF beneficiaries participating in cts by reviewing and summarizing the #pts, states and countries of residence, age, type of cancer, location and distance to cts site, type of assistance, and #of advocacy/outreach. Results: From 1/01/2010 – 12/31/2015 1479 pts were assisted; age range 4-86 yrs, median 50-60; 638(43%) male, 790 (53%) female, 51 (3.4%) undeclared. 434 did not give racial/ethnic identity; of 1045, 67 (6.4%) were African American, 108 (10.3%) Hispanic, 38 (3.6) Asian Pacific Islander, other 22 (2.1), and Caucasian 760 (72.7%) –total minority 235 (22.5%). Pts resided in 49 states with largest CA-280, TX-131, MA-119, FL-81. Cts were at 115 sites; 38 NCI CCC, 8 NCI DCC. The most common diagnoses were breast-116, leukemia-87, colorectal-48 and many rare type tumors. The median household income was $75,000. Financial assistance to travel to and living expenses at the cts site was the most frequently identified need. Conclusions: Relieving pts of financial burden allows greater access to and participation in cancer clinical trials. Further research and greater resources are needed to define the patient needs and determine methods to eliminate and remove barriers to enrollment and retention. Future research should investigate coverage thresholds that minimize adverse financial outcomes and identify ca pts at greatest risk for financial toxicity to increase par in cts and enhance QoL.
Palliative care and palliative radiotherapy education in radiation oncology: A survey of US radiation oncology program directors.
Authors: Wei Randy , Colbert Lauren , Jones Joshua Adam , Kane Gabrielle , Racsa-Alamgir Margarita , Vapiwala Neha , Dharmarajan Kavita Vyas 
Published: February 2017

178 Background: To assess the state of palliative care education curricula in radiation oncology residency programs in the United States. Methods: We surveyed 90 program directors of radiation oncology residency programs in the United States from September 2015 to November 2015. An electronic survey on palliative care education during residency was sent to all program directors. The survey consisted of questions on perceived relevance of palliative care in radiation oncology residency, formal didactics on domains of palliative care, effective teaching formats for palliative care education, and perceived barriers for integrating palliative care into the residency curriculum. Results: Sixty-three percent (57/90) residency program directors completed the survey. Most (93%) program directors agree or strongly agree that palliative care is an important competency for radiation oncologists. A vast majority (90%) of programs have dedicated palliative care services; however, only 57% of programs offer residents an opportunity to spend elective time on a palliative care service. Of these programs, only 30% reported residents rotating on a palliative care service in the past two years. Furthermore, 67% of residency programs have formal educational activities in principles and practice of palliative care. The palliative care curriculum included faculty-led lectures (73%), resident-led lectures (42%), and seminars (22%). Most programs have one or more hours of formal didactics on management of pain (66%), management of neuropathic pain (64%), and management of nausea and vomiting (64%). 35%, 46%, and 48% programs had one or more hours of management of non-physical symptoms including fatigue, anorexia, and anxiety, respectively. Conclusions: Residency program directors believe that palliative care is an important competency for their trainees. The survey revealed that many programs have structured curricula on PSC and palliative radiation education, but that there are still areas for improvement.
Advance care planning and specialty palliative care utilization for patients with hematologic malignancies who undergo allogeneic hematopoietic cell transplant.
Authors: Schoenbeck Kelly L. , McNey Lisa M. , Eckhert Erik , Galligan Derek , Mannis Gabriel N. 
Published: February 2017

18 Background: Unlike most metastatic solid tumors, many advanced hematologic malignancies are treated with curative intent. Accordingly, aggressive interventions often continue until late in the disease course because it can be difficult to discern when cure is no longer possible. This is particularly true for recipients of allogeneic hematopoietic cell transplant (alloHCT). We hypothesized that alloHCT recipients and their providers would be less likely to utilize specialty Palliative Care (PC) services or to engage in early communication regarding advance care planning. Methods: This was a single-center, retrospective chart review of all alloHCT recipients at the University of California, San Francisco who died between 2012-2016. Patients were excluded if there was insufficient data available for analysis. Results: Of the 122 alloHCT deaths identified, 75 met inclusion criteria. The median age at alloHCT was 55, and most patients were Caucasian (69%), were transplanted for acute leukemia or MDS (77%), and received a well-matched allograft (81%). 57% died from disease relapse and 20% died from treatment-related causes. 61% of alloHCT recipients died in the hospital, with 37% dying in an ICU. 52% of patients received chemotherapy within 2 months of death, and 17% within 2 weeks. While 79% of patients were DNR/DNI at the time of death, the median time from change of code status to death was 4.5 days. 80% of patients had no prior code status documented in an outpatient note, and a specific goals-of-care conversation was documented in < 25% of outpatient charts. The PC service was consulted for the majority of patients (57%), although the median time from consultation to death was 13 days, with 23% of all consultations occurring within 3 days of death. Only 16% of patients accessed specialty PC services more than 30 days prior to their death. Conclusions: Despite high rates of both disease- and treatment-related mortality, as well as significant morbidity associated with alloHCT, recipients of alloHCT at our institution infrequently engaged in early conversations about end-of-life care and rarely utilized specialty PC services more than 1 month prior to dying.
Effect of supportive care consultation on reducing 30-day readmissions to oncology inpatient services at an academic hospital.
Authors: Knestrick Mark W. , Grey Carl , Kodali Dheeraj , Wen Sijin , Craig Michael D. , Moss Alvin Howard 
Published: February 2017

181 Background: Decreasing 30-day hospital readmissions is an important quality care measure and signifies high-quality care. This study seeks to identify the benefits of Supportive Care consultations on 30-day readmissions to oncology inpatient services in an academic hospital. Methods: A retrospective review of all patients that had at least one 30-day readmission to the medical oncology or hematological malignancy service during a 2 year period (2011-2012). Data was collected on age, sex, cancer type, stage, number of readmissions, and presence of inpatient Supportive Care consultation. Results: During the study period 410 patients were identified with at least one 30-day readmission to an oncology service. Patients with a supportive care consult, 111 (27.7%), had an average of 2.5 readmissions and patients without a consultation, 299 (72.9%), had an average of 2.0 readmissions (p = 0.014). After Supportive Care consultation a reduction of 0.87 admissions (p < 0.001) was observed. Stage IV disease was observed in 203 (49.5%) of patients studied. Conclusions: Supportive Care is often consulted for patients with significant symptoms and suffering during advanced illness. The higher observed average readmissions in patients seen by Supportive Care may reflect the complex assistance needed by this patient population. This study demonstrates a benefit of Supportive Care consultation in reducing 30-day readmissions after consultation.
Symptom distress and patterns of palliative-care referral among oncology outpatients.
Authors: Christianer Kaylan , Blinderman Craig D 
Published: February 2017

185 Background: The early implementation of palliative care services is recognized as an important aspect of oncologic care. However, rates of referral to palliative care services among oncology patients are still low, and the decision to refer is frequently at the discretion of the treating oncologist or by patient request. We sought to better identify the patterns of referral to outpatient palliative care, as well as patient symptom burden in an effort to target early and high-yield palliative care interventions. Methods: We conducted a cross-sectional survey among outpatients presenting to a Hematology/Oncology practice at a tertiary care hospital. Patients presenting to the clinic were asked to complete an Edmonton Symptom Assessment Scale (ESAS) survey at time of registration. Chart review was completed to identify basic demographic information, timing and extent of cancer diagnosis, basic medical and psychiatric comorbidities, and existing referral to palliative care services. Results: Between November 15, 2014 and December 24, 2014, a total of 146 complete surveys were collected from oncology outpatients. The most common malignancies were hematologic (40.4%), lung (24.6%), breast (8.2%), gastrointestinal (6.8%) and genitourinary (6.8%); 30.1% had metastatic disease at the time of the visit. A total of 13 patients (8.9%) were receiving outpatient palliative care services. As compared to patients not receiving palliative care services, those who were reported higher overall symptom distress scores (26.3 vs. 12.7, p = 0.013) and pain scores (3.5 vs. 1.6, p = 0.03). Patients receiving palliative care services also had fewer years since diagnosis (2.8 years vs. 4.5 years, p = 0.028), and a non-significant trend toward higher rates of metastatic disease (72.7% vs. 47.3%, p = 0.059). Conclusions: Overall, low rates of referrals to palliative care were found among oncology outpatients. In addition, this study suggests oncology patients are referred to palliative care at later stages of disease, when they are already experiencing significant symptom burden. Future research will determine which patients will benefit from earlier referrals to palliative care before symptoms become more advanced.