bluuebunny/crossref_metadata_2025_split huggingface dataset:
Consensus development: Within general oncology practice, what constitutes high-quality palliative care delivery?
Authors: Bickel Kathleen Elizabeth , McNiff Kristen , Malin Jennifer , Abernethy Amy Pickar , Kurup Acheson Anupama , Shapiro Charles L. , Evans Tracey L. , Kamal Arif , Buss Mary K. , Lupu Dale , Broder Michael S. , Krzyzanowska Monika K. 
Published: February 2017

280 Background: Multiple studies illustrate the benefits of combined palliative and standard cancer care, but oncology practices need guidance to fill existing gaps in delivering high quality palliative care (PC) to cancer patients. As a first step, ASCO and the American Academy of Hospice and Palliative Medicine (AAHPM) sought to develop a consensus definition of which PC aspects are within the purview of general adult oncology practice in the United States. Methods: An ASCO and AAHPM steering group used existing publications to define 9 domains of PC in oncology: Symptom Assessment and Management (A&M), Psychosocial A&M, Spiritual and Cultural A&M, Communication and Shared Decision-Making, Care Planning, Appropriate Palliative Care and Hospice Referral, Coordination and Continuity of Care, Carer Support, and End-of-Life Care. Within each domain, key PC activities were itemized and described (e.g. pain assessment using a standardized scale at every clinical encounter), totaling 966 activities. A 31-member multidisciplinary panel participated in a modified RAND Delphi process, rating each activity on a 9-point scale according to 3 constructs: importance, feasibility, and scope of practice. Composite scoring categorized activities as either reasonably within scope of oncology practice, uncertain, or typically not in scope. Results: The response rate for each round was 94%. Notable panelist concerns included the breadth of palliative care practice, the varied access that oncology practices have to PC resources, and the varied individual knowledge and comfort with specific activities. Despite multiple small ranking changes between surveys, only 41 activities changed in scope of practice category. Of 966 activities, 62% were ranked as reasonably within scope of oncology practice, 36% were uncertain, and 2% were typically not in scope. Conclusions: Despite the diverse range of PC activities, panelists strongly agreed that more than half were reasonably within the scope of adult medical oncology practice. These items provide a foundation for improving palliative care delivery within an oncology practice, with suggestions for future performance measures and quality improvement activities.
Measurement of mutation-specific survival as a real-time cancer care quality indicator.
Authors: Warner Jeremy , Wang Lucy L. , Burden Joseph , Carney Pam , Sobecki Scott , Levy Mia Alyce 
Published: February 2017

30 Background: As targeted therapies become widespread in the treatment of cancer, tracking clinical effectiveness as a function of mutation status, outside of the research setting, is needed. We evaluated whether mutation-specific survival statistics could be derived in a completely automated fashion from electronic medical record data sources, for quality assurance and purposes preparatory to research. Methods: Patients with cancer mutation analysis obtained for clinical care at Vanderbilt University up to June 2013 were included. Informatics algorithms were developed to automatically extract tumor mutation status, cancer type, date of diagnosis, and date of death or date of last contact using multiple structured and unstructured clinical data sources including billing codes, narrative pathology reports, and the Social Security Death Index. Survival was modeled using Cox proportional hazards, stratified by mutation type; mutations occurring less than 10 times were aggregated into an “Other” category. Results: 2,636 out of 3,115,904 patients had sufficient data for inclusion. Date of death was recorded for 32% of patients; overall median follow-up was 19 months. The median mutation-specific survival for lung cancer and melanoma patients is shown in the Table. For lung cancer patients, EGFR mutation was associated with superior survival (HR 0.7, 95% CI 0.5-1, p = 0.05). For melanoma patients, GNAQ mutation was associated with inferior survival (HR 2.2, 95% CI 1.3-3.8, p = 0.006) whereas BRAF mutation was not statistically significant (p = 0.32). Conclusions: It is feasible to create survival curves based on cancer mutation status in a fully automated fashion for quality assurance and purposes preparatory to research. Further iterative improvements in the data extraction algorithms are continuing; updates will be presented. Future work will enable stratification by mutation subtype, treatment exposure, staging, and demographics. [Table: see text]
Patterns of referral to palliative care in clinical practice in patients with stage IV non-small cell lung cancer.
Authors: Karim Safiya , Ahmed Shahid 
Published: February 2017

39 Background: Recent evidence has shown that patients with stage IV NSCLC benefit from early referral to palliative care (PC). In August 2010, a landmark randomized control trial revealed that patients with advanced NSCLC, who received early PC, had better quality of life, mood and survival (NEJM 2010; 363:733-42). Our study aimed to determine pattern of PC referral in clinical practice, in patients with stage IV NSCLC before and after the publication of the trial, and to assess factors correlated with PC referral. Methods: The study population was comprised of a cohort of patients with stage IV NSCLC, diagnosed between 2009 and 2011, and referred to the Saskatoon Cancer Center. Logistic regression models were used to assess factors correlated with PC referral. Kaplan Meier method was used to estimate survival. Cox regression analyses were used to determine factors correlated with survival. Results: 215 patients with median age of 68 yrs (range: 40-92) and M:F of 108:107 were identified. 101 (47%) patients had comorbid illness, 100 (47%) had ECOG performance status <2, 136 (63%) were married/common law and 161 (75%) had symptomatic disease. 126/251 (58%) were referred to PC. 70/118 (59%) diagnosed before Sep 2010 were referred to PC compared with 56/97 (58%) diagnosed after Sep 2010 (p=NS). The median time to PC referral from date of diagnosis was 51 days (inter-quartile range: 19-155). 33% patients were referred within 4 wks of diagnosis. Symptomatic disease (odd ratio [OR]=3.7, 95% CI =1.8-7.5), bone metastasis (OR = 3.0, 95% CI = 1.6-5.6), and brain metastasis (OR=2.2, 95% CI =1.1-4.5) were correlated with referral to PC. Median survival of whole cohort was 4 months (95% CI: 3.1-4.8). 2nd or 3rd line therapy (Hazard ratio [HR]= 0.54, 95% CI:0.34-0.87), non-smoking status (HR= 0.58, 95% CI:0.38-0.87), chemotherapy (HR 0.64, 95% CI:0.46-0.89), and lack of symptoms (HR=0.68, 95%CI:0.48-0.96) were correlated with better survival. Conclusions: Our study shows that publication of the landmark trial did not influence the pattern of referral to PC at our center. Symptomatic patients and those with metastasis to brain or bone were more often referred to PC. No survival benefit was seen in patients who were referred to PC.
Implementation of a statewide quality assessment program for rectal cancer.
Authors: Hendren Samantha K. , McKeown Ellen , Wong Sandra L. , Oerline Mary , Campbell Darrell A. , Birkmeyer Nancy J. 
Published: February 2017

4 Background: The quality of surgical care for rectal cancer (RC) has been extensively studied in Europe; however, efforts in the United States are limited by the lack of detail about surgical care in available registries. We describe a unique quality assessment program for RC designed within the Michigan Surgical Quality Collaborative (MSQC), a collaborative quality improvement organization that includes community and academic medical centers. Methods: 10 MSQC hospitals contributed to this retrospective cohort study (2007-2012). Experienced nurse reviewers were trained to abstract cancer surgery-specific data from hospital medical records and local tumor registries. Five RC surgery-specific quality measures were designed based on literature review and current guidelines: adequate lymph node (LN) procurement (>=12); use of mesorectal excision; rate of margin positivity; use of neoadjuvant therapy for clinical stage II/III; and sphincter preservation rate for mid/upper RC. Results: 353 RC cases were studied (333 radical surgery, 20 local surgery). Participating hospitals varied in size (5 <400 beds), teaching status (6 major teaching, 2 minor teaching, 2 non-teaching), and urban/rural location (9 urban). Challenges encountered in the data abstraction training process included overcoming technical jargon in pathology and operative reports. Regular conference calls, access to a specialist for questions, and modifications to definitions helped overcome difficulties; 9 of 10 abstractors scored >90% correct on test cases. Analysis reveals wide variation between hospitals on quality measures. 75% of cases had adequate LN procurement (range by hospital 64-100%); mesorectal excision was performed in 76% of cases (38-97%); 9% had positive margins (0-17%); 94% of clinical stage II/III cases had neoadjuvant therapy (67-100%); and 86% of eligible cases had sphincter preservation (62-100%). Conclusions: A program designed to provide salient feedback to surgeons regarding RC treatment is feasible, and reveals that high-quality processes of care are not consistently used. These data suggest opportunities for process improvement. The program will be disseminated statewide for prospective data feedback and quality assessment.
Improving immunization (imm) rates among oncology patients and health care providers (HCP) through a partnership of continuing medical education (CME) and quality improvement (QI) in an NCI-designated comprehensive cancer center.
Authors: Leong Lucille A. , Mendelsohn Mary , Bruno Ted , Kagan Jean , Saavedra Crystal J. , Scales Wendy , Morgan Robert 
Published: February 2017

43 Background: Onc pts are at increased risk of vaccine (vac)-preventable diseases and suffer worse sequelae. Regulatory requirements demand imm of patients and HCP. There is a large practice gap among clinicians in awareness of imm guidelines, of pt imm status, and of the high risk of transmission from HCP to immunocompromised pt. Methods: From May 2012 to June 2013 the City of Hope CME coordinated a team of MDs, QI specialists, infection control, IT, nursing, and pharmacy in a QI CME initiative to increase the imm rates of pt and HCP by education (ed) to clinicians, pt and families. Multiple ed platforms were used (live CME meetings, web-based content, point of care applications, visual cues, clinician longitudinal self-assessment surveys, systems-based support tools, patient handouts) with emphasis on MD-friendly platforms. Results: >350 HCP participated in CME events (59% MDs, 18% RN). Analysis of ed and clinical outcomes is from 4 areas. (1) Change in HCP attitudes through self-assessment surveys shows an increase in clinician knowledge of types and timing of imm, in use of system-based tools (standard orders, vac computerized manager), and in involvement of pts in imm history and ed. (2) There was an increase of doses of influenza vaccines in pts (Sept-March, 2010-11/ 2011-12/ 2012-13: 1129/1480(31% increase)/1838(24% increase). (3) Respiratory viral testing of pts was done to assess number of confirmed infections. (4) Influenza vac rates of hospital workers improved with the largest increase in the medical staff (65 to 76%). Conclusions: This interdisciplinary CME initiative to improve imm rates among onc pts involved ed activities and system-based changes. Improvements were seen in areas of HCP attitude, performance, and acceptance of their own vac. 24% of the medical staff remain unvaccinated, raising both ethical and compliance challenges to reach the 2020 90% goal of Joint Commission. A gap remains in HCP attitudes regarding their own vac which may not be amenable to analytical-based CME. Use of other decision-making/learning styles is necessary for further progress. CA62505 and Pfizer.
Process improvement in breast cancer care: Is mammography volume associated with a greater need for process improvement?
Authors: Francois Teena L. , Weldon Christine B. , Trosman Julia Rachel , Dupuy Danielle , Marcus Elizabeth A. , Roggenkamp Betty , Schink Julian C. , Ansell David , Murphy Anne Marie 
Published: February 2017

45 Background: Chicago black women are 62% more likely to die from breast cancer than white women. Previous data from 39 Chicago hospitals suggested significant variation in mammography quality (Chicago Breast Cancer Quality Consortium, 2010). We developed process improvement recommendations for sites that participated in our care process assessment (Weldon CB, et al, ASCO-Abstract-6120-2012). This study was funded through a generous grant from the Susan G. Komen for the Cure Foundation. We compared improvement needs between high and low patient volume institutions. Methods: Using Deming’s PDCA cycle for continuous improvement, we created care process improvement recommendations for 25 Chicago institutions with the patient base averaging more than 50% minority patients (20 community, 3 academic and 2 public hospitals). Low mammography volume (< 5,000 mammograms/ year) was reported by 12 of the 25 sites. Recommendations are based on analysis across sites, literature, and input from institution staff. Thematic and statistical analyses were performed using simple frequencies and Fisher's exact test. Results: Improvement recommendations are classified into nine areas (see Table). We found that 100% (12/12) of low mammography volume institutions have specific improvement needs in 6 or more process improvement areas, as compared to 23% (3/13) of the high mammography volume institutions (p value > 0.0001). Conclusions: Lower volume mammography sites have a larger need for breast cancer care process improvements. [Table: see text]
Health care practitioner prescribing patterns and perspectives on oral chemotherapy management: A survey of cancer centers in Toronto, Canada.
Authors: Pasetka Mark , Day Larissa , Ford Maggie , Boudreau Angela , Giotis Angie , Ko Yoo-Joung , Gandhi Sonal 
Published: February 2017

48 Background: With an increasing number of patients receiving oral cancer therapies, evaluation of safe prescription practices, effective patient education, and toxicity monitoring of these agents is imperative. Methods: Multi-disciplinary oncology practitioners at several cancer centres in Toronto, Canada were surveyed using a web-based platform, to evaluate their prescription practices, use of patient education and symptom management tools, as well as their views on patient adherence and toxicity reporting. Results: Of 170 respondents, 43% were nurses, 34% were pharmacists, and 23% were physicians. Seventy nine percent considered patient education, medication adherence (76%), and toxicity management (78%) as “very important” components of oral chemotherapy management. Prescription methods varied: 59% of respondents used written prescriptions, 39% computerized physician order entry (CPOE), and 0% pre-printed orders, ≥50% of the time. Clinicians felt that patients report side effects from oral agents only “some of the time” (53%), and the most problematic toxicities were nausea (61%) and diarrhea (61%). Practitioners perceived the most common reasons for patient underreporting of side effects to be “fear of treatment interruption” (62%), and that “toxicities are part of the treatment” (66%). Seventy three percent of those surveyed felt individual counseling, follow-up calls (69%), and updated medication information (57%) would improve patient adherence and safety. Conclusions: A diverse group of surveyed oncology professionals expressed the importance of utilizing educational and toxicity monitoring tools for patients on oral cancer therapies, particularly as patients are thought to under-report symptoms. Prescription practices are variable, and CPOE use should be improved. The results of this survey will also be compared to a patient survey, to help develop better tools and policies to standardize practice, and improve patient adherence and toxicity management on oral cancer agents.
Implementing an innovation to improve coordination of care in breast cancer.
Authors: Bickell Nina A. , Franco Rebeca , Moss Alexandra , Lawrence Zoe , McAlearney Ann Scheck 
Published: February 2017

52 Background: Underuse of adjuvant breast cancer treatments delivered by different specialists may be worsened by fragmented care and improved by effective coordination. To improve care coordination and adjuvant treatment delivery, we assessed the challenges to and feasibility of implementing a web-based Tracking and Feedback (T&F) innovation in hospitals serving predominantly minority breast cancer patients. Methods: We interviewed 67 key informants [Clinical (n = 39), Administrative (n = 14), Clerical (n = 11), Other (IT, Social Work) (n = 3)] from 8 inner-city hospitals to better understand how organizational characteristics might impact coordination of care and implementation of the T & F innovation. We used the constant comparative method of qualitative data analysis and standard techniques to code the data. Results: We found considerable variability across hospitals’ abilities to coordinate and track care. All sites have multi-disciplinary Tumor Board meetings and active Quality Improvement departments. Yet, in several sites, specialty care remains siloed, quality improvement efforts focus on inpatient care and communications systems across outpatient specialties are poor. All hospitals have electronic medical records but they are not integrated and are unable to track requested referrals. Many physicians rely on follow-up appointments to ascertain treatment receipt but sites vary in their ability to address “no-shows.” Several rely on staff to manually identify and follow up “no-shows,” but many of these staff are overwhelmed with ever increasing tasks and responsibilities. While quality was important, several interviewees felt they were bucking an inflexible system and devised ways to work around the obstacles. Perceived successful coordination factors included strong clinical leadership, designated accountabilities, and flexibility of staff. Conclusions: As care integration is encouraged by federal law, specialty care silos and rigid communication systems still pose barriers to change. Our results suggest that a web-based T&F innovation must be tailored to individual hospital characteristics, and flexible to permit modification of care processes at the organization level. Clinical trial information: NCT01544374.
How is KRAS testing associated with treatment and supportive care for patients with metastatic colorectal cancer? VA national assist project.
Authors: Parikh Aparna Raj , Kim Benjamin , Pantoja Philip , Tisnado Diana M. , Ahluwalia Sangeeta C , Walling Anne M. , Asch Steven M , Lorenz Karl 
Published: February 2017

64 Background: EGFR monoclonal antibody (mAb) therapies improve quality of life and outcomes for metastatic colorectal cancer (mCRC), but only wild-type KRAS benefit from treatment. We evaluated KRAS testing and pharmacogenetic-guided treatment and supportive and end of life (EOL) care. Methods: Among a national random sample of 265 veterans diagnosed with mCRC in 2008 we evaluated KRAS testing, EGFR mAb therapy, supportive care using the Cancer Quality ASSIST indicators, and healthcare use. Three oncology nurses abstracted charts for care received 2008-2011. We linked chart to VA and Medicare administrative data and compared care received by KRAS testing and results. Results: 227/265 (85%) veterans died within 3 years and received an average of 48% of recommended supportive care processes. 96 / 265 (36%) underwent KRAS testing, of whom 41, 42, and 13 had wild-type, mutant, and indeterminant/unknown KRAS. 27/41 (66%) wild-type KRAS patients received an EGFR mAb; 18/45 (40%) patients receiving an EGFR mAb had mutant, indeterminant/unknown, or untested KRAS. KRAS testing was associated with increased systemic therapy but not differences in supportive care or intensity of care at the EOL. KRAS tested vs. not tested received hospice or palliative care (67 vs. 73%, p=0.55); any systemic therapy (96 vs. 40%, p<0.001) including new regimen in last month (0 vs. 6%); any chemotherapy in last 14 days of life (9 vs. 7%); and any acute care in last month of life (28 vs. 32%, p=0.78). Conclusions: KRAS testing was not performed for most veterans with mCRC in 2008, and EGFR mAb therapy was administered to many without wild-type KRAS. KRAS-tested patients were more likely to receive systemic treatments, and testing was not associated with greater intensity or inappropriate EOL care, and rates of such care were low among veterans.
The effect of guidelines, policy initiatives, and feedback tools on hospital adherence with the 12-node measure for colon cancer.
Authors: Paruch Jennifer L. , Merkow Ryan P. , Ju Mila H. , Winchester David Porter , Ko Clifford Y. , Bilimoria Karl Y. 
Published: February 2017

65 Background: Examination of > = 12 lymph nodes after colectomy is one of few surgical process measures. Several initiatives have targeted this measure; one tool developed by the Commission on Cancer (CoC) provides benchmarked feedback on hospital performance (CP3R). Our objectives were to (1) examine changes in measure performance over time in response to guidelines, policy initiatives, and feedback, and (2) identify hospital characteristics associated with failure to improve adherence. Methods: Patients having surgery for Stage I-III colon cancer (1990-2010) were identified from the National Cancer Data Base (NCDB). For hospital-level analyses, NCDB and American Hospital Association (2010) data were merged. Hospital CP3R use was obtained from the user log system. Multivariable logistic regression adjusted for age and tumor factors was used to identify hospital characteristics associated with adherence in 2009-2010 (> = 12 nodes in > 80% of patients). Results: The percentage of patients with > = 12 nodes removed increased from 31.5% in 1990 to 84.1% in 2010 (p < 0.0001). The percentage of adherent hospitals increased from 2.2% in 1990 to 70% in 2010 (p < 0.0001). The steepest increase in adherence occurred with introduction of CP3R. Median CP3R use increased from 5 to 57 logins annually (2005-2010). Hospital predictors of poor adherence included low volume, community hospital type, private ownership, rural location, and lower number of specialists (Table). Conclusions: Guidelines, policy initiatives, and feedback tools have helped dramatically increase adherence with the 12-node measure, but small, non-academic hospitals have been slower to improve. Additional efforts are needed to understand barriers and improve adherence at these facilities. [Table: see text]