bluuebunny/crossref_metadata_2025_split huggingface dataset:
Value metrics of a nurse navigator patient support program within a multidisciplinary esophageal cancer clinic.
Authors: Ross Helen J. , Freese Joy , Ciafone Denise , Ashman Jonathan Ben , Rule William G. , Jaroszewski Dawn E. , Harold Kristi L. , Paripati Harshita , Crowell Michael , Pannala Rahul , Faigel Douglas , Ramirez Francisco , Bright Robert , Fleischer David 
Published: February 2017

158 Background: Esophageal cancer patients (pts) require multidisciplinary management involving thoracic and general surgeons, medical and radiation oncologists, gastroenterologists and psychiatrists. Pts navigate complex medical discussions and endure challenges to nutrition, body image, swallowing mechanics, energy level and weight, mood, and performance status. Coordination of care is complicated by multiple sites of pt entry, complex scheduling requirements, and incomplete information at multidisciplinary consultation. A nurse navigator to coordinate the patient experience may optimize treatment and improve outcomes, quality of life and patient satisfaction. Methods: The nurse navigator evaluates all pt records prior to initial appointment and coordinates scheduling, records acquisition, testing and specialty appointments. The nurse navigator serves as a liaison with pts throughout the course of care and provides a patient navigation book (PNB) as a central source for patient-directed information and record keeping. Benchmarks compared before and after creation of the nurse navigator position include: (1) time from appointment request to multidisciplinary evaluation and start of treatment; (2) completeness of medical records and data (scans, pathology slides); (3) patient awareness of support services for themselves and caregivers; (4) utilization of the PNB; (5) number and frequency of interim hospitalizations and emergency room visits; (6) patient, caregiver, and physician satisfaction. Results: From January to July 2012, 27 gastroesophageal cancer pts have been followed by the nurse navigator. Most of these patients remain on active treatment, hence benchmark analysis is ongoing. Metrics thus far suggest improvement in time to treatment start and awareness of patient resources, use of the PNB and patient satisfaction. Conclusions: Esophageal cancer pts undergo complex and toxic multimodality therapy with curative intent. A dedicated nurse navigator may improve the patient experience, optimize adherence to guideline based therapy and appropriate timeframes and provide continuity to pts undergoing multidisciplinary treatment.
Use of advanced imaging and biomarker tests for post-treatment surveillance in early-stage breast cancer survivors.
Authors: Hahn Erin E. , Mody Kaizeen C. , Jacobson Amy Ann , Ganz Patricia A. 
Published: February 2017

168 Background: The American Society of Clinical Oncology (ASCO) released a “Top Five” list of opportunities to improve the quality of cancer care. #4 focused on post-treatment surveillance in breast cancer patients treated with curative intent. The ASCO guideline on breast cancer follow up advises against using advanced imaging and biomarkers in this setting. We undertook an examination of the patterns of follow-up care for breast cancer survivors treated at an academic medical center to evaluate use of non-recommended services. Methods: Claims data and medical records were reviewed and abstracted for early stage (0-IIIA) breast cancer survivors starting one year post diagnosis, with an average of 5 years of follow-up data. A trained abstractor classified imaging tests as diagnostic/surveillance based on medical record content. A 10% random sample was abstracted by a second abstractor and compared for concordance. Descriptive statistics were generated for patient demographic and medical characteristics, and proportions for receipt of non-recommended services, including if imaging procedures were performed for diagnostic/surveillance purposes. Multivariate logistic regression modeling was used to determine factors associated with receiving non-recommended services. Results: Records were available for 258 patients. The mean age was 62 (SD 13), mean time since diagnosis was 6 years (SD 2), 66% were stage 0/1. 35% received at least one abdominal CT, 31% at least one chest CT, 20% at least one PET, 30% at least one bone scan. Of these services, 90 abdominal CT scans (47%), 131 chest CT scans (65%), 77 PET scans (90%), and 29 bone scans (26%) were classified as surveillance. 80% received CEA and/or CA 27.29 tests; 8% received CA 15-3 tests. Logistic regression revealed no consistent association of medical, demographic, or provider factors with receiving non-recommended services. Conclusions: Use of non-recommended services for surveillance occurs frequently among early stage survivors. Providers in this academic center had no personal financial incentive for ordering these services. There are opportunities to increase use of guideline concordant post-treatment care for breast cancer survivors.
Adherence to guidelines for adjuvant chemotherapy (AC) use in stage II colon cancer (CC).
Authors: Cheung Winson Y. , Lim Howard John , Renouf Daniel John , Woods Ryan , Speers Caroline 
Published: February 2017

169 Background: Treatment guidelines suggest that AC may be considered inpatients (pts) with "high risk" stage II CC, defined by the presence of >/=1 poor prognostic features, such as obstruction or perforation, T4 stage, <12 lymph nodes retrieved, positive resection margins, and lymphovascular or perineural invasion. However, survival benefits associated with AC use in high risk pts remain largely unproven. Therefore, current recommendations are primarily driven by consensus rather than by evidence. Our aims were to examine population-based concordance with current guidelines for AC use in stage II CC and to explore the relationship between AC use and survival in high- vs. low-risk pts. Methods: All pts diagnosed with stage II CC in British Columbia from 1999 to 2008 and evaluated at 1 of 5 regional cancer centers were reviewed. Kaplan-Meier and Cox regression methods were used to correlate high- vs. low-risk status as well as receipt of AC with relapse-free (RFS), disease specific (DSS), and overall survival (OS). Results: We identified 1,697 stage II CC pts: 1,236 (73%) high risk and 461 (27%) low risk among whom only 363 (29%) and 61 (13%) received AC, respectively. Individuals with high risk features who received guideline-concordant AC were younger (median 62 vs. 72 years, p<0.001) and had better performance status (ECOG 0/1 47% vs. 34%, p=0.02). In the high-risk group, AC was associated with improved 5-year OS, but not with RFS or DSS. After adjusting for confounders, an OS advantage from AC persisted for high-risk pts (HR 0.67, 95 CI 0.52-0.86, p=0.002), but no significant RFS or DSS benefits were seen (HR 0.76, 95 CI 0.58-0.99, p=0.05 and HR 0.75, 95 CI 0.55-1.02, p=0.11, respectively). Subgroup analyses showed that only individuals with T4 lesions had improved RFS (HR 0.63, 95 CI 0.42-0.95, p=0.03), DSS (HR 0.59, 95 CI 0.37-0.93, p=0.02), and OS (HR 0.50, 95 CI 0.33-0.77, p=0.002). Conclusions: In this population-based cohort of stage II CC patients, less than one-third of high risk patients received guideline-concordant AC. Consistent survival benefits were only seen in those with T4 lesions, suggesting a very limited role for AC. Guidelines that are mainly consensus-driven and associated with minimal survival benefits have poor uptake.
Rates of bone mineral density measurement in men with prostate cancer starting androgen deprivation therapy.
Authors: Suarez-Almazor Maria , Peddi Prashanth , Luo Ruili , Nguyen Hoang , Elting Linda S. 
Published: February 2017

174 Background: Men with prostate cancer on androgen deprivation therapy (ADT) are at risk for accelerated bone loss and osteoporotic fractures. Current National Comprehensive Cancer Network (NCCN) guidelines recommend dual-energy X-ray absorptiometry (DXA) scan for risk assessment when starting ADT. Our objective was to determine if DXA scans were performed prior or soon after ADT initiation among men with prostate cancer. Methods: In this claims-based database linkage study, men with prostate cancer were identified fromthe Texas Cancer Registry between 2006-2007 and their records were linked with Medicare databases parts A, B and D to identify claims for ADT using generic names, predefined J codes and ICD codes. Part D claims are currently available for years 2007 and 2008. DXA claims were obtained using CPT/HCPS codes from Medicare part A and part B. Patients were considered to have undergone a DXA exam, useful as a baseline screening test for ADT therapy if a claim could be identified within 2 years before starting ADT therapy, or 6 months afterwards. Multivariate logistic regression models were performed to examine determinants of DXA use. Results: 1,647 men 65 years and older were included in the study. A total of 144 (8.3%) had a DXA scan obtained within 2 years and 6 months after initiation of ADT. Age older than 75 years, history of prior bisphosphonate usage and residence in the metropolitan area were statistically significantly associated with higher likelihood of obtaining DXA. Race, gender, median income, high school percentage, number of ADT claims, and type of ADT used were not associated with DXA usage. Conclusions: Despite the importance of osteoporosis screening, men with prostate cancer and Medicare insurance, in the state of Texas, had very low DXA utilization rates prior, or soon after, the initiation of ADT. Further research is needed to identify barriers to adherence to recommendations for the evaluation of bone health in patients with prostate cancer.
Compliance with NCCN guidelines in the management of extra-abdominal soft tissue sarcoma across the United States.
Authors: Wasif Nabil , Bagaria Sanjay Prakash , Ashman Jonathan Ben , Beauchamp Chritsopher P. , Gray Richard J. 
Published: February 2017

178 Background: Soft tissue sarcoma is a rare disease requiring multidisciplinary care for effective treatment. The National Comprehensive Cancer Network has developed guidelines for surgical resection and adjuvant therapy based on best available evidence. We sought to examine variance from these guidelines in treatment across the United States. Methods: The Surveillance, Epidemiology and End Results cancer registry was queried to identify patients undergoing surgery for extra-abdominal soft tissue sarcoma from 2004-2009. Coded variables signifying radical excision (RE) and the use of radiation therapy (RT) were correlated with stage of the primary tumor. Patients with metastatic disease, unknown size and unknown grade were excluded. Results: A total of 5,600 patients were identified with a median age of 61. Median tumor size was 8cm and most tumors were high grade (57% G3). Stage specific breakdown was as follows; Stage I 24%, Stage II 37% and Stage III 39%. Overall, 54% of patients underwent RE and 50% received RT, mostly in the post-operative setting (83%). The amputation rate was 4%. Although routine radiation therapy is not recommended for Stage IA and IB patients, 24% still underwent RT, whereas only 49% of Stage I patients were noted to have undergone a RE. Even though routine RT is recommended for Stage II and III tumors, 42% of patients did not undergo any RT, and only 58% underwent RE. On multivariate analysis predictors of RE were age <50 (OR 1.3, 95% CI 1.1-1.6), lower extremity tumor (OR 2.2, 95% CI 1.6- 2.8), Stage III, (OR 2.1, 95% CI 1.7- 2.6), and white race (OR 1.4, 95% CI 1.2- 1.8). Variance from guidelines was seen in 64% of patients. Conclusions: Significant heterogeneity and variation in the contemporary treatment for soft tissue sarcoma in the United States exists. Although low rates of RE may be related to coding discrepancies, rates as low as 54% are still a cause for concern. Overuse, and more importantly, underuse of RT is seen for a significant proportion of patients. If these trends are confirmed by further study, more effort will have to be directed towards compliance with appropriate treatment recommendations, perhaps by regionalizing sarcoma care.
Does a quality-of-care problem exist? Cancer Care Ontario practice pattern data and the recommendations of two lung cancer practice guidelines.
Authors: Brouwers Melissa C. , Makarski Julie 
Published: February 2017

190 Background: Practice-pattern data, evidence-based knowledge and transfer, and performance management strategies define Cancer Care Ontario’s quality improvement strategy. Knowledge products, such as practice guidelines, are intended to provide recommendations for practice, based on best available evidence, to improve quality of care and reduce variation in practice. Review of 2010-2011 Cancer System Quality Index (CSQI) data revealed complex practice patterns in treatment of non-small cell lung cancer patients with stages II and IIIa resected and stages IIIa and IIIb non-resected disease in Ontario. A multi-method study was initiated to understand the patterns, to identify if a quality of care problem exists and to propose improvements moving forward. Methods: Surgeons, medical oncologists and radiation oncologists from Ontario were invited to participate in a survey consisting of 6 areas of inquiry. A grounded theory approach was used to guide key informant interviews of purposively sampled clinicians and administrators. A more in-depth analysis of the CSQI data was planned. Results: Clinicians responding to survey provided positive assessments of PG recommendations and evidentiary base; perceptions of practice patterns were less problematic than hypothesized; estimates of benchmarks were highly variable; and assessments of barriers to recommendation implementation included slow referral process, lack of organization support and patients seen in practice not reflected in the evidence. From the interviews, 5 themes emerged: unique patient, unique physician, family, clinical team, and clinical evidence. Further analysis of CSQI data was not possible given limitations related to data collection. Conclusions: A perceived quality of care problem initiated this study. Concerns centred on significant proportion of patients receiving no treatment; modest percentage of patients receiving treatment that aligned with PG recommendations; and regional variation within each of the clinical care options. Our data show that defining a quality of care problem is significantly more complex than consideration of practice patterns alone.
Prospective synoptic template recording to assess for compliance of care with NCCN guidelines for breast cancer.
Authors: Adegboyega Titilayo , Landercasper Jeffrey , Linebarger Jared , Johnson Jeanne , Dietrich Leah L. , Driscoll Collin , Andersen Jeremiah , Go Ronald S. , Vang Choua , Marcou Kristen , Hudak Jane 
Published: February 2017

197 Background: There is a wide variation of compliance with National Comprehensive Cancer Network (NCCN) guidelines for diagnosis and treatment. Overutilization of preoperative testing and underutilization of adjuvant treatments have been documented. The former is associated with higher costs of care; the latter with poor patient outcomes. Prior reports of adherence to NCCN Guidelines contain methodological limitations due to lack of contemporary review and incomplete listing of reasons for non-compliance. This limits the “real time” analysis of breast cancer quality and delays action plans to address quality and cost issues of care. Methods: NCCN Guideline compliance was recorded prospectively by use of electronic synoptic templates for all newly diagnosed breast cancer patients treated at a single institution between January 2010 and December 2011. A retrospective review of the synoptic templates was then conducted. Accuracy of the synoptic auditing method was assessed as well as NCCN compliance and reasons for non-compliance. Results: A total of 312 new breast cancer patients who underwent surgery as initial treatment were identified. Compliance with NCCN Guidelines for preoperative testing, breast surgery and lymph node surgery was 98% (306/312), 99.7% (311/312) and 93% (290/312) respectively. Reasons for non-compliance include patient refusal, comorbidities, advanced age and overutilization of systemic imaging. There was 100% compliance to College of American Pathologist (CAP) molecular profile documentation for all breast cancer cases. There were two discrepancies noted between the prospective template reporting and medical record review. The average time needed to populate data into synoptic templates was less than 2 minutes per patient. Conclusions: Prospective auditing of adherence to NCCN Guidelines with electronic synoptic templates is accurate and time efficient. High compliance rates with NCCN Guidelines were demonstrated. Electronic synoptic NCCN templates potentially facilitate early recognition of quality gaps in compliance and provide a framework for peer performance comparison.
Utilizing QOPI in the quality improvement efforts of the NCI Community Cancer Centers Program (NCCCP).
Authors: Siegel Robert D. , Stallings Holley , Bryant Donna M. , Kadlubek Pamela , Borowski Laurel , Castro Kathleen M. , Clauser Steven B. ,   NCI Community Cancer Centers Program
Published: February 2017

208 Background: The NCCCP is a network of community based institutions from New England to Hawaii funded by the NCI. Quality of care is a priority of the NCCCP with participation in ASCO’s Quality Oncology Practice Initiative (QOPI) playing a fundamental role. QOPI provides a process for quality assessment but we have also used it as a measure of quality improvement (QI) network-wide. Using QOPI methodology, we have analyzed our performance twice a year in an effort to enhance our implementation of quality indicators relevant to program aims. Methods: A data sharing agreement allows individual practice QOPI data to be electronically sent to the NCI where it is aggregated with the other NCCCP QOPI participants. Data are presented via webinar within the network using a variety of QI strategies. For example, blinded site performance distributions are benchmarked against NCCCP national averages on specific indicators. High performing practices voluntarily present their QI initiatives and best practices to the network. The NCCCP Quality of Care Subcommittee then selects QI projects and areas to focus quality improvement efforts. Results: In Spring 2012, 44 practices affiliated with 25 NCCCP sites participated in QOPI, a consistent pattern since Fall 2010. The table below describes the percent compliance with certain QOPI measures for the NCCCP aggregate over time. Selected measures were perceived as having had suboptimal compliance in Fall 2010. Conclusions: QOPI is an effective tool for assessing quality within a network and for measuring quality improvement efforts. Best practices from within the network can be leveraged and disseminated to enhance the quality of cancer care. This methodology facilitates quality initiatives despite the logistical challenges of working with practices across the country. [Table: see text]
Peer-review of radiation treatment planning in a provincial radiation oncology program: A survey of current practice.
Authors: McGowan Thomas S. , Foxcroft Sophie , Brundage Michael Donald , Sharpe Michael , Gutierrez Eric , Warde Padraig Richard 
Published: February 2017

211 Background: The use of peer-review activities in oncology is not well described as a quality improvement process. We sought to describe current patterns of practice of radiation oncology peer-review across a large Provincial Cancer program and to identifiy barriers to its use. Methods: Ontario cancer centres were surveyed. Survey item responses were typically scored using a 10-point Likert scale. The survey was administered electronically with follow-up reminders as required. The use of free-text for comments elaborating on responses was encouraged. Results: Fourteen (100%) centres responded. All rated the importance of peer-review as at least 8/10 (10=extremely important). Detection of medical error and improvement of planning processes were the highest-rated benefits of peer-review (each median 9/10). Four centres (29%) conducted peer-review in more than 80% of cases treated with curative intent; six (43%) peer-reviewed at least 50% of curative cases. Five centres (36%) reported “always” or “almost always” conducting peer-review prior to the initiation of treatment. Variation was seen in which aspects of a case were typically reviewed (e.g., GTV “almost always” reviewed in 67%; contouring of organs at risk in 50%). Five centres (46% of those with regular peer-review) reported that 5% to 9% of peer-reviewed cases were flagged as requiring a change, whereas 3 centres (27%) reported that < 2% of peer-reviewed cases required a change to be made. Five centres (36%) recorded the outcomes of peer-review on the medical record. Thirteen centres (93%) planned to expand peer-review activities; the two factors rated as most limiting to expanding peer-review were a critical mass of radiation oncologists (median score 6/10), and prioritization of peer review by the program overall (median 5/10). Conclusions: Peer review in radiation oncology practices it is now widely used as a quality assurance activity in Ontario, identifies changes to improve quality in the individual case, and improves departmental process. The development of guidelines and standards for peer-review activities, coupled with effective knowledge translation activities are recommended.
Targeted agent use in patients with cancer at the end of life.
Authors: Hui David , Karuturi Meghan Sri , Tanco Kimberson Cochien , Kwon Jung Hye , Kim Sun Hyun , Zhang Tao , Kang Jung Hun , Chisholm Gary B. , Bruera Eduardo 
Published: February 2017

215 Background: Chemotherapy use at the end of life is considered an indicator of poor quality of care. The use of targeted agent has not been well characterized. In this study, we determined the frequency and predictors of targeted therapy use in the last 30 days of life. Methods: All adult patients residing in the Houston area who died of advanced cancer between September 1, 2009 and February 28, 2010 and had contact with our institution within the last three months of life were included. We collected baseline demographics and data on chemotherapy and targeted agents. Results: 816 patients were included: average age 62 (range 21 to 97), female 48% and White 61%. The median interval between the last treatment and death was 47 (interquartile range 21 to 97) days for targeted agents and 57 (26 to 118) days for chemotherapeutic agents. 116 (14%) patients received targeted agents and 147 (18%) received chemotherapy within the last 30 days of life. 43 (5%) patients received targeted agents had concurrent chemotherapy. The most common targeted agents in the last 30 days of life were erlotinib (n=25), bevacizumab (n=20) and rituximab (n=11). In multivariate analysis, younger age, hematologic, and lung malignancies were associated with increased targeted agent use in the last 30 days of life (Table). Conclusions: Targeted agents were used as often as chemotherapy at the end of life, particularly among younger patients and those with hematologic malignancies. Guidelines on targeted therapy use at the end of life are needed. [Table: see text]