bluuebunny/crossref_metadata_2025_split huggingface dataset:
Designing and implementing a payment system to support cancer care coordination: A literature review.
Authors: Girault Anne , Gerves-Pinquie Chloe , Minvielle Etienne 
Published: February 2017

40 Background: Demands for new payment systems to better coordinate services along the care continuum are emerging in oncology. Among them, bundling payments for defined episodes of care are considered as a promising payment option. The study objective was to understand how to develop an optimal payment system in order to foster coordination between hospitals and post-acute providers, and to identify potential pitfalls associated with its implementation. Methods: We conducted a literature review, exploring articles published between 2010 and 2015 in Medline. 47 papers were finally retrieved, including 18 articles focusing on cancer care. Results: The review highlighted key issues in the design and implementation of an alternative payment model in oncology. First, some studies explained that the level of integration of the different stakeholders would condition the choice of the payment design. They advised that the enrolled caregivers had a prior experience of working together so that the payment could rely on already formalized care processes. Second, most papers insisted that healthcare professionals had to be included since the design phase to agree on a standardized care pathway that would be consistent with current guidelines. To do so, focus groups and semi-structured interviews conducted with professionals from the enrolled facilities, as well as payers and patient associations, were favored. Third, the review showed that economic evaluations were necessary to have an understanding of the episode costs and determine gain-sharing arrangements between caregivers as well as their respective financial accountability. Using a micro-costing approach and adopting a societal perspective to estimate direct, indirect and intangible costs were demanded. Contingent evaluations measuring professionals’ willingness to participate in the payment scheme could serve as complementary analyses. Conclusions: The adoption of a new payment system would be strongly dependent on the design choices and implementation processes. A pilot study assessing its effectiveness in cancer care should bring important knowledge for policymakers willing to develop value-based payment systems in oncology.
Early impact of the Affordable Care Act (ACA) on financial worry.
Authors: Davidoff Amy J. , Hu Xin , Parsons Helen M. , Zheng Zhiyuan ,   Interagency Consortium to Promote Health Economics Research on Cancer (HEROiC)
Published: February 2017

44 Background: We examined changes in financial worry for working-aged cancer survivors compared to individuals without a cancer history (controls) after ACA-mandated health insurance enrollment and caps on cost-sharing were implemented in 2014. We hypothesized that cancer survivors would be more likely to report financial worry, and that ACA implementation would reduce financial worry. Methods: We pooled data from the 2013-2014 National Health Interview Survey for adults aged 21-64 years. Cancer survivors were identified based on self-report of ever being told by a physician that they had cancer (excluding non-melanoma skin cancer). Reports of worry about eight financial matters were dichotomized as “very worried” vs. “less worried”; a summary measure captured reports of being “very worried” about any item. Linear probability regressions assessed the impact of being a cancer survivor and the post-ACA period on high financial worry, controlling for demographics and health status. Interaction terms between cancer and post-ACA tested for differential ACA effects for cancer survivors. Results: Compared to controls (n = 50,304), cancer survivors (n = 2,192) were more likely to report being very worried about finances pre-ACA (46.7% vs. 39.6%) and post-ACA (42.3% vs. 36.0%). The ACA was associated with an adjusted 3.9 (CI: 2.9-4.9) percentage point (PPT) decrease in the probability of financial worry overall. Being a cancer survivor was associated with increased likelihood of being very worried about finances overall (PPT = 3.5, CI: 0.8-6.2), medical costs associated with a serious illness (PPT = 3.4, CI: 0.9-5.9) and normal healthcare (PPT = 3.4, CI: 1.1-5.7), having enough money for retirement (PPT = 2.4, CI: 0.0-4.8), and being able to maintain an enjoyable standard of living (PPT = 2.5, CI: 0.3-4.7). The ACA did not affect financial worry for cancer survivors differently than for controls. Conclusions: The ACA was associated with small but significant reductions in financial worry for working-aged adults, with similar effects for cancer survivors and controls. Cancer survivors were more likely to report financial worry, and worried about both paying for healthcare and the ability to maintain an adequate financial position in the short and longer run.
Making steps to decrease emergency room visits in patients with cancer: Our experience after participating in the ASCO Quality Training Program.
Authors: Hunis Brian , Alencar Alvaro Jose , Castrellon Aurelio Bartolome , Raez Luis E. , Guerrier Vedner 
Published: February 2017

51 Background: Overutilization of emergency room services by oncology patients is a known problem associated with increased admission rates and health care expenditure. A review of our oncology patients’ emergency room (ER) visits from January to May 2015 demonstrated that 48% of ER visits happened during office hours. Consequently a rapid cycle quality improvement project was developed with an aim to decrease ER visits by 30% by September 2015. Methods: A multidisciplinary team completed an action plan, starting with a project charter and definition of aim statement. A process map for patient scheduling/triage was created. A cause and effect diagram helped identify potential causes patient utilization of the ER. Diagnostic data were obtained querying our EMR (EPIC) for ER visits from January to May 2015. A Pareto chart identified Breast, Hematology and GI malignancies as main diagnosis utilizing the ER. Plan-do-study-act (PDSA) #1 began with development of a protocol to guide the handling of patients' calls that could previously resulted in an ER visit. Staff from the patient access center (PAC), a telephone operator service, and physicians’ offices were trained on its application. PDSA #2 focused on patient education to the importance of contacting the PAC for any concern or symptom related to active chemotherapy treatment. Results: The implementation of a triage system at our PAC resulted in a 60% decrease in the number of patients utilizing the ER, which met our goal. Patients’ calls to the PAC have increased. Two new materials were developed: a telephone triage form categorizing the patient’s complaint and the resulting action by our PAC center staff, and a patient Clinical Intervention Triage Tracking Log which allowed for the tracking of all patients triaged, their data, and the responsible team member. Conclusions: This study suggests that the development of a tool to properly identify and address emergent chemotherapy symptoms without utilizing the ER during working hours resulted in an intervention that positively affected the pre-specified endpoint.
Multidisciplinary optimization of oral chemotherapy delivery at the UW Carbone Cancer Center.
Authors: Mulkerin Daniel , Mably Mary , Bergsbaken Jason , Schuhmacher Kari , Nemergut Chris , Bohler Aaron , Fischer Jessica 
Published: February 2017

58 Background: Use of oral chemotherapy is expanding and offers advantages but introduces unique safety challenges. ASCO and ONS addressed these issues with inclusion of oral chemotherapy in published chemotherapy administration safety standards. Methods: The updated ASCO/ONS standards offered a framework for the University of Wisconsin Carbone Cancer Center to evaluate and improve our practice with the goal of full compliance with these standards. Gap analysis revealed noncompliance with five and partial compliance with eleven standards. We divided areas for improvement into three foci: patient education, workflow, and information technology. Multidisciplinary groups addressed each area generating twenty-five recommendations. Important changes included: defining chemotherapy, standardization of patient and caregiver education, mandated use of standardized electronic order sets incorporating safety checks, and standardizing dose modification documentation. The revised electronic process allows for prospective order review of all oral chemotherapy by pharmacists and supports automated processes for assessing adherence and toxicities utilizing a library of scripted drug specific materials. Results: Prior to implementation of new processes we estimated that only 39% of our oral chemotherapy was delivered with potential demonstrable compliance with ASCO/ONS standards. Audit of oral chemotherapy orders from February to July 2015 now shows compliance with use of electronic chemotherapy plans in 244/251 (97.5%) of cases. Prospective pharmacist order review resulted in one or more interventions in 24% of these cases.Identification of patients to receive adherence and toxicity monitoring calls is 100%. Conclusions: Closure of significant gaps between institutional practice and published standards was accomplished for our oral chemotherapy practice. Key elements of success included: multidisciplinary approach, defining chemotherapy, leveraging our electronic health record with mandated use of standardized order sets, and standardization of clinical and educational processes. We are disseminating this approach across our regional network and we believe our tools are broadly applicable.
Do informed patients have different CIPN outcomes? Results of a Research Advocacy Network survey.
Authors: Smith Mary Lou , White Carol B. , Railey Elda , Bellucci Robert , Thompson Cara 
Published: February 2017

60 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is common in cancer patients (pts). CIPN impacts quality of life (QoL) and causes emotional distress and treatment (Tx) delays. No agents are recommended for prevention and one agent is recommended for Tx of CIPN (ASCO Guidelines, 2014). Limited data exist about pt experiences with CIPN. The study goal was to understand pt experiences related to CIPN. Methods: An online, 67-question survey was completed by pts with breast or lung cancer. All had chemotherapy and self-reported moderate (mod) or severe CIPN within the past 2 years (mild CIPN excluded). Pts rated CIPN symptom frequency, socioemotional wellness, and impact on a 6- or 7-point scale (depending on item) and bothersomeness on a 5-point scale. Results were not analyzed by chemotherapy type. Results: Respondents had early breast cancer (EBC; n = 114), metastatic breast cancer (MBC; n = 96), or lung cancer (LC, all stages; n = 65). All EBC and MBC and 72% of LC pts were women; > 80% were White. Moderate CIPN existed in 63%, 67%, and 82% of EBC, MBC, and LC pts; severe CIPN occurred in 37%, 33%, and 18%, respectively. CIPN severity was associated with reduced QoL. Very/extremely bothersome effects on QoL occurred in 63% severe CIPN (n = 86) and 15% mod CIPN (n = 189) pts. Almost all EBC (94%) and two-thirds of MBC and LC pts had persistent CIPN. Symptoms included foot (97%)/hand (88%) numbness/tingling, foot (92%)/hand (81%) discomfort, foot/leg pain (85%), and joint pain (83%). Pts reported reduced physical function, productivity, and socioemotional wellness. Receiving information before Tx was linked with greater chance of mod vs severe CIPN. More pts with mod vs severe CIPN (37% vs 21%) received information about CIPN before chemotherapy. Having healthcare providers (HCPs) ask about symptoms was linked with a greater chance of mod vs severe CIPN. More pts with mod vs severe CIPN (28% vs 17%) had HCPs ask about CIPN symptoms. Conclusions: Learning about CIPN before chemotherapy was associated with a lower chance of severe CIPN. Early and ongoing communication with pts about risks, manifestations, and importance of reporting CIPN may limit severe CIPN and preserve QoL specifically with regards to socioemotional wellness.
Utilization and effectiveness of extended-duration thromboprophylaxis after high-risk abdominopelvic cancer surgery.
Authors: Wright Jason Dennis , Chen Ling , Jorge Soledad , Burke William M. , Tergas Ana , Hou June , Hu Jim , Neugut Alfred I. , Ananth Cande , Hershman Dawn L. 
Published: February 2017

62 Background: Extended-duration thromboprophylaxis for 4 weeks after discharge has been demonstrated to reduce venous thromboembolic events (VTE) in cancer patients undergoing abdominopelvic surgery and is recommended in national guidelines. We examined the utilization and effectiveness of extended-duration low molecular weight heparin prophylaxis in high-risk cancer patients after surgery. Methods: We analyzed patients with colon, ovarian, and uterine cancer who underwent surgery from 2009-2013 and who were recorded in the MarketScan database. Multivariable models and propensity score analysis with inverse probability of treatment weights were developed to examine uptake and predictors of use of post-discharge low molecular weight heparin (LMWH) use, VTE incidence, and associated adverse events (transfusion, and hemorrhage). Results: A total of 63,280 patients were identified. Use of extended-duration prophylaxis increased from 2009 to 2013 from 1.4% to 1.7% (P = 0.67) for colectomy, 5.9% to 18.3% for ovarian cancer surgery (P < 0.001), and 6.3% to 12.2% (P < 0.001) for hysterectomy for endometrial cancer. There was no association between use of extended-duration prophylaxis and reductions in VTE for any of the procedures: colectomy (2.4% with extended-duration prophylaxis vs. 2.9% without prophylaxis, OR = 0.84; 95% CI, 0.54-1.31), ovarian cancer-directed surgery (3.7% vs. 3.6%, OR = 1.01; 95% CI, 0.76-1.33), hysterectomy (2.1% vs. 2.1%; OR = 0.96; 95% CI, 0.67-1.38). Extended-duration prophylaxis was associated with an increased risk of adverse postoperative events: 2.20 (95% CI, 1.51-3.19) after colectomy, 1.24 (95% CI, 0.92-1.68) following ovarian cancer-directed surgery and 0.99 (95% CI, 0.66-1.48) for hysterectomy for endometrial cancer. Conclusions: Use of extended-duration thromboprophylaxis is low among high-risk cancer patients undergoing surgery. The effectiveness of prophylaxis in real world populations requires further evaluation.
Quality of life (QoL) in patients (pts) with squamous (SCC) NSCLC treated with nab-paclitaxel with carboplatin (nab-P/C) induction therapy: Interim analysis of the phase III ABOUND.sqm study.
Authors: Lilenbaum Rogerio , Langer Corey J. , Jotte Robert M. , Kim Edward S. , Ko Amy , Ong Teng Jin , Socinski Mark A. , Staib Peter , Trunova Nataliya , Spigel David R. 
Published: February 2017

64 Background: Recent data on QoL in pts with advanced NSCLC treated with platinum-doublets are limited. This interim analysis evaluated QoL in pts with SCC NSCLC treated with nab-P/C during the induction part of the ABOUND.sqm study. Methods: In the ongoing phase III ABOUND.sqm study, pts with advanced SCC NSCLC are treated with first-line nab-P 100 mg/m2 d 1, 8, 15 and C AUC 6 mg•min/mL d 1 (21-d cycles) for 4 cycles (induction). Pts not progressing after 4 cycles are randomized 2:1 to maintenance nab-P 100 mg/m2d 1 and 8 of each 21-d cycle + best supportive care (BSC) or BSC alone until progression. The primary endpoint is PFS from randomization to maintenance. QoL, an exploratory endpoint, was assessed using predefined PRO instruments, LCSS and EQ-5D-5L, on d 1 of each cycle. As the study is ongoing, this pre-planned analysis included data for QoL that were reported up to the cutoff date. Results: Of 128 pts included in this interim analysis, > 80% completed baseline (BL) + ≥ 1 post-BL PRO assessments. The median age was 68 years, 65% were male, and 99% had an ECOG PS of 0-1. Overall, the symptom burden index and average total score of the LCSS PRO were improved during induction therapy with nab-P/C; ≈ 50% of pts had clinically meaningful improvements (≥ 10 mm [VAS]) from BL in the composite LCSS items of cough, shortness of breath, and hemoptysis. More than 80% of pts maintained or improved each dimension of the EQ-5D-5L from BL, and a substantial proportion reported complete resolution of ≥ 1 specific dimension problem during induction (33%-48%; Table). No unusual safety signals were observed. Conclusions: This interim analysis demonstrates that QoL was maintained or improved in pts with SCC NSCLC during nab-P/C induction therapy. For pts who reported problems in EQ-5D-5L dimensions at BL, many achieved complete resolution at least once during chemotherapy. Clinical trial information: NCT02027428. [Table: see text]
Learning from and engaging patients/families during the implementation of a new medical record system.
Authors: Flaherty Stephen , Horvath Kathleen , Jahoda Stahl Patricia 
Published: February 2017

66 Background: Dana-Farber Cancer Institute implemented a new medical record system to improve clinical and revenue cycle services. Through the formation of a Patient Experience (PX) committee we thoughtfully and methodically revised materials and processes putting patient and family perspectives first. Methods: Formed PX committee with PFAC members, executive leadership, Patient/Family Relations (PFR), Volunteer Services, Management operations, and Quality/ Patient Safety representation. Created and vetted plan for measuring and mitigating patient experience/satisfaction during a hospital-wide EHR roll-out. Involved patient and families in every committee meeting; presented with plans and ideas for their input and approval before implementation and updated post. Deployed volunteers (composed of former/current patients and families) in increased numbers during system roll out to help patients navigate changes in hospital processes, to answer questions about the roll-out, including wait times. Staff/Ambassador rounding implemented for month 1 of roll out to gather real-time patient concerns. Manager, director or nurse leader were involved in the completion of every service recovery. Modified communication tools, volunteer and staffing patterns, and service adjustment plans. Identified and prioritized patient satisfaction questions for longitudinal analysis. These questions and associated personal comments were tracked and presented as Institutional success metrics. Results: No formal filing of patient or family complaints related to this implementation. Service Recovery costs were minimal. Volunteer Services facilitated a 33% increase in volunteer hours from same time period the previous year. Patient Satisfaction scores for the outpatient service saw one month positive impact, followed by one month negative impact followed by recovery to normal. Conclusions: Working with patients and families to ensure a seamless and smooth roll-out of a new EHR is imperative. Implementation is felt by patients as work flows for all hospital employees are impacted by initial utilization of a new system. The impact of implementation to patients was mitigated through work done by our committee.
Does physical function impact the acceptability of routine patient-reported outcome surveys in cancer patients?
Authors: Wong Lauren , Brown Catherine , Perez-Cosio Andrea , Leung Yvonne , Liang Mindy , Gill Gursharan , Sarabia Samantha , Yeung Sabrina , Liu Aixin , Howell Doris , Liu Geoffrey 
Published: February 2017

67 Background: Patient-reported outcome measures (PROMs) are used to collect cancer-related symptom and symptomatic toxicity data. Understanding factors that affect the acceptability of PROMs is useful for improving the participation of such routine screening practices. We investigated the association between patient’s functional status on their acceptance and perception of usefulness of tablet technology to routine collection of PROM data in the clinical setting. Methods: 279 adult cancer outpatients at Toronto’s Princess Margaret Cancer Centre completed two physical function surveys, the HAQ-DI and WHODAS, using touchscreen tablet technology. Patient socio-demographics and their willingness of completing PROMs on a routine basis were also collected. Results: The median age was 62 (range: 20–94); 50% male, and 68% Caucasian. Patients were recruited from breast (10.4%), gastrointestinal (10.4%), genitourinary (14%), gynecology (14.3%), head & neck (17.9%), hematology (17.6%), and thoracic (15.4%) cancer clinics. 87% were willing to complete the survey on a touchscreen tablet, 74% did not find it time-consuming, and 4% found completion of the survey made their clinic visit more difficult. Only 1% found the questions upsetting or distressful; however, less than 60% were willing to complete similar surveys at every visit. Being Caucasian (p = 0.015) and Canadian-born (p = 0.021) were significantly associated with acceptability of the survey on a regular basis. However, HAQ-DI and WHODAS are not significantly associated with willingness to complete PROMs regularly (p = 0.30 & p = 0.16 respectively). Conclusions: Physical function status is not associated with acceptability; however, ethnicity does play a role where Canadian-born and Caucasian patients are more likely to complete PROMs regularly. Despite this, over 40% of patients were not willing to fill in the PROMs at each visit. Socio-cultural factors may impact on patients’ perceptions of the value of routine screening; however, assessment burden may also limit willingness to complete surveys on an ongoing basis. Further research is underway to gain more insight into the limiting factors of patients to complete the survey routinely.
Use of alkylating chemotherapy in high-grade neuroendocrine tumours: Evaluation of real-world data.
Authors: Sathiyapalan Arani , Sanatani Michael Susmoy , Welch Stephen , Kocha Walter Ilarion , Richter Sue 
Published: February 2017

78 Background: High-grade neuroendocrine tumours (NETs) are believed to have activity to certain alkylating agents, although data are scant. These regimens include streptozotocin (STZ) (used in combination with doxorubicin or 5-fluorouracil) and dacarbazine (DTIC). Current series report variable responses between 6 – 69%. Our objective was to evaluate our real world data to better understand treatment decision-making and clinical outcomes with alkylating agents in advanced high-grade NETs. Methods: We reviewed the medical records of 36 patients with metastatic NETs who received alkylating systemic chemotherapy with either a DTIC regimen (n = 15) or STZ based regimen (n = 21). Patient cases were evaluated for age, time to treatment failure (TTF), time to progression (TTP Results: Among 36 patients treated, the predominant primary NET was pancreas (n = 28) with a median age at treatment of 61.9 years. Observed TTF was similar with both regimens (STZ: 3 months and DTIC: 4 months), however there was prolonged TTP of 11 months with STZ vs. 5.3 months with DTIC (p = 0.047). There was no significant difference in OS with a mean of 48.7 months (DTIC) vs. 47.6 months (STZ) (p = 0.47). Baseline progression at treatment initiation was higher in DTIC at 77% versus 57% in STZ. The predominant cause of treatment discontinuation in both groups was progressive disease; DTIC (71%) versus STZ (42%). Toxicity resulted in treatment discontinuation in 19% for STZ vs 7% for DTIC. Other causes of treatment cessation were completion of the intended treatment. Conclusions: In the groups evaluated, STZ containing regimens demonstrated prolonged PFS in comparison to DTIC, but there was no difference in OS between the two groups. Additionally, despite STZ appearing to have an increased toxicity rate, the rate of cessation between the groups was similar. This real world evaluation suggests similar efficacy with improved tolerability of DTIC based chemotherapy as a potential alternative to other alkylating agents.