bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative care training: A national survey of U.S. hematology/oncology fellows.
Authors: Curley Brendan F. , Thomas Roby Antony , Wen Sijin , Zhang Jianjun , Abraham Jame , Moss Alvin Howard ,   West Virginia Clinical and Translational Science Institute
Published: February 2017

28 Background: The American Society of Clinical Oncology (ASCO) has recommended integration of palliative care into oncology practice at the time of diagnosis of advanced cancer. The attitudes, knowledge, and skills of Hematology/Oncology fellows in palliative medicine to implement this recommendation have not been assessed. Methods: In 2013 we surveyed current US Hematology/Oncology fellows to assess their attitudes and the quality of teaching in palliative care received during fellowship and their perceived preparedness to care for patients at End of Life (EOL). Trainees at all US programs were surveyed via Research Electronic Data Capture. The survey was IRB approved, anonymous and voluntary. Results: 176 surveys were collected. Statistical analysis was performed with t-test for numeric and Fisher’s exact test for categorical variables. 98% of respondents felt that providing care for dying patients was important. 99% indicated that physicians have a responsibility to help patients at EOL. Fellows felt their overall training in fellowship was superior to their quality of training (p<0.0001) or teaching (p <0.0001) on EOL. Pearson correlation showed that those with training in palliative care felt more prepared caring for patients at EOL (p <0.0001). Fellows who had training in palliative care during fellowship (45.4% of those surveyed) felt they had better teaching on managing a patient at EOL than those who did not (p<0.0001). There was no statistical significance noted with self-identified roles of spirituality or religion in attitudes, knowledge, or skills. 64% reported having conducted over ten family meetings regarding EOL. Only 18.9% were supervised (p<0.0001) and only 13.1% were given feedback more than ten times (p<0.0001). 89.7% of fellows surveyed stated they have disagreed with treatment without palliative care on at least one occasion. 40% of respondents did not know how to respond to a request to stop chemotherapy. Conclusions: Hematology/Oncology fellows believe that EOL care is important. Education about EOL is not at the same level of their overall fellowship training despite the recognition of the benefit of palliative care in Oncology. Educational initiatives need to be introduced to improve training on EOL care.
Compliance with evidence-based guidelines for radiation of vertebral metastases.
Authors: Curry Heather A , Forastiere Arlene A. , Jagsi Reshma , Palladino M. Lou 
Published: February 2017

36 Background: Evidence based guidelines pertaining to the management of bony metastases have been published. However, up to 30% of oncology treatments deviate from evidence based standards and widespread variations in clinical practice continue to exist. To explore patterns of care in the treatment of vertebral metastases in a group of working age, insured patients, we assessed treatment plans submitted for preauthorization through eviti Connect. Methods: Eviti Connect is a web-based application that enables oncology providers to obtain automated precertification for patients. The platform evaluates treatment plans for consistency with EBM and compliance with payer policies and plan language. All requests for radiation treatment submitted during a two year period from 6/1/11-5/31/13 were reviewed. Peer to peer discussions were conducted in cases that deviated from EBM. Results: A total of 229 cases for the treatment of vertebral metastases were submitted. 46/229 plans (19.8%) did not meet EBM standards. Some cases displayed more than one deviation. Reasons for non-compliance included atypical treatment schedules (8.69%), SRS/SBRT (36.9%), IMRT (32.6%), and IGRT (58.7%). In 26/46 cases (56.5%) the treating physician provided a medical rationale for the deviation. In 9 cases the physician altered the plan to be compliant; in 5 cases the physician did not agree to a change. The most common dose fractionation schedules were 30 Gy/10 fractions (48.9%) and 37.5 Gy/15 fractions (20.5%). 17 cases were treated using 20 Gy/5 fractions and only 2 cases were treated using 8 Gy X 1. Conclusions: Radiation of vertebral metastases was prescribed in accordance with EBM in the majority of cases. The main reasons for deviation were patient-specific issues that justified the medical necessity of the variance. Case review and peer to peer discussion contributed to understanding the rationale for treatment deviation from guidelines and allowed providers to bring plans into compliance with EBM. Overall only 5% of plans were non-evidence based or lacked a medical justification for deviation. Consistent with patterns of care across the US, within this group of patients, single fraction and hypofractionated radiation regimens were underutilized.
Onco-fertility care in a children's hospital: A quality improvement initiative.
Authors: Hayashi Masanori , Albert Catherine Michelle , Gubin Alexandra , Katz Ann , Kramer Cara , Loeb David Mark , Chen Allen Ray Sing 
Published: February 2017

41 Background: Patients who will receive gonadotoxic cancer therapy should be counseled on fertility risks and be offered appropriate fertility preservation methods. Previous studies have shown low adherence to these quality measures. At Johns Hopkins Pediatric Oncology, a baseline survey revealed that only 70% of patients or their parents recalled receiving fertility counseling at initial diagnosis, and 50% of eligible patients were referred for fertility preservation procedures. Methods: A multidisciplinary group comprising Pediatric Oncology physicians, nurses, and social workers was formed to address barriers to appropriate oncofertility care. The team identified staff education, a practice standard, and familiarity with fertility preservation resources as needs. Many active resources were available, such as a pediatric ovarian cryopreservation research protocol. Results: Comprehensive fertility counseling and preservation practices for boys and girls were established to provide guidance and resources to the treating primary oncology team. Girls are risk stratified according to the planned therapy for their disease, and offered ovarian or oocyte cryopreservation if therapy carries an intermediate to high risk of fertility loss. Non-invasive sperm banking is recommended for all post-pubertal males who will receive therapy with any degree of gonadotoxicity. An oncofertility team provides 24/7 consultation for the primary oncology team and patients and proactively identifies newly diagnosed patients who need counseling. The comprehensive protocol has been published on the online center-wide policy repository, and the consult service has been frequently utilized. A cross-sectional questionnaire study will be performed annually to monitor compliance to protocol and quality of care. Conclusions: A proactive team approach can overcome barriers to quality oncofertility practice.
Identifying knowledge-translation opportunities in the treatment of locally advanced breast cancer.
Authors: Rajmohan Yanchini , Leonard Robyn , Hogeveen Sophie , Ebrahim Jalal , Han Dolly , Wong Audrey , Boileau Jean-Francois , Gandhi Sonal , Lee Justin , Dinniwell Robert Edward , Brackstone Muriel , Simmons Christine E. 
Published: February 2017

47 Background: Guidelines are usually developed using systematic literature reviews. Expert opinion plays a key role but can be difficult to incorporate. The objective of this study was to develop a national consensus of expert opinion on the management of Locally Advanced Breast Cancer (LABC) and subsequently identify gaps in knowledge translation in current practice. Methods: 361 Canadian oncologists were subdivided into LABC experts (n = 83) and non-experts (n = 278). Experts were surveyed with a modified Delphi protocol to establish consensus. A systematic literature review was performed and compared to expert opinion. Non-experts were then surveyed with a 29-item questionnaire to determine current practice patterns. Z test was used to assess discordance. Results: Response rate for the expert survey was 61% (51/83). Consensus was achieved in all key aspects of care and was concordant to published literature in areas of: clinical assessment with caliper at each cycle, option of lumpectomy if good clinical response, radiotherapy to loco-regional lymph nodes, and no further adjuvant chemotherapy outside of clinical trial if residual disease found at time of surgery. Response rate for the non-expert survey was 50% (140/278). Areas of discordance are highlighted below. Conclusions: A national practice consensus guideline reflective of current evidence and expert opinion has been developed on the management of LABC. Differences in expert opinion and current practice have been identified as targets for knowledge translation interventions (KTIs) that may improve quality of care and resource utilization. Further exploration of KTIs to address identified gaps is warranted. [Table: see text]
Timeliness of care in patients with non-small cell lung cancer (NSCLC) at the Louis Stokes Veteran Affairs Medical Center (LSVAMC).
Authors: Manochakian Rami , Mervar Stephanie , Fox Deborah , Liu Yang , Bokar Joseph A. , Arfons Lisa 
Published: February 2017

50 Background: Timeliness of care in patients with newly diagnosed lung cancer is a controversial topic. Although some studies have concluded that timeliness does not improve clinical outcomes, many experts agree that timeliness is an important aspect of quality care as it leads to shorter duration of emotional distress during the diagnostic process and treatment initiation. Methods: At the LSVAMC, we have established a 60-day time interval from first abnormal radiology to treatment initiation as our institutional standard of care. We have initiated several interventions to improve timeliness of care through our new lung cancer program launched in July 2012. These interventions, which were implemented over a 1 year period, include: 1) Weekly interdisciplinary lung nodule rounds. 2) A cancer care tracking system. 3) A lung cancer-specific case manager who collaborates with all disciplines to expedite workup and treatment initiation. We have retrospectively reviewed all NSCLC cases since the launch of the new lung cancer program (group 1) and compared the timeliness to a sample of patients before the interventions (group 2). Results: 58 patients (group 1) and 107 patients ( group 2) with NSCLC were diagnosed and treated at the LSVAMC from January to July 2011 and July 2012 to May 2013 respectively. Median time from first abnormal radiology to first treatment was 104 days (range 13-375, mean 113.4) in group 1 and 81 days (range 1-261, mean 84.9) in group 2. Median time from diagnostic radiology to tissue diagnosis was 39 days (range 2-226, mean 66) in group 1 and 29 days (range 2-206, mean 42.6) in group 2. Median time from tissue diagnosis to first treatment was 23 days (range 0-177, mean 38) in group 1 and 28 days (range 0-254, mean 36.5) in group 2. Conclusions: Timeliness of care in NSCLC patients at our center has improved. We still have not reached our target. Continued progress is expected as we transition to a multidisciplinary multi specialty care lung cancer program.
Survey of the University of Florida hematology/oncology fellows on perceived skills of independent management of oncologic pain, chemotherapy-related nausea and vomiting, and end-of-life discussions.
Authors: Ricks Jennifer Lynn , Chang Myron , An Qi , Dang Nam H. 
Published: February 2017

7 Background: Prior literature in oncology suggests that oncologists receive less training during fellowship in the areas of pain management, chemotherapy-related nausea/vomiting (CRNV), and end-of-life (EOL) discussions than is desired for later practice. As such, confidence in management could be improved by focused interventions. This survey sought to determine whether fellows in the department of Hematology/Oncology at the University of Florida (UF) felt they would benefit from additional education in these areas. Methods: An anonymous voluntary survey was administered by an impartial third party to assess the fourteen fellows’ comfort levels. Questions numbered 1-7 focused on oncologic pain, numbers 8-17 on CRNV, and numbers 18-28 on EOL care. Answers were converted to a numeric scale in the range of 1-4, with 4 points as the highest endorsement of confidence and 1 point as the lowest comfort level. 95% confidence intervals were used to analyze results of each question. Results: 79% (95% CI:57%-100%) of fellows felt additional training in pain management and CRNV would be beneficial. Half of fellows surveyed (50%, 95% CI:24%-76%) considered need for additional training in EOL discussions worthwhile. The scores were not significantly different when stratified by year of training (p value = 0.10, 0.48, 0.20). Conclusions: We conclude that the majority of UF Hematology/Oncology fellows feel that additional training in oncologic pain and CRNV is desired. This is significant as it parallels national trends. Limitations of the study include relatively small sample size, thus the absence of any statistically significant differences in responses by year of training may have been a result of the sample size. Several methods exist to satisfy this perceived need, including targeted lectures or standardized online teaching modules from the American Society of Clinical Oncology. A future prospective study using these modules is underway to further validate our findings. [Table: see text]
Using RFID technology to drive quality improvement.
Authors: de Mendonca Ben , Cheung Matthew C. , Singh Simron , Charbonneau Flay , Wield Kirsty , Soudsa Philomena de 
Published: February 2017

70 Background: The Odette Cancer Centre (OCC) is the sixth largest cancer institution in North America and manages over 24,000 chemotherapy patient visits/year. We initiated an automated system whereby patients can “actively” self-check-in using Radio Frequency Identification (RFID) cards to the chemotherapy unit as part of a quality improvement initiative. Methods: Four self check-in kiosks were implemented into the OCC and all patients received a unique identifiable RFID card. Patients “self-arrived” to the OCC upon entry as well as before the nursing assessment. The technology created an electronic data infrastructure to capture patient experience data for ambulatory chemotherapy. In addition, visual management boards have been implemented that display the patients’ unique identifiers and communicates their process status. This tool also acts as a call-in system wherein the screen flashes and prompts the patient to proceed to the service area. Data was extracted electronically from various information systems, consolidated in excel linking information by the patients hospital file number. Results were analyzed. Results: The mean number of patients treated per day is 85 with a range of 65 to 105 (n=853). Median wait time from arrival to chair placement was 1:52 minutes ranging 0:02 to 6:12. There were 43% of patients that had medication ready within 30 minutes of their appointment time. There was an observed reduction in interruptions to the assessment nurses related to patient status updates (data to be presented). Patient satisfaction was high despite the modest improvement in efficiency. Conclusions: A comprehensive business analysis is being performed on the operations of the OCC with the implementation of this technology. The visual management boards enhance communication to patients while increasing privacy and patient confidentiality. The boards allow for patient mobility in the waiting room and eases anxiety associated with being “lost in the queue”. Next steps for the OCC are to create a data cube linked with other systems to further enrich the data. This technology enabled data analysis, evaluated the impact of change, set baseline targets for performance and built continuous quality improvement.
Impact of a novel decision counseling program on treatment knowledge, decisional conflict, and choice in men with early-stage, low-risk prostate cancer.
Authors: Hoffman-Censits Jean H. , Petrich Anett , Quinn Anna , Leader Amy , Gomella Leonard G. , Dicker Adam , Den Robert Benjamin , Hurwitz Mark , Kelly William Kevin , Lallas Costas D. , Burns Katherine , Trabulsi Edouard John , Myers Ronald 
Published: February 2017

9 Background: Active surveillance (AS - serial follow-up PSA, exam, and biopsy) is an option for men with early stage, low risk prostate cancer (LRPca). While data show comparable survival for AS vs active treatment (AT - surgery or radiation), currently most men with LRPca undergo AT. A pilot Decision Counseling Program (DCP) to assist men in making an informed, shared LRPca treatment decision was implemented. Methods: Men with LRPca seen at the Jefferson Genitourinary Multidisciplinary Cancer Center (JGUMDCC) were consented. A nurse educator (NE) reviewed risks/benefits of AS and AT; had the participant identify factors influencing treatment decision making and specify decision factor weights; entered data into an online DCP; and generated a report of participant treatment preference and decision factors. The report was used by the participant and clinicians in shared treatment decision making. A follow-up survey was administered 30 days after the visit, with treatment status assessed. Change in treatment-related knowledge and decisional conflict were measured using baseline and 30-day survey data. Results: Baseline decision counseling preference of 16 participants: 4 - AS, 8 equal for AS and AT, 4 - AT. At 30 days, 12 participants initiated AS, 4 chose AT; participant mean treatment knowledge scores (8-point scale) increased (+1.13 points); decisional conflict subscale scores (strongly disagree = 1, strongly agree = 5) decreased (uncertain: -1.15, uninformed: -1.36, unclear: -1.12; and unsupported: -1.15). Conclusions: Decision counseling and shared decision making helped participants become better informed about treatment choices and reduced uncertainty in treatment decision making. The combined intervention resulted in most participants choosing AS. Ongoing study recruitment, data collection, and analyses are planned.
A randomized, open-label, phase III study of lapatinib in combination with weekly paclitaxel versus weekly paclitaxel alone in the second-line treatment of HER2 amplified advanced gastric cancer (AGC) in Asian population: Tytan study.
Authors: Bang Yung-Jue 
Published: February 2017

11 Background: The use of trastuzumab has been established as the standard first-line treatment of HER2 positive (+) AGC. However, the role of anti-HER2 agents in the second-line treatment of HER2+ AGC has not been clearly established yet. TyTAN is the first randomized study to compare the efficacy and safety of adding lapatinib (L) to paclitaxel (P) vs P alone in the second-line treatment of HER2+ AGC. Methods: Eligibility required patients (pts) with AGC, amplification of HER2 by fluorescence in situ hybridization (FISH), and one prior regimen containing fluoropyrimidines and/or cisplatin. Pts were randomized 1:1 to L (1500mg QD) and P (80mg/m2, Day 1, 8, 15 q4w) or P alone. The treatments were given until disease progression or unacceptable toxicity. Stratification variables were prior trastuzumab treatment and gastrectomy status. Primary endpoint was overall survival (OS). Results: From March 2008 to June 2011, 1923 pts were screened and 430 pts were HER2+ AGC. 261 out of 430 pts were enrolled. All pts were from Asian countries: Japan (100), China (95), Korea (46), and Taiwan (20). Median OS was 11.0 months for L+P and 8.9 months for P alone in the intent-to-treat (ITT) population (HR 0.84; p=0.2088). In a pre-planned subgroup analysis, median OS in HER2 immunohistochemistry (IHC) 3+ subgroup was 14.0 months for L+P and 7.6 months for P alone (HR 0.59; p=0.0176). The endpoints in efficacy and AEs of special interest for L+P are summarized below (Table). Conclusions: Although OS was prolonged in L+P arm by 2 months, the difference was not statistically significant. HER2 IHC 3+ subgroup demonstrated statistically significant prolongation of OS by adding L. Clinical trial information: NCT00486954. [Table: see text]
C-reactive protein as an independent prognostic factor for metastatic gastric cancer.
Authors: Kitagawa Mika , Shimura Takaya , Yamada Tomonori , Itoh Keisuke , Hasegawa Chihiro , Kawai Takashi 
Published: February 2017

110 Background: S-1 plus cisplatin has been recognized as the standard chemotherapy for metastatic gastric cancer (MGC). Inflammation is considered to be a critical component of tumor progression. C-reactive protein (CRP) has been associated with the development of many cancers, but the significance of CRP remains unclear for MGC. The present study assessed the relationship between serum levels CRP and antitumor effects in MGC. Methods: Among 109 MGC patients who received S-1 plus cisplatin as first-line chemotherapy from January 2006 to December 2011 in 3 Japanese institutions, we retrospectively identified 70 patients who fulfilled eligibility criteria of this study. Patients were categorized into 2 groups depending on serum CRP level before chemotherapy: 43 patients with CRP <1.0 mg/dl (CRP <1.0 group) and 27 patients with CRP ≥1.0 mg/dl (CRP ≥1.0 group). Results: Median overall survival was significantly shorter in the CRP ≥1.0 group than in the CRP <1.0 group [267 days (95% CI, 208 to 326) versus 416 days (95% CI, 325 to 507); p = 0.0007]. Moreover, progression-free survival (PFS) was significantly shorter in the CRP ≥1.0 group than in the CRP <1.0 group (median PFS 126 days [95% CI, 63 to 189) versus 188 days (95% CI, 159 to 217); p = 0.0050]. Meanwhile, response rate was determined in 58 patients with target lesions. No significant differences were noted between the CRP <1.0 group and the CRP ≥1.0 group (10/33, 30.3% versus 7/25, 28.0%; p = 0.663). In a multivariate analysis, serum CRP level before chemotherapy was an only independent prognostic factor for MGC (hazard ratio 3.09 (95% CI, 1.46 to 6.54); p = 0.003). Conclusions: Serum CRP level before chemotherapy might be an independent and potential prognostic factor for MGC. Stringent follow-up during chemotherapy is expected for patients with MGC and a high CRP level.