bluuebunny/crossref_metadata_2025_split huggingface dataset:
Choosing Wisely in oncology: Are we ready for value-based care?
Authors: Rocque Gabrielle Betty , Blayney Doug , Jahanzeb Mohammad , Kadlubek Pamela , Knape August , Markham Merry Jennifer , Pham Trang , Evans Tracey L. 
Published: February 2017

275 Background: The Choosing Wisely (CW) Campaign challenges patients, healthcare providers, and specialty disease societies to make better decisions about healthcare delivery. In 2012, Schnipper et al. published ASCO’s Top Five List targeting overuse of medications, tests, and procedures that are costly and lack evidence. 1.) Do not use cancer-directed therapy for patients with low performance status (undocumented, 3 or 4). 2.) Do not use PET, CT and radionuclide bone scans in the staging of early prostate cancer. 3.) Do not use PET, CT and radionuclide bone scans in the staging of early breast cancer. 4.) Blood tests for biomarkers and advanced imaging tests should not be used to screen for cancer recurrences in early breast cancer. 5.) Avoid administering colony stimulating factors (CSFs) to patients undergoing chemotherapy who have less than a 20 percent risk for febrile neutropenia. These recommendations are an opportunity to provide a tool to identify the gaps in care and enhance the value of care. Methods: We evaluated results from the ASCO Quality Oncology Practice Initiative (QOPI) CW “test” measures. We analyzed four QOPI collection periods for which measures were available to all participants (Spring ‘13, Fall ‘13, Spring ‘14, Spring ‘15). Results: 361 unique oncology practices (155, 160, 161, and 187 participants in the Spring ‘13, Fall ‘13, Spring ‘14, and Spring ‘15 cycles, respectively) collected data on CW measures within QOPI. Trends for performance varied for specific recommendations and marked variability was noted between practices in performance (range 0% to 100% adherent for any measure). Measure 2 was reported by only one practice in 3 out of the 4 cycles. Using linear regression, adherence decreased over time between rounds for measures 1 and 5 (-2.05; p<0.01 and 1.37; p=0.05), while adherence to measures 3 and 4 increased (0.26; p=0.60 and 2.63; p=0.04). Conclusions: This is the first examination of cancer-related CW measures among oncology practices reporting their performance in QOPI. Although significant variability exists, concordance with CW guidelines remains low across the United States. Opportunity exists for further research into the causes of this low compliance and to share best practices.
A pragmatic approach for measuring and monitoring hospitalizations in patients receiving chemotherapy for pancreatic cancer.
Authors: Brooks Gabriel , Dalby Carole Kathleen , Chaudary Saira , Jacobson Joseph O. 
Published: February 2017

278 Background: Hospitalizations in patients receiving chemotherapy are common and costly. In order to test interventions to reduce hospitalizations in chemotherapy patients, efficient approaches are needed for monitoring the incidence of hospitalization. Methods: We evaluated the monthly frequency of hospitalization in patients receiving active chemotherapy for pancreas cancer. Two definitions were used to identify patients under “active” chemotherapy treatment in a given month; both definitions required that patients were alive on the first day of the evaluation month. For definition A, patients were defined as active if they received any chemotherapy treatment in the evaluation month or the preceding calendar month. Definition B included any chemotherapy during the evaluation month or the two prior months. Reporting functions of the electronic health record (EHR, Epic Systems) were used to generate reports of chemotherapy treatment history and hospital discharges. Data were then combined using statistical software (SAS). Outcomes included the number of active chemotherapy patients per month, the number of hospital discharges per 100 chemotherapy patients, and discharge disposition by hospitalization. Results: There were an average of 101 active chemotherapy patients and 11 hospitalizations per month, using definition A to identify active chemotherapy patients. Corresponding figures using definition B were 115 active patients and 13 hospitalizations per month. The mean number of hospital discharges per month per 100 patients was 10.5 (SD 3.9) vs. 10.9 (4.4). Hospital discharge dispositions (using the inclusive definition B population) included home (49%), home w/ services (19%), home hospice (14%), hospice facility (11%), and SNF (8%). Conclusions: EHRs permit efficient approaches for monitoring monthly hospitalization frequency across a population of active chemotherapy patients. The observed frequency of hospitalization was similar with both active patient definitions. Capability to monitor hospitalization frequencies in active chemotherapy patients will facilitate development of quality improvement programs to reduce hospitalizations.
The availability versus accessibility gap in supportive care services at 40 NCI-designated cancer centers.
Authors: Hutchins Kathryn , Hamlyn Geoffrey , Johnston Abby , Thomas Rishonda , Tian James , Kamal Arif 
Published: February 2017

283 Background: Many cancer centers have developed and fostered several supportive care services to ease the stress of a cancer diagnosis. The availability of such services is key to Commission on Cancer (CoC) for accreditation, which many cancer centers pursue and patients seek as a measure of quality. Despite the stated availability of supportive care services, we wondered how easily new patients could access these services when first contacting a major cancer center. Methods: We used a ‘mystery shopper’ format to simulate calls made by a family member of a recently diagnosed patient to 40 NCI-designated cancer centers. We called each center four times on different days, twice with the caller reporting Medicaid insurance, twice with private insurance. We evaluated quantitative and qualitative components of the call, including time to next available appointment and reported availability of the 7 supportive services reported to the CoC. Descriptive statistics were calculated for each quantitative measure. Results: We placed 160 calls to 40 NCI-designated cancer centers. 38.2% of callers were unable to receive complete information about the number of supportive care services offered, whether because they were unable to reach a person or because the person they reached did not know whether one or more of the services was offered. Overall, only 37.6% of callers (60.8% of those who reached a person who could answer their questions) were told that all seven supportive care services were offered. Call recipients responded with an answer other than yes to whether the cancer center offered a multidisciplinary team approach (14.6%), patient navigation services (12.1%), genetic assessment/counseling (9.5%), palliative care (9.5%), counseling/psychological services (7.6%), or cancer education services (6.4%). Conclusions: Despite the stated availability of seven key supportive care services, we were unable to access all services during a call to establish an appointment about one-third of the time. For individual services, about 10% of the time we were told such services did not exist at the cancer center. Further research is needed to close the availability vs. accessibility gap in oncology supportive care.
Quality of radiation therapy referral and utilization post-prostatectomy: A population-based study of time trends.
Authors: Jin Chunzi Jenny , Brundage Michael Donald , Cook Earl Francis , Miao Qun , Hanna Timothy P 
Published: February 2017

286 Background: Adjuvant radiotherapy (ART) post-radical prostatectomy (RP) has been shown to benefit patients with pathologic T3 or margin-positive prostate cancer. It remains unclear whether early salvage radiotherapy (SRT) confers equivalent outcomes to ART. Practice Guidelines recommend referral to radiation oncology (RO) within 6 months of RP to discuss ART and SRT. The study objectives were to (1) assess post-RP referral patterns to RO; (2) describe ART and SRT utilization; and (3) compare time trends before and after seminal trials and guidelines were published. These provide indications of access to quality care. Methods: This was a retrospective cohort study. Electronic clinic visit and RT treatment records were linked to the population-based Ontario Cancer Registry. The study population included all prostate cancer cases treated with RP in Ontario January 1, 2003 - November 30, 2012. ART was defined as curative RT within 6 months of RP, and SRT was 6 - 24 months post-RP. Changes in RO referral and RT rates over time were statistically analyzed using the Cochran-Mantel-Haenszel Chi-Square test. Results: Over the study period, 30,447 prostate cancer patients received RP and 15.2% saw an RO within 6 months of RP. This proportion doubled between 2003 and 2012 (from 10.7% in 2003-2004 to 21.7% in 2011-2012, p < 0.001 for trend). The annual percentage change was largest 2009-2011 (3.4%). In comparison, the proportion seen within 24 months of RP remained stable at 32.3% ± 1.4%. Amongst the 4,641 patients seen by an RO within 6 months of RP for consideration of ART or SRT, the proportion receiving ART remained relatively constant at 51.0% ± 3.0%. Commensurate with RO referral trends, there was a doubling in ART rates amongst all RP cases, ranging from 5.4% in 2003-2004 to 11.0% in 2011-2012 (p < 0.001), compared to relatively stable SRT rates of 8.5% ± 0.2% (7.9% in 2003-2004, 8.9% in 2010-2011). Consequently, the total proportion receiving RT within 24 months of RP increased from 14.1% in 2003-2004 to 19.8% in 2010-2011 (p < 0.0001). Conclusions: There was an increase in access to early RO referral post-RP and in ART utilization in Ontario from 2003 to 2012, following publication of key clinical trials and guidelines.
Breast oncology precision medicine: Genomic testing and treatment at the population level.
Authors: Friese Christopher Ryan , Li Yun , Kurian Allison W. , Katz Steven J. 
Published: February 2017

288 Background: The 21-gene assay used to estimate breast cancer recurrence and tailor chemotherapy (chemo) receipt has demonstrated predictive validity and clinical utility. Yet it is unclear how involved patients are in the decision to perform the test, or how oncologists use results to recommend systemic chemo. We examined the patient experience with assay testing, physician recommendations, and chemo receipt based on test results. Methods: The iCanCare study surveyed a weighted random sample of newly diagnosed patients with early-stage breast cancer who were treated in 2013-14, identified through the population-based SEER registries of Los Angeles and Georgia about 3 months after surgical treatment, and merged with SEER data (N=2632, RR=70%). Registries partnered with Genomic Health, Inc. to link assay results to patients. We examined validated results against patient self report; patient satisfaction with testing and chemo decisions (1= not at all satisfied; 5= very satisfied); physician chemo recommendations, and; chemo receipt based on test scores (0-10= low risk; 30-100= high risk for recurrence). Results: Of the 1,908 women with invasive disease, 1,307 (68.5%) women had lower-risk features (Stage 1a/b, 2a, ER-positive, HER-2 negative) and 695 (53.2%) of them had tests performed. Of those tested, 60% recalled scores accurately. Most women were satisfied with their communication with doctors about testing (93%) and the chemo decision (90%). Testing varied slightly across risk groups: Grade 1 or 2 disease (54%), Grade 3 disease (61%), and any node-positive disease (62%). Most (91%) women with high-risk scores (>30) reported their oncologist recommended chemo. Fewer (65%) women with low-risk scores (<10) reported recommendations against chemo. Chemo receipt rates varied by risk scores: 2% for low-risk scores and 66% for high-risk scores. Conclusions: Most women were satisfied with testing and chemo decisions, yet many patients do not accurately recall test scores. Testing is higher in uncertain clinical groups. Physician recommendations and chemo receipt are tightly linked to test scores, suggesting that precision medicine has tailored treatment effectively to women with breast cancer. Funding: P01CA163233
Prostate cancer care in Canada: Informed decision-making, patterns of care, and treatment trends.
Authors: Tran Kim , Rahal Rami , Sandoval Carolyn , Porter Geoff , Fung Sharon , Louzado Cheryl , Xu Julie , Bryant Heather E. ,   System Performance Steering Committee and Technical Working Group
Published: February 2017

289 Background: Because treatment options for localized prostate cancer (PCa) have similar survival outcomes but varying side effects, it is important that patients are meaningfully involved in the decision-making process to ensure the chosen treatment aligns with their needs, wants and preferences. Here, we describe PCa patients’ experience with informed decision-making as well as treatment patterns and trends over time. Methods: Focus groups were conducted with 47 men treated for PCa across Canada to understand their cancer journey experience. Thematic analysis was conducted. A subset of this data on informed decision-making is described. Men (≥ 35 years) diagnosed with localized, low-risk PCa from 2011-2013 were identified using data from six provincial cancer registries. Treatment data were identified by linking hospital/cancer centre data with registry data. Descriptive statistics were generated to describe treatment patterns and trends. Results: Focus group participants expressed a desire to be involved in the treatment decision-making process. While many participants felt completely informed about the treatment choices available to them, others felt they had not been properly engaged in the treatment decision-making process. Some participants felt they had opted for surgery or radiation therapy (RT) without full knowledge of the trade-offs between potential benefits and side effects. Others felt they may have made different decisions about their care had they been more informed. From registry data, in 2013 surgery was the most common primary treatment for men with low-risk PCa ranging from 12.0% in New Brunswick to 41.7% in Nova Scotia. RT was the second most common ranging from 6.4% in New Brunswick to 18.3% in Saskatchewan. Varying majorities of men had no record of surgical or radiation treatment, a proxy for active surveillance. Treatment trends over time suggest an increase in the use of non-active treatment approaches from 60.7% in 2011 to 69.9% in 2013. Conclusions: System performance indicators yield useful information about oncology practice patterns and trends. This information is enhanced when combined with patient level information on how men felt about decision-making around their PCa care.
Patient-centered outcomes with post-approval nivolumab in metastatic NSCLC at the Cleveland Clinic Taussig Cancer Institute (TCI).
Authors: Shapiro Marc A. , Glass Katherine , Redden Alicia M , Pennell Nathan A. , Stevenson James , Velcheti Vamsidhar , Van Wagoner Emily , Cummings Chad W , Bolwell Brian James 
Published: February 2017

29 Background: Patient-centered outcomes are important quality metrics of value-based cancer care. For NSCLC, these include chemotherapy administration within 30 days of death and end of life hospitalizations. Nivolumab was initially FDA approved in March 2015 for second-line therapy of squamous NSCLC and subsequently for non-squamous NSCLC. To evaluate the impact of post-approval nivolumab use on patient-centered outcomes, a retrospective review was performed of patients (pts) with metastatic NSLCC receiving nivolumab at TCI main campus and regional centers. Methods: All pts with NSCLC receiving nivolumab from 3/4/15 to 10/5/15 were identified (cohort A) and treatment characteristics were collected from pharmacy, billing, and tumor registry databases and manual chart review. Similar data for a cohort of NSCLC pts (cohort B) initiating care with 4 academic thoracic and 12 community TCI oncologists from 1/1/12 to 7/1/13 and who received second-line therapy were used for comparison. Results: 113 cohort A pts received nivolumab with a median follow up of 101 days. 82 (73%) were alive at the time of evaluation. 70 (62%) received ≤ 1 prior chemotherapy regimens for metastatic disease. 19 of 52 (37%) cohort A pts completing nivolumab received drug within 30 days of death, 13 (68%) of whom had received ≤ 1 prior chemotherapy regimens. 3 of 50 (6%) cohort B pts completing second-line therapy received drug within 30 days of death. In patients with a known date of death, median time from first dose of nivolumab in cohort A and second-line therapy in cohort B and death was 41 and 145 days respectively. 28 (25%) cohort A pts and 18 (36%) cohort B pts were hospitalized at a TCI facility during therapy. Conclusions: This study shows the brisk uptake of nivolumab to clinical practice, but with potential for inappropriate utilization. Continued evaluation of practice patterns is necessary including cost analysis. Further research is needed to better understand outcomes in patients with EGOG PS ≥ 2, front-line use, and cost effectiveness.
Cancer claims and registry data: A California linkage for quality measurement.
Authors: Yanagihara Dolores , Senathirajah Mahil , Novich Marilyn 
Published: February 2017

296 Background: Breast and colon are 2 of the most prevalent cancers in California according to the California Cancer Registry (CCR). Health claims data contains a wealth of information on diagnoses and treatment but lacks clinical information critical for evaluating care. Registry data contains key clinical information, but often does not contain the complete treatment regimen. This project aims to assess the feasibility of linking commercial claims data to population-based cancer registry data, and to use the linked data to examine variation in quality measures at the regional and physician organization (PO) levels. Methods: Nine NQF endorsed breast and colon cancer measures were selected and measure specifications with code sets were developed. Data on members identified with a diagnosis of breast and/or colon cancer in claims (2009-2012) from 4 commercial HMO health plans was linked with CCR data. Results were generated at the regional and PO levels. Results: The feasibility test was a success; CCR and claims data was linked for 8,757 individuals, and the data sets proved complementary. Rates relying on the linked dataset were typically higher than when either data source was used alone. For example, see the Table. Performance was strong across 8 of 9 measures with scores ranging from 80-98%. The 9th measure, which relied only on CCR data, was 51%. PO level measurement was limited by small sample sizes, but where sample size was adequate, a significant amount of variation in performance across POs was found. Conclusions: The project showed that linkage of claims and registry data is feasible and that the linked dataset supports more robust assessment of the quality of cancer care. Further, the data dictionary and programmable code sets that were developed are available to other entities interested in creating linkages. With larger sample size, robust benchmarks could be established. Linked registry and claims data could be used for additional research in areas such as compliance with clinical guidelines and examining patterns of treatment. [Table: see text]
Racial and ethnic disparities in the survival of adolescents and young adults (AYA) with acute myeloid leukemia (AML).
Authors: Durani Urshila , Bartley Adam C , Go Ronald S. 
Published: February 2017

297 Background: Unlike acute lymphoblastic leukemia, no studies have examined the effect of race on survival among AML in AYA using national data. Methods: We studied patients in the US National Cancer Data Base aged 15-39 diagnosed with AML from 2001-2011 (excluding acute promyelocytic leukemia). AMLs harboring inv(16) or t(8;21) were defined as good-risk. We examined overall survival (OS) according to race/ethnicity and survival trends over three time-periods: 2001-2004, 2005-2008, and 2009-2011. Results: We identified 8,986 patients, with a mean follow-up of 37 months. The median OS according to race/ethnicity was 56, 49, 41, and 22 months for Asians/Pacific Islanders (A/PI), Hispanics, Whites, and Blacks respectively (P < 0.001). OS improved over time among Whites only, with respective median OS of 31, 43, and 49 months (P < 0.001). Multivariate analysis adjusting for socio-demographics, travel distance, and AML type, showed that, compared to Whites, Blacks had a significantly worse and Hispanics a significantly better OS (Table). Conclusions: We found significant disparities in OS among racial/ethnic subgroups in AYA with AML despite adjustment for socio-demographic factors. Blacks had the worse and Hispanics the best outcome. In the past decade, OS improved only among the Whites. Further studies should examine provider and patient care delivery factors that may contribute to these disparities. [Table: see text]
Optimizing surgical instrument sets for cases involving breast and plastic surgeons.
Authors: Caudle Abigail Suzanne , Fleming Jason B. , Garcia Brian M , Lozano Marina , Rigby Darryl , Manuel-Byrd Rita , McMillian Lisa , Avalos Chris , Hodge Rachel , Butler Charles E , Hunt Kelly , Baumann Don 
Published: February 2017

33 Background: Processing operative instrumemt sets is a major cost for surgical cancer care. Optimizing standard sets requires availability of instruments reflecting varied surgeon preferences while minimizing unnecessary instruments. Additionally, increasing utilization of oncoplastic reconstruction after mastectomy and lumpectomy requiring breast and plastic surgery sets further expands the number of instruments required. The goal of our study was to optimize standard sets used for cases combining breast and plastic surgeons and to determine cost savings Methods: Baseline data was recorded over a 2 week period (13 cases) including number of instruments available and number unused for non- flap breast-plastics combo (BPC) cases. An independent observer timed instrument set-up times. 22 breast and 14 plastic surgeons were polled for their requested instruments for designated cases. A BPC set was designed based on this data and reviewed with surgeons to update preference cards. After a 6 week implamentation/education period, repeat data was recorded (18 cases). Cost of instrument processing was based on labor and supply cost of $0.22/instrument. Results: Two breast surgery sets (65 and 97 instruments) and one plastics set ( 93 instruments) were used at baseline. The median number of available instrumeets was 172.5/case, with median 126.5 instruments unused. A mean of 3.8 separately packaged instruments were required per case with mean set-up time of 4m46s. The new BPC set contains 103 instruments. A median of 106.5 instruments were available after implementation. The median number of unused was reduced by 53% to 59.5, with a drop in number of separately processed instruments to 2.5. Mean set-up time was reduced to 2m16s. Reducing the size of of standard sets reduced processing costs by $12.10 or $19.14/case (depending on the breast set used for comparison). Combining sets resulted in an additional cost savings of $6.56/case by reducing extra packaging costs. Conclusions: combining breast and plastic sets and eliminating unnecessary instruments resulted in cost savings of $18.66-$25.70/case. It also reduced OR instrument set-up time by 2.5 minutes/case which has significant impact at high volume centers.