bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outpatient palliative care at a tertiary cancer center: Perceptions, pathways, and pitfalls.
Authors: Ramchandran Kavitha , Trieu Sandy , Harman Stephanie , Passaglia Judy , Rodriguez Janet , Dwyer Patricia , Oden Ryan 
Published: February 2017

28 Background: To describe an outpatient palliative care program at a quaternary cancer center- Stanford Cancer Institute. Outpatient palliative care (PC) programs are still in their nascency. Best practices are still being developed and key performance metrics are being delineated. This is a description of Stanford Cancer Institute outpatient PC program. Methods: Observational study of the first six months of encounters to the outpatient PC program. Description of potential barriers to launch and growth, as well as description of resources required for continued success. Data evaluated included program volume, referral patterns, advance care planning, symptom assessment and team structure as collected by the clinical team. Results: Initial barriers to program initiation included lack of funding and infrastructure. Additional barriers included coordination between teams, flow of care (patients late for next appointments), and cultural perceptions of palliative care as equal to end of life care. There are 32 referring practitioners to the program. Over the first six months the outpatient PC program has seen growth with volume increasing from 10 consults per month to 26 consults per month for a total of 60 patients. At the time of initial consult, 11 of the 60 patients seen had an advance directive. Only 1 patient had a physician order for life sustaining treatment (POLST). Code status was documented in 21 of the 60 patients. Conclusions: Our program had multiple barriers to launch: perceptions that palliative care equaled end of life care, lack of infrastructure and funding, and difficulty with coordination between teams. With administrative support the program secured funding, developed infrastructure with the assistance of IT, Cancer Center administration, and Care Coordination. Consults now come from a wide range of providers. Based on preliminary data indicating a very low percentage of completion of these tasks by patients on initial consult there is need for outpatient palliative care for advance care planning. Future growth will include continued penetration of the cancer center, increasing volume of consults, and additional assessments of patient satisfaction, symptom improvement, and hospital utilization.
Comprehensive stem cell transplant (SCT) outcome data submission.
Authors: Jones Roy B. , Martinez Charles , Rizzo J. Douglas , Reeves Dianne 
Published: February 2017

293 Background: All U.S. transplant centers must report comprehensive SCT outcome data to a federal registry. The current electronic data capture method requires manual data entry of 700+ unique data elements into an internet application, FormsNet (Center for International Blood and Marrow Transplant Research). Data is routinely copied from program databases or the EMR by manual transcription, an inefficient, inaccurate and expensive process. A method was needed to allow electronic transmission of outcome data directly from these databases to the mandated SCT Outcomes Database (SCTOD). Methods: We designed an interface engine (IE) to transmit structured data through a caGRID subnet (AGNIS) directly to the SCTOD from a proprietary MDACC SCT database using a secure, auditable method. To make this method applicable to other centers, we collaborated with the NCI and others to expand the Biomedical Research Informatics Domain Group (BRIDG) standard data model to support a full set of granular data elements (>1,900) required to describe SCT outcomes. The IE was modified to transmit SCT data from the expanded BRIDG database to the SCTOD. The IE and expanded BRIDG database model will be made available to all centers without charge. In this way centers interfacing data to this new structure can transmit data to the SCTOD without transcription. Results: The BRIDG oversight committee has approved the extended model and made its structure and content publically available. The IE has been used to transmit >4,000 data forms from MDACC to the SCTOD. The full set of SCT common data elements (CDE) has been published in the Cancer Data Standards Repository of the NCI. The American Society of Blood and Marrow Transplantation is publishing an RFA to identify 1-3 vendors qualified to interface data from center-specific systems to the BRIDG database. Conclusions: Comprehensive and direct electronic data transmission to the SCTOD is feasible and can be done without modifying individual center’s legacy applications. The plan will make appropriate tools available to all transplant centers. This paradigm should be applicable to other areas of oncology.
Using the electronic medical record to identify and follow survivors of pediatric malignancies.
Authors: Bell Elizabeth , Cooper Robert Michael , Mueller Lisa 
Published: February 2017

302 Background: There are currently more than 328,000 survivors of pediatric malignancies in the United States (NCI, The Childhood Cancer Survivor Study: An Overview, http://www.cancer.gov/cancertopics/coping/ccss . 6/6/2012). These survivors are at risk for significant late effects from their cancer treatments (Childhood Cancer Survivors Study (Oeffinger, et al, NEJM 2006)). The Kaiser Permanente health care system has good insurance retention of patients treated for pediatric malignancies. Kaiser also uses an electronic medical record, which improves our ability to identify survivors and follow them over time to identify and manage late effects of cancer treatment. The Children’s Oncology Group (COG) has released a summary of cancer treatment form and specific guidelines for follow-up based on patients’ treatment. Methods: In 2010, we queried the Kaiser Permanente Southern California Cancer Registry for all patients who were diagnosed with a malignancy under the age of 18 from 1980 to 2009. This was cross-referenced with list of current Kaiser members as of 2010. We created a database of the current members and their diagnosis, treatment center, age at diagnosis, date of diagnosis, current age, years of survivorship, and sex. We divided the patients into priority groups: (1) more than 5 years from diagnosis and over age 18, (2) more than 5 years from diagnosis and less than age 18, and (3) less than 5 years from diagnosis. We began to prepare summaries of cancer treatment for the groups using the COG form. Results: We identified 1,267 survivors of pediatric malignancies who were Kaiser members in 2010. 54% are still Kaiser members 10 years after diagnosis. There were 611 in Group 1, 293 in Group 2, and 363 in Group 3. We have prepared summaries of cancer treatment including late effects for 400 of the survivors, 360 from Group 1, and 40 from Group 2. Conclusions: The combination of an electronic medical record and insurance retention allows us to identify and track survivors of pediatric malignancies into adulthood. With completed summaries of cancer treatment we will be able to quickly identify at-risk populations for monitoring and potential interventions.
Use of online resources by patients with cancer: The Canadian experience.
Authors: Eng Lawson , Pringle Dan , Brown Catherine , Shen Xiaowei , Mahler Mary , Niu Chongya , Villeneuve Jodie , Charow Rebecca , Lam Christine , Shani Ravi M. , Alibhai Shabbir M. H. , Jones Jennifer M. , Xu Wei , Liu Geoffrey , Grover Samir C. 
Published: February 2017

318 Background: Canadians are among the highest users of the Internet. Online health information resources are easily accessible and provide quick information, but concerns exist about their role within a physician–patient relationship. Methods: Cancer patients across multiple disease sites, recruited from a regional cancer center, were interviewed regarding their internet use for health-related data. Descriptive statistics characterized online resource usage. Univariate and multivariate logistic regression models evaluated the association between socio-demographics, functional status, clinico-pathological variables and internet usage. Results: Of 191 patients in an interim analysis, 87% had home internet access. Google was the most commonly accessed website (79%), followed by cancer society websites (43%), Mayo Clinic (32%) and Wikipedia (28%). Disease-specific information (91%) was more commonly researched than information about specific physicians (30%). As expected, being married, having completed high school, earning a higher income and having home internet access were each associated with accessing information online (p<0.05). Patients were more likely to access disease-specific information through eMedicine than Wikipedia. Younger patients were more likely to evaluate support group information (aOR=5.9, 95%CI [1.6-21.3], p=0.02) and cancer society websites (aOR=2.6 [1.2-5.4], p=0.04). More educated patients used cancer society (aOR=2.7 [1.3-6.0], p=0.03) and subscription websites (aOR=3.8 [1.6-8.8], p=0.01). Surgical patients used subscription websites more than non-surgical patients (aOR=3.9 [1.7-8.8], p=0.006), obtaining disease-specific information (aOR=5.0 [1.4-18.5], p=0.04). Conclusions: Cancer patients commonly acquire health information from search engine queries. Socio-demographic and clinico-pathological variables affect online information access among cancer patients. Oncologists need to consider the potential benefits and pitfalls of patient online use in cancer management and in their physician-patient communication and shared decision making. Recruitment ends in August 2012 and data on the full 400 patient cohort will be presented. GL and SCG are co-senior authors.
The Pink Ribbon Survivors Network: An Internet resource for breast cancer survivorship education for patients and the health care providers that care for them.
Authors: Fisher Robert E. , Adams Kelly Ann 
Published: February 2017

329 Background: The authors identified a need to provide three online tools for the benefit of breast cancer survivors and health care providers: 1) An online collection of relevant publications from all cancer specialties regarding breast cancer survivorship housed in one virtual library. 2) An online collection of guidelines and relevant publications as a resource for primary care providers to access clinical information on medical care and psychosocial issues regarding breast cancer survivorship. 3) An online collection of resources, organizations, and supportive programs and selected readings for breast cancer survivors. These readings would be organized in a "Curriculum for Recovery" Library. We were motivated by the belief that, "all breast cancer survivors are underserved, if their healthcare providers are undereducated." Methods: Using the Joomla software system, a free, online website has been developed. This site houses the three virtual libraries, on separate landing pages, described above. Additional resources for breast cancer survivors are also housed on the website. Results: The Pink Ribbon Survivors Network now provides a resource of over 500 separate listings designed to educate and support breast cancer survivors, and health care professionals. The online professional libraries were created from abstracts available from medical journals and similar mainstream oncology publications. The libraries are continuously updated with new publications. These collective libraries will serve as unique breast cancer survivorship tools for women and their health care providers, for new publications, and for resources. Conclusions: This abstract establishes that a system using internet technology can provide virtual resources for breast cancer survivors, cancer specialists, and primary health care providers. This is now a functional online system for the 2.5 million breast cancer survivors and nearly 500,000 health care providers involved in the care of these survivors. The organization’s website is www.PinkRibbonSurvivorsNetwork.org.
Pharmacy inventory control ordering web application.
Authors: Sumaida Dalia 
Published: February 2017

330 Background: Many departments within the hospital system were complaining of errors in the carousel system and the quantity of drugs ordered vs. received. Methods: Development of a communication tool between purchasing, inventory control, materials management, finance and accounts payable to streamline the process of ordering and receiving throughout the hospital system. Results: Communication between the departments in ordering and receiving. Reduction in errors of drug quantities ordered vs drug quantity received. Automating the receiving log system and the packing slip process. The web app cut down the time to process a drug by 50%. Conclusions: The use of IT to reduce waste, increase productivity, and improve quality of the system.
Evaluating the quality of supportive oncology using patient-reported survey data.
Authors: Walling Anne M. , Dy Sydney Morss , Malin Jennifer , Mack Jennifer W. , Kim Benjamin , Lorenz Karl , Tisnado Diana M. 
Published: February 2017

42 Background: Quality indicators for supportive oncology care are critical for measuring and monitoring improvement in domains such as symptom management and communication. Patient-reported outcome (PRO) data may complement medical record documentation in assessing quality of care patients receive and perceive. To evaluate how PRO data may be used in quality indicators for key supportive oncology domains, we conducted a study using patient-reported data from a national cohort study, the Cancer Care Outcomes Research and Surveillance Consortium initiative. Methods: We analyzed patient survey responses with utilization and outcomes data from 4,174 patients diagnosed with lung or colorectal cancer of any tumor stage between 2003 and 2005, which included a variety of validated PRO instruments administered within approximately five months of diagnosis. We defined existing supportive oncology indicators addressing symptom management and end-of-life discussions, primarily from Cancer Quality-ASSIST and the American Society of Clinical Oncology Quality Oncology Practice Initiative, that could be feasibly obtained from the survey data, with adaptations as needed. For example, all patients were asked whether they had pain; for pain screening, a survey item asked patients who reported pain whether a provider knew about the patient’s pain, and for treatment, the survey asked patients whether the provider provided help for the pain. Results: See Table. Conclusions: In summary, quality of care for symptom management as measured by patient-reported survey data was highest for pain screening and treatment, and lowest for fatigue treatment and significant depressive symptoms. Quality was much lower for end-of-life discussions. Patient-reported outcome data can provide a valuable, patient-centered perspective on the quality of supportive oncology care. [Table: see text]
Addressing distress in head and neck cancer patients: A quality improvement project.
Authors: Riblet Natalie , Skalla Karen , Peterson Alison , McClure Auden , Homa Karen , Davis Thomas H. 
Published: February 2017

43 Background: To better address the emotional needs of cancer patients by improving mental health care in Head and Neck Cancer (HNC) Medical oncology at Norris Cotton Cancer Center, Lebanon, NH, through implementing an evidence-based process for identifying and managing psychological distress. Methods: Using quality improvement methods, mental health care in HNC Medical Oncology was evaluated and revised November 2010 through April 2012. In January 2011, a two-component intervention was put into routine care including 1) the validated National Comprehensive Cancer Network (NCCN) distress thermometer (DT) and 2) a treatment decision algorithm. A licensed nursing assistant administered the DT and providers reviewed results as part of the clinical exam. Heightened distress was defined as a score of ≥ 4. Screening processes were improved through Plan-Do-Study-Act (PDSA) cycles. Results: Prior to January 2011, identification of distress was based on provider’s clinical assessment. Of 104 patients seen between November 2010 and January 2011, 25% (26) were diagnosed with psychological problems. Cause-effect diagraming suggested that lack of a formalized process for distress assessment contributed to missed diagnoses. Providers were unfamiliar with mental health resources. As reported in Psycho-Oncology 21(Suppl. 1): 51(2012) after implementing process changes, bi-weekly distress screening rates rose from 0% to 38% between January and July 2011. With additional PDSA cycles, these rates increased to 74% between October 2011 and April 2012. Similar to proposed benchmarks, 84% (47) of newly diagnosed patients (56) were assessed for distress. Furthermore, of 138 unique patients seen, 71% (98) were screened for distress and 47% (46) of these had heightened distress. Providers addressed the needs of all those identified. Improvement was attributed to the empowerment of staff and participation of senior leadership. Barriers included a heavy reliance on the presence of trained staff. Conclusions: Quality improvement methods can be applied to the cancer setting in order to create systems of care, which more reliably identify and address distress. Teams, however, must be invested in the work and receive support from senior leadership.
Patterns of antidepressant use in patients with cancer: An analysis from SOAPP (E2Z02: Symptom Outcomes and Practice Patterns).
Authors: Fisch Michael , Zhao Fengmin , Manola Judith , Miller Andrew H. , Pirl William F. , Wagner Lynne I. ,   ECOG-ACRIN
Published: February 2017

59 Background: Antidepressant (AD) use is common in outpatient oncology, but the pattern and determinants of prescribing for commonly used AD are unknown. Methods: 3,106 pts with cancer of the breast, prostate, colon/rectum, or lung were enrolled from multiple sites in a study of symptoms. Five depression case-finding methods were explored: 3 based on MDASI items reported by patients (1) sadness/depression>=4, (2) distress>=4, (3) interference with mood>=7 or enjoyment>=7; 2 based on clinician’s report (4) presence of psychological distress, (5) depression being listed as one of top 3 symptoms. AD use (excluding tricyclic antidepressants and psychostimulants) was examined by depression status. Logistic regression models were used to examine the effect of demographic and clinical characteristics on AD use. Results: Rates of depressive symptoms varied by casefinding method (1=29%, 2=28%, 3=14%, 4=24%, 5=11%); 47% (1,457) pts were defined as having depressive symptoms by at least one method. AD were prescribed in 25% of depressed pts compared to 14% of non-depressed pts. After adjusting for other covariates, factors associated with greater use of AD included depression (OR=1.7, p<0.01), family history of depression (OR=2.2, p<0.01), female sex (OR=1.8, P<0.01), younger age (OR=1.2, P=0.04), non-Hispanic White race (OR=2.0, p<0.01), prior chemo/immune/ hormonal treatment (OR=1.5, p<0.01), more concurrent medication use (OR=3.3, p<0.01), anxiolytics use (OR=2.0, p<0.01), sedative use (OR=2.1, p<0.01), receiving counseling (OR=1.6, p=0.04), patient’s perception of poor QOL (OR=1.3, p=0.02), duration of current treatment >1 year (OR=1.6, p<0.01), and being enrolled by a CCOP (OR=1.8, p=0.01). These significant associations remained regardless of the case-finding method used for depression. Conclusions: One-fourth of solid tumor pts with depressive symptoms are taking an AD. Antidepressant prescribing varies by type of institution, race/ethnicity, age, concomitant medication exposure and several other clinical factors. There is an opportunity to improve outcomes through quality improvement initiatives related to antidepressant prescribing.
Four questions: Daily assessment of pain, anxiety, problems or concerns, and need to see physician during a course of radiation therapy.
Authors: Howell David D. 
Published: February 2017

62 Background: Patients (Pts) undergoing radiation therapy (RT) as part of their treatment (Rx) for a malignancy may have pain, distress, anxiety or other problems at the time of initiation of RT. Pts may also develop or have an exacerbation one or more of the above during RT. During RT, pts are seen weekly by the treating physician (MD), and are seen daily by the treating radiation therapy technologists (RTT) as they undergo Rx. Pts may develop problems between weekly MD visits which may benefit from interventions. A system was developed where pts would be asked four questions each treatment day by the RTT: 1) Are you having pain, and if so, how would you rate it on a scale of zero to 10? (PainQ) 2) Are you having anxiety today? (AQ) 3) Are you having new problems or concerns? (ProConQ) 4) Do you want to see the physician today? (CMDQ) This information was used in pt’s management. Methods: 100 pt charts were reviewed for demographics including gender, age, primary malignancy, region treated, number of Rx and radiation dose. The information from the four question instrument was also reviewed for each pt’s course of RT. Results: Of the 100 pts, 56 were male. Disease distribution: Breast-22; Prostate-20; Head and Neck-20; Lung-13; Brain-7; Other-18. For the AQ, 83 did not report anxiety; 17 reported anxiety on one or two occasions. For the ProConQ, 35 reported none, 34 reported yes on 1 or 2 occasions, 22 reported yes on 3 to 5 occasions, and 9 reported yes on greater than five occasions. 29 reported yes on 2 days in a row, and 15 reported yes to problems or concerns on 3 days in a row. For the PainQ, 31 reported no pain throughout their course of RT, with 22, 23, and 25 reporting pain of any magnitude for 1 to 5, 6 to10, and greater than ten days, respectively. 22 reported pain greater than 6 on at least one occasion. For CMDQ, 26 of pts did not request to see the MD, 71 and 3 requested to see the MD an additional 1 to 5, and 6 to 10 times. Conclusions: A simple instrument prompting a four question query to pts undergoing a course of RT may prompt the need for further evaluation and interventions between scheduled MD visits. This may facilitate more expeditious interventions for Rx related toxicity and treatment dependent or independent symptoms or needs.