bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of worry about recurrence in breast cancer survivors.
Authors: Shumway Dean Alden , Leinberger Rebecca , Griffith Kent A. , Zikmund-Fisher Brian , Hawley Sarah T. , Jagsi Reshma , Janz Nancy K. 
Published: February 2017

21 Background: Worry about recurrence is a significant concern for breast cancer survivors. We explored physicians‘ confidence and practices in identifying and managing worry. Methods: We surveyed a random sample of 1,500 surgeons and medical oncologists drawn from the AMA Masterfile in 2012. Physician responses to questions regarding their confidence were stratified by practice specialty and compared using the Wilcoxon rank-sum test. Correlates of use of each strategy for managing worry were modeled using multiple variable logistic regression. Results: 896 physicians (59.7%) responded: 498 surgeons and 398 medical oncologists, of whom 85.5% saw breast cancer patients. 62% reported initiating discussions regarding worry about recurrence. Overall, medical oncologists reported more confidence than surgeons in their ability to present risk information to patients, identify survivors with high levels of worry, and help patients manage their worry (p<0.001). Of note, 40.2% of physicians reported low levels of confidence managing worries surrounding recurrence. Confidence presenting risk information was significantly associated with treatment volume, which was highest with >50 cases/year. Surgeons who routinely followed breast cancer survivors for >3 years reported higher confidence; no such correlation existed among medical oncologists, but >90% of this group routinely followed patients for >3 yrs. Female physicians were significantly more likely to report being able to identify survivors with high levels of worry. Practice in an academic setting demonstrated associations with increased confidence. Use of worry management strategies varied by specialty. Medical oncologists were more likely to prescribe medication, address concerns in detail themselves, or refer to a psychologist or social worker. Longer follow-up was associated with increased likelihood of physicians addressing concerns themselves. Conclusions: A sizeable minority of physicians lack confidence in their ability to identify and manage worry in cancer survivors. Medical oncologists and surgeons differ significantly in their approach to worry management, suggesting that greater attention toward this issue in training and continuing education may be warranted.
Lean implementation of electronic health records (EHR).
Authors: Reed Paula , Chan Albert , Colocci Natalia , Carter-West Virginia , Kunkel Matthew , Pierce Tina , Isle Mathew , Nguyen Diana , Roth Julie , Yu Peter Paul 
Published: February 2017

211 Background: The Palo Alto Medical Foundation (PAMF), an integrated multispecialty physician group and one of five regions of Sutter Health in Northern California, is converting from an electronic chemotherapy ordering and administration system, Intellidose, to Epic Beacon to achieve full EHR integration. As chemotherapy workflows are complex with multiple interactions between providers and high potential for patient harm, we adopted a novel approach of incorporating Lean process improvement principles in advance of our Beacon deployment to improve the design of our software build and increase operational safety and efficiency. Methods: Two multi-disciplinary teams including oncologists, pharmacists, nurses, administrative and technical support staff were deployed; a Sutter Beacon team responsible for technical design and build of the Sutter Beacon standard and a second PAMF team to evaluate workflow variation among PAMF chemotherapy infusion centers, identify best practices, engage the Sutter Beacon Build team around system design and institute rapid cycle process improvement in partnership with the PAMF Lean Promotion Office. Results: Visio maps of current state workflows were constructed to reflect oncologist, pharmacy and nursing workflows from medication ordering to chemotherapy administration and billing submission. Two Rapid Process Improvement Workshops designed future state workflows and identified key areas requiring re-engineering. Lean rapid cycle improvement strategies will be leveraged to improve clinical workflows prior to Beacon implementation. To support the 40% of infusion treatments that are for non-oncology patients, a second process was designed as an important patient safety initiative to avoid discordant nursing administration workflows. Conclusions: Successful design, build and implementation of EHR require achieving consensus-driven work processes that maximize patient safety, eliminate workflow redundancies and maximizes the value-added component. It requires coordination between the EHR technical build team who design the system and the implementation team who integrate it with re-engineered workflows. Lean methodology provides the conceptual framework to achieve a successful EHR deployment.
Partnering to build a statewide cancer disparities program.
Authors: Murray Betty C. , Hogarty Lucinda H. , Latney Devon , Salner Andrew L. 
Published: February 2017

216 Background: People of color die from cancer in disproportionately higher rates than Caucasians. As an NCI Community Cancer Centers Program (NCCCP) network member, we utilized American Recovery and Reinvestment Act (ARRA) funding to develop a unique partnership. Hartford Hospital’s Helen and Harry Gray Cancer Center (GCC) has worked closely with our statewide comprehensive cancer control coalition, the Connecticut Cancer Partnership (CCP), to address racial and ethnic health disparities across the state of Connecticut. Methods: We provided a Disparities Project Coordinator (DPC) to work for the CCP as a loaned executive. In this role, the DPC leveraged GCC resources, shared best practices, convened and coordinated statewide activities, and provided oversight for statewide implementation of evidence-based disparities- related cancer projects. This project has been funded in whole or in part with Federal Funds from the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E. Results: The DPC worked within the CCP structure to inform decision-making, initiate educational activities, and spearhead innovative projects such as a disparities internship with local universities and the evidence-based Body and Soul program in churches. Beyond CCP integration, the DPC represents CCP and the GCC on key statewide bodies to influence and inform policy affecting racial and ethnic minorities. Conclusions: This unique partnership is an example of a successful private-public partnership that has resulted in increased minority involvement in the state coalition and creation of multiple key partnerships with private, non-profit and state agencies. The accomplishments of the DPC have resulted in sustainability for this position and the establishment of an effective partnership model to address cancer disparities in the state.
Oral anticancer medication: Does the patient understand?
Authors: Graham Donna M. , O'Shea Alan , Ismail Jeffri R. M. , Bambury Richard Martin , O'Keefe Margaret , Drake Catherine , Moylan Eugene J. , Power Derek Gerard , O'Reilly Seamus 
Published: February 2017

219 Background: Oral anti-cancer medication (OAM) prescribing is increasing. Safety and adherence issues surrounding OAM are causing a shift in the traditional roles and responsibilities of oncologists, nurses and pharmacists. This study aims to investigate patients’ perception of education and safety surrounding OAM use. Methods: Over a 6-month period an anonymous cross-sectional survey was offered to all patients (pts) attending for cancer treatment with OAM at Irish hospitals with cancer services in the South-West region. Data was prospectively analysed using standard statistical tools for non-parametric data. Results: A total of 172 surveys were distributed and 101 pts responded (59%). Of these, 53 (54%) were female. Median age was 62 (range 29-80 yrs). Diagnosis was colorectal cancer in 49 pts (48%), breast cancer in 13 (13%) and brain tumour in 12 (12%). Of treatments used, 85% were oral chemotherapy and 15% oral biological therapy. The most commonly used agent was capecitabine (61%). When commencing OAM, 17% of respondents felt they did not understand it. Understanding was improved by pt education by a doctor (p=0.03) or hospital-based nurse (p=0.04) and provision of information booklets (p=0.04). Pts were unaware of interactions in 30% of cases and 20% were not aware of any safety issues. Pts who had been given information leaflets were significantly more aware of safety including careful handling (p<0.001), storage conditions (p=0.02) and safe disposal (p<0.001). Pts attending nurse-led oral chemotherapy clinics (NOCC) were significantly more aware of safety issues (p=0.04). Of respondents, 1% reported taking too many tablets and 15% had forgotten to take OAM on ≥1 occasion. NOCC improved adherence (p=0.03). Conclusions: OAM, when indicated, is an option for selected pts who are compliant and educated about complications. This study highlights issues with pt education and safety awareness. To our knowledge the factors influencing this have not been previously explored. A significant proportion of our pts were sub-optimally educated regarding medication interactions, storage needs, handling and disposal precautions. Educational tools to aid healthcare professionals in pt instruction and NOCC significantly improve patient understanding.
Chemotherapy order review, activation, preparation, and administration redesign at a large academic cancer center.
Authors: Lennes Inga Tolin , Bohlen Nie , Rosato Erika , Fitzgerald Ellen , Cashavelly Barbara J. , Lafleur Katie , Ahmed Sami , Burke Debra , Ryan David P. 
Published: February 2017

221 Background: Chemotherapy medication errors are potentially catastrophic due to the small window of therapeutic index, high toxicity, and the compromised clinical status of most recipients. Although compliant with major guidelines for chemotherapy administration, MGH Cancer Center still experienced chemotherapy medication errors tracked in the safety reporting system. Analysis of the safety report data prompted the chemotherapy order review, activation, preparation and administration redesign project with two aims: 1) establish the standard for safety checks for chemotherapy order review, mixing, product verification and administration across all areas of adult chemotherapy infusion by April 2013 and 2) reduce to zero the number of chemotherapy related medication errors by January 2014. Methods: A multidisciplinary team including nursing, pharmacy, and physicians was convened and a problem statement, aim statement, project scope, boundaries and measures of success were delineated. Process maps of each chemotherapy administration area (four in total) were created in an iterative fashion via meetings with front line staff and administration. Cause and effect diagrams were created by small groups of staff members from each area and improvement projects were brainstormed and implemented by nursing directors. Error data from safety reports was compiled quarterly and shared with all workers. Results: A single gold standard for MGH Cancer Center chemotherapy order review, activation, preparation and administration was created for all areas that administer chemotherapy to adults. This redesign project has led to several spin off improvement projects including a medication error awareness project led by nursing and a new competency assessment for oncology nurses. The total number of medication related safety reports has decreased by 67%. The time since our last major chemotherapy administration error is 239 days and we are on track to meet our second project aim. Conclusions: This project employed quality improvement tools and practices to redesign and standardize chemotherapy administration and decrease safety reports related to chemotherapy errors by 67%.
Storage, disposal, and utilization of opioids among cancer outpatients.
Authors: Reddy Akhila Sunkepally , De La Cruz Maxine Grace Jaucian , Rodriguez Eden Mae , Thames Jessica , Wu Jimin , Chisholm Gary B. , Liu Diane , Frisbee-Hume Susan , Cantu Hilda , Marin Alejandra , Gayle Vicki , Shinn Nancy , Xu Angela , Williams Janet L. , Yennurajalingam Sriram , Hui David , Bruera Eduardo 
Published: February 2017

222 Background: Prescription opioid abuse is an epidemic in the US. Of the abusers, 75% obtain the opioid from a friend or relative, which may be related to improper opioid storage and disposal practices. Our aim was to determine patients’ practices of opioid use, storage, and disposal. Methods: We surveyed 300 cancer outpatients presenting to our Supportive Care Center who were receiving opioids for at least 1 month and collected information regarding opioid use, storage, and disposal along with patient characteristics and scores on Cut-down, Annoyed, Guilty, Eye-opener (CAGE) questionnaire for alcoholism. Sharing or losing their opioids was defined as an unsafe use. Results: The median age of the patients was 57 years; 53% were female, 72% were white, and 63% were married. Most (89%) had advanced cancer, and lung cancer was the most common (22%). CAGE was positive in 19%, 9% had history of illicit drug use, and 36% lived with adult/young adult children. Of the 300 respondents, 19% stored opioids in the open, 69% kept opioids hidden but unlocked, and 9% locked their opioids. Patients with history of CAGE positivity (P=.007), illicit drug use (.0002), smoking (P=.03), and those living with adult children (P=.004) were more likely to keep their opioids locked. 66% were unaware of proper opioid disposal methods. 46% had unused opioids at home. 53% did not routinely dispose opioids, of whom 44% saved them for future use. 26% indulged in unsafe use by sharing (9%) or losing (17%) their opioids, and 44% informed their family and friends that they were on pain medications. 39% were unaware that their opioid could be fatal when taken by others. Compared with married patients, those who were never married [OR=2.92; 95% CI 1.48-5.77], separated [OR=11.38; 1.52-112.5], or divorced [OR=1.27; 0.55-2.91] had higher odds of unsafe use (P=.006). CAGE positivity (40% vs. 21%, P=.003) and illicit drug use (42% vs. 23%, P=.031) were also significant predictors of unsafe use. Conclusions: An alarming proportion of patients improperly and unsafely use, store, and dispose of opioids. Patient education by physicians/pharmacists and creation of more drug take back programs may reduce availability of prescription opioids for potential abuse. More research is needed in this area.
The frequency of falls in patients with advanced cancer followed in an outpatient palliative care center.
Authors: De la Cruz Maxine , Didwaniya Neha , Tanco Kimberson , Shin SeongHoon , Reddy Akhila Sunkepally , San Miguel Arregui Maria Teresa , Moreno Herlinda , Bruera Eduardo , Chisholm Gary B. , Williams Janet L. 
Published: February 2017

225 Background: Falls are a concern in patients who are frail, have advance age or severe underlying medical condition as a significant cause of morbidity and reduced quality of life. It has been reported to occur in up to 50% of palliative care patients in different settings. Our aim was to determine the frequency of falls and identify its predictors and correlates in patients with advanced cancer. Methods: We reviewed 1,984 consecutive patients with advanced cancer seen in the outpatient supportive care center and determined the frequency of patient reported falls within the last month prior to the visit. Baseline patient characteristics, symptom severity scores in the Edmonton Symptom Assessment Scale (ESAS), medication use, functional status, and use of assistive devices were used to identify factors that are predictive of falls using backwards stepwise logistic regression. Results: 1,041 (52%) were female, 1,377 (69%) were non-Hispanic-white, 343 (17%) had peripheral neuropathy, 237 (12%) were on psychotropic medications, and 1,140 (58%) were on opioids. There were 211 (11%) patient reported falls. Presence of brain metastasis, use of assistive device, ECOG, ESAS depression, and weight prior to visit were significantly associated with patient reported falls in the multivariate model. Conclusions: One tenth of patients seen in the outpatient supportive care clinic reported falls. Our findings showing that falls to be associated with brain metastasis, assistive device, functional status, ESAS depression and weight are useful in stratifying high risk patients. They also show that certain medications deemed as risk factors in other populations were not associated with falls. [Table: see text]
Retrospective evaluation on safety concerns of adjuvant therapy for elderly breast cancer patients in a clinical setting.
Authors: Illarramendi Jose Juan , Illarramendi Jorge , De La Cruz Susana , Lainez Nuria , Salgado Esteban , Vera Ruth 
Published: February 2017

232 Background: Safety concerns have an important role for the decision making of systemic adjuvant therapy in elderly frail breast cancer patients. These patients are not common in controlled clinical trials. Methods: Retrospective observational assessment of major events in a subgroup of elderly (>70 years) breast cancer patients who received adjuvant systemic therapy in a single center (2001-2011). Events were especially evaluated in case of a potential relation to antiestrogen therapy and chemotherapy. Results: 176 patients have been evaluated. Median age: 77.5 years (70-94). Median follow-up: 7.3 years (1-12,5). Most patients received hormone therapy with aromatase inhibitors (70 anastrozol, 43 letrozol, 2 exemestane) ot tamoxifen (41 p.). Some patients received adjuvant chemotherapy (41 p.) and trastuzumab (2 p.). Events found in this population included as follows: fractures (19 hip and/or pelvic, 19 arm, 5 leg, 7 vertebral), severe cognitive impairment (27), cardiac failure (23), ocular surgery for cataracts (15), joint and tendon surgery (10), cerebrovascular accidents (9), polymyalgia (4), second neoplasms (1 leukemia, 1 fallopian tube, 2 colon, 1 vulva, 1 uterus, 1 gastric, 1 bladder, 1 maxillary, 1 muultiple myeloma, 1 myelodysplastic syndrome), symptomatic arrythmia (11), cardiac ischemia (4), thromboembolic events (15), neutropenic fever (4) repeated urinary tract infections (9). Conclusions: Events with potential safety concerns are not uncommon in elderly breast cancer patients receiving adjuvant therapy and must be addressed in the treatment plans of these patients.
Informal decision support networks and treatment decisions for breast cancer.
Authors: Hawley Sarah T. , Janz Nancy K. , Juhasz Rose , Katz Steven J. 
Published: February 2017

24 Background: Although nearly 80% of breast cancer patients have someone with them during surgical consultations, there is little research that examines the extent, nature, or impact of informal decision support persons (DSPs) such as partner/spouse, other family members, or friends on breast cancer treatment decision making. Methods: Two data sources were used: 1) A population based sample of patients recently diagnosed in 2006/7 in the Detroit and Los Angeles SEER catchment areas completed a survey 9 months (N=1837, 72% response rate); and 2) A pilot survey study of a convenience sample of 150 breast cancer patients at three clinical sites surveyed within 18 months that examined more details on the extent and nature of informal decision support networks, including: a) quantity and type of DSPs involved in their treatments, b) number of appointments attended by DSPs, and c) patient-reported satisfaction with DSP’s involvement in treatment decision making. Results: Both a spouse/partner and another family member were very important in treatment decision-making for 33% of patients; a spouse/partner alone was very important for 19%; a family member alone was very important for 13%. A spouse/partner or friends were not important in treatment decision making for 24% of patients. Only 19% of patients reported that a friend was very important in treatment decision making. Friends were much more frequently endorsed among patients with family involvement (45%) vs those without family involvement (5%). Latina patients significantly more often reported that the opinion of a family member was very important vs. other race/ethnic groups (71% vs. 39%, p<0.001). Patients in the pilot study reported an average of 2.67 DSPs were involved in locoregional decision making (SD = 2.57 ) vs. an average of 0.8 (SD=1.03) for involvement in systemic treatment decision making. Conclusions: Many breast cancer patients rely on some informal decision support, but there is a very wide variation in the extent and nature of this support. Further work is needed to understand how to best incorporate DSPs into the treatment decision process. Additional findings will be presented to further describe the impact of informal treatment decision support for women with breast cancer.
Systematic identification of metastatic population subsets for advance care planning (ACP) discussions: A scalable approach using electronic health record (EHR) technology.
Authors: Taniguchi Cynthia , Olson Kevin Donald , Harrison Deb , Hoverman J. Russell , Arlen Aimee Ginsburg , Mikan Sabrina Q. , Ash-Lee Susan 
Published: February 2017

243 Background: Comprehensive cancer care embraces the concept of having timely discussions with patients about end of life care preferences regarding treatment interventions. Physicians and healthcare teams are frequently challenged with identifying patients who are clinically appropriate for these discussions and subsequent management of ACP work within the context of clinic resource capacity. A data extraction process is needed to systematically identify cancer population subsets for ACP based on clinical data elements maintained within an EHR database. Methods: Seven cancer center sites of service participated in a 90-day pilot study for delivering ACP services to discrete patient populations who it was believed would most benefit from ACP. Electronic methodology was developed and tested through the pilot process to systematically identify those patients having documented evidence of designated clinical criteria, including metastatic disease status. Metastatic status was determined using five clinical data elements. EHR technology enabled further targeting by cancer diagnoses and allowed this program to be scalable to individual practice capacity. Additional filtering capability was incorporated to exclude non-applicable patient records. Results: On a weekly basis, each pilot site received a report of eligible patients based on clinical criteria and practice-specific diagnoses. During the 90-day pilot period, sites collectively identified an average of 871 patients per week who met clinically-based selection criteria. Once a patient was identified, physicians were able to determine if the patient was appropriate for ACP introduction. The systematic patient identification process allowed ACP to be easily integrated into mainstream practice workflow. Conclusions: EHR technology is invaluable for strategically identifying cancer patient population subsets for clinically appropriate delivery of ACP services. Automated notification of eligible patients and the ability to filter the population enabled practices to engage the ACP process wholly within the scope of comprehensive cancer care delivery.