bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of neurocognitive function on health utility scores (HUS) in Stage 4 (S4) lung cancer patients (pts) with and without brain metastases (BrM).
Authors: Tse Brandon C , Tam Vivian , Tse Tiffany , Lu Lin , Borean Michael , Tam Emily , Labbé Catherine , Doherty Mark K. , Bradbury Penelope Ann , Leighl Natasha B. , Brown M. Catherine , Xu Wei , Howell Doris , Liu Geoffrey , O'Kane Grainne 
Published: March 2017

225 Background: As targeted therapies for S4LC pts have improved survival, the impact of health-related quality of life (HRQoL) in these pts grows in importance. In pts with BrM, loss of NCF may affect HRQoL significantly. We evaluated the relationship between NCF and HUS as a measure of HRQoL in S4LC pts. Methods: Self-reported HUS data from EQ5D-3L were obtained cross-sectionally from S4LC pts with (BrM) or without BrM (non-BrM). NCF was measured using the Hopkins Verbal Learning Test – Revised (HVLT-R), the Controlled Oral Word Association Test (COWAT) and Trail Making Tests (TMT-A/B). NCF scores were correlated with HUS (Pearson Coefficient, R). Results: BrM (n = 54) and non-BrM (n = 40) patients had similar demographics- overall median age was 61 (range 33-89) years; 59% were female; 45% had EGFR/ALK alterations; BrM pts were treated with whole brain (n = 20), stereotactic radiation (n = 19), both (n = 6), or sole use of systemic agents (n = 6); 3 were observed; 7 had BrM resection. Overall HUS were similar between BrM and non-BrM groups (mean HUS (mHUS): 0.77 vs. 0.78; p = 0.86). However, pts with stable brain disease had higher HUS than those with progressive brain disease (mHUS: 0.80 (n = 36) vs 0.69 (n = 17); p = 0.045). There was a trend towards lower HUS in symptomatic vs. asymptomatic BrM (mHUS: 0.70 (n = 10) vs. 0.78 (n = 43); p = 0.07). Multiple correlations between NCF scores and HUS were found. HLVT-Total Recall correlated with HUS in BrM but not non-BrM (R=0.35, p = 0.01; vs. non- R=0.04, p = 0.84 respectively) as did the HLVT-Recognition (BrM: R=0.32, p = 0.03 vs. non-BrM: R=0.13, p = 0.51). In contrast, TMT-A/B were associated with HUS in both BrM (p = 0.03, 0.06) and non-BrM pts (p = 0.001, 0.03). COWAT was associated with HUS only when all pts were analyzed together (p = 0.04). Conclusions: In S4LC pts, HUS were correlated with multiple measures of NCF. The impact of uncontrolled brain disease and poor NCF on HUS demonstrates that this measure has clinical utility, with important HRQoL implications as metastatic lung cancer pts live longer.
Measuring the impact of extended cancer survival on broader aspects of life and wellbeing: The PROACT Study.
Authors: Shilling Valerie M , Starkings Rachel , Jenkins Valerie A. , Fallowfield Lesley 
Published: March 2017

227 Background: Living with cancer and its treatment affects many aspects of life, impacting roles and responsibilities. Formal assessment of these impacts is not normal practice and there is a need for rigorously developed, well-validated measures for both patients (pts) and informal caregivers (cgs). We present an overview of work (PROACT) detailing the development of such tools. Methods: Stage 1: Two systematic reviews of existing PROs used to measure broad life impact in pts and cgs, mapping individual scale items to conceptual domains to identify what is currently being measured and where gaps exist. Stage 2: Qualitative 1: Thematic analysis of in-depth interviews with pt-cg dyads about the impact of extended cancer survival on broader aspects of life and wellbeing to generate potential items for new measures. Qualitative 2: Cognitive interviews with new pt-cg dyad cohort using "think aloud" and specific probes to refine items for new measures. An advisory panel of 5 people with lived experience of cancer or caregiving worked with us throughout the project. Results: Systematic reviews identified gaps in existing measures around changes in occupational, financial, household and family roles and responsibilities and informed topic guides for Qualitative 1. Interviews with 24 pt-cg dyads generated 20 themes and 33 sub-themes from which 31 pt and 64 cg items were devised. Cognitive interviews with 20 pt-cg dyads in Qualitative 2 refined the measures. The final measures consisted of 29 items for pts (intended to be administered alongside FACT-G/QLQ-C30) and 60 for cgs (stand alone). Items cover family responsibilities, financial well-being, jobs and careers and additional sections on relationships and communication, lifestyle and outlook and health and well-being for cgs. Conclusions: We have developed two scales to measure broad life impacts of cancer for patients and informal caregivers. These are currently being evaluated and validated in Stage 3 of the project. Once validated these scales will be useful tools for clinicians and researchers enabling wide-ranging longer-term evaluation of new treatments in clinical trials and to aid decision-making about treatment options and supportive interventions.
Patient-reported outcomes in metastatic breast cancer: QoL, needs, and expectations of survivors.
Authors: Caleffi Maira , Burchardt Norah Ana , Scapin Helio Pasqualotto , Crivelatti Isabel , Gomes Carlos Spode , Gomes Ana Lucia , Pohlmann Paula Raffin 
Published: March 2017

228 Background: Breast cancer is still a leading cause of death and suffering worldwide. To date, metastatic breast cancer (MBC) is a treatable but incurable disease. Molecular subtypes influence outcomes, with recent increase in median overall survival to 56 months in HER2+ disease (Swain et al NEJM 2015). The success of MBC treatment underscores the increasing importance of discussing quality of life (QoL) and patients’ needs. A survey evaluating patient-reported outcomes was carried out in a Brazilian center with the aim of evaluating patient’s QoL, needs and expectations. Methods: In this IRB approved study, MBC patients were selected from clinical database for phone interviews. During the call, verbal consent was obtained and recorded. Patients answered a standardized questionnaire containing 28 questions about their experience with MBC. RedCap database was created with data from interviews for further analysis. Results: A total of 94 patients with MBC were initially screened. From these, 50 were interviewed (24 deceased, 6 declined and 14 had technical problems). Patient’s age ranged from 31-87y. In 44% family income decreased after MBC diagnosis. Median time from diagnosis of MBC to interview was 62 months (range 1-274 months). Most patients (86%) kept themselves informed about MBC; main sources being doctors (100%), internet (76%), media (71%), other patients (54%), and family (48%). Only 6% didn’t know what MBC meant. Majority were on therapy: chemotherapy/injectables (54%), oral medication (36%), and radiation (2%). Most (86%) preferred follow up by a multidisciplinary team, and 18% would prefer exclusive MBC clinics. Only 6% accepted the label “metastatic”. Less popular labels were “advanced disease” (6%), “recurred” (4%), “palliative” (4%), or “disseminated” (0%). They preferred this disease phase be called “controlled disease” (50%) or “chronic disease” (28%). Conclusions: The main sources of information about MBC for patients are the internet and their providers. In this center, communication between providers, policy makers and MBC patients could potentially be improved with terminology changes, since patients would prefer the metastatic phase of their disease be called “Controlled Disease”.
Implementation of an electronic surveillance database for patients with colorectal cancer.
Authors: Li Yan , Rizzo Michael , Washington Pamela Kim , Ajayi Olakunle , Dixon Matthew 
Published: March 2017

231 Background: An electronic surveillance database was created to monitor patients for five years following curative treatment for colorectal cancer. The database serves as an alert system and data repository for imaging, serology, and colonoscopy surveillance tests preloaded for each patient in accordance with NCCN guidelines based upon TNM cancer staging. Methods: The chiefs of Surgery and Oncology defined end-user specifications for the Filemaker Pro database. Key features include preloaded tests based upon NCCN guidelines, expected date of completion, and exam results. The database also tracks tests overdue or ordered but not yet obtained. A new workflow consisting of a monthly report of new colorectal cases from Pathology and a meeting of surgical and oncology physicians and physician assistants to review the report, update the database with new patients, and identify patients due for follow-up was established. Results: 250 cases are currently being monitored. By 2019, the database is poised to be the largest in Kaiser Permanente (KP) dedicated to active surveillance following colorectal cancer treatment. Conclusions: In addition to ensuring that individual patients obtain surveillance tests at the intervals based upon national guidelines for each TNM classification, the database can also be used to assess surveillance results and recurrence rates. The database format has also proven invaluable for other services. The Thoracic service recently created a database modeled after colorectal surveillance to begin tracking lung cancer patients. Beginning in 2016, the colorectal database became a Regional KP initiative and will be incorporated into HealthConnect (electronic medical record).
Adequacy of breast cancer screening in women previously treated with chest wall radiation for lymphoma at the Cancer Therapy and Research Center in San Antonio.
Authors: Jones Jessica Trevino , Lathrop Kate Ida , Janania Martinez Michelle , Mushtaq Uzair , Fiazuddin Faraz 
Published: March 2017

232 Background: Research has established that woman with a history of lymphoma who receive chest wall radiation are at a greater risk to develop breast cancer. As such, recommendations for breast cancer screening for woman who received prior RT < 30yr of age have been a topic of discussions for the better part of 20 ears. Survivorship screening programs for our successfully treated hematologic malignancies should include referring survivors for breast cancer screening given their substantially increased risk of treatment related breast cancer. Methods: We investigated 88 patients who had lymphoma treated by radiation for lymphoma from 2016 to present time. We excluded 49 patients due to age, or not receiving chest wall radiation. For the 39 patients identified, further data included was the average amount of total grays received, if they were counselled about possibility of treatment related breast cancer, if they were Hispanic, and if they were referred for breast cancer screening/referred to specialty breast clinics. Results: We identified that all 39 patients in our study have not had any breast cancer screening despite being qualified to get breast MRI or mammogram. Less than 10% were advised of the possibility of treatment related breast cancer by radiation oncology per documentation. We have found that 48% of our patients are Hispanic, 7 patients’ records did not show total amount of grays received but 61% received greater than or equal to 30 grays. Conclusions: As our results showed that all 39 subjects were not properly screened to the best of our knowledge, we intervened because of our results. As a result, we plan on doing further quality care measures in our clinics to increase breast clinic referrals. Additionally, we are working on IRB approval to contact patients we have found needing screening to get screened appropriately. We are optimistic that our study will ensure future protocols for patients who received radiation to the chest, and look forward to presenting data as it becomes available.
Kansas cancer survivors: An opportunity for lifestyle modification targeting primary and secondary cancer prevention.
Authors: Klemp Jennifer R. , Wu Mickey H.C. , Sergeant Julie 
Published: March 2017

233 Background: Cancer survivors are at increased risk for cancer recurrence and new primary cancer, and engage in lifestyle behaviors that can adversely affect risk and quality of life. Primary care physicians and oncologists are in a position to refer patients to evidence-based interventions for primary and secondary cancer prevention. This study aims to gain an understanding into the diagnostic characteristics of cancer survivors and lifestyle behaviors between persons ever diagnosed and never diagnosed with cancer in Kansas. Methods: Data from Kansas Cancer Registry (KCR) was used to examine the diagnostic characteristics by cancer status: cancer survivor (diagnosed and alive) or non-survivors (diagnosed and deceased). Group differences in selected characteristics were evaluated by t-tests and chi-square tests. Logistic regression was applied to assess the odds of being a survivor based on stage of diagnosis. The 2014 Kansas Behavioral Risk Factor Surveillance System (KS-BRFSS) data was used to compare health risk behaviors, health status, and health care access between persons ever diagnosed and never diagnosed with cancer. Distributions of both groups were evaluated by linear and logistic regression to produce adjusted percentages. Results: Significant group differences were observed between cancer survivors and non-survivors.The odds of being a non-survivor were 11.6 times greater for those initially diagnosed at a distant stage compared to those diagnosed with localized disease. Survivors were significantly more likely to be older, female, and retired; and were significantly more likely to be current smokers, physically inactive, and emotionally unhealthy. Conclusions: Cancer survivors are now living longer with and through their disease, but in our study reported an increase in unhealthy behaviors compared with those never diagnosed with cancer. Results from this study indicate the need of survivor health education and access to care, and provider continuing education (for both primary care physicians and oncologists), targeting lifestyle behaviors associated with cancer and chronic disease management.
Factors associated with neurokinin-1 receptor antagonist use among commercially insured cancer patients receiving highly emetogenic chemotherapy.
Authors: Onishi Maika , Vasan Sowmya , Accordino Melissa Kate , Hillyer Grace , Neugut Alfred I. , Wright Jason Dennis , Hershman Dawn L. 
Published: March 2017

24 Background: Neurokinin-1 receptor antagonists (NK1RA) reduce chemotherapy-induced nausea/vomiting (CINV) among patients undergoing highly emetogenic chemotherapy (HEC). We evaluated factors associated with the use of NK1RA in patients treated with HEC. Methods: We performed a retrospective cohort study using Truven Health Marketscan to identify subjects who initiated HEC (doxorubicin or cisplatin) between 2009 and 2013, and concurrently received a NK1RA. Multivariable logistic regression was used, to determine the association of clinical and demographic factors and NK1RA use. Results: Of 32,004 subjects with cancer who were treated with either doxorubicin or cisplatin-containing regimens, 11,325 (33.3%) did not receive an NK1RA. From 2009 to 2013, NK1RA use increased from 53.2% to 73.5% (p < 0.0001). Compared to non-users, NK1RA users were more frequently treated with cisplatin-based regimens (67.9% vs. 32.1%, p < 0.0001), had in-network claims (66.7% vs. 33.3%, p < 0.0001), were younger, and without other comorbidities. Multivariate analysis demonstrated that NK1RA use was more likely with cisplatin compared to doxorubicin (OR = 1.71, 95% CI 1.62-1.81) and with female compared to male patients (OR = 1.75, 95% CI 1.65-1.84). In-network claims (OR 1.26, 95% CI 1.16-1.36) and comprehensive benefit plans (OR = 1.14, 95% CI 1.04-1.25) were associated with increased NK1RA use, compared to out-of network claims and preferred provider organizations (PPO), respectively. Age ≥ 65 years (OR = 0.64, 95% CI 0.5-0.69) and increased comorbidities (comorbidity score of 1: OR 0.88, 95% CI 0.83-0.94; score of 2- OR 0.61, 95% CI 0.56-0.67) versus a score of 0 were associated with decreased NK1RA use. Conclusions: A substantial proportion of patients receiving HEC do not receive NK1RA, and type of insurance coverage was associated with receipt.
NP model of survivorship care: Lessons learned.
Authors: Dawson Gretchen , Wentworth Stacy 
Published: March 2017

26 Background: The number of cancer survivors is expected to reach 20 million by 2026. As patient volumes increase, oncologists are tasked with seeing more patients, often allowing less time for survivorship-related concerns. In an effort to address this issue, nurse practitioners (NPs) are equipped to aid survivors by managing late/long-term side effects of treatment, monitor for recurrence, provide survivorship care plan (SCP), and promote overall health and wellness. Methods: When initiating a survivorship program, our community cancer center utilized survivorship nurse practitioners (SNP) to address increasing patient volumes and patients’ survivorship issues. By beginning with breast cancer survivors, we were able to meet patients prospectively at diagnosis to provide support and introduce survivorship. SNP later saw patients in designated Survivorship Clinic, after completing treatment and in long-term survivorship to address physical/psychosocial concerns, place appropriate referrals, and promote overall wellness. Collaboration with local Primary Care Providers (PCP) was integral for the long-term care of survivors. Results: In 9 months, prospective data collection surveys helped to better understand patients’ needs, allocation of appropriate resources, and measure patient empowerment. Collaboration with EMR team helped address patient volumes and workflow. Future collaboration of survivors’ healthcare needs with PCP was done by routing 162 completed SCPs to patient-designated PCP and mailing over 185 survivorship program introduction letters to community PCPs. Conclusions: Meeting patients prospectively aided in promoting the importance of survivorship helped provide evaluation of our survivorship program’s growth and development. However, patients introduced to survivorship at diagnosis required a formal referral at the completion of treatment, which disrupted workflow. Collaborating with EMR team to develop survivorship referrals, survivorship clinic templates, and SCP reports were important. Continued work with PCPs will be integral to future success. NPs provide survivorship-focused care in the oncology setting, while meeting continued demands of a growing cancer survivorship patient population.
Effects of delays in the adoption of cancer innovation: Case studies of six landmark medications.
Authors: Shafrin Jason , Shim Jin Joo , Vine Seanna , Huber Caroline , Korytowsky Beata , Shah Manan , Chan David 
Published: March 2017

27 Background: Although new oncology treatments have the potential to improve patient health, these innovations take time to reach to real-world patients. In this study, we estimated how delays in the uptake of novel oncology treatments affect real-world patient survival. Methods: This retrospective cohort study used 1991-2013 data from a cancer-registry linked to health care claims (SEER-Medicare). Our endpoint of interest was patient overall survival. We used variability in the adoption of new cancer treatments across aggregated Metropolitan Statistical Areas (MSAs) (n = 50) as a “natural experiment” that assigned treatments randomly across patients, depending entirely on where they live. This approach recovers the effect of the new treatment on the overall survival of the “marginal patient,” who received treatment solely because she resides in an area with faster uptake. This framework was applied to six case studies: trastuzumab (breast), bevacizumab (colorectal), bevacizumab (lung), erlotinib (lung), bortezomib (myeloma) and lenalidomide (myeloma). Results: Among the 92,496 patients in the study, the difference between adoption rates among eligible patients for MSAs at the 90th percentile and those at the 10th percentile was 20.1 percentage points, with the largest differences being for bevacizumab (colorectal) (51.2% at the 90th percentile MSA vs. 20.9% at the 10th percentile), and smallest for erlotinib (10.3% vs. 2.8%). Median OS among eligible patients gaining access to these landmark therapies increased by 9.6 months. Survival improvements were largest for the lenalidomide case study (33.4 months OS improvement, p < 0.005) followed by erlotinib (21.2 mo., p < 0.001), trastuzumab (19.2 mo., p = 0.016), bevacizumab for lung (7.4 mo., p = 0.002), bevacizumab for colorectal cancer (4.0 mo., p = 0.062), and bortezomib (2.9 mo., p = 0.630). Conclusions: Improving the speed at which landmark treatments are adopted in practice—through physician education and outreach or more generous health insurance access policies—has the potential to improve real-world survival for cancer patients.
Empowering breast cancer survivors: Results of a community-based survivorship clinic.
Authors: Mackey Heather Thompson , Wentworth Stacy 
Published: March 2017

29 Background: Based on advances in detection and treatment, survival for breast cancer patients has increased over the past decade with 5-year survival rates approaching 90%. Survivors remain at risk for treatment related side effects, which can profoundly impact their quality of life. The Breast Cancer Survivorship Clinic (BCSC) was established in January 2016 to provide patient-centered care to survivors with the intent to maximize quality of life, empower decision making, and facilitate care coordination in order to pursue a life of wellness and overall health in patients’ lives after cancer. Methods: A Survivorship Nurse Practitioner (SNP) meets newly diagnosed breast cancer patients to introduce survivorship as part of the treatment course for those treated with curative intent. Upon completion of active treatment, survivors are scheduled to see the SNP to review their Survivorship Care Plan (SCP) outlining treatment history, surveillance schedule, side effects of treatment, and recommendations for cancer screening and health maintenance. Survivors are surveyed to assess symptoms and concerns at the end of treatment, as well as assess patient empowerment after meeting with the SNP. Results: Over the first nine months of BCSC, 95 patients have been seen. The most common concerns related to physical side effects include fatigue (57%), hormone changes (39%), and insomnia (39%). Survivors report fear of recurrence (58%), finances (47%), and anxiety (35%) to be among their greatest psychosocial concerns. 86% said they would appreciate reviewing a SCP with the SNP. After meeting with the SNP, 93% felt better or much better able to understand their illness, cope with illness, and keep themselves healthy. After meeting with the SNP, 92% felt more confident in their health and felt as though they can better help themselves. Conclusions: The first months of the BCSC have been a success with excellent reported empowerment via validated survey measure. Continued refinement in program development will ensure the initial successes of the program will continue in order to provide all survivors with late/long-term side effect management, physical/emotional support, and survivorship care planning at the completion of cancer treatments.