bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-oncologist cost communication, financial distress, and medication adherence.
Authors: Bestvina Christine M , Zullig Leah L. , Rushing Christel , Chino Fumiko Ladd , Samsa Greg , Altomare Ivy , Tulsky James A , Ubel Peter A , Schrag Deborah , Nicolla Jonathan , Abernethy Amy Pickar , Peppercorn Jeffrey M. , Zafar Yousuf 
Published: February 2017

2 Background: Little is known about the association between patient-oncologist discussion of cancer treatment out-of-pocket (OOP) cost and medication adherence, a critical component of quality cancer care. Methods: We conducted a cross-sectional survey of insured adults receiving anti-cancer therapy. Patients were asked if they had discussed OOP cost with their oncologist. Medication non-adherence was defined as skipping doses to make prescriptions last longer, taking less medication than prescribed to make prescriptions last longer, or not filling prescriptions due to cost. Multivariable analysis assessed the association between cost discussions with an oncologist and non-adherence. Results: Among 300 respondents (84% response), 77% (n=230) were white and 53% (n=158) were men. 17% (n=52) reported “high” or “overwhelming” financial distress. 19% (n=56) had talked to their oncologist about cost. 27% (n=81) reported medication non-adherence. 14% (n=43) skipped medication doses to make the prescription last longer; 7% (n=3) of these had skipped chemotherapy. 11% (n=34) took less medication than prescribed to make the prescription last longer; 15% (n=5) of these took less chemotherapy. 22% (n=67) did not fill a prescription because of cost; 15% (n=10) of these did not fill a chemotherapy prescription. In adjusted analyses, cost discussion (OR 2.56, 95% CI 1.15-5.68; p=0.02), financial distress (OR 1.57, 95% CI 1.33-1.85, P<0.001) and female gender (OR 2.02, 95% CI 1.005-4.07, p=0.048) were associated with increased odds of non-adherence. Private insurance was associated with lower odds of non-adherence (OR 0.30, 95% CI 0.14-0.60, p<0.001). Conclusions: Patients reported non-adherence to medications and chemotherapy in order to make prescriptions last longer or due to cost. While these data cannot determine temporality or the affect of cost discussion on medication non-adherence, patient-oncologist cost communication and financial distress were associated with non-adherence. Future research should examine the timing, content, and quality of cost-related discussions.
Variation in patterns of health care and survival among patients with brain metastases in the VHA health system.
Authors: Ray Saurabh , Wang Li , Martel Marie-Josee , Baser Onur 
Published: February 2017

204 Background: Brain metastases (BM) occur in approximately 15-25% of patients with advanced primary cancers and cause significant morbidity and mortality. This study examines the variation in patterns of healthcare and survival among patients with brain metastases in the US veterans’ population. Methods: A retrospective cohort design identified BM patients, divided into 5 most prevalent primary cancer cohorts using claims and enrollment data (10/1/2005 - 5/31/2012) from the Veterans Health Administration (VHA), the largest integrated health care system in US. Inclusion required ≥ 2 diagnoses of BM (ICD-9 code 198.3x) separated by ≥ 7 days with 1 primary cancer diagnosed before BM. The different BM cohorts were compared to the cohort with the highest prevalence of a primary cancer for the following outcomes: median survival (Kaplan-Meier estimates), per patient month (PPM) rate of healthcare utilization, baseline comorbidities, and use of brain-directed and supportive treatments. Results: Study sample consisted 4,393 BM patients (mean age of 65.6 years, 97% male), divided into 5 most prevalent primary cancer cohorts - 2,783 lung cancer, 574 skin, 568 prostate, 236 kidney, and 232 colorectal cancer patients. Median time to death after BM diagnosis was 103 days for lung, compared to 84 (p<0.01) for skin, and 127, 109, 99 days (all p>0.05) for kidney, prostate and colorectal cohorts respectively. Patients with ≥3 comorbidities ranged from 50% (skin) to 62% (colorectal). Compared to lung, the kidney cohort reported higher emergency room visits (21.6% vs. 16.3%, p=0.04), prostate and colorectal cohorts reported higher inpatient visits (65.3%, 69.4% vs. 59.6%, p=0.011, 0.003, respectively). Whole brain radiotherapy was the most common brain-directed treatment, ranging from 24% (kidney) to 37% (lung); brain-surgery ranged from 7% (lung) to 10% (colorectal); 89% to 94% used corticosteroid supportive therapy. Conclusions: High unmet need exists in the brain metastases population in terms of poor survival, high comorbidity burden and significant healthcare resource utilization. Patient outcomes vary significantly by primary cancer sites reflecting the heterogeneity of this disease.
Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria.
Authors: Loo Ronald , Rabrenovich Violeta , Aspera Ann Michelle , Jacobsen Steven , Landa Howard , Lieberman Stephen F. , Mariani Albert J. , Nicolaisen Gary , Slezak Jeff , StLezin Mark 
Published: February 2017

223 Background: AMH in the general population is common, occurring in up to 9-18%. Even low degrees of AMH have been considered a risk factor for UTMT. Although the prevalence of UTMT is low (.01-3%), many asymptomatic patients undergo unnecessary and hazardous evaluations. In 2007, the Kaiser Permanente (KP) Urologists started a multi-year QI effort to research and develop a risk stratified evidence-based approach in the evaluation of AMH. Methods: The group first conducted a retrospective analysis to determine the incidence of urinary cancer, and stratify risk according to age, gender, smoking history, and degree of hematuria. A multi-regional prospective, observational study was then conducted over a two year period. We used a data collection tool embedded within an EMR to determine patients with AMH who are at greatest risk for UTMT, and patients who might benefit from urologic evaluation or safely avoid unnecessary workup and radiation exposure. Results: 4,414 patients had full urologic work up. Overall, 100 bladder cancers were diagnosed among 4,414 patients (2.3%), and only 11 renal cancers (0.2%) were pathologically confirmed. Multivariable logistic regression was conducted for 5 common parameters: age, gender, smoking history, degree of microscopic hematuria, and history of gross hematuria within the past 6 months. The two most important risk factors were age > 50, and prior history of gross hematuria. A hematuria risk index (HRI) was developed, which significantly improved predictability (AUC = .809-HRI vs .532-AUA guideline). Overall, 32% of the population was identified as low risk with only 0.2% cancer detected; 14% of the population was identified as high risk, of whom 11.1% had a cancer diagnosed. Conclusions: These results suggest that a considerable proportion of patients may safely avoid hazardous evaluation using multivariate risk stratification. An evidence-based algorithm was developed for the management of asymptomatic microscopic hematuria and implemented within KP. We expect to significantly improve patient safety and improve reliability of patient evaluation.
Safe administration of intracerebrospinal fluid chemotherapy (ICC).
Authors: Bidros Michel , Holle Lisa , Riemer Jessie , Tannenbaum Susan , Clement Jessica Mary 
Published: February 2017

229 Background: ICC administration, which includes intrathecal and intraventricular routes, is a complex procedure that involves staff from different disciplines. ICC administration errors are rare, yet potentially fatal. Since 1968, more than 55 cases of ICC administration errors have been documented, but the incidence is suspected to be higher because of underreporting. Little unified action has occurred despite alerts issued by the Joint Commission on Accreditation of Healthcare Organizations and World Health Organization. We have taken a multidisciplinary approach to address this issue. Methods: We identified two problems that could potentially lead to ICC errors: the lack of a formal institutional training/certification program and a comprehensive institutional safe ICC administration policy. Our Hematology-Oncology Fellowship Program along with Pharmacy and Nursing at the University of Connecticut Health Center (UCHC), created a multidisciplinary work group whose purpose is to create a comprehensive institutional policy and training program for disciplines involved in the administration of ICC. Results: The safeICC administration policy has been finalized and presented for approval. Creation of the training program is in progress and will be a part of the educational Core Curriculum of the Fellowship Program. Fellows will be required to demonstrate competency in lumbar and Ommaya reservoir puncture using simulation training on mannequins. Computer-based training with classroom review and testing will be required for all disciplines involved with ICC and will include safe preparation, delivery, handling, verification, administration of ICC, and identification of potential complications. Annual certification will be required. Conclusions: The lack of a formal ICC administration policy and training can lead to catastrophic errors. Development of an institutional policy and training program has heightened awareness of potential sources of ICC administration errors at UCHC and will serve as a mechanism for assessing quality care in the future. We believe the establishment of such a policy and definition of training should be part of the general ASCO/ONS guidelines for safe administration of chemotherapy.
Standardized criteria for required palliative care consultation on the solid tumor oncology service.
Authors: Adelson Kerin , Paris Julia , Smith Cardinale B. , Horton Jay , Morrison R. Sean 
Published: February 2017

37 Background: Studies have shown that routine integration of Palliative Care (PC) for patients with advanced cancer is associated with improved symptom control, clearer understanding of prognosis, lower utilization of health care resources, and increased hospice use. The 2012 ASCO guidelines call for incorporation of PC for any patient with metastatic cancer and/or high symptom burden. Despite a top-rated PC division at Mount Sinai, our Solid Tumor (ST) Division utilized PC and hospice less than other medical centers. Our inpatient ST service consistently demonstrated poor quality metrics. Our 2011-2012 UHC statistics were: mortality index, 1.35 (target <1), 30-day readmission rate, 21.7%, (target < 10.3%) and length of stay (LOS) index, 1.23 (target <1). We hypothesized that implementing standardized criteria for PC consultation would improve these metrics. Methods: During this 3-month pilot, criteria for PC consultation included patients with one or more of the following: stage IV disease, Stage III lung or pancreatic cancer, hospitalization within prior 30 days, >7 day hospitalization, uncontrolled symptoms (pain, nausea, dyspnea, delirium, distress). We looked at two baseline groups for comparison: 1) patients who met eligibility in a six week period prior to the intervention 2) For UHC index data, we used the hospital dashboard average over a 1-year period prior to the intervention. This included all ST patients who were eligible for the intervention (60%) and those who were not (40%). Primary outcomes were: hospice utilization, ST mortality index, 30-day readmission rate and LOS. Results: Comparing Group 1 to the Pilot Group, palliative care consultation doubled from 41% to 82%, 30-day readmission decreased from 36% to 17% (p= .022), and hospice utilization increased from 14% to 25% (p=.146). UHC data (Group 2 vs. Pilot) showed: mortality index improved (1.35 to .59) and 30-day readmission rates decreased (21.7% to 13.5%, p=.026). LOS was unchanged (1.23 to 1.25). Conclusions: Mandating palliative care consults for patients at the highest risk for in hospital death and readmission improved hospice utilization, 30-day readmission, oncology service mortality and adherence with ASCO guidelines.
Evaluation of quality of life from a phase II study of anamorelin HCl in NSCLC patients.
Authors: Temel Jennifer S. , Bondarde Shailesh Arjun , Jain Minish Mahendra , Yan Ying , Duus Elizabeth Manning , Allen Suzan , Mann William 
Published: February 2017

42 Background: Anamorelin HCl (ANA) is an oral ghrelin receptor agonist in development for non-small cell lung cancer (NSCLC)-associated anorexia/cachexia. Cancer cachexia is a multifactorial syndrome, characterized by decreased body weight and muscle, and worsened survival and quality of life (QoL). Here we present Phase II data, including an evaluation of QoL using the MD Anderson Symptom Inventory (MDASI) to assess severity of core symptoms in cancer patients and their impact on daily life. Methods: An international, randomized, double-blind, placebo-controlled, 12-week Phase II trial (NCT00622193) enrolled 226 Stage IIIB/IV NSCLC patients (N=76 for 50 mg ANA; N=73 for 100 mg ANA; N=77 for placebo [PL]). Co-primary endpoints were body weight and handgrip strength (HGS); safety was also assessed. QoL by MDASI was a secondary endpoint; a negative change in MDASI score represents improvement. Assessments were performed at baseline and approximately every 3 weeks over the 12-week treatment period. Results: MDASI total and domain scores improved with 100 mg ANA vs PL, although these changes were not statistically significant (mean±SE change from baseline at Week 12 for 100 mg ANA vs PL was -8.6±4.58 vs -1.5±3.29 for total score; -6.7±2.98 vs -2.9±2.24 for symptom domain score; and -1.9±1.99 vs 1.5±1.39 for interference domain score). Seven individual MDASI symptom/interference items most improved in the 100 mg ANA vs PL group were fatigue, nausea, work around the house, disturbed sleep, distressed, general activity, and mood. Over 12 weeks, ANA also significantly increased body weight vs PL (mean change from baseline was 0.14 kg, -0.3 kg, and -1.32 kg for 100 mg ANA, 50 mg ANA, and PL, respectively [p=0.0005]), and directional (non-significant) changes in HGS were also noted for both active arms vs PL. ANA was safe and well-tolerated, with less adverse events of fatigue, anorexia, and nausea reported in ANA vs PL patients. Conclusions: In this study, ANA significantly increased body weight, improved HGS and QoL, and had an overall favorable safety/tolerability profile. MDASI individual item changes demonstrated improvements in key cancer-related symptoms including fatigue, and were consistent with the adverse event profile. Clinical trial information: NCT00622193.
Using a statewide collaborative approach to improve primary palliative care performance.
Authors: Abstoss Katie , Mahmood Tallat , Martin Claudia Jane , Muir J. Cameron , Severson Jane Alcyne , Smerage Jeffrey B. , Blayney Douglas W. 
Published: February 2017

53 Background: The Michigan Oncology Quality Consortium (MOQC) is a statewide collaborative of oncology practices. Using the Quality Oncology Practice Initiative (QOPI) measurement tool, MOQC identified a gap in the provision of palliative care. We designed and tested interventions to enhance the capacity and capabilities of the oncologist to deliver primary palliative care earlier in a patient’s course. Methods: MOQC created a process to assist oncology care teams in providing primary palliative care services using the Edmonton Symptom Assessment Scale tool. 11 practices participated in two pilots over 18 months. During and after these pilots, we disseminated tools for improvement, including customized palliative care dashboards, to the entire consortium. Pilot teams also shared their successes, insights, and best practices during semiannual live consortium meetings. Results: Shown are palliative care-focused QOPI results, comparing baseline (Fall 2011, F11) and post project (Spring 2013, S13) for all MOQC practices compared with all participating QOPI practices, using a paired t-test. MOQC sites outperformed the QOPI national average on multiple palliative care measures. Furthermore, the MOQC improvement rate since the project initiation was greater than that of national. Although clinically important, the measures did not reach standard statistical significance. Conclusions: Running successive pilot projects improved primary palliative care performance of the teams involved; additionally, this momentum and gain in knowledge facilitated dissemination of innovation and measurable improvement in all members of a statewide consortium. [Table: see text]
Impact of a dedicated supportive care center telephone triaging program (SCCTP) for patients with advanced cancer.
Authors: Pimentel Lindsey E , Yennurajalingam Sriram , Chisholm Gary B. , Edwards Tonya , Guerra-Sanchez Maria , De La Cruz Maxine Grace Jaucian , Vidal Marieberta , Tanco Kimberson , Bruera Eduardo 
Published: February 2017

54 Background: Due to high symptom burden in advanced cancer patients, ongoing symptom management for outpatient palliative care patients is vital. More patients are receiving outpatient care; Yet, most palliative care patients receive less than 2 follow ups. Nurse telephone care can improve quality of life in these patients. Our aim was to determine frequency and care provided by Supportive Care Center Telephone Program (SCCTP) in advanced cancer patients. Methods: 400 consecutive patients who utilized palliative care service, 200 from outpatient Supportive Care Center (SCC) and 200 from inpatient Palliative Care (IPC), were followed for 6 months starting 3/2012 to examine call frequency and reason and outcomes including pain and other symptoms [Edmonton Symptom Assessment Scale (ESAS) and Memorial Delirium Assessment Scale (MDAS)] associated with utilization of SCCTP. We also examined the effect of SCCTP interventions on pain, ESAS and counseling needs. Results: 375 patients were evaluable. Median age 59 years, 53% female, 70% white. Most frequent cancer type were gastrointestinal (20%, p < 0.0001) for IPC and thoracic (23%, p <0.0001) for SCC. SCC patients had higher prevalence of CAGE positivity (28% SCC vs 11% IPC, p <0.0001), ESAS SDS(p=0.0134), depression(p=0.0009), anxiety(p=0.0097) and sleep(p=0.0015); MDAS scores were significantly higher in IPC (p<0.0001).115/400 patients (29%) utilized SCCTP. 96/115 outpatients (83%) used the SCCTP vs 19/115 IPC (17%). Common reasons for calls were pain (24%), pain medication refills (24%) and counseling (12%). Of 115 phone calls, 340 recommendations were made; 43% (145/340) were regarding care at home; 56% of these recommendations were regarding opioids. Patients who utilized SCCTP had worse pain(p=0.0059), fatigue(p=0.0448), depression(p=0.0410), FWB(p=0.0149) and better MDAS scores(p=0.0138) compared to non-utilizers. Conclusions: There was more frequent SCCTP use by outpatients than inpatients. Most common reason for utilization was pain control. Frequently, recommendations were made to continue symptom management at home. Patients who utilized SCCTP had worse pain, fatigue, depression, well-being scores and better delirium scores.
Value of thoracic multidisciplinary clinic (TMDC) in determining appropriate treatment of stage III non-small cell lung cancer (NSCLC).
Authors: Friedman Eliot L , Szwerc Michael F , Kruklitis Robert , Weiss Michael J 
Published: February 2017

82 Background: Treatment of stage III NSCLC involves surgery, radiation therapy and chemotherapy. Treatment depends on the size and location of the primary tumor and lymph nodes as well as clinical status of the patient. Evaluation of these patients should take place in a multidisciplinary clinic, where treating physicians and pulmonary medicine provide a unified treatment plan. Methods: All patients with Stage III NSCLC seen at the Lehigh Valley Health Network (LVHN) between March of 2010 and March of 2012 were analyzed retrospectively. We compared initial treatment of out-patients seen in our TMDC with those out-patients seen outside the TMDC. Results: Thirty-five patients were seen in TMDC (34 treated at LVHN) and 44 patients were seen outside TMDC (34 treated at LVHN). Eleven patients were treated elsewhere or were not treatable. Of patients with stage III NSCLC, 37.5% were seen in TMDC year 1 (March 2010 – March 2011) compared to 61% of patients year 2 (March 2011 – March 2012) (p = 0.05). Patients were seen by physicians from at least two specialties 100% of the time when seen in TMDC, but only 64.7% of the time when seen outside TMDC (p < 0.001). Mediastinal staging (EBUS or mediastinoscopy) was performed more frequently in patients seen in TMDC; 58.9% compared to 23.5% outside TMDC (p = 0.009). The LVHN clinical pathway for stage III NSCLC recommends initial therapy with concomitant chemoradiation, either in the neo-adjuvant setting or as definitive treatment. Eighty-eight percent of patients seen in TMDC followed our clinical pathway while 46% of patients seen outside TMDC conformed to the clinical pathway (p < 0.001). The time from first contact with a treating physician to initiation of treatment was reduced by almost 30% (29.03 days outside TMDC; 20.62 days at TMDC). Conclusions: All patients with stage III NSCLC should be seen in a multidisciplinary setting. At LVHN we saw an increase in these patients being referred to our TMDC over time. These patients were more likely to have mediastinal staging and enjoyed quicker initiation of their therapy. They were more likely to have at least two physicians involved in their initial treatment plan and were more likely to conform to our clinical pathways.
A national survey: Are oncology caregivers getting what they want?
Authors: Patel Kamal , Lis Christopher G. , Rodeghier Mark , Rogers Mark , Gupta Digant 
Published: February 2017

91 Background: More than 65 million people will serve as caregivers and about 1.6 million new cancer cases will be diagnosed in the US in 2013. These staggering numbers serve as the impetus on evaluating the quality of medical care. To this end, we conducted a national cancer survey to evaluate caregiver experience with service quality. Methods: An online survey was conducted among a national random sample of 1000 cancer caregivers in Aug-Sept 2012. Importance of 15 service quality items was measured on a 5-point Likert scale ranging from “not at all important” to “extremely important”. Caregiver experience with those 15 service quality items was captured as a yes/no response. Caregiver satisfaction was measured on a 5-point Likert scale ranging from “completely dissatisfied” to “completely satisfied”. Results: The top 3 areas of gaps between importance and experience were ‘having a specific individual to coordinate care’ (33%, p<.01), ‘after-treatment care and support’ (25%, p < 0.01) and ‘providing a comforting and stress-free environment’ (25%, p < 0.01). Among respondents who rated these areas as very/extremely important, only 45%, 63% and 64% experienced it, respectively. Conclusions: These national findings illustrate that information on caregiver satisfaction can be useful for healthcare managers in the exercise of quality assurance and identification of unmet needs. [Table: see text]