bluuebunny/crossref_metadata_2025_split huggingface dataset:
Readmissions following umbilical cord blood stem cell transplantation.
Authors: Crombie Jennifer , Spring Laura Michelle , Li Shuli , Soiffer Robert , Antin Joseph Harry , Alyea Edwin , Glotzbecker Brett 
Published: February 2017

272 Background: Readmission within 30 days of discharge has been perceived by the Centers for Medicare and Medicaid Services to be an indicator of poor healthcare quality, however it is unclear how accurately this applies to oncology patients. Patients treated with allogeneic hematopoietic stem cell transplantation (HSCT) have high rates of readmission, but the incidence following umbilical cord blood transplantation (UCBT) is poorly described. The goal of this study was to identify the incidence, reasons, and risk factors for readmission following UCBT. Methods: A retrospective review of patients receiving an UCBT at Dana-Farber/Brigham and Women’s Hospital between January 1, 2004 and December 31, 2013 was performed. The 30-day and the day +100, a traditional assessment point in transplantation, readmission rates were examined. Reasons for readmission, as well as sociodemographic and disease and stem cell transplant related variables were evaluated. Predictors of readmission were identified using multivariate regression analysis. Results: 33.6% (42/125) of patients were readmitted within 30 days of discharge. Of patients who survived until day +100, 46.7% (57/122) were readmitted within 100 days of UCBT. The most common cause for readmission was infection (38.3%), followed by fever without a source (14.8%) and graft vs. host disease (GVHD) (8.6%) (Table). A multivariate logistic regression model of the probability of being readmitted within 30 days and by day +100 suggested that infection during transplant admission was a significant risk factor for readmission (OR: 5.1, p=0.003 and OR: 2.9, p=0.014, respectively). Conclusions: There is a high rate of readmission within 30 days and by day +100 following UCBT. The most common causes of readmission were infection and fever without a source. Infection during the transplant admission predicted a higher risk of readmission, suggesting a possible group to target for interventions aimed at reducing readmissions and improving quality of care. [Table: see text]
Incidence and determinants of 1-month mortality after cancer-directed surgery.
Authors: Mahal Brandon Arvin Virgil , Inverso Gino , Aizer Ayal Aaron , Ziehr David R. , Hyatt Andrew , Choueiri Toni K. , Hoffman Karen Elizabeth , Hu Jim C. , Beard Clair , D'Amico Anthony Victor , Martin Neil E. , Orio Peter F. , Trinh Quoc-Dien , Nguyen Paul Linh 
Published: February 2017

282 Background: Death within 1 month of surgery is considered treatment related and serves as an important healthcare quality metric. We sought to identify the incidence of and factors associated with 1-month mortality after cancer-directed surgery. Methods: We used the Surveillance, Epidemiology and End Results Program to study a cohort of 1,110,236 patients diagnosed from 2004-2011 with cancers that are among the 10 most common or most fatal who received cancer-directed surgery. Multivariable logistic regression analyses were used to identify factors associated with 1-month mortality after cancer-directed surgery. Results: 53,498 patients (4.8%) died within 1 month of cancer-directed surgery. Patients who were married, insured, or who had a top 50th percentile income or educational status had lower odds of 1-month mortality from cancer-directed surgery ([adjusted odds ratio (AOR) 0.80; 95% CI 0.79 – 0.82; P<0.001], [AOR 0.88; (0.82 – 0.94); P<0.001], [AOR 0.95; (0.93 – 0.97); P<0.001], and [AOR 0.98; (0.96 – 0.99); P=0.043], respectively). Patients who were non-white minority, male, or older (per year increase), or who had advanced tumor stage 4 disease all had a higher risk of 1-month mortality after cancer-directed surgery, with AORs of 1.13 (1.11 – 1.15), P<0.001; 1.11 (1.08 – 1.13), P<0.001; 1.02 (1.02 – 1.03), P<0.001; and 1.89 (1.82 – 1.95), P<0.001 respectively. Conclusions: Unmarried, uninsured, non-white, male, older, less educated, and poorer patients were all at a significantly higher risk for death within 1 month of cancer-directed surgery. Efforts to reduce 1-month surgical mortality and eliminate sociodemographic disparities in this adverse outcome could significantly improve survival among patients with cancer.
The impact of physician use of electronic medical records on colorectal cancer screening.
Authors: Richardson Devon Paula , Daly Corinne , Li Qing , Sutradhar Rinku , Del Giudice Elisabeth M. , Paszat Lawrence Frank , Tinmouth Jill , Rabeneck Linda , Baxter Nancy N. 
Published: February 2017

288 Background: The use of electronic medical records (EMR) by primary care physicians (PCP) is promoted as a method to enhance screening rates, however the impact of these systems on screening participation is uncertain. The purpose of this study was to determine if the use of EMR among a population-based sample of Ontario PCPs affects the colorectal cancer (CRC) screening participation of their patients. Methods: A survey was sent to 1,463 randomly selected PCPs in Ontario regarding adoption of EMR and cancer screening management enabled by EMR. Patients who were treated by PCP survey respondents were identified from administrative health care databases and were included if they were eligible for CRC screening (age 50-74) during the study window (April 1, 2012 – March 31, 2013). We identified patients who were up to date with CRC screening (FOBT within 2 years, flexible sigmoidoscopy within 5 years or colonoscopy within 10 years) as of March 31, 2013. Logistic regression models were created to examine the association between EMR usage and screening participation, adjusted for physician practice model, physician sex, years in practice, patient age patient sex, patient SES, and patient comorbidities using propensity scores. Results: A total of 855 PCPs responded to the survey (58.4% response rate) and 845 could be linked to administrative databases. The patient cohort included 330,441 eligible patients linked to a PCP included in the study. The proportion of patients up to date with CRC screening as of March 31, 2013 was 61.6% (203,720/330,441). After propensity score adjustment, patients were more likely to be up to date with CRC screening if their physician used an EMR (OR 1.16, 95% CI 1.04 – 1.29). Conclusions: PCP use of EMR was associated with a small, but measurable increase the likelihood that their patients were up to date with CRC screening. Enhanced use of the EMR might improve the uptake of CRC screening on a population level.
Gynecologic cancer outcomes of Medicare's elderly poor: A population-based study of North Carolina.
Authors: Doll Kemi Morenikeji , Meng Ke , Basch Ethan M , Gehrig Paola A. , Brewster Wendy R. , Meyer Anne-Marie 
Published: February 2017

290 Background: Women ≥ 65 years dually enrolled in Medicare and Medicaid (‘Duals’) represent an at-risk group in cancer care, yet their outcomes across the spectrum of gynecologic cancers have not been studied. Our goal was to compare the association of insurance type to stage at diagnosis and mortality of older women after a gynecologic cancer diagnosis. Methods: Population-based, retrospective cohort study of women ≥ 65 years, diagnosed with gynecologic cancers from 2003 – 2009 in North Carolina Central Cancer Registry files. Medicare, Medicaid, and claims from privately insured health plans were linked with census data. Multiple logistic regression, Cox proportional hazard models, and Kaplan Meier survival curves were constructed comparing Medicare, Medicare HMO, and Medicare/Medicaid populations. Results: Among 4,554 patients in the cohort, 3,403 (74%) Medicare+/- supplemental private, 531(11%) Medicare HMO, and 620 (14%) Medicare + Medicaid (Dual). There were 2,215(49%) cases of early stage disease and 1,447(32%) deaths. Dual enrollees had increased mortality rates vs. Medicare overall (HR 1.61, 95%CI:1.4–1.8), and within each cancer site: uterine HR 1.50 (95%CI:1.2-1.9); ovarian HR 1.46 (95%CI:1.1-1.9); cervical HR 1.54 (95%CI:1.0–2.3); and vulvar/vaginal HR 2.84 (95%CI:1.9–4.2). Duals also had increased odds of advanced stage diagnosis in uterine cancer (OR 1.48, 95%CI:1.1–2.0). Stratified survival curves demonstrate the largest disparities amongst women with early stage uterine, advanced stage ovarian, and early stage vulvar/vaginal cancers. Conclusions: Dually enrolled gynecologic cancer patients have a 60% increased mortality rate compared to non-duals despite equivalent stage distribution at the time of diagnosis. Specific site/stage subgroups drive these results and should be the focus of future studies elucidating mediators of these disparate outcomes, including barriers in access to specialty surgical care.
Comparison of Hispanic and non-Hispanic patients with HCC.
Authors: Babalola Atinuke , Miksad Rebecca A. , Oladunjoye Olubunmi , Nwosu Ugonna , Castro-Webb Nelsy , Srivastava Neeharika , Burns Bethany 
Published: February 2017

294 Background: In the U.S., Hispanics have a higher incidence of hepatocellular cancer (HCC) and higher disease-specific mortality. The country of origin for Hispanics varies throughout the U.S. However, little is known about Hispanics with HCC in the Northeast. We compared Hispanic and non-Hispanic patients with HCC at a Boston teaching hospital. Methods: Hispanic patients with HCC seen at Beth Israel Deaconess Medical Center (BIDMC) from 1998-2012 were identified in our database. Ethnicity was determined from demographic and language preference information in electronic medical records and supplemented by comparing surnames with the 1990 Census Spanish Surname List. The comparison group was identified by randomly choosing non-Hispanic patients diagnosed the same years as Hispanic patients. We compared both groups using Chi Squared test. Results: 59 Hispanic and 89 non-Hispanic patients with HCC were included in the analysis. The majority (48%) of Hispanic HCC patients were Puerto Rican. Although the median age at diagnosis was similar (59.1 vs 60.3 years for Hispanics and non-Hispanics), there were more women in the Hispanic cohort (28.8% vs 12.4% p0.012). Hispanics had greater odds of not having private insurance (OR 4.24, 95%CI: 2.101, 8.554). Evaluation of HCC risk factors revealed Hispanics were significantly more likely to have hepatitis C (OR 3.68, 95% CI: 1.830, 7.420). In addition, the incidence of Metabolic Syndrome was significantly higher for Hispanics (44.7% vs. 21.7% p0.025). Although individual components of metabolic syndrome were higher in Hispanics, they were not statistically significant: hypertension (52.5% vs 40.4%), Diabetes Mellitus (39% vs 25%), BMI ≥ 30 (39% vs 27%), hypertrigylceridemia (57% vs 52%) and low HDL levels (50% vs 41%). Hispanics were more likely to have received Transarterial Chemoembolization (TACE) and Radiofrequency ablation (RFA) treatments (OR 2.48, 95% CI: 1.261, 4.858). Conclusions: Hispanic HCC patients at BIDMC were more likely to have hepatitis C, metabolic syndrome and to be female than their non-Hispanic counterparts. Outreach to Hispanic communities to identify patients with hepatitis C and metabolic syndrome, particularly in women, may improve HCC prevention, screening and treatment outcomes.
Emergency department use and expenditures among cancer survivors in the United States, 2008-2011.
Authors: Lash Rebecca Salisbury , Bell Janice , Whitney Robin L. , Reed Sarah , Davis Andra , Joseph Jill G. 
Published: February 2017

3 Background: The number of cancer survivors in the US surpassed 13 million in 2012. In response to rising costs or care and greater demand for services, recent national reports and policies promote cancer care coordination to reduce costly and potentially avoidable services such as Emergency Department (ED) visits. Such efforts must be informed by reliable estimates and improved understanding of ED use and costs among oncology patients. This study quantifies the extent to which cancer survivors use the ED compared to individuals with other chronic conditions and estimates related annual expenses. Methods: Data from the 2008-2011 Medical Expenditure Panel Survey (MEPS) and survey-weighted regression models were used to determine the odds of any ED use (logistic), counts of ED visits (negative binomial) and mean annual medical expenditures attributed to ED use (generalized linear models) in three groups of respondents: cancer survivors, those with chronic conditions other than cancer, and those with neither (reference group). All models were adjusted for important confounding variables (age, sex, race/ethnicity, education, health insurance and health status). Estimates are generalizable to US non-institutionalized populations. Results: Among individuals with cancer, other chronic conditions, and neither condition, 17%, 15% and 9% visited the ED, respectively. Mean annual expenditures attributed to ED use among those with visits were $1471 (95% CI: $1262-$1678), $1517 (95% CI:$1395-$1640) and $1106 (95% CI: $984-$1228). Cancer survivors and individuals with other chronic conditions consistently had significantly higher ED use and costs than did the reference group. The likelihood of having any ED visit was similar between cancer survivors and those with other conditions, however cancer survivors incurred more visits (IRR: 1.17; 95% CI: 1.01, 1.36). Conclusions: ED use and expenditures are substantial among cancer survivors and equal or exceed the same outcomes in individuals with other chronic conditions. Future research is recommended to explore specific areas of unmet health need that may be driving increased frequency of ED visits in the growing population of cancer survivors.
Transfusion utilization at the end of life.
Authors: Prescott Lauren S. , Brown Alaina J. , Sun Charlotte C. , Levenback Charles F. , Ramondetta Lois M. , Bodurka Diane C. 
Published: February 2017

303 Background: Both the AMA’s Consortium for Performance Improvement and the Joint Commission have identified blood transfusions as one of the top 5 treatments that are over-utilized. We sought to quantify packed red blood cell transfusion (PRBT) utilization among ovarian cancer (OCa) pts in the last 6 months of life and identify risk factors for PRBT. Methods: We performed a retrospective cohort study of deceased OCa pts treated at our institution in their last 6 months of life from 2007-2011. Pts who underwent emergent procedures for bleeding were excluded. Demographic and end of life-interventions were compared between transfusion and non-transfusion groups using chi-squared and univariate analysis. End-of-life interventions included anti-cancer treatment (chemotherapy radiation, or hormonal therapy), invasive procedure or abdominal surgery, as well as aggressive end-of-life care as defined by the NQF. Results: Of the 182 pts who met inclusion criteria, 59.9% received a PRBT in the last 6 months of life. Of those pts, 54.1% received a PRBT in the last 30 days of life. Mean hgb level at which pts were transfused was 8.4 ± 0.9 g/dL. Pts received a combined total of 436 units of PRBC. The majority of pts received 1 transfusion (n=50, range 1-16). Mean number of total units transfused was 4 (range 1-25). The most common indication for PRBT was hgb < 9 g/dL (61.1%), followed by symptomatic anemia (21.9%). There was no difference in PRBT rate between pts who received medical interventions in the last 6 months of life v. those who did not. Specifically, transfusion rate was not correlated with: anti-cancer treatments (93.2% v. 92.7%, OR 0.93; 95% CI (0.29, 2.96)), invasive procedures (82.2% v. 81.7%, OR 0.96; CI (0.45,2.08)), abdominal surgery (11.0% v. 11.0%, OR 1.01; 95% CI(0.39,2.59)), or aggressive end-of-life care (46.6% v. 56.9%, OR 1.51; 95% CI (0.83,2.74)). Conclusions: The majority of our pts received a PRBT in the last 6 months of life. We did not identify significant differences in clinical interventions between pts who received a PRBT and those who did not. Based on our analysis, transfusion practices in terminally ill OCa pts should be reevaluated. Creation of transfusion guidelines for cancer pts could potentially result in better utilization of blood bank resources.
Relationship between financial toxicity and health-related quality of life in patients with advanced solid tumors.
Authors: De Souza Jonas A. , Yap Bonnie J. 
Published: February 2017

31 Background: Financial toxicity is an important Patient-Reported Outcome (PRO). Its relationship with health-related quality of life (HRQOL) has not been previously described. Therefore, we report the relationship between financial toxicity and health-related quality of life (HRQOL) in patients with advanced cancers. Methods: The global HRQOL was measured by the Functional Assessment of Cancer Therapy-General (FACT-G) and its subscales Physical Well-Being (PWB), Social/Family Well-Being (SWB), Emotional Well-Being (EWB) and Functional Well-Being (FWB). Financial toxicity was assessed by the COST (COmprehensive Score for financial Toxicity), a PRO measure previously developed in 155 patients with advanced cancers. Correlations were calculated using Spearman's correlation. Subject data on tumor type, age, gender, race, income, insurance type and educational level were collected. Results: Fifty patients were assessed. All participants were diagnosed with advanced cancers, were receiving treatment at the time of participation, and had received treatment for at least 3 months. The median COST was 22 (range 0-44), and mean 22.51 (s.d. ±10.80). A negative correlation existed between the COST and HRQOL as measured by the FACT-G (r = -0.47, P <.001), and its subscales: PWB (r=-0.35, p < 0.05), SWB (r=-0.33, p < 0.05), EWB (r=-0.32, p < 0.05) and FWB (r=-0.41, p < 0.01). In this small sample, there were no correlations between the COST and sociodemographic characteristics. Conclusions: Results demonstrate an inverse relationship between patient-reported HRQOL and financial toxicity, suggesting that higher financial toxicity is associated with worse HRQOL. A larger study is in progress to identify cancer patients at higher risk of financial toxicity.
Overuse of five expensive oncology pharmaceuticals in the southeastern United States: A physician-level analysis.
Authors: Bennett Charles L. , Huff Dinah Faith Q. , Shimp William S. , Baranwal Anmol , Mamgain Avinash , Fishman Marc L. , Davis Sharon , Kogler Jurgen , Schorer Anna E. , Bobolts Laura Rose , Armitage Melissa , Hrushesky William J. 
Published: February 2017

33 Background: The Wall Street Journal recently identified that the highest rates of use of erythropoietin to Medicare-covered persons with cancer in the United States was by 11 oncologists who practiced in Florida (WSJ, June 20, 2014). We asked a related, but similar question: Could chemotherapy claims databases be used to identify individual physicians in the southeastern United States who had high rates of prescribing five expensive oncology agents: levoleucovorin (Fusilev), palonosetron plus fosapretitant (Aloxi+Emend), peg-filgastrim (Neulasta), albumin-paclitaxel (Abraxane), and epoetin/darbepoetin? Methods: Chemotherapy requests for more than 2,000 oncologists who practiced in the southeastern United States for the years 2012- 2014 were reviewed. A “high user” oncology provider for a specific drug was operationally defined as an individual whose number of prescriptions for the specific drug was more than 2 standard deviations above that for other oncology providers whose chemotherapy requests were also contained in the same database. Results: Two out of 1,479 oncology providers were identified as “extremely high users” of expensive oncology drugs (operationally defined as a high user for 5 of the 5 study drugs), two were “very high users” of expensive oncology drugs (a high user for 4 of the 5 study drugs), and 25 were “high users” (a high user for three of the five study drugs). The overwhelming majority of oncology providers (1,450) were neither extremely high, very high, nor even high users of the five study drugs. Conclusions: In the Southeastern United States, a small number of oncology physicians are extremely high, very high, and high users of expensive oncology drugs. Additional studies are needed to evaluate case-mix and other patient-related factors that might explain this finding. Focused quality improvement initiatives might also be considered. [Table: see text]
Characteristics of emergency department visits among non-admitted oncology patients.
Authors: Fraile Belen , Schleicher Stephen , Baugh Christopher , Bunnell Craig A. , Mersereau Robert , Potiris Spyros , Jacobson Joseph O. 
Published: February 2017

37 Background: Use of costly emergency department (ED) resources is high amongst oncology patients. However, many oncology patients who visit the ED are discharged home without admission to an inpatient setting. A better understanding of why this group of patients presents to the ED can inform alternative interventions to shift care to less costly settings and reduce ED utilization. Methods: We conducted a review of administrative data at Brigham and Women’s Hospital (BWH) that serves as the ED for patients undergoing cancer treatment at the Dana Farber Cancer Institute. We identified oncology diagnosed patients that presented to the ED between 9/1/2011 and 9/30/2012 (n=6,035 unique visits). We focused our analysis in those patients ultimately discharged home, directly discharged (Home n=1647) or after an ED observation stay < 24 hours (ED Obs n=379) to evaluate opportunities for improvement. We then reported charges, cancer type, primary ED discharge ICD-9 code, and tests ordered per ED visit by disposition status. Results: We found that 34% of the ED encounters (n=2,026) were ultimately discharged home (directly discharged or after an ED observation stay). Among them, the average charge per visit for these patients varied from $3,304 (SD= 2,734) for Home to $10,951 (SD= 6,540) for ED Obs. 73% (n=1,473) of these patients had solid tumor diagnoses. The five most common solid tumor diagnoses associated with these patients were gastrointestinal (16%), gynecologic (12%), genitourinary (10%), breast (10%), and thoracic (9%). The most common ICD-9 codes associated with these patients’ admissions were abdominal pain (9%), fever (5%), dyspnea (5%), chest pain (3%), and nausea (3%). Of these outpatients, 53% (n=1,066) had at least one radiologic test performed, the most common tests being chest x-ray in 41% and CT scans in 16%. Conclusions: About 1 in 3 cancer patients who present to the ED are not admitted to an inpatient setting, representing potentially avoidable costly ED visits. Most of these patients are represented by five solid tumor diseases. Improved alternative outpatient access and management strategies of symptoms such as abdominal pain, dyspnea, and nausea in these patients may reduce ED utilization in this patient population.