bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transitions in care and reduction in discharge errors.
Authors: Fenton Mary Anne , Szyamnski Tara , Begnoche Megan , Chase Carol , Moreau Michelle , Barnett Jessica 
Published: February 2017

77 Background: Patients are often overwhelmed at the time of hospital discharge and focus on home rather than the discharge process. Fragmented communication and lack of planning between the hospital team, patient, family and primary oncologist can lead to frustration and delays in implementation of palliative or curative therapies and potential hospital readmission when the plan of care is not followed in a timely manner. Our goal is to avoid medication errors, delays in implementation of a care plan and reemergence of symptoms or new symptoms as a result of a suboptimal discharge transition. Methods: A multidisciplinary care transition team including phone nurses, social workers, pharmacists, physicians, nursing leadership and a palliative care practitioner meet monthly to review and refine discharge transitions. Our intervention is a proactive phone call, by specially trained ambulatory oncology nurses, to patients within 1-2 business days after discharge from the inpatient Hematology Oncology service. The nurse asks consistent questions to address common issues in the discharge transition including review of symptoms, understanding of discharge medications, confirmation of new medication initiation, side effects, coping, and next appointment with the oncologist. The nurse reinforces the ambulatory nurse phone line and availability of same day sick visits. Results: Preliminary discharge phone call results from the nurses’ interventions include clarification of discharge medications, interventions when a patient had not obtained the ordered medication including antibiotics, referrals for same day sick visits, referrals to social work for emotional and financial distress, education on medications or side effect management, and follow-up appointments. The average time for the post discharge call is 13 minutes. Conclusions: Our follow up discharge intervention by the oncology nurse has shown many patients are uncertain of medications and follow-up even when provided with detailed discharge paperwork and medication reconciliation. A proactive discharge phone call may help resolve these issues and prevent future readmissions. A six month summary of our intervention will be presented.
Improving the quality of the consenting and education process for patients starting on oral oncology medications.
Authors: Zatarain Lauren Azure , Ashford Jessica , Bivens David 
Published: February 2017

82 Background: Oral oncology medication prescribing is on the rise nationwide. Given that these medications are self-administered, drug compliance is a concern. Appropriate patient education directly impacts drug adherence. Prior to the process improvement initiative in our community based medical oncology clinic, implied consent was obtained while educating patients on side effects and written informed consent was documented 0% of the time. This creates a patient safety and risk management problem. Methods: Our clinic implemented a new process for consenting and educating patients starting on new oral oncology medications from April – October 2015. The plan/do/study/act performance improvement technique was utilized. A new consent form was created for oral oncology medications meeting ASCO/ONS safety standards. The consent and education packets were placed centrally in the office and coincided with an initiative to improve consenting for IV chemotherapy. Providers were in-serviced to contact the nurse prior to patients exiting clinic to initiate the new prescription and begin the patient education process. Reminder checklists were placed in exam rooms to trigger the provider to communicate with nursing staff. Outcome measures included data on the percent of patients with written informed consent in health record and percent of patients with patient education handouts in health record prior to drug start. Data on percent of patients for whom the provider notified nurse prior to end of clinic visit were collected as a balance measure. Results: Over a 6 month period, 101 consecutive patients initiated on oral oncology drugs were included in the data analysis. The baseline mean improved from 0% to 75% for obtaining written informed consent (p chart, 3 sigma). The baseline mean improved from 37% to 80% for documenting patient education in health record prior to oral oncology medication start (p chart, 3 sigma). Conclusions: There was significant improvement in obtaining written informed consent and providing patient education prior to oral oncology drug start after implementation of new clinic processes.
Outcomes by schedule and line of therapy in patients (pts) with metastatic breast cancer (MBC) treated with nab-paclitaxel (nab-P): A U.S. retrospective, community-based, real-world cohort analysis.
Authors: Patt Debra A. , Stergiopoulos Sotirios G. , Hippert Rick , Harrell Robyn K. , Espirito Janet L. , Squier Peg , Ko Amy 
Published: February 2017

86 Background: In a phase III study in MBC, nab-P showed activity across lines of therapy. nab-P is approved for MBC at 260 mg/m2 every 3 weeks (q3w). This analysis evaluated outcomes with use of nab-P in MBC by schedule and line of therapy in a U.S. community setting. Methods: A multicenter, retrospective cohort analysis was conducted using iKnowMed electronic health record data and electronic medical chart review of women with ≥ 5 visits to a site in the US Oncology Network. Vital status was supplemented by the Social Security Death Index. Pts with MBC treated with nab-P between April 1, 2011, and February 1, 2013, were followed through August 1, 2013. Pts diagnosed with another primary cancer or with prior nab-P use were excluded. Data were analyzed by line (first [1L] vs ≥ second [≥2L]) or schedule (weekly [qw] vs q3w) based on the first therapy (index therapy) received in the study period. The usage pattern of index therapy was described by pt demographics and baseline characteristics. Effectiveness of index therapy was assessed by adjusted duration of treatment (DOT; time from first to last date of treatment + 6 days for qw and 20 days for q3w [to reflect true treatment duration]), time to new treatment (TTNT; time from start of index therapy), and overall survival (OS; time from start of index therapy). Analyses of other efficacy/safety endpoints, healthcare utilization, and corresponding costs will be performed. Results: 766 pts were included; 333 and 433 initiated index therapy as 1L and ≥ 2L, and 650 and 116 received index therapy qw and q3w. 76% received nab-P monotherapy. Most pts were < 65 years (64%), HER2− (76%), ER+ (76%), ER+/HER2− (60%), and postmenopausal (79%). 16% had triple-negative MBC. No notable differences in pt characteristics between the 1L/≥ 2L or qw/q3w groups were seen. Sensory neuropathy rates were 35% vs 39% for the 1L and ≥ 2L and 36% vs 45% for qw vs q3w. Conclusions: This analysis of a community-based cohort indicated that nab-P was primarily used as monotherapy on a qw schedule and in the ≥ 2L setting. [Table: see text]
Do survivors of adolescent and young adult cancer value follow-up cancer care?
Authors: Kaul Sapna , Zamora Eduardo , Smits-Seemann Rochelle , Boyle Kevin , Perlman Holly , Kirchhoff Anne C. 
Published: February 2017

8 Background: Survivors of adolescent and young adult (AYA) cancer, diagnosed between the ages of 15-39, require life-long medical care. Cost is a known barrier. However, survivors’ valuation of follow-up care has not been investigated. We used willingness to pay (WTP), an economic tool for evaluating monetary values associated with medical services, to examine how survivors value follow-up care. Methods: AYA cancer survivors ≥18 years of age who had completed their primary therapy were identified by the Utah Cancer Registry. Of 137 randomly-selected survivors, 64 agreed to be contacted; 32 participated. We conducted 6 focus groups and 4 interviews from April-August 2015. Participants filled out a mini-survey, discussed cancer-related follow-up care, and responded to WTP questions. Focus group transcripts were coded in NVivo by 2 researchers (percent agreement = 97.8%). An interval regression identified factors associated with higher WTP. Results: 56% of participants were females and average age was 31 years. Over 45% reported ≥1 day of poor physical health in the previous month, with 15% reporting ≥10 days. Yet, 28% and 10% had no routine follow-up visit with a doctor in the previous 1-2 and 2-5 years, respectively. Focus group coding suggested that survivors valued follow-up care for early detection and management of health conditions, although this decreased over time because of other responsibilities (e.g., college/work/family), they felt the medical visits were costly/ineffective, and because they lacked easy access to specialists. WTP analysis showed that married survivors were willing to pay $456 more for an annual follow-up visit than never-married/single/separated (p = .05). Those with recent checkups were willing to pay more than others (p = .07). Insurance did not affect WTP. Conclusions: Targeted survivorship care strategies are needed to address the needs of AYA cancer survivors who are at risk for skipping follow-up care. Survivors with no recent medical visits or who are not married need additional support.
Successful completion of EGFR/ALK testing in non-squamous non-small cell lung cancer (non-sq NSCLC) with the implementation of reflex testing (RT) by pathologists.
Authors: Menjak Ines B. , Winterton-Perks Zoe , Raphael Simon , Cheng Susanna Y. , Verma Sunil , Freedman Ryan , Toor Nevkeet , Perera Joseph , Anaka Matthew , Victor Charles , Cheema Parneet Kaur 
Published: February 2017

93 Background: EGFR mutation and ALK rearrangement testing is standard in the management of advanced non-sq NSCLC patients (pts). Previously at our centre, EGFR/ALK biomarker testing was requested by medical oncologists (MO). In June 2013 we implemented biomarker RT, defined as pathologists requesting EGFR/ALK at time of diagnosis of non sq-NSCLC irrespective of stage. The objective of this study was to test the hypothesis that if pathologists requested biomarker testing, appropriate tissue would be preserved and selected for testing, which would improve success rates of biomarker testing. Methods: Retrospective review of advanced non-sq NSCLC pts seen by MO at Sunnybrook Odette Cancer Centre from March 2010 to April 2014. Pt and EGFR/ALK test characteristics were compared before and after RT using Chi-square tests of association. Time outcomes were compared using Mann-Whitney U tests. Results: Of the 310 pts included, median age was 68, 44% female, 47% Caucasian, 93% adenocarcinoma, 22% EGFR+, 1% ALK+ and 84% either presented with or developed stage IV. Samples tested for EGFR and ALK were respectively: 53%, 51% core biopsies; 25%, 32% surgical resections; 20%, 16% cytology. The number of biomarker tests across all stages increased with RT (EGFR 70% vs 95%, p < 0.001 / ALK 44% vs 83%, p < 0.001). RT improved the rate of successfully completed tests (EGFR 86% vs 96%, p = 0.04 / ALK 83% vs 97%, p = 0.04). The remainder of tests were unsuccessful due to inconclusive results (EGFR 9% vs 4%, p = 0.25 / ALK 7% vs 2%, p = 0.25), insufficient tissue (EGFR 3% vs 0%, p = 0.33 / ALK 10% vs 0%, p = 0.03) or cancellation due to appropriate tissue not being sent from holding lab to testing lab (EGFR 2% vs 0, p = NS / ALK 0% vs 2%, p = NS). From core biopsies, there was trend to improved success of EGFR testing with RT (82% vs 97%, p = 0.06) and significant improvement of ALK testing (82% vs 100%, p = 0.04), with no impact on success from cytology samples. Rebiopsy rate for biomarker testing was low in both cohorts. Turnaround time for EGFR testing decreased [19 days (IQR 15-25) vs 17 days (IQR 12-21), p = 0.02]; ALK was unchanged. Conclusions: Implementation of RT improved successful completion of EGFR/ALK testing.
How well are cancer centers addressing supportive oncology needs?
Authors: Weldon Christine B. , Obel Jennifer Carrie , Deamant Catherine , Berardi Rosa , Robinson Patricia A. , Dale William , Danciu Oana C. , Gerhart James , Khosla Paramjeet , Patel Urjeet , Savory Colleen , Trosman Julia Rachel 
Published: February 2017

96 Background: The IOM 2013 report recommends comprehensive supportive oncology care from diagnosis through survivorship to end of life. The Coleman Foundation supported a baseline assessment of supportive oncology care using key COC, ASCO-QOPI and NQF measures. Methods: Data extracted from medical records at 6 Chicago cancer centers in 2014 (n = 843 patients), including stage I-III (n = 391) and stage IV solid tumor or refractory hematologic malignancy (n = 452). Results: Fifty-four percent of patients had discussions on understanding of illness, 24% were informed of prognosis timeframe, and 5% had a documented healthcare power of attorney. Only 6% of stage IV patients received distress screening within 2 weeks of diagnosis and 15% of Stage IV patients had referrals to palliative care. Among patients with Stage I-III cancer, 38% had a supportive oncology screening, and 2% received treatment summaries and a SCPs. Conclusions: There are still large gaps in important supportive care processes based on IOM 2013 recommendations, COC, and ASCO QOPI measures. Future steps include implementing supportive care processes that address gaps across the 6 cancer centers. [Table: see text]
Protein Intake and Breast Cancer Survival in the Nurses’ Health Study
Authors: Holmes Michelle D. , Wang Jun , Hankinson Susan E. , Tamimi Rulla M. , Chen Wendy Y. 
Published: February 2017

PurposeGreater protein intake has been associated with better breast cancer survival in several prospective studies, including among 1,982 women in the Nurses’ Health Study. We proposed to extend this previous finding. We hypothesized that protein, essential amino acid, branched-chain amino acid, and leucine intakes are associated with improved survival and that these associations are stronger in tumors expressing insulin receptor (IR).Patients and MethodsWe included 6,348 women diagnosed with stage I to III breast cancer between 1976 and 2004. There were 1,046 distant recurrences. Relative risks (RRs) and 95% CIs were calculated according to quintiles of updated postdiagnostic diet using adjusted Cox proportional hazards models based on follow-up until 2010.ResultsThere was an inverse association between energy-adjusted protein intake and recurrence. Multivariable RRs for increasing quintiles of intake compared with the lowest were 0.95 (95% CI, 0.79 to 1.15), 0.92 (95% CI, 0.76 to 1.11), 0.75 (95% CI, 0.61 to 0.91), and 0.84 (95% CI, 0.69 to 1.03; trend P = .02). For animal protein intake, the RRs were 0.88 (95% CI, 0.73 to 1.06), 0.85 (95% CI, 0.70 to 1.02), 0.75 (95% CI, 0.62 to 0.92), and 0.78 (95% CI, 0.63 to 0.95; trend P = .003). Neither essential amino acids, branched-chain amino acids, nor any individual amino acid stood out as being the source of the association. The association also did not differ by IR status. There was no clear association with any protein-containing foods.ConclusionWe found a modest survival advantage with higher intake of protein, regardless of IR status. There was no clear mechanism for this association, although it is consistent with prior studies. Our data suggest that there is likely no advantage for women with a history of breast cancer in restricting protein intake or protein-containing foods.
Morbidity and Mortality Differences Between Hematopoietic Cell Transplantation Survivors and Other Cancer Survivors
Authors: Chow Eric J. , Cushing-Haugen Kara L. , Cheng Guang-Shing , Boeckh Michael , Khera Nandita , Lee Stephanie J. , Leisenring Wendy M. , Martin Paul J. , Mueller Beth A. , Schwartz Stephen M. , Baker K. Scott 
Published: February 2017

Purpose To compare the risks of serious health outcomes among hematopoietic cell transplantation (HCT) survivors versus a matched population of patients with cancer who did not undergo HCT, where the primary difference may be exposure to HCT. Methods Two-year HCT survivors treated at a comprehensive cancer center from 1992 through 2009 who were Washington State residents (n = 1,792; 52% allogeneic and 90% hematologic malignancies) were frequency matched by demographic characteristics and underlying cancer diagnosis (as applicable) to non-HCT 2-year cancer survivors, using the state cancer registry (n = 5,455) and the general population (n = 16,340) using driver’s license files. Late outcomes for all three cohorts were ascertained from the state hospital discharge and death registries; subsequent cancers were ascertained from the state cancer registry. Results After median follow-up of 7.1 years, HCT survivors experienced significantly greater rates of hospitalization compared with matched non-HCT cancer survivors (280 v 173 episodes per 1,000 person-years, P < .001) and greater all-cause mortality (hazard ratio [HR], 1.1; 95% CI, 1.01 to 1.3). HCT survivors had more hospitalizations or death with infections (10-year cumulative incidence, 31% v 22%; HR, 1.4; 95% CI, 1.3 to 1.6) and respiratory complications (cumulative incidence, 27% v 20%; HR, 1.4; 95% CI, 1.2 to 1.5). Risks of digestive, skin, and musculoskeletal complications also were greater among HCT versus non-HCT cancer survivors. The two groups had similar risks of circulatory complications and second cancers. Both HCT and non-HCT cancer survivors had significantly greater 10-year cumulative incidences of all major organ-system outcomes versus the general population. Conclusion History of HCT was associated with late morbidity and mortality among cancer survivors. In particular, clinicians who care for HCT survivors should be aware of their high rates of late respiratory and infectious complications.
Ofatumumab Versus Rituximab Salvage Chemoimmunotherapy in Relapsed or Refractory Diffuse Large B-Cell Lymphoma: The ORCHARRD Study
Authors: van Imhoff Gustaaf W. , McMillan Andrew , Matasar Matthew J. , Radford John , Ardeshna Kirit M. , Kuliczkowski Kazimierz , Kim WonSeog , Hong Xiaonan , Goerloev Jette Soenderskov , Davies Andrew , Barrigón María Dolores Caballero , Ogura Michinori , Leppä Sirpa , Fennessy Michael , Liao Qiming , van der Holt Bronno , Lisby Steen , Hagenbeek Anton 
Published: February 2017

Purpose We compared the efficacy of ofatumumab (O) versus rituximab (R) in combination with cisplatin, cytarabine, and dexamethasone (DHAP) salvage treatment, followed by autologous stem-cell transplantation (ASCT) in patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). Patients and Methods Patients with CD20+ DLBCL age ≥ 18 years who had experienced their first relapse or who were refractory to first-line R-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)–like treatment were randomly assigned between three cycles of R-DHAP or O-DHAP. Either O 1,000 mg or R 375 mg/m2 was administered for a total of four infusions (days 1 and 8 of cycle 1; day 1 of cycles 2 and 3 of DHAP). Patients who experienced a response after two cycles of treatment received the third cycle, followed by high-dose therapy and ASCT. Primary end point was progression-free survival (PFS), with failure to achieve a response after cycle 2 included as an event. Results Between March 2010 and December 2013, 447 patients were randomly assigned. Median age was 57 years (range, 18 to 83 years); 17% were age ≥ 65 years; 63% had stage III and IV disease; 71% did not achieve complete response (CR) or experience response for < 1 year on first-line R-CHOP. Response rate for O-DHAP was 38% (CR, 15%) versus 42% (CR, 22%) for R-DHAP. ASCT on protocol was completed by 74 patients (33%) in the O arm and 83 patients (37%) in the R arm. PFS, event-free survival, and overall survival were not significantly different between O-DHAP versus R-DHAP: PFS at 2 years was 24% versus 26% (hazard ratio [HR], 1.12; 95% CI, 0.89 to 1.42; P = .33); event-free survival at 2 years was 16% versus 18% (HR, 1.10; P = .35); and overall survival at 2 years was 41% versus 38% (HR, 0.90; P = .38). Positron emission tomography negativity before ASCT was highly predictive for superior outcome. Conclusion No difference in efficacy was found between O-DHAP and R-DHAP as salvage treatment of relapsed or refractory DLBCL.
Practical Guidelines for the Prevention, Diagnosis, and Treatment of Osteonecrosis of the Jaw in Patients With Cancer
Authors: Ruggiero Salvatore , Gralow Julie , Marx Robert E. , Hoff Ana O. , Schubert Mark M. , Huryn Joseph M. , Toth Bela , Damato Kathryn , Valero Vicente 
Published: February 2017

Purpose This article discusses osteonecrosis of the jaw (ONJ) and offers health care professionals practical guidelines and recommendations for the prevention, diagnosis, and management of ONJ in cancer patients receiving bisphosphonate treatment. Methods A panel of experts representing oral and maxillofacial surgery, oral medicine, endocrinology, and medical oncology was convened to review the literature and clinical evidence, identify risk factors for ONJ, and develop clinical guidelines for the prevention, early diagnosis, and multidisciplinary treatment of ONJ in patients with cancer. The guidelines are based on experience and have not been evaluated within the context of controlled clinical trials. Results ONJ is a clinical entity with many possible etiologies; historically identified risk factors include corticosteroids, chemotherapy, radiotherapy, trauma, infection, and cancer. With emerging concern for potential development of ONJ in patients receiving bisphosphonates, the panel recommends a dental examination before patients begin therapy with intravenous bisphosphonates. Dental treatments and procedures that require bone healing should be completed before initiating intravenous bisphosphonate therapy. Patients should be instructed on the importance of maintaining good oral hygiene and having regular dental assessments. For patients currently receiving bisphosphonates who require dental procedures, there is no evidence to suggest that interrupting bisphosphonate therapy will prevent or lower the risk of ONJ. Frequent clinical assessments and conservative dental management are suggested for these patients. For treatment of patients who develop ONJ, a conservative, nonsurgical approach is strongly recommended. Conclusion An increased awareness of the potential risk of ONJ in patients receiving bisphosphonate therapy is needed. Close coordination between the treating physician and oral surgeon and/or a dental specialist is strongly recommended in making treatment decisions.