bluuebunny/crossref_metadata_2025_split huggingface dataset:
Access to personalized medicine: Factors influencing the use and value of gene expression profiling in treatment decision making.
Authors: Bombard Yvonne , Rozmovits Linda , Trudeau Maureen E. , Leighl Natasha B. , Deal Ken , Marshall Deborah 
Published: February 2017

10 Background: Genomic information is increasingly used to personalize health care. One example is gene-expression profiling (GEP) tests that estimate recurrence risk to inform chemotherapy decisions in breast cancer treatment. Recently, GEP tests were publicly funded in Ontario. We assessed the clinical utility of GEP tests, exploring the factors facilitating their use and value in treatment decision-making. Methods: As part of a mixed-methods clinical utility study, we conducted interviews with oncologists (n=14), and focus groups and interviews with breast cancer patients (n=28) who underwent GEP, recruited through oncology clinics in Ontario. Data were analyzed using content analysis and constant comparison. Results: Various factors governing access to GEP have given rise to challenges for patients and oncologists. Oncologists are positioned as gatekeepers of GEP, providing access in medically appropriate cases. However, varying perceptions of appropriateness led to perceived inequities in access and negative impacts on the doctor-patient relationship. Media attention facilitated patient awareness of GEP but complicated gatekeeping. Additional administration burden and long waits for results led to increased patient anxiety and delayed treatment. Collectively, these factors inadvertently heightened GEP’s perceived value for patients relative to other prognostic indicators because of barriers to access. Conclusions: This study delineates the factors facilitating and restricting access to GEP, and highlights the roles of the media and organization of services in GEP’s perceived value and utilization. Results identify a need for administrative changes and practice guidelines to support streamlined and standardized utilization of the test.
Coordinating cancer care: Measurement and intervention approaches across the cancer continuum.
Authors: Sheinfeld Gorin Sherri , Haggstrom David , McDonald Kathryn , Han Paul , Fairfield Kathleen , Ganz Patricia A. , Cheung Winson Y. , Clauser Steven ,   QCCC_CCI Work Group
Published: February 2017

103 Background: According to a landmark study by the Institute of Medicine, patients with cancer often receive poorly coordinated care in multiple settings from many providers. Lack of coordination is associated with poor symptom control, medical errors, and higher costs. The aims of this presentation are to: (1) describe the state-of-the science on cancer care coordination measures and intervention outcomes from a systematic review and meta-analysis of empirical papers published between 1980-2013; (2) explore the implications of these findings from the patient, provider, healthcare system, and national policy perspectives. No similar review has yet been published. Methods: Of 1,241 abstracts collected from a systematic search of PubMed, MeEMBASE, Medline, CINAHL, and Cochrane Library, 50 studies met the inclusion criteria. Each study had US or Canadian participants; comparison or control groups, measures, times, samples, and/or interventions. Two raters independently applied a standardized search strategy and coding scheme. Eight studies (14 outcomes) met the additional criteria for the meta-analysis. We used the Care Coordination Atlas (McDonald, 2010) definition of care coordination. Results: Overall, coordination improved cancer care across 83% (44) of the measured outcomes. Interventions led to more appropriate healthcare use (g = 0.37 [95% CI = 0.29 – 0.46]; I2= 0.00) across screening (patient navigation), treatment (home telehealth, nurse case management and education), and end-of-life care (early palliation). Measures varied considerably in psychometric quality and were limited in focus. They included; rates of guideline compliance (screening), timeliness of care (diagnosis), health-related quality of life (treatment), cancer-related distress (survivorship), and home death (end-of-life). Conclusions: The findings revealed effective interventions across the cancer continuum from screening to end-of-life. More, and better measures are needed across the cancer continuum. We discuss the implications of these findings for more and better measures, approaches to implement effective interventions in clinical settings, and to develop supportive policy (and reimbursement) contexts.
Guideline discordance in the use of radiographic imaging during initial workup of patients with prostate cancer (CaP).
Authors: Falchook Aaron David , Hendrix Laura H. , Chen Ronald C. 
Published: February 2017

109 Background: Overuse of imaging in patients unlikely to have metastatic disease is costly and can lead to patient harm from unnecessary procedures. However, underuse of imaging leads to undiagnosed metastatic disease, resulting in aggressive treatments in incurable patients. The National Comprehensive Cancer Network (NCCN) recommends bone scans and computed tomography (CT) or magnetic resonance imaging (MRI) during initial work-up of select patients with intermediate or high risk CaP. We quantify the proportion of patients who received work-up discordant with NCCN guidelines. Methods: Patients in the Surveillance Epidemiology and End Results (SEER)-Medicare database diagnosed from 2004-2007 were included. We report bone scan and CT/MRI from date of diagnosis to the earlier of treatment or 6 months. Results: 65% of patients for whom bone scan is recommended received it, and 49% received recommended CT/MRI. Further, 43% of patients for whom bone scan is not recommended received it, and 38% received unnecessary CT/MRI. Age and race were significantly associated with discordance on multivariate models (Table). Underuse of recommended bone and CT/MRI scans decreased in more recent years, but overuse of unnecessary CT/MRI increased. There was significant regional variation. Conclusions: There is a high prevalence of both overuse and underuse of guideline-recommended imaging in CaP. [Table: see text]
Impact of an oncology management program using level I pathways, a nurse call system, and advance care planning.
Authors: Hoverman J. Russell , Klein Ira , Harrison Deb , Hayes Jad , Nelson Greg C. , Garey Jody S. , Harrell Robyn K. , Sipala Maria , Houldin Scott , Ciaglo John , Taniguchi Cynthia , Jameson Melissa , Abdullahpour Mitra , McQueen Jessica , Verrilli Diana K. , Neubauer Marcus A. 
Published: February 2017

119 Background: The Innovent Oncology Program (IOP) addresses rising costs of cancer treatment but maintains the use of evidence-based medicine. McKesson Specialty Health and Texas Oncology (TXO) collaborated with Aetna, Inc to launch a pilot program to evaluate IOP’s impact on Level I Pathways (PW) compliance, implement Patient Support Services (PSS), measure the rate and costs of chemotherapy-related ER visits and hospital admissions (IP), and evaluate the feasibility of introducing Advance Care Planning (ACP). Methods: Prospective, nonrandomized evaluation of pts enrolled in IOP June 1, 2010-May 31, 2012. Data from the iKnowMed electronic health record, McKesson Specialty Health’s financial data warehouse, and Aetna’s claims data warehouse were analyzed. Results: 221 pts were included and stratified by disease and age. 76% of ordered regimens were ON-PW, improved from TXO’s baseline adherence of 63%. Of 221 pts, 81% enrolled in PSS. ACP was introduced to 85% and 14% of these participated in ACP discussions. In the breast, colorectal, and lung groups, 14% and 24% had an ER visit and IP (baseline) vs. 10% and 18% in the IOP. Average IP days decreased from 2.1 to 1.2, respectively (table). Total savings for all 3 groups was $506,481. Conclusions: Implementation of IOP positively impacted pt care with fewer ER visits, IP, and IP days, cancer-related utilization costs, and increased Pathway adherence. [Table: see text]
Mental health outcomes in a national sample of adult cancer survivors in the United States: Has psychosocial care improved?
Authors: Whitney Robin L. , Bell Janice F. , Joseph Jill G. , Bold Richard J. 
Published: February 2017

120 Background: Recent cancer care recommendations include routine mental health (MH) screening and support. We provide national estimates of psychological distress, MH visits, and unmet need (defined as having distress but no MH visit) for MH services among adult cancer survivors. Additionally, we test for temporal differences between years 2005 and 2010 to assess whether the estimates differ before and after important policy recommendations for psychosocial cancer care. Methods: This study analyzed cross-sectional data from the National Health Interview Survey (NHIS), years 2005 and 2010, for adults (≥18yrs) in the United States (n=58,585) categorized as having: 1) no chronic disease; 2) chronic disease other than cancer; 3) cancer without co-morbid chronic disease; 4) cancer with co-morbid chronic disease. In these four groups we compared psychological distress, MH visits, and unmet need for MH services. Survey-weighted logistic regression was used to model the dependent variables as functions of disease status, socio-demographic variables and self-reported health status. Estimates are generalizable to the US civilian non-institutionalized population. Results: Compared to the group with no chronic disease, the cancer with co-morbid chronic disease group had the highest odds of psychological distress (OR 2.78; 95% CI: 2.18, 3.54) and MH visits (OR 1.7; 95% CI: 1.42, 2.05), with no change from 2005 to 2010. The other two groups (cancer without co-morbid chronic disease and chronic disease other than cancer) also had statistically significantly higher odds of both outcomes compared to those with no chronic disease. Among individuals with cancer, estimates of unmet need for MH services were significantly lower in 2010 (OR 1.53; 95% CI: 1.03, 1.88) compared to 2005 (OR 2.89; 95% CI: 2.09, 3.99). Conclusions: Individuals with cancer have disproportionate MH needs. We find evidence of MH care quality improvement among individuals with cancer between 2005 and 2010, a time period that coincides with continued policy and clinical attention to psychosocial needs in this population. These efforts appear to have reduced, but not eliminated, unmet need for MH services for individuals with cancer.
Long-term central venous catheters and infections in older adults with cancer.
Authors: Lipitz Snyderman Allison Nicole , Sepkowitz Kent , Elkin Elena B. , Pinheiro Laura C. , Bach Peter 
Published: February 2017

125 Background: Long-term central venous catheters (CVCs) facilitate venous access to administer intravenous fluids and treatments such as chemotherapy. However, CVCs can also be a source of harmful bloodstream infections, a risk that may be underappreciated. Our objective was to assess the impact of long-term CVC use on the risk of infections in a population-based cohort of cancer patients. Methods: Retrospective analysis using the population-based SEER-Medicare dataset for patients over age 65, diagnosed from 2005 to 2007 with invasive colorectal cancer (n = 36,272), head and neck cancers (n = 8,459), lung cancer (n = 56,770), pancreatic cancer (n = 10,536), or non-Hodgkin lymphoma (n = 14,432), or invasive or non-invasive breast cancer (n = 42,271). Cox proportional hazards regression was used to examine the impact of CVC use on infection risk, with CVC exposure treated as a time-varying predictor. We used multivariable analysis and propensity score methods to control for patient characteristics. Results: Adjusting for demographic and disease characteristics, long-term CVCs significantly increased the risk of infection by at least 40%, across all cancer types (Table). The greatest effect of CVCs on infection risk was in patients with breast cancer. Conclusions: Long-term CVC use is associated with an increased risk of infections for older adults with cancer. Careful assessment of the need for long-term CVCs, and targeted strategies to reduce infections for patients requiring their use, are critical to improving cancer care quality. [Table: see text]
Evaluation of the physician-patient communication assessment tool (CAT) in a hematology-oncology practice.
Authors: Desai Amrita , Olszewski Adam J. 
Published: February 2017

14 Background: Interpersonal communication skills are critical for building physician-patient relationships. The usefulness of feedback instruments to assess communication in oncology is uncertain. The simple, 15-item, patient-oriented CAT (Makoul G, et al. Patient Educ Couns 2007;67:333) was previously validated in non-oncologic specialties, using 20-30 samples per physician. The mean proportion of “Excellent” scores (MPES) was recommended as a summary estimate (76% in the above study). We evaluated the usefulness of this survey in a hematology-oncology practice. Methods: We administered CAT anonymously to all consenting outpatients during visits in our center, from January to March 2013. The association of “Excellent” scoring with patient age, gender and type of visit (cancer-related or unrelated) was studied using random-effects logistic regression. Results: We obtained 144 surveys (23-52 per physician). Median patient age was 65 years (range, 19-93) with 67% women and 54% cancer-related visits. The MPES for each survey question varied between 86% and 96%. The average MPES per physician was 92.1% (range 88.5-95.8%). MPES was higher for patients >65 years old (94.9% vs. 90.4%), men (96.7% vs. 90.3%), and for cancer-related visits (94.8% vs. 89.7%). In a multivariable model, the association was significant for age>65 (odds ratio, OR 5.38, 95%CI 1.06-27.5, p=.043) and female sex (OR 0.12, 95%CI 0.02-0.76, p=.024). The physician score strongly correlated with satisfaction with office staff recorded as part of the CAT (odds ratio, OR, 28.5, p<.0001). Conclusions: In a hematology-oncology practice, CAT results were considerably more skewed towards “Excellent” scores than in other previously studied specialties. Patients’ age and gender significantly influence the scores, which may confound comparisons between physicians or practices in quality assessment projects. As the needs, concerns and problems of cancer patients may differ from other medical settings, further research is needed to establish if CAT can be used for performance improvement, and whether oncology-specific questions can provide more discriminating measures of patient satisfaction and physician communication skills.
Avoidable and unavoidable visits to the emergency department among advanced cancer patients (AdCa) followed by the supportive care (SCPC) outpatient clinic.
Authors: Delgado-Guay Marvin Omar , Shin SeongHoon , Chisholm Gary B. , Williams Janet L. , Allo Julio , Bruera Eduardo 
Published: February 2017

140 Background: Admissions to ED are considered undesirable for AdCa receiving palliative care. There is limited research about clinical characteristics of AdCa followed by SCPC who visited ED, and if these ED visits can be categorized as avoidable or unavoidable. Methods: Retrospective study of 200 consecutive AdCa evaluated by the SCPC physician who visited ED between January 2010 and December 2011. All patients were instructed to call to our main number if any change in symptoms. Based on pre-defined criteria AdCa were classified as having an avoidable (if the problem could have been managed at the outpatient center or by telephone) or unavoidable visit. Demographics and clinical characteristics were collected and analyzed. Results: 47/200 (23.5%) AdCa had avoidable ED-visits (AvED) and 153/200 (76.5%) had unavoidable ED-visits (NAvED). Main reasons for NAvED: changes in mental statu s(24/153, 16%), infectious processes (32/153, 21%), new onset/worsening of pain and dyspnea (75/153,49%), and severe worsening others symptoms (22/153,14%). Age, gender, marital status, and cancer types, reasons for referral to SCPC, and time to ED-visit after SCPC visit were not significantly different between AvED and NAvED patients. Baseline Edmonton Symptom Assessment Scale showed no significant difference in pain, dyspnea, fatigue, drowsiness, nausea, well-being, anxiety, and depression for AvED vs. NAvED; except for sleep ≥1: 141/153 (92%) vs. 37/47 (79%), p=0.01001, respectively. None of the patients phoned the SCPC before to ED visit. 17/153 (11%) of AdCa called their primary oncology before NAvED visit vs. 1/46(2%) call before AvED, p=0.078. Multivariate analysis showed that NAvED was associated with worsening of pain (OR:2.485, p<0.0179), changes in mental status (OR:23.143, p<0.0098), and sleep disturbance(OR:3.611, p<0.0116). 0/47(0%) AvED vs. 93/153 (51%) of NAvED were admitted to the hospital, p<0.0001. Conclusions: More than one in five of ED visits by AdCa are avoidable. Efforts through to improve communication after the scheduled appointments, through clinician initiated phone calls, electronic communication and more frequent visits are needed.
Effect of intervention on a quality measure of pain management at Medstar Washington Cancer Institute.
Authors: Ranpura Vishal Navnitray , Wood Lynne , Heller Stephanie , Self Linda , Jang Sekwon 
Published: February 2017

144 Background: Medstar Washington Cancer Institute (MWCI) has participated in Quality Oncology Practice Initiative (QOPI) since 2008. Adherence to pain assessment and intensity documentation was high, but lower in plan of care for moderate/severe pain documentation (69%, compared to QOPI aggregate of 79%) during the fall 2011 round. One potential explanation for the discrepancy was lack of communication between the nursing staff assessing the pain and the physician treating pain. We hypothesized that the use of pain card can improve the communication between nurses and doctors, as well as prompt physicians to document the plan of care for moderate/severe pain. Methods: MWCI created a team of physicians, nurses, quality resources, and administrative staff in December 2011. We abstracted up to 10 patients charts per oncologist for those patientswho reported moderate to severe pain (pain score of more than 3 of 10 on numeric rating scale) each quarter during 2012.We used data for quarter 1 and 2 as a baseline. We implemented the use of pain card by nurses to report pain for these patients to the physician in quarter 3 and 4. Chi square test was used to compare documentation rate in the first two quarters and last two quarters. Results: The total number of charts evaluated, pain documentation as well as confidence intervals for each quarter are shown in the table. Our results show significant improvement in pain documentation by physician in last two quarters compared to first two quarters ( p = 0.0007). Conclusions: Our study demonstrates pain card improved communication between nurse and physician resulting improved documentation of pain by physician. [Table: see text]
Enhancing the quality of the patient experience in an academic medical center.
Authors: Colman Gerard , Hardeman Emily , Moorad Julianna Grisham 
Published: February 2017

149 Background: As value-based purchasing evolves, there is a constant focus on efficiency and quality of care delivered during patient interactions before, during, and after each encounter. While perception of quality varies amongst patients, effective communication, patient involvement, and employee engagement have proven to impact patient satisfaction and perceived quality. MD Anderson Cancer Center is re-thinking its practices to provide exceptional quality in clinical care and operations. Methods: MDA has developed a Patient Experience Steering Committee to lay the foundation for the experience strategy and standardization of quality care. The creation of a dedicated patient experience position and the formation of inpatient and ambulatory experience groups have helped to focus initiatives around patient feedback and satisfaction scores. Steps have been taken to enhance patient-focused care: Incentive goals for staff/faculty; Focused communications; Enhanced standards and accountability; Formal rounding; Patient Ambassador pilot; Physician partnerships; New Employee Orientation re-design; Patient involvement; Language of Caring. Results: Ambulatory satisfaction awareness began in July 2011 with an overall score (including custom questions) of 85.6. Focused initiatives began fall 2011, and by March 2013 the score jumped 2.1 points to 87.7. The standard score moved from 88 to 89.6 taking MDA’s C4QI percentile ranking from 6 to 35 over 20 months. Incentive goals focused on information around delays (75.2 to 79.3) and courtesy of staff (93.6 to 94.3). Satisfaction around wait times to see physicians increased from 74.8 to 79.3. Focused efforts revealed increased scores for reaching office staff on the phone and wait time between 1st call and appointment. Conclusions: While a portion of value realized by these initiatives will be evident through reimbursement, VBP rules have led to a much needed structure of standardized operational practices and quality across an academic system. We understand that quality of administrative practices substantially impacts the patient experience, but with over 19,000 employees that treat over 100,000 patients per year, identifying ways to change those practices is not always simple.
Development of a side-effect self-monitoring HOME notebook (HNB): Results from a single institution experience.
Authors: de Marino Elvira , Rossetti Sabrina , Posca Teresa , Lattuada Sara , Chiavola Laura , Cecutti Mara , Pettinati Veronica 
Published: February 2017

150 Background: Cancer treatments can be associated with distress and side effects. As therapies are often provided in ambulatory care settings, patients (Pts) have to manage related effects at home, without specialised real-time support. In some cases, Pts are also responsible of prescribed oral adiuvant therapy. In this study we present evaluation results of a self-monitoring and self-education tool to be included in clinical record. Methods: From Jan 2011 to Jan 2013, we enrolled 227 (114M, 113F) Pts new diagnosed with cancer, 204 entered the study, 23 refused. Pts received a note book (HNB) including 2 guidelines about alimentation and skin/mucous/sexuality, 1 daily diary. Pts were asked to complete diary recording side-effects and managing toxicities following the simple guidelines provided. Pts also had a self-administered questionnaire (SQ) to give opinion about tool. Two hundred and four diaries were given; 112 SQ collected. Start-up educational meetings were conducted to illustrate how to register symptoms on diary and monthly we monitored compliance by auditing. Results: SQ analysis shows the following. Average age was 65.14 (median 66); 55% were ≥65 yrs old; 50% received adiuvant treatment, 43% palliative. HNB was used by 33% Pts, 64% Pts and relatives, 3% relatives. 100% Pts say it’s very useful and 98% easy to understand/fill. Most usefull and consulted sections are: alimentation 42%, diary symptoms checklist 31%, skin/mucous/sexuality 25%. Alimentation 42% and diary 24% were the parts they would deepen. Most usefull suggestions about self-care were those on fatigue/decrease in appetite 54%, altered taste 27%, oral cavity inflammation 13%. Sixtynine Pts had nausea and find suggestions given on it useful; 111 rated informations on treatments helpful. Evaluations on study were excellent for 46% Pts, good for 50%, sufficient for 4%. Conclusions: Results confirm HNB efficacy and usefulness. It is easy to understand and fill and provides Pts with heplfull self-managed informations. It’s a precise and higly reliable assessment and monitoring tool at home both for Pts and oncologists. We are evaluating use of HNB as a tool for continuity of care and for phase IV trials.