bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changing patterns of care for locally advanced non-small cell lung cancer (NSCLC): Implications for quality initiatives.
Authors: Hall Matthew David , Gabriel Peter Edward , Guo Wensheng , Upasani Sandhya , van der Pas Marjorie , Schultheiss Timothy E. , Goldwein Joel W. , Christodouleas John Paul 
Published: February 2017

302 Background: Our purpose was to assess the utilization of dose escalated radiotherapy (RT) in Stage III NSCLC patients in the United States from 2004-2013, a period when no Level 1 evidence on dose escalation was published. Methods: Data on all NSCLC patients treated with RT were extracted from the National Oncology Data Alliance (NODA), a pooled database of cancer registries from >150 US hospitals. The NODA contains the same data submitted to state cancer registries and SEER, but also contains RT dose fields that are manually verified by trained staff. Search algorithms to identify patients with complete RT dose data and who met the RTOG 0617 eligibility criteria were developed and validated by manual chart review at two institutions. The search algorithm positive predictive values for RT dose and RTOG 0617 eligibility were 97% and 91%, respectively. The primary endpoint was utilization of dose escalated RT, defined as >70 Gy. Multivariate logistic regression (MVA) was used to measure the association of treatment year with dose escalated RT use in two predefined periods straddling the early closure of RTOG 0617 on 6/17/2011: Period 1 2004-2010 and Period 2 2010-2013. To address potential limitations in generalizability, we repeated the same analysis in the National Cancer Database (NCDB). Results: The percentage of patients treated with >70 Gy increased monotonically from 22% in 2004 to 37% in 2010 and then declined to 20% in 2012. On MVA, increasing utilization of doses >70 Gy was observed during Period 1 (p<0.001) followed by decreasing use during Period 2 (p=0.002), after adjusting for the effects of other significant patient and hospital level variables. A similar utilization pattern was observed in the NCDB. After adjusting for age and comorbidities, significant changes in the mean RT dose prescribed compared to the 3-year moving average could have been detected in 2008 and 2012, if dose had been prospectively monitored in the NODA. Conclusions: Our study suggests that US radiation oncologists increasingly utilized RT doses >70 Gy in Stage III NSCLC patients treated from 2004-2010 followed by a decline after 2010. RT dose may be an important standardization metric in national quality initiatives.
The Dutch Upper GI Cancer Audit: 2011-2014.
Authors: Busweiler Linde A.D. , Wijnhoven Bas P.L. , van Berge Henegouwen Mark I. , Henneman Daniel , Wouters Michel W.J.M. , van Hillegersberg Richard , van Sandick Johanna W. ,   Dutch Upper GI Cancer Audit group
Published: February 2017

309 Background: In 2011, the Dutch Upper GI Cancer Audit (DUCA) group started with a nationwide registration of all patients who underwent surgery for esophageal or gastric cancer. The aim of this study was to describe the initiation and implementation of the DUCA and to provide an overview of the results. Methods: The DUCA is part of the Dutch Institute for Clinical Auditing. It provides (surgical) teams with reliable, weekly updated, benchmarked information on process and (casemix-adjusted) outcome measures. A web-based registration was designed, based on a set of predefined quality measures. Results: Between 2011 and 2014, a total of 4672 patients with esophageal or gastric cancer was registered in the DUCA. Case ascertainment has approached 100% for patients registered in 2014. The percentage of patients with esophageal cancer starting treatment within 5 weeks after diagnosis significantly increased over time (33 to 41%) and the percentage of patients with a minimum of 15 lymph nodes in the resected specimen significantly increased for both esophageal cancer (50 to 73%) and gastric cancer (48 to 74%). Postoperative mortality decreased for patients with gastric cancer (8.0% in 2011 to 4.0% in 2014; p = 0.020) and remained stable (around 4%) for patients with esophageal cancer. Conclusions: Nationwide implementation of the DUCA has been successful. Results give a valuable insight in the quality of the surgical care for patients with esophageal or gastric cancer and show a positive trend for various process and outcome measures.
Financial risk-sharing agreements: Using options to make marginal benefits cost effective.
Authors: Conter Henry Jacob 
Published: February 2017

41 Background: New cancer treatments have become increasingly costly. Although new drugs may be sufficiently cost-efficiency for a primary indication (i1) to receive funding, subsequent indications (ia) may not prove cost-effective. A financial risk-sharing agreement to increase access is proposed. A potential 2012 real-world implementation in Canada for pazopanib use in metastatic renal cell carcinoma (mRCC) as i1, and soft-tissue sarcoma (STS) as ia is presented. Methods: The market value of an indication can be approximated by its net-present-value (NPV) of expected cash flows. If the incremental cost-effectiveness ratio (ICER) for ia is expected to be greater than willingness-to-pay (WTP), the payer then has an incentive to enter into a risk-sharing agreement. A binomial option pricing model is employed to compute the price of the call option to contract such an agreement. The probability of being eligible for ia is extracted from the pan-Canadian Oncology Drug Review (pCODR), a national drug funding advisory body. Correspondence with industry was performed to identify additional ia. Cost, effectiveness, the ICER, discount rates, and drug revenues are calculated using inputs from pCODR, the Bank of Canada, Statistics Canada, and pazopanib’s relevant clinical data at the time of its submission for i1. Results: Of the 47 drugs eligible for i1, 46% are eligible for an ia(Wilson interval 33%-60%). For pazopanib in mRCC, at a mean price of $164/day and an ICER of $0-$57,309, the expected NPV was computed to be $338M. In STS, based on its clinical data at the time, at the same price, the ICER was expected to be > $100,000, with an NPV of $37M. The price of the call option is $17M. Alternatively, the price of pazopanib could be adjusted to $172/day in mRCC, keeping its ICER below WTP, with an agreement that if efficacious, the drug would be provided by the company gratis for STS patients. Conclusions: In a reality where high drug costs are limiting access for vulnerable patients, risk sharing agreements using financial instruments offer an opportunity to re-deploy health technology assessment to expand drug access. For a price increase of $8 per day in i1, Canadian STS patients could have had access to an effective treatment instead of nothing.
Early discussion of advance directives for patients with newly diagnosed cancer.
Authors: Jang Sekwon , Sundaram Suvarna , Finlay Andrea , Romanova Natalia , Knopp Laura , Pierattini Chiara , Fuentes Jenny , Hidalgo Emily , Daye Marian , Kokon Megan , Gustavson Christina , Radomsky Pamela , Buras Josefina , DeSimone Jennifer , Venna Suraj S. , Deeken John F. , Trump Donald L. 
Published: February 2017

91 Background: Although advance care planning and the completion of advance directives (ADs) are important methods to prevent unwanted aggressive care once patients have lost their decision-making capacity, only a minority of patients have ADs at the time of cancer diagnosis. Methods: We established a new multidisciplinary outpatient clinic to provide comprehensive care to patients with newly diagnosed cancer at the Inova Dwight and Martha Schar Cancer Institute in Northern Virginia. Improvement in advance care planning was chosen as one of the first quality improvement initiatives for 2015. We started the first PDSA cycle after creating the team, establishing the problem and goal statement, and reviewing the process map. We had three measures including: 1. Inquiring whether the patient has advance directives or not at the time of scheduling their first appointment, 2. Provide written information about advance directives at the patient’s first visit, 3. Obtain advance directives by the third office visit. The goal for each measure was 90%, 90%, and 50% by the end of 2015. Results: Between May-June 2015, 65 patients were evaluable. Baseline rates were 26%, 2%, and 12%, respectively for measures 1, 2, and 3. In July 2015, we convened a staff meeting to review each staff’s role in the process of advance care planning. The new patient schedulers had training and created a telephone script to effectively communicate advance directives information with patients. The front desk staff included written information about advance care planning in the new patient information folders. Clinical staff were asked to address any questions or concerns that patients have and to encourage patients to complete the ADs by next visit. After this intervention, the rates increased to 100%, 44%, and 33%, respectively for measures 1, 2, and 3 in August and September, 2015 (n = 45). Conclusions: Early discussion about the ADs for newly diagnosed cancer patients at our outpatient clinic showed improvement in the rate of completed ADs by a third office visit.
Cognitive Complaints in Survivors of Breast Cancer After Chemotherapy Compared With Age-Matched Controls: An Analysis From a Nationwide, Multicenter, Prospective Longitudinal Study
Authors: Janelsins Michelle C. , Heckler Charles E. , Peppone Luke J. , Kamen Charles , Mustian Karen M. , Mohile Supriya G. , Magnuson Allison , Kleckner Ian R. , Guido Joseph J. , Young Kelley L. , Conlin Alison K. , Weiselberg Lora R. , Mitchell Jerry W. , Ambrosone Christine A. , Ahles Tim A. , Morrow Gary R. 
Published: February 2017

Purpose Cancer-related cognitive impairment is an important problem for patients with breast cancer, yet its trajectory is not fully understood. Some previous cancer-related cognitive impairment research is limited by heterogeneous populations, small samples, lack of prechemotherapy and longitudinal assessments, use of normative data, and lack of generalizability. We addressed these limitations in a large prospective, longitudinal, nationwide study. Patients and Methods Patients with breast cancer from community oncology clinics and age-matched noncancer controls completed the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) at prechemotherapy and postchemotherapy and at a 6-month follow-up as an a priori exploratory aim. Longitudinal models compared FACT-Cog scores between patients and controls at the three assessments and adjusted for age, education, race, menopausal status, and baseline reading ability, anxiety, and depressive symptoms. A minimal clinically important difference cutoff determined percentages of impairment over time. Results Of patients, 581 patients with breast cancer (mean age, 53 years; 48% anthracycline-based regimens) and 364 controls (mean age, 53 years) were assessed. Patients reported significantly greater cognitive difficulties on the FACT-Cog total score and four subscales from prechemotherapy to postchemotherapy compared with controls as well as from prechemotherapy to 6-month follow-up (all P < .001). Increased baseline anxiety, depression, and decreased cognitive reserve were significantly associated with lower FACT-Cog total scores. Treatment regimen, hormone, or radiation therapy was not significantly associated with FACT-Cog total scores in patients from postchemotherapy to 6-month follow-up. Patients were more likely to report a clinically significant decline in self-reported cognitive function than were controls from prechemotherapy to postchemotherapy (45.2% v 10.4%) and from prechemotherapy to 6-month follow-up (36.5% v 13.6%). Conclusion Patients with breast cancer who were treated in community oncology clinics report substantially more cognitive difficulties up to 6 months after treatment with chemotherapy than do age-matched noncancer controls.
Accrual of Older Patients With Breast Cancer to Alliance Systemic Therapy Trials Over Time: Protocol A151527
Authors: Freedman Rachel A. , Foster Jared C. , Seisler Drew K. , Lafky Jacqueline M. , Muss Hyman B. , Cohen Harvey J. , Mandelblatt Jeanne , Winer Eric P. , Hudis Clifford A. , Partridge Ann H. , Carey Lisa A. , Cirrincione Constance , Moreno-Aspitia Alvaro , Kimmick Gretchen , Jatoi Aminah , Hurria Arti 
Published: February 2017

Purpose Despite increasing awareness of accrual challenges, it is unknown if accrual of older patients to breast cancer treatment trials is improving. Methods We examined accrual of older patients to Alliance for Clinical Trials in Oncology systemic therapy breast cancer trials during 1985-2012 and compared disease characteristics and reasons for therapy cessation for older (age ≥ 65 years and ≥ 70 years) versus younger (age < 65 years and < 70 years) participants. To examine accrual trends, we modeled age as a function of time, using logistic regression. Results Overall, 17% of study participants were ≥ 65 years of age. Approximately 15%, 24%, and 24% of participants in adjuvant, neoadjuvant, and metastatic trials were age ≥ 65 years, and 7%, 15%, and 13% were age ≥ 70 years, respectively. The odds of a patient age ≥ 65 years enrolling significantly increased over time for adjuvant trials (odds ratio [OR] per year, 1.04; 95% CI, 1.04 to 1.05) but decreased significantly for neoadjuvant and metastatic trials (OR, 0.62; 95% CI, 0.58 to 0.67 and OR, 0.98, 95% CI, 0.97 to 1.00). Similar trends were seen for those age ≥ 70 years but these were statistically significant for adjuvant and neoadjuvant trials only (OR, 1.05, 95% CI, 1.04 to 1.07; and OR, 0.57, 95% CI, 0.52 to 0.62). In general, those age ≥ 65 years ( v those < 65 years) in adjuvant studies had a higher mean number of lymph nodes involved and more hormone receptor-negative tumors, although tumor sizes were similar. Early protocol treatment cessation was also more frequent in those age ≥ 65 years (50%) versus < 65 years (35.9%) across trials. Conclusion Older patients with breast cancer remain largely underrepresented in cooperative group therapeutic trials. We observed some improvement in accrual to adjuvant trials but worsening of accrual for neoadjuvant/metastatic trials. Novel strategies to increase accrual of older patients are critical to meaningfully change the evidence base for this growing patient population.
Adjuvant Therapy Choices in Patients With Resected Non-Small-Cell Lung Cancer: Correlation of Doctors' Treatment Plans and Relevant Phase III Trial Data
Authors: Green Mark R. , Andrews Michele , Leff Richard , Willey Joanne , Allegra Carmen , Denes Alex , Epstein James , Jones James , Lokey Lee 
Published: February 2017

Purpose To evaluate case-based choices selected from among preselected options for adjuvant therapy management in patients with completely resected non-small-cell lung cancer (NSCLC). Methods In a series of meetings in which US oncologists participated in case-based discussions, market research data were acquired using audience response keypad technology. Participant's anonymous responses to specific case-based questions were recorded electronically and tabulated. Results Core behaviors among the majority of physician participants are driven by emerging level 1 evidence. However, a “more aggressive than literature-supported treatment posture” is frequently selected. For the scenario involving a patient with completely resected pT1N0 disease, approximately 60% recommended observation but one third of respondents indicated they would propose three to four cycles of platinum-based adjuvant chemotherapy. Twenty-three percent would recommend adjuvant radiation following adjuvant chemotherapy for a patient with completely resected pT2N1 (stage IIB) disease. In the stage IIB setting, when cisplatin or carboplatin chemotherapy choices were specified, carboplatin-based combinations were selected by 43.6% compared with 30% for cisplatin regimens. Eight respondents (3.5%) favored observation for the stage IIB setting. This is consistent with the preponderance of level 1 evidence for adjuvant management. Carboplatin combinations are also recommended despite the availability of only abstract data and a meeting report for a single phase III trial showing a survival benefit for carboplatin based management in stage IB disease. The use of radiation as an element in adjuvant therapy in the settings assessed in this research is not supported by prospective data. Conclusions Treatment plans that include adjuvant platinum-based chemotherapy have been widely adopted by US oncologists for a large fraction of patients with completely resected NSCLC. Recommendations for adjuvant chemotherapy for the patient described here with stage IA disease, or for adjuvant radiation alone or after adjuvant chemotherapy, for the stage IIB disease patient presented are overly aggressive, not evidence based, and carry potential harm. In settings in which level 1 evidence for a survival benefit from adjuvant chemotherapy does exist, some of the specific adjuvant chemotherapy regimens selected, while widely used in NSCLC patients with more advanced disease, have not yet been demonstrated to provide improved disease-free or overall survival as adjuvant treatment. Individualized adjuvant treatment recommendations not specifically grounded in level 1 evidence appear to be widely recommended by US medical oncologists for patients with completely resected NSCLC.
Technical Note—An Expectation-Maximization Method to Estimate a Rank-Based Choice Model of Demand
Authors: van Ryzin Garrett , Vulcano Gustavo 
Published: February 2017

We propose an expectation-maximization (EM) method to estimate customer preferences for a category of products using only sales transaction and product availability data. The demand model combines a general, rank-based discrete choice model of preferences with a Bernoulli process of customer arrivals over time. The discrete choice model is defined by a probability mass function (pmf) on a given set of preference rankings of alternatives, including the no-purchase alternative. Each customer is represented by a preference list, and when faced with a given choice set is assumed to either purchase the available option that ranks highest in her preference list, or not purchase at all if no available product ranks higher than the no-purchase alternative.We apply the EM method to jointly estimate the arrival rate of customers and the pmf of the rank-based choice model, and show that it leads to a remarkably simple and highly efficient estimation procedure. All limit points of the procedure are provably stationary points of the associated incomplete data log-likelihood function, and the output produced are maximum likelihood estimates (MLEs). Our numerical experiments confirm the practical potential of the proposal.The online appendix is available at https://doi.org/10.1287/opre.2016.1559 .
Impact of Support from Significant Others on Adolescents' Academic Performance, Self-esteem and Interest in Academic Work
Authors: Mclnerney Dennis M. , Dowson Martin , Yeung Alexander Seeshing 
Published: February 2017

AbstractHigh school students in the U.S. (N=1,078; 47% boys) responded to survey items on their self-esteem and interest in schoolwork, their personal expectancy of high school completion, and their perceived support from parents, teachers and peers for their expectancy. Their GPA and days absent from school were collected from school records. Personal expectancy, parent, teacher, and peer support all had significant positive impacts on students' self-esteem, interest in schoolwork, and GPA. The pattern of effects was consistent across the subsamples of Grades 5 to 6 (n=264), Grades 7 and 8 (n=226), and Grades 9 to 12 (n=319). Positive personal expectancy and teacher support also had significant negative effects on absence from school for Grades 7 and 8. Of all the significant others considered, support from teachers had the strongest impact on self-esteem, interest, and GPA in the high school subsamples. Teachers are probably the most influential agent in promoting self-esteem, interest, and academic performance in the school context.
Technology in Strength and Conditioning Tracking Lower-Limb Exercises With Wearable Sensors
Authors: O'Reilly Martin A. , Whelan Darragh F. , Ward Tomas E. , Delahunt Eamonn , Caulfield Brian 
Published: February 2017

Abstract
O'Reilly, MA, Whelan, DF, Ward, TE, Delahunt, E, and Caulfield, B. Technology in strength and conditioning tracking lower-limb exercises with wearable sensors. J Strength Cond Res 31(6): 1726–1736, 2017—Strength and conditioning (S&C) coaches offer expert guidance to help those they work with achieve their personal fitness goals. However, because of cost and availability issues, individuals are often left training without expert supervision. Recent developments in inertial measurement units (IMUs) and mobile computing platforms have allowed for the possibility of unobtrusive motion tracking systems and the provision of real-time individualized feedback regarding exercise performance. These systems could enable S&C coaches to remotely monitor sessions and help gym users record workouts. One component of these IMU systems is the ability to identify the exercises completed. In this study, IMUs were positioned on the lumbar spine, thighs, and shanks on 82 healthy participants. Participants completed 10 repetitions of the squat, lunge, single-leg squat, deadlift, and tuck jump with acceptable form. Descriptive features were extracted from the IMU signals for each repetition of each exercise, and these were used to train an exercise classifier. The exercises were detected with 99% accuracy when using signals from all 5 IMUs, 99% when using signals from the thigh and lumbar IMUs and 98% with just a single IMU on the shank. These results indicate that a single IMU can accurately distinguish between 5 common multijoint exercises.
A Systematic Review of the Association Between Physical Fitness and Musculoskeletal Injury Risk: Part 1—Cardiorespiratory Endurance
Authors: Lisman Peter J. , de la Motte Sarah J. , Gribbin Timothy C. , Jaffin Dianna P. , Murphy Kaitlin , Deuster Patricia A. 
Published: February 2017

Abstract
Lisman, PJ, de la Motte, SJ, Gribbin, TC, Jaffin, DP, Murphy, K, and Deuster, PA. A systematic review of the association between physical fitness and musculoskeletal injury risk: part 1—cardiorespiratory endurance. J Strength Cond Res 31(6): 1744–1757, 2017—Musculoskeletal injuries (MSK-Is) are a significant health problem for both military and athletic populations. Research indicates that MSK-I is associated with physical fitness; however, the association between specific components of physical fitness and MSK-I in military and athletic populations has not been systematically examined. Our goal was to systematically review the literature to provide a best evidence synthesis on the relationship between components of physical fitness and MSK-I risk in military and civilian athletic populations. This first of 3 manuscripts focuses on cardiorespiratory endurance (CRE). MEDLINE, EBSCO, EMBASE, and the Defense Technical Information Center were searched for original studies published from 1970 through 2015 that examined associations between physical fitness and MSK-I. Forty-nine of 4,229 citations met our inclusion criteria. Primary findings indicate that there is (a) strong evidence that poor performance on a set distance run for time is a predictor for MSK-I risk in both genders; (b) strong evidence that poor performance on timed shuttle runs is a predictor for MSK-I risk in males; (c) moderate evidence in males and limited evidence in females that poor performance on a timed step test is a predictor of MSK-I risk; and (d) limited or insufficient evidence that poor performance on the Cooper run test, maximal and submaximal aerobic graded exercise tests, and the Conconi test are predictors of MSK-I risk in males or females or both. Several measures of CRE are risk factors for training-related MSK-I in military and civilian athletic populations, indicating that CRE may be an important measure for MSK-I risk stratification.