bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health economic impact of breast cancer index (BCI) in patients with hormone responsive breast cancer (HRBC) considering extended adjuvant endocrine therapy (EET).
Authors: Sanft Tara Beth , Berkowitz Alyssa , Schroeder Brock , Hatzis Christos , Schnabel Catherine A. , Aktas Bilge , Brufsky Adam M. , Pusztai Lajos , Gustavsen Gary , Van Londen G J. 
Published: April 2017

25 Background: Previous research has demonstrated the benefit of EET for HRBC, however, the absolute benefit is modest and commits women to an extra 5 yrs of treatment. The Breast Cancer Index (BCI) is a gene expression-based test that has been validated to quantify the risk of late recurrence (BCI subscore) and to predict likelihood of benefit from EET (H/I subscore). We have previously shown that the use of BCI increases patient and physician confidence in decision-making and leads to fewer recommendations for EET. The current analysis extends our results to a larger sample size and presents a health economic analysis to assess the cost effectiveness of the use of BCI for EET decision-making. Methods: We developed a fact-based economic model to project the cost effectiveness of BCI using a cohort of 140 patients with stage I-III HRBC from Yale Cancer Center and University of Pittsburgh Medical Center who had completed ≥3.5 yrs of endocrine therapy and had undergone BCI testing in the context of this study. Physicians completed questionnaires to indicate their recommendations for EET before and after BCI results. Costs associated with EET, toxicity, follow-up, and metastatic recurrence were modeled over 5 yrs of extended therapy. Model inputs were based on published literature. Sensitivity analyses were performed around key inputs to estimate effects on the model. Results: Changes in EET recommendations after BCI were observed in 29% of patients, with 21% changing from recommended to not recommended, and 8% from not recommended to recommended. The projected net cost savings of BCI testing in this population of patients who are disease free at 5 yrs post-diagnosis is $5,190 per patient tested. Gross cost savings were projected to be achieved through reduced recurrence in patients receiving EET based on BCI results and decreased adverse events and comorbidities for patients with low BCI scores who did not receive EET. Conclusions: Based on the decision impact of BCI in a real-world cohort, the test is projected to be cost saving for women with early stage hormone receptor positive breast cancer who are recurrence free at 5 yrs post-diagnosis on adjuvant endocrine therapy.
Influence of provider and health system factors on uptake and disparities in breast cancer gene expression profile testing.
Authors: Reeder-Hayes Katherine Elizabeth , Wheeler Stephanie B. , Roberts Megan , Meng Ke , Zhou Xi , Baggett Christopher , Meyer Anne-Marie 
Published: April 2017

250 Background: Gene expression profiles (GEPs) have been rapidly and widely adopted to guide chemotherapy decisions in early hormone receptor-positive (HR+) breast cancer, but not all eligible patients receive testing. Patient-level predictors of testing have been reported. However, the role of provider and insurance factors in GEP use has not been well described. Racial disparities in access to testing are also under-studied. Methods: We used state cancer registry data linked to claims from multiple insurance payers to identify 11,958 patients eligible for GEP testing between 2005 and 2012. For each patient, we characterized specialty and breast cancer volume for the provider deemed most likely to make the testing decision. We identified claims for the most commonly used GEP (OncotypeDX) and used adjusted incidence rate models to examine predictors of testing, stratified by nodal status (N0 versus N1). Results: Overall, 26% of eligible patients were tested with rates increasing over time. In multivariable analyses among N0 patients, black women were 12% less likely than clinically similar whites to be tested. Patients treated by a general surgeon were less likely to be tested than those treated by oncologic specialists, while those seen by middle-volume providers were significantly more likely to be tested than patients of the highest-volume providers. Black women with N1 disease were 27% less likely to be tested. Among N1 patients, testing was most common among patients of highest-volume providers and declined consistently with provider volume. Private insurance increasing the likelihood of testing for N0, but not N1 disease. Conclusions: Insurance status and provider characteristics appear to influence the likelihood of GEP testing for early breast cancer, but do not fully explain racial disparities in access to testing. Black women are less likely than whites to receive testing in either the node-negative or node-positive setting after adjustment for clinical factors. These date suggest a need to develop quality programs that enable uptake of appropriate breast cancer genomic tests, with a focus on elimination of disparities.
Supportive oncology and survivorship care: Initial impact of the Coleman Supportive Oncology Collaborative.
Authors: Trosman Julia Rachel , Gerhart James , Garcia Sofia F. , Dale William , Patel Urjeet , Khosla Paramjeet , Lo Shelly S. , Macias Javier , Robinson Patricia A. , Knightly Eileen , Deamant Catherine , Scheu Amy , Boecher Stephanie , Diaz Aidnag , Newsom Carol , Berardi Rosa , Penedo Frank J. , Weldon Christine B. 
Published: April 2017

27 Background: The Institute of Medicine (IOM) and Commission on Cancer (CoC) recommend supportive oncology and survivorship care. The Coleman Supportive Oncology Collaborative (CSOC) aims to improve quality of supportive care and survivorship in Chicago. Methods: CSOC includes 35 institutions (cancer centers, support and hospice), structured in two design teams (Distress & Survivorship and Palliative). Participants identified opportunities and gaps in supportive and survivorship care in an iterative development of: screening tools, follow-up processes, provider training, and quality metrics to assess CSOC impact. Six process improvement sites (2 safety-net, 3 academic, and 1 public) reviewed patient charts at baseline and Q1 2015, compared by Fisher’s exact test. Results: Eight metrics contained patient data at the 2 time points; improvements were seen in 6/8 metrics. Conclusions: CSOC successfully developed supportive oncology, survivorship screening, and care processes aligned with IOM and CoC standards. Significant improvements were shown after implementation in diverse settings. Ongoing work will continue to evaluate the impact of the CSOC on patient care.[Table: see text]
Implementing a patient-centered approach to immunotherapy treatment on an inpatient step-down unit.
Authors: Delacruz Buenagracia , Estrella Joylynn Mae , Reimschissel Elizabeth , Gonzalez Melissa , Buitrago Joaquin , Kuriakose Bindu , Partee Tara 
Published: April 2017

38 Background: Executing an innovative investigational therapy within a pre-existing infrastructure, while incorporating the organizational mission and vision is a complex process. Literature supports the use of patient-centered framework and integration of evidence in standardizing nursing practice to promote efficient workflow, accountability, and ultimately, optimal patient-care outcomes. The aim of this presentation is to describe the experience of a step-down unit at a comprehensive cancer center in developing and implementing processes to safely administer immunotherapy. Methods: A multidisciplinary workgroup reviewed the pre-existing infrastructure, determined the financial impact of new clinical trials and availability of resources, distinguished roles and stakeholder responsibilities, and developed staff education and technology utilization. A unit-prospective analysis, using the Strengths, Weaknesses, Opportunities, and Threats (SWOT) methodology was performed to assist in planning and reducing variations in processes during initial implementation. Results: This initiative resulted in the standardization of immunotherapy treatment workflow and development of patient care tools. The workflow consisted of patient education and treatment pathways, whereas the tools included the treatment calendar and nursing assessment forms comprised of daily handwriting sentence construction and CAR-T Toxicity (CARTOX) Grading Assessment. EHR collaboration resulted in the incorporation of CARTOX into nursing documentation in EMR. These workflow and tools are essential in ensuring timely assessment and management of treatment-related toxicities, escalation of care needs, and reduction of potential missed care and adverse events that impact staffing needs and health care costs. Conclusions: A patient-centered approach provides a framework in implementing innovative changes that promote patient safety. Engaging the frontline staff throughout the journey promoted empowerment and accountability. Multidisciplinary planning and nursing leadership transparency in orchestrating multi-level routines for actualization of competence proved immensely invaluable.
Post-antibiotic management of immunocompromised children with febrile neutropenia.
Authors: Russo Carolyn Lucille , Morgan Jennifer 
Published: April 2017

39 Background: Febrile neutropenia in immunocompromised children is a medical emergency and requires prompt administration of antibiotics and supportive care management to prevent death from sepsis. We have previously shown that improvement in time to antibiotic administration from a baseline of 108 minutes was decreased to 64 minutes in 67 children in six St. Jude affiliate clinics. The improvement was achieved by designing a unique order set and process for prompt dispensing of antibiotics at each affiliate site. However, the clinical assessment of patients after antibiotic administration to provide early intervention for treatment of septic shock did not improve. Management of fluid status, oxygen therapy, and blood pressure support are critical for optimal outcome. The time from antibiotic administration to clinical assessment remained above the expected time of 15 minutes at an average of 60 minutes. To improve the post-antibiotic management, additional guidelines were established and monitored for compliance. Methods: Clinical guidelines were written. The guidelines included: patient assessed by nurse and vital signs checked within 15 minutes of arrival, patient assessed by a clinician within 30 minutes of arrival, antibiotic administrated within 60 minutes of arrival, nurse completed post-antibiotic assessment and vital signs rechecked within 15 minutes of administration, and clinician completed post antibiotic assessment within 30 minutes of administration. Results: After establishing guidelines, each site developed a process for implementation using a similar approach of automated order sets, time reminders, and staff education of the initial management of septic shock. Chart reviews were done at one year after implementation and all were in compliance. Conclusions: Clinical guidelines, automated order sets, and continued awareness and education in the management of immunocompromised children with febrile neutropenia improved compliance with this quality project. Continued monitoring is needed to ensure the results are sustained.
Empowering patients to self-identify financial assistance programs using an online application.
Authors: Nicolla Jonathan , Friedman Fred , Manners Ian , Zafar Yousuf 
Published: April 2017

4 Background: Available financial resources are relatively unknown to many patients with cancer facing high treatment-related costs. PAPNavigator is a web-based app designed to reduce out-of-pocket treatment costs by connecting patients to financial assistance programs specific to them. Traditionally used by financial counselors, PAPNavigator was modified to be patient-facing for this study, testing preliminary usability and effectiveness. Methods: Eligible patients with cancer were receiving anti-cancer treatment and reported out-of-pocket treatment costs. Patients interacted with PAPNavigator, inputted personal and financial data, and reviewed personalized financial resource results. Usability was assessed via the validated System Usability Scale (SUS). Effectiveness was assessed by two measures: “PAPNavigator improved my knowledge about financial aspects of cancer care and what can be done about it” and “Using this website was helpful with my financial concerns.” For all items, patients responded using a 5-point Likert scale. Results: 19 of 20 patients completed pilot testing (95%, 1 withdrew due to illness). 53% of patients were male, 26% were non-white, 79% had greater than a high school education, and 21% were employed full- or part-time. Median annual household income was $77,500. The median SUS score was 75 out of 100 (with >68 considered above average.) In response to statements, “I think that I would need assistance to be able to use this website,” and “I felt very confident using this website,” the median scores were 2 and 5 respectively. Additionally, in response to the statements, “PAPNavigator improved my knowledge about financial aspects of cancer care and what can be done about it,” and “Using this website was helpful with my financial concerns,” the median score for each was 4. Conclusions: The modified version of PAPNavigator demonstrated high usability and preliminary effectiveness in improving knowledge about financial aspects of cancer care and potential interventions to reduce cost. Further testing in larger samples is necessary.
Association between caring for a high proportion of older patients and adhering to standard care for younger patients.
Authors: Kamitani Satoru , Watanabe Tomone , Iwamoto Momoko , Higashi Takahiro 
Published: April 2017

41 Background: Multiple comorbidities and physiologic decline often prevent older patients from receiving the same standard care provided to younger patients. Therefore, providers who mainly treat older patients may become accustomed to not adhering to standards and thus might be less likely to provide standard care to younger patients. In this study, we compared the care provided to younger patients between facilities that care for a large number of elderly patients and those that treat relatively few older patients. Methods: We used a nationwide registry-linked claims database of 297 hospitals. Among the quality indicators (QIs) we formerly developed, we selected 2 and 3 QIs for lung cancer and gastric cancer, respectively, based on the variation in adherence across facilities. Facilities were divided into 2 groups based on the proportion of older patients (≥75) with each cancer type. We then compared the QI adherence in treating patients younger than 60 years old between the groups. The difference in adherence to standards of care (quality scores) between the 2 groups of facilities was assessed by using a logistic regression model adjusting for patient age and sex. Results: We analyzed data for 6,708 patients with lung cancer and 26,470 patients with gastric cancer. Respective quality scores for facilities with more older patients versus facilities with fewer older patients were 63.4% versus 66.1% (p=0.439) for the EGFR mutation test before the first chemotherapy among stage IV lung adenocarcinoma patients; 63.2% versus 52.5% (p=0.238) for concurrent chemoradiotherapy (CCRT) for localized small cell lung carcinoma patients; 51.6% versus 46.9% (p=0.229) for HER2 test before the first chemotherapy among patients with unresectable gastric cancer; 81.8% versus 79.7% (p=0.354) for Helicobacter pylori test on patients with gastric cancer who had ESD/EMR; and 60.9% versus 60.7% (p=0.948) for adjuvant chemotherapy within 6 weeks among pathological stage II/III gastric cancer patients. Conclusions: Caring for a high proportion of older patients is not associated with diminished provision of standard care to younger patients.
Potential drug-drug interaction events in patients treated with abiraterone acetate plus prednisone or enzalutamide.
Authors: Pilon Dominic , Behl Ajay S. , Emond Bruno , Xiao Yongling , Lefebvre Patrick , Kane Christopher J. 
Published: April 2017

44 Background: The treatment of patients with advanced cancer generally requires multiple medications, and the consideration of potential drug-drug interactions (DDIs) is important to avoid unintended consequences; therefore, this study assessed potential DDIs in patients treated with oral metastatic castrate-resistant prostate cancer (mCRPC) therapies (abiraterone acetate plus prednisone [AA+P] and enzalutamide [ENZ]). Methods: The MarketScan databases from 03/2012 to 10/2015 were used to conduct a retrospective analysis, in which patients initiated on AA+P or ENZ after 09/2012 (index date) with ≥6 months of continuous eligibility prior to index date and ≥1 PC diagnosis were included. Inverse probability of treatment weighting (IPTW) was used to adjust for observed baseline confounders between groups. Weighted Kaplan-Meier (KM) rates and Cox proportional hazard models were used to compare the occurrence of potential DDIs. Potential DDI was defined as having a claim for a drug that can interact with the index drug (AA+P or ENZ) during the exposure to index treatment (i.e., the time between the first and last claim [plus days of supply] of the index treatment). Interaction drugs were selected based on the prescribing information for each drug and included strong CYP3A4 inducers and CYP2D6 substrates for AA+P and strong CYP3A4 inducers, CYP2C8 inhibitors, CYP2C9 substrates, CYP3A4 substrates, and CYP2C19 substrates for ENZ. Results: A total of 2,540 AA+P and 1,265 ENZ patients were identified. IPTW resulted in balanced baseline demographic, comorbidities, and disease characteristics. At 3, 6, 9, and 12 months post-index, patients initiated on ENZ were more likely to have a potential DDI during their exposure to ENZ treatment when compared to patients initiated on AA+P (ENZ vs. AA+P, KM rates at 12 months: 30.3% vs. 1.5%, hazard ratio [95% confidence interval]: 28.9 [14.5, 57.4], p < 0.0001). Conclusions: This study showed that mCRPC patients treated with ENZ were more likely to be exposed to a potential DDI during their treatment than those treated with AA+P.
Out of system (OOS) costs for oncology clinics treating patients with breast, colorectal, and non-small cell lung cancer in Washington state.
Authors: Fedorenko Catherine R. , Kreizenbeck Karma L. , Panattoni Laura , Walker Julia Rose , Greenwood-Hickman Mikael Anne , Lyman Gary H. , Conklin Ted , Smith Bruce , Barger Sarah , Ramsey Scott David 
Published: April 2017

5 Background: As payers move from fee-for-service to episode-based reimbursement, there is a need for oncology providers to accurately measure in- and out-of-system resource use and cost for patients under their care. Medicare assigns management of a patient to only one provider, yet delivery systems may assume contractual responsibility for a patient with cancer’s entire episode costs, including care received outside of their system. Accordingly, the goal of this study was to estimate OOS care for patients with breast, colorectal (CRC), and non-small cell lung cancer (NSCLC). Methods: Cancer registry records for patients with breast, CRC, or NSCLC diagnosed in Western Washington State from January 2007 to June 2016 were linked with claims from two regional commercial insurers. The analysis focused on initial treatment phase: first day of treatment (surgery, radiation, chemotherapy) through the first 4-month gap in treatment. Patients were assigned an oncology provider group by identifying the clinic Tax ID Number (TIN) with the most Evaluation & Management (E&M) claims with a cancer diagnosis. Claims were considered in system if the TIN matched the assigned clinic. Costs included claims paid to all providers (adjusted to 2016 dollars). Results: The study included 7,686 newly diagnosed patients with breast, CRC, or NSCLC. The average cost for the initial treatment phase was $61,147/patient (SD $75,432, median $35,750). Nearly 31% of claims paid (mean $18,684, SD $32,649) were out of system. Among OOS costs, 24% were for inpatient care, 68% were for outpatient care, and 8% were for outpatient pharmacy. Conclusions: Among newly diagnosed patients with breast, CRC, or NSCLC, approximately 1/3 of costs for the initial treatment period stemmed from OOS care. Developing best practices for the reporting and management of OOS will be critical for organizations to succeed under episode-based reimbursement plans.[Table: see text]
Effect of the establishment of a hematological multidisciplinary oral chemotherapy clinic at a community hospital on the number of emergency department visits.
Authors: Disperati Patricia , Kagramanov Dalia , Bjorkman Hannah , Horsley Rose , Thede Katie 
Published: April 2017

50 Background: Oral chemotherapy is an efficacious albeit toxic treatment of Malignant Hematological diseases. Multidisciplinary oral chemotherapy clinics (MOCC) have been proven to improve care in patients with solid tumors such as prostate and gastrointestinal cancer but there is little data in the Hematological setting. A MOCC was formed to determine if it would lead to a 20% decrease in emergency department (ED) visits and hospital admission over a 10-month period after implementation in patients with Malignant hematological disease on oral chemotherapy. Methods: A chart review of patients on oral Hematological drugs was performed for baseline data. A MOCC consisting of a nurse and a pharmacist was established, with physician backup. Checklists that were drug and disease specific were created for 5 different drugs (Lenalidomide, Ibrutinib, Dasatinib, Nilotinib and Idelalisib) for treatment initiation, follow-up and monitoring and incorporated into the electronic health record. This model was piloted and outcomes were measured to determine improvements in medicine reconciliation, documentation of adverse events, dose modification, patient compliance, unscheduled MD assessments and ED visits. Qualitative interviews were performed with patients and nurses to assess satisfaction with this team approach. Results: 30 patients with Hematological malignancies were enrolled sequentially during the 10-month period. After a median follow up of 7 months, there was 100% medicine reconciliation and 92% compliance with treatment protocols; 47% of patients had interventions requiring dose modifications that would not previously have been documented or addressed. There was a 20% increase in unscheduled MD assessments and a 33% decrease in ED visits and hospital admission from baseline. Both patients and nursing staff were satisfied with the team approach. Conclusions: In a community setting, the implementation of MOCC resulted in early recognition of AE and reduced ED visits. In addition, the new model lead to improved patient and staff satisfaction.