bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors correlated with HPV vaccination in the LGBT community.
Authors: Anders Amber M. , Chagpar Anees B. 
Published: February 2017

202 Background: Human papillomavirus (HPV) infections and related cancers including cervical and anogenital cancer disproportionately affect LGBT populations. Currently, little is known about HPV vaccination in this community. The purpose of this study was to determine what factors were correlated to HPV vaccine receipt in LGBT individuals. Methods: A prospective web-based survey was conducted with regards to cancer related risks in LGBT populations. The data set was restricted to individuals ≤26 years of age who identified as LGBT (n=206). All analyses were performed using SPSS software v.22. Results: Of the 206 individuals in this survey, 92.2% stated they had heard about the vaccine, and 53.4% had received it. Factors correlating with receipt of the vaccine on bivariate analysis are shown in the table below. On multivariate analysis, gender and having a usual site of care remained significant predictors of having received the vaccine. Women were 3.6 times more likely to receive the vaccine than men (95% CI: 1.97-6.71, p <0.0001), and those that had a usual place for health care were 2.9 times more likely to be vaccinated than those who did not (95% CI: 1.26-6.50, p< 0.012). (See Table.) Conclusions: In this survey, 53.4% of people reported having received the HPV vaccine. The only predictive factors of receipt of the vaccine were female gender and having a usual site of care. This reinforces the need for clinicians to be cognizant of vaccinating gay or bisexual men against HPV, and highlights the importance of having a usual site of care as a public health imperative in this population. [Table: see text]
Evaluation of national treatment trends in ovarian cancer.
Authors: Seal Brian S. , Yao Jianying , Kish Jonathan K , Stafkey-Mailey Dana , Eaddy Michael 
Published: February 2017

204 Background: Evaluate patterns of care among women diagnosed with metastatic (M) and non-metastatic (NM) ovarian cancer (OvCa). Methods: Using MarketScan Commercial/Medicare databases, women ≥18 years old with primary diagnosis of OvCa continuously enrolled ≥6 months pre- and post-index diagnosis were selected. Patients receiving chemotherapy (chemo) prior to index diagnosis were excluded. Eligible patients were stratified into NM and M cohorts and M patients into those diagnosed with M ≤90 days (M1), 91-180 days (M2) and ≥ 181 days (M3) post index diagnosis. Types of treatments, time to initiation and adherence to NCCN treatment guidelines were evaluated. Results: A total of 64,483 women were included; 59,277 (91.9%) NM and 5,472 (8.1%) M. Among M patients, 70.5% were M1, 4.5% M2 and 25.0% M3. Of the NM 57.1% underwent surgery (mean = 43 days), 2.5% received chemoradiation (chemorad) therapy (mean = 618 days), 2.5% received chemo (mean = 213 (NCCN) to 496 (nonNCCN) days), 3.4% received any oral antineoplastic (chemo/non, hormone, other, mean = 635 (NCCN) to 584 (nonNCCN) days), and 1.7% received hormone therapy (mean = 537 days) post index diagnosis. In comparison 70.0% of M patients had surgery, 37.2% received chemorad, 63.9% received chemo, 10.2% received an oral antineoplastic, and 19.0% received hormone therapy. As time to M diagnosis increased, utilization of chemorad (33.5% M1 to 46.9% M3), hormone therapy (17.9% M1 to 21.6% M3), and oral antineoplastic (8.9%% M1 to 14.2% M3) increased while receipt of surgery (76.6% M1 to 53.1% M3) and chemo (68.6% M1 to 52.3% M3) decreased. Time to initiation of all treatments increased as time to M increased. Among NM patients receiving oral antineoplastic 1.9% received NCCN recommended agents compared to 66.0% of M patients (72.2% M1 to 55.7% M3).Similarly, 52.2% of NM patients receiving chemo received NCCN recommended treatment compared to 98.3% of M patients (99.0% M1 to 96.2% M3). Conclusions: As recommended by the NCCN guidelines surgery was the standard of care for all patients. Utilization of chemo, chemorad and oral antineoplastics were largely reserved for M patients. M patients with a longer duration between initial and M diagnosis were more likely to receive treatment not recommended by NCCN guidelines.
Do breast cancer treatment and imaging providers follow hereditary breast and ovarian cancer risk screening guidelines?
Authors: Tossas-Milligan Katherine Y. , Murphy Anne Marie , Weldon Christine B. , Trosman Julia Rachel , Simon Melissa A. , Roggenkamp Betty , Gradishar William J. 
Published: February 2017

207 Background: Women with personal or family history suggestive of susceptibility to hereditary breast or ovarian cancer (HBOC) should be referred to genetic assessment (USPSTF, Ann Intern Med. 2005). Women with HBOC have a 50-85% lifetime risk of breast cancer, 30-50% of breast cancer before 50 years old,15-50% lifetime risk of ovarian cancer, and 40-60% chance of developing a second breast cancer (ASCO Cancer.net HBOC 8/2013). Our goal is to examine if this almost decade old guideline is followed in breast cancer treatment and breast cancer imaging centers in a large metropolitan area. Methods: We conducted an IRB approved web survey of all 35 breast cancer treatment sites (5 academic, 21 community, 9 public or safety net) and 58 breast imaging sites (5 academic, 27 community, 26 public or safety net) in Chicago. Results were analyzed using simple frequencies and Fisher's exact test. Results: We achieved a response rate of 91% (32/35 treatment sites, 53/58 imaging sites). We found that 56% (18/32) of treatment sites have a hereditary cancer syndrome (HBOC) screening process for newly diagnosed breast cancer patients. Most of these sites, 83% (15/18), always use genetic test results in surgical decisions, as compared to 21% (3/14) of sites that do not have an HBOC screening process, p=0.0009. Only 8% (4/53) of breast imaging sites have an HBOC screening process and provide indicated patients genetic assessment information and/or referrals. While 38% (20/53) of imaging sites conduct daily internal staff discussions of hereditary risk, only 15% of them (3/20) provide genetic assessment information to indicated patients. We found no statistically significant difference between practices of academic, community, public and safety net sites. Conclusions: Breast cancer treatment sites have partial adherence to HBOC risk screening guidelines; while breast imaging sites rarely adhere to HBOC risk assessment guidelines. Consistent HBOC risk screening protocols are needed in breast cancer treatment and breast cancer imaging sites that include providing indicated patients information about, and access to, genetic assessment.
Challenges with insurance and finances: Results from the 2012 Livestrong survey.
Authors: Nutt Stephanie , Bann Carla , Arvey Sarah R. , Squiers Linda , Rechis Ruth 
Published: February 2017

208 Background: More than 1.5 million new cancer cases occur each year in the U.S., and accessing health care is critical for mortality as well as for improving survivorship outcomes for cancer survivors. Methods: LIVESTRONG conducted an online survey of cancer survivors from June to December 2012. The current analyses include 4,320 respondents who were U.S. residents and diagnosed in 2002 or later. Results: Survivors in this study reported that for those who did not receive all of the medical care they needed they did not receive care because the insurance company wouldn’t pay for the care (41%) or they couldn’t afford the care (23%), with nine percent being denied health insurance coverage due to a cancer diagnosis. Other challenges reported included insurance not paying for a second opinion (8%) or the doctor/facility of the survivor’s choice (18%). Controlling for demographic and cancer-related factors, those diagnosed most recently (2010-2012) were less likely to report experiencing these challenges. Compounding insurance issues was the financial burden. Thirty percent of survivors reported that they or their family members had to borrow money or go into debt because of their cancer and five percent of survivors reported spending down their assets to qualify for Medicaid or a cancer-related program. Conclusions: In previous studies, patients who lack sufficient health insurance coverage tend to have poorer health outcomes. Overall, the data highlights that more can be done to connect survivors with the needed insurance and financial resources they need to access adequate cancer care during their treatment and beyond. [Table: see text]
Integration of a cancer registry dataset into a hospital-wide central data warehouse.
Authors: Flaherty Stephen , Savage Robert , Stendhal Ingrid , Roston Susan , Makhe Abhijeet , Mead Veronica 
Published: February 2017

212 Background: The ability to link cancer registry data to clinical and administrative data sets for quality improvement has long been desired. We sought to integrate registry data into a central data warehouse in an effort to make available for the first time consistent and reliable diagnosis and staging data to a broad hospital user group. Methods: After a short period of data analysis, the tables for Cancer Registry data (Oracle) were modeled. The source data (SQL Server) was conformed and integrated using an ETL tool (Informatica). All ETL QA work was performed with SQL queries. Cancer registry data was integrated into reporting architecture (Microstrategy) to facilitate design of standardized and ad hoc reports. Results: 140 distinct fields on demographics, staging (clinical, pathological, collaborative), site specific categories, diagnosis, and treatment were integrated into the Dana-Farber Analytics Reporting Tool (DART) for historic Cancer Registry data beginning with January 2010 newly diagnosed cancers. All Cancer Registry data and patient files (new and old) are updated in DART on a monthly basis. Conclusions: Individuals across the hospital now have the ability to link clinical and administrative data from our EMR, institutional QI data from varied systems, and pharmacy data to Cancer Registry data in the DART tool. One example of the integration of these multiple data sets is the linkage of staging data from the Cancer Registry data set and time to referral data from the administrative data set by patient MRN. As DFCI aims to cohort its patients based on their primary diagnosis for quality improvement and other internal reporting needs, the ability to analyze patients in this way becomes critical. This project sets an example for other centers as they integrate Cancer Registry data into user friendly business intelligence systems to help meet federal reporting mandates and aid internal improvement work. [Table: see text]
Effect of intervention on a quality measure of pain management at Medstar Washington Cancer Institute.
Authors: Ranpura Vishal Navnitray , Chokshi Puja , Yerasi Charan , Agrawal Sundeep , Wood Lynne , Harkness Jaylon , Self Linda , Jang Sekwon 
Published: February 2017

218 Background: Appropriate cancer pain documentation is one of the quality indicators in American Society of Clinical Oncology (ASCO)’s Quality Oncology Practice Initiative (QOPI). Medstar Washington Cancer Institute (MWCI) has participated in QOPI since 2008. Documentation of plan of care for moderate/severe pain defined as a pain score of ≥4 on a numeric pain scale was 69%, (compared to QOPI aggregate of 79%) during the fall 2011 round which led to a quality improvement project with an aim of ≥ 90%. Methods: MWCI created a team of physicians, nurses and administrative staff. We attended ASCO’s quality training workshop from October 2013 to March 2014 for guidance. We implemented a Plan Do Study Act (PDSA) methodology for our quality improvement project. We created a process map, cause and effect diagram and Pareto chart based on survey of physicians citing common reasons for lack of documented plan of care for pain. Results: Baseline rate of documented plan of care for pain control in November 2013 was 70%. In January 2014, we implemented action plans to increase the awareness of pain documentation (Electronic Health Record (HER) trigger for pain ≥ 4, fellows and mid level education and faculty consensus on documenting management for pain unrelated to cancer). After intervention, the pain documentation rate was improved to 90.2% (Table). Conclusions: After one cycle of PDSA, we achieved our goal of pain documentation rate. In order to sustain our project, we will continue to monitor the pain documentation rate quarterly in 2014 and continue the process of education and orientation to new staff as well rotating residents and fellows. [Table: see text]
Use of a fever fast track tool to reduce time to antibiotic dose in febrile pediatric oncology patients.
Authors: Ananth Prasanna , Archer Natasha , Collins Natalie Bucheimer , Croteau Stacy , Hong Andrew Lee , Kamihara Junne , Kim Dan , Kort Kelly , Mersereau Robert , Mosadegh Sara , Billett Amy 
Published: February 2017

222 Background: Given the risk of serious bacterial infection in immunocompromised cancer patients, fever should be promptly treated with empiric antibiotics. Our institutional standard is to administer antibiotics in ≤ 60 minutes from on-site fever or from arrival time with known fever. Review of our febrile outpatient pediatric oncology clinic patients from October-December 2013 revealed that 53% met this metric. Our aim: To achieve a sustained rate of 80% of febrile patients receiving antibiotics in ≤ 60 minutes within 8 weeks. Methods: We developed and implemented a fever fast track tool in our pediatric oncology clinic. Providers time stamped each step in the process from fever to antibiotic administration; additional time points were collected from the medical record. Interviews with staff were conducted to identify barriers. Five revisions of the fever fast track tool were made. We also streamlined same-day encounters for febrile patients in order to flag their acute visits and facilitate pre-arrival order entry. Results: 21 patients were treated for fever between 2/26/14 and 4/17/14. 4 fevers were documented in clinic. Time to antibiotics ranged from 23 minutes to 165 minutes. The median time to antibiotic administration was reduced from 58 minutes during the first four weeks to 40 minutes after the second 4-week block. Over the same period, patients receiving antibiotics in ≤ 60 minutes increased from 62% to 88%. Conclusions: Use of a fever fast track tool improved the proportion of febrile patients receiving antibiotics in ≤ 60 minutes. Modifications facilitating antibiotic order entry and pre-arrival awareness of febrile patients should prove helpful in sustaining this success.
The importance of caregivers in improving the care of geriatric oncology patients.
Authors: Bhagat Vicky , Isaiah Benjamin , Soriano-Pisaturo Maria , Somasundar Ponnandai 
Published: February 2017

223 Background: Geriatric patients with cancer have special needs. The diagnosis of cancer is stressful for patients and their caregivers. A new age of medicine has emerged to facilitate caregivers in aiding elderly oncology patients through oncology programs. Many caregivers need support themselves. The purpose of this study is to evaluate our geriatric oncology program’s effectiveness and to demonstrate specific factors that caregivers believe have the greatest positive impact. The aim is to determine different interventions that can be implemented to help caregivers of geriatric oncology patients. Methods: This is a qualitative study that used a questionnaire completed by caregivers of patients enrolled in a geriatric oncology program directed towards easing the stressors encountered when caring for patients. Caregivers rated the effectiveness of the program by responding to 12 statements and 2 open-ended questions via telephone. Results: There were 94 patients in the program from November 2012 to November 2013. After excluding patients that did not meet criteria 71 caregivers were available. Analysis of results from 37 out of 71 caregivers enrolled identified six areas that the program most helped them with: time management of caregivers (82.8%), delivery of decision-making information (97.3%), resources available to caregivers and patients (88.23%), establishing goals of care (94.59%), and pain control for patients (100%). 83.78% of respondents agreed that the well-being and quality of their life improved with the program. Analysis on the patient survey conducted for the same time period also showed significant improvement. Conclusions: Caregivers play a vital role in cancer management of geriatric patients. In order to help both the patients and their caregivers, programs have emerged focusing on the teamwork of social workers, clinicians, and counselors. Caregivers express that this approach helps them effectively provide care to patients, and helps them get through this stressful period. The specific areas found to be most positively impacted by this type of organized program are what oncology departments may focus on in order to improve quality of life for caregivers which may ultimately improve the patient’s care.
Development of chemotherapy-induced extravasation management algorithm to facilitate and improve care of cancer patients.
Authors: Kim Sara S , Holcombe Randall F. 
Published: February 2017

224 Background: Chemotherapy administration has up to a 6% incidence of extravasation, which can cause ulcer formation, tissue necrosis and loss of limb function, requiring surgical intervention (debridement and skin grafting). Because of its rare occurrences and the lack of uniform consensus on management strategies, much time is spent on decision making process by the patient care team and treatments are often delayed. To facilitate and improve the care of cancer patients in cases of chemotherapy extravasation, a task force was created to develop chemotherapy extravasation management algorithm. Methods: Chemotherapy extravasation management task force comprised of oncology pharmacy and oncology nursing leaderships. Literature search (limited to English language) was performed in PubMed (through April 2014) and of 34 “hits”, 13 articles on management of chemotherapy extravasation were reviewed. An algorithm was developed which contained 7 distinct intervention pathways dependent upon the drug involved in extravasation. The treatment algorithm was adopted after review by the cancer institute’s QI committee and oncology pharmacy and therapeutics subcommittee. Results: Chemotherapy extravasation algorithm provides the following guidance to nurses and providers: (1) Initial steps for nurses to follow in case of chemotherapy extravasation; (2) Chemotherapeutic agent-specific recommendations for cold or hot compress with antidote if indicated; (3) Nursing instruction for documentation of the adverse event and recommendation to photograph the site of extravasation; (4) Preparation and administration instruction of the antidotes (hyaluronidase, dexrazoxane, sodium thiosulfate, and DMSO). Finalized chemotherapy extravasation algorithm was made available in all oncology treatment areas and included in each extravasation kit. Conclusions: The development of algorithm for chemotherapy extravasation management provides clear and comprehensive instructions to oncology nurses and oncology providers on management and shortens the time to initiate management, thereby minimizing the risk of potentially debilitating sequelae from delayed management.
Improve optimal treatment in head and neck cancer patients (HNCA).
Authors: Mills Glenn Morris , DeKay Rebecca L. , Devarakonda Srinivas S. , Nicholson Jennifer , Maranto Lee Ann , Mehta Vikas 
Published: February 2017

227 Background: Since 2011, 50% of HNCA patients receiving concurrent chemoradiation with Cisplatin (CIS/XRT) have not been able to complete their therapy per protocol (dose over time interval) leading to suboptimal therapy. Based on historical data, the non-completion rate for patients HNCA receiving radiation/ high dose Cisplatin was 15%. We aim to improve this in our patients. Methods: A chart review of patients on CIS/XRT conducted and, using a Pareto Chart, the data indicated Acute Kidney Iinjury as the major cause for failure of completion. Using methodology from ASCO’s Quality Training Program, a process map for patients on treatment was created and an Ishikawa diagram (cause and effect) assisted in pinpointing breaks in processes. A telephone survey of surviving patients further clarified inadequacies. Using the Plan, Do, Study, Act (PDSA) improvement cycle, inadequacies were identified. Results: Chart review showed that significant side effects from treatment began around the 2nd cycle of Cisplatin in spite of adequate IV hydration following chemotherapy. Inadequate documentation of dietary and speech pathology consultations, patient weight and serum creatinine levels during treatment were noted. Patients reported minimal PEG tube education and infrequent use of PEG tube for hydration. Analysis of post treatment weight and creatinine level revealed a significant change in creatinine clearance. Checking daily weights, speech pathology and dietary consult prior to initiation of therapy, added hydration instructions to EPIC PEG tube instruction sheet, and nurse practitioner education and follow-up in symptom management clinic were part of the PDSA cycle interventions. If 2lb. weight loss, patients were brought in for repeat lab and IV hydration. Conclusions: Patients with advanced head and neck cancer are frail and subject to acute toxicity from chemotherapy. Change in Creatinine Clearance is a sensitive measure of renal damage/likely predictor of non-completion. Post-intervention patients had fewer unplanned admissions leading to lower costs. PDSA helped identify inadequacies in our education and monitoring processes. More post intervention data are needed to determine if true improvement in patient outcomes exist.