bluuebunny/crossref_metadata_2025_split huggingface dataset:
Network wide national and international radiation oncology accreditation program.
Authors: Kennedy Andrew S. , Wotring Tammy , Liu Zejian , Burris Howard A. , LeMaistre Charles F. 
Published: February 2017

271 Background: Modern radiation oncology departments contain an extensive array of complex therapies and technologies. Adoption of new treatments and staff changes challenge each team in maintaining high levels of performance and standards. Fewer than 15% of US centers have independent certification of quality. We plan to achieve American College of Radiology (ACR) Accreditation for all USA and UK Radiation Oncology Centers of HCA. Methods: A GAP analysis tool was developed to enable each center to approach the ACR application with the coordinated and simultaneous efforts of all sections of the radiation oncology department. Data was prospectively gathered for each department, highlighting areas of strength and aspects that need focused attention to improve. A scale of 1-5 was assigned to each task regarding the initial and ongoing level of progress towards meeting the standard with documentation for each required. Our intent is for each of the 52 radiation oncology departments to achieve full ACR Accreditation in a timeframe of no more than 4.5 months from start of the GAP analysis. Results: One program was fully accredited when the program began in July 2013. Since then 6 have achieved full accreditation and 12 are in process with the GAP tool. Analyses of full GAP data are available from eight programs thus far. High achievement in compliance with ACR Standards (95-100% compliance) was found in policies monitoring complications, adverse reactions and ‘time out’ procedures. Areas needing improvement s (<80% compliance) included annual review of policies and procedures, physician peer review, formal treatment planning system QA and imaging equipment quality control. Our facility in London will be the first achieving ACR accreditation in the UK. Conclusions: Significant time savings, engagement of staff, and accreditation success has thus far been realized with the utilization of a GAP tool for radiation oncology program accreditation. Common deficiencies were identified across facilities and allowed sharing of successful corrective action plans. The success of the program in improving quality led to the adoption of the ACR program from our USA sites to our radiation oncology departments in the UK.
Policy and procedure manuals: Does existence imply standardization in practice?
Authors: Kapur Ajay , Barbee David , Cao Yijan , Jamshidi Abolghassem , Potters Louis 
Published: February 2017

275 Background: Patient safety organizations recommend the use of policy and procedure manuals (PPM) to effectuate standards and guidelines in practice. In this work we explored inter-physicist variability in the interpretation of five established physics policies amongst physicists in our department. Methods: The policies for treatment planning, 2nd physics checks, 1st day physics checks, weekly chart checks and final physics checks were reviewed by members of the quality management team in our department. Specific definitive statements were extracted into a spreadsheet and provided to 11 physicists and 6 dosimetrists. The intent was to obtain individual responses on adherence to the statements and thereby assess the level of standardization in perception and practice amongst the staff using free-margin kappa statistics. The responses were limited to affirmation, rejection or non-applicability. A total of 732 responses were assessed. Results: Based on the Landis-and-Koch criteria for interpretation of kappa values, the consistency amongst the respondents varied from moderate (0.40-0.60) to good (0.60-0.80). The kappa scores for the statements assessed were 0.56 for treatment planning, 0.64 for second physics check, 0.70 for the first day physics check, 0.54 for the weekly physics check and 0.73 for the final physics check. Conclusions: Validating the effectiveness of PPMs by measuring uniformity in staff interpretation is an important step in establishing their effectiveness. Mere existence of a PPM may not be sufficient. This work demonstrated reasonable uniformity of interpretation of existing policies, but underscored the need for further improvement. The review of specific policy statements with weaker consensus may lead to more effective revisions and in-servicing to enhance clarity and reduce ambiguity, re-testable using the same approach. Absence of validation will tend to retain ambiguity, thereby rendering the policy not as effective as it could be.
Hepatocellular carcinoma and end-of-life care.
Authors: Hunter Natasha , Potosek Jamie Erin , Miksad Rebecca A. 
Published: February 2017

278 Background: Patients with hepatocellular carcinoma (HCC) usually present with incurable tumors and advanced underlying liver disease. Although guidelines exist to assess the quality of end of life (EOL) care for cancer patients, little is known about EOL care for HCC patients. Due to the complexity and multidisciplinary nature of the disease, we hypothesized that EOL care for HCC patients differs from that delivered to other cancer patients and may be heterogenous based on patient characteristics and primary clinician specialty. Methods: We assessed EOL HCC care through medical chart review of 188 consecutive HCC patients treated at an academic tertiary care hospital who died between 2007 and 2013. Based on available data, EOL care and documentation was assessed per published guidelines. Patient, HCC and liver disease characteristics, cancer treatments, symptom burden, and EOL care and documentation was compared by provider specialty. The odds of receiving aggressive EOL care by provider specialty, patient characteristics, and documentation measures were calculated. Using data from the Dartmouth Atlas Project, we compared results with EOL data for cancer patients overall at our institution and nationally during a similar time frame. Results: Fewer HCC patients enrolled in hospice compared with cancer patients overall at our institution, and nationally (36%, 49% and 55%, respectively). In addition, HCC patients spent fewer days on hospice, spent more time in the hospital, and experienced more (and longer) intensive care unit admissions. Compared to those primarily cared for by other specialties, HCC patients seen by an oncologist were more likely to have goals of care (GOC) documentation and to enroll in hospice. Patients never seen by an oncologist were more likely to have a psychiatric illness. English as a non-primary language and code status documentation were among factors associated with more aggressive EOL care. Conclusions: At our institution, EOL care for HCC patients is more aggressive compared to cancer patients overall and nationally. The subset of HCC patients seen by oncology were more likely to meet EOL quality guidelines (GOC documentation and hospice enrollment). A better understanding of EOL practices for HCC may impact multidisciplinary care.
Variation in adherence to QOPI core measures based on tumor type.
Authors: Patel Sunil M. , Sarma Amit , Ip Mee-chung Puscilla , Sturdevant Laurie , Kian Leslie , Schaub Diane , Theriault Rachel Leigh , Nelson Douglas A. , Jasani Nikesh Ramesh , Fisch Michael 
Published: February 2017

280 Background: QOPI measures fall into one of three categories: (1) core, (2) disease-specific (breast, colon, lung, non-Hodgkin lymphoma, gynecologic cancers), or (3) domain-specific (symptom control, end-of-life). For each data collection period (DCP), participating sites choose to submit data in at least one disease- or domain-specific module. Charts are identified and abstracted for the selected module(s) based on eligibility criteria. The same charts are also abstracted for core measures. Our group hypothesized that the case mix resulting from choice of module(s) would impact performance for a subset of core measures. Methods: The MD Anderson Regional Care Centers have participated in QOPI over nine DCPs from Fall 2009 to Spring 2014. Unexplained variation was identified in staging documentation (core measure 2) and chemotherapy intent documentation (core measure 10). For each DCP, QOPI chart-level data were reviewed. Adherence for each measure was tabulated and stratified by tumor type. Due to small sample sizes within each DCP, data were pooled and analyzed with descriptive statistics and chi-square testing. Results: Over nine DCPs, stage and chemotherapy intent were documented in 89.1% and 81.3% of charts, respectively. There was a significant association between tumor type and documentation of stage (χ2(4) = 30.4, N=727, p <.001) and chemotherapy intent (χ2(4) = 157.5, N=534, p <.001). Documentation of stage and chemotherapy intent was highest for breast (100%, 93.6%) and colorectal cancers (92.7%, 92.1%) and lowest for NHL (71.8% 32.8%). Conclusions: Observed variation in documentation of stage and chemotherapy intent was primarily due to tumor type. Reasons for this observation are myriad and likely include factors related to the providers, the practice, the measures, and differing complexity of tumor types. This variation in quality scores by tumor type (driven by module selection) could have significant implications in today’s pay for performance environment. [Table: see text]
Association between certificate of need (CON) legislation and radiotherapy use among elderly patients with early cancers: A population-based examination.
Authors: Falchook Aaron David , Chen Ronald C. 
Published: February 2017

283 Background: High quality cancer care includes reducing overtreatment, a well-recognized problem for elderly patients with ductal carcinoma in situ (Stage 0) or Stage 1 breast cancer and low-risk prostate cancer. The federal Health Planning Resources Development Act of 1974 led to implementation of CON programs in multiple states. The stated purpose of CON is to facilitate coordinated health care services to reduce overall medical costs. We examined whether CON is associated with less radiotherapy (RT) use in elderly patients with Stage 0-1 breast cancer, and low-risk prostate cancer. Methods: We compared RT use in 6 Surveillance, Epidemiology and End Results (SEER) states with CON for radiotherapy vs. 6 states without CON for 1) men 65 years and older with low-risk prostate cancer, 2) women 70 years and older with Stage 0-1 breast cancer after lumpectomy. In both clinical scenarios, the use of RT is controversial. Patients diagnosed from 2004-2011 were included. Results: 40,267 men and 24,385 women were included. Radiotherapy use was higher in CON states: prostate cancer (64.3 vs. 56.0%, p<.001), and breast cancer (59.5% vs. 53.6%, p<.001) overall, and for each year studied (Table). RT use decreased from 2004 to 2011, but remains persistently higher in states with CON programs. On multivariate analysis controlling for age, race, stage and year, CON was associated with higher use in both prostate cancer (OR 1.46, p<.001) and breast cancer (OR 1.35, p<.001). Conclusions: There is more RT use in CON states for elderly patients who may not need this treatment for Stage 0-1 breast cancer and low-risk prostate cancer. This suggests that CON programs may not be effective in reducing overtreatment, an important quality of care issue in oncology. [Table: see text]
Effectiveness of cisplatin versus carboplatin-based doublet chemotherapy in elderly Medicare patients with advanced non-small cell lung cancer.
Authors: Lamont Elizabeth B. , Keating Nancy Lynn , Azzoli Christopher G. , Landrum Mary Beth 
Published: February 2017

284 Background: There is some evidence that cisplatin-based chemotherapy doublet regimens are more efficacious than the less toxic carboplatin-based doublet regimens for advanced non-small cell lung cancer (NSCLC) but little evidence of effectiveness in elderly cancer patients treated in the usual care setting. We estimated differences in survival and post-treatment morbidity between first-line cisplatin-based and carboplatin-based doublet regimens in elderly Medicare patients with advanced NSCLC. Methods: We identified 13,406 elderly Medicare patients who were diagnosed with stage IV NSCLC between 1995-2009 in SEER regions and treated with either a cisplatin-based doublet chemotherapy regimen or a carboplatin-based doublet chemotherapy regimen in the subsequent six months. Using propensity score weighting, we balanced the two treatment cohorts with respect to observable attributes. We then estimated survival and toxicity according to treatment. Results: Overall patients treated with cisplatin-based doublets lived nearly two weeks longer on average than patients treated with carboplatin-based doublets (i.e., 7.4 months vs. 7.0 months, p=0.05) survival differences were not appreciated in subsets of patients with adenocarcinoma or squamous carcinoma. Patients treated with cisplatin-based doublets were slightly more likely than those patients treated with carboplatin-based doublets to be hospitalized (i.e., 42.9% vs 39.8%, p<0.01) and use intensive hospital-based care. Conclusions: Among elderly Medicare patients with advanced NSCLC, those treated with first line cisplatin-based doublet chemotherapy regimens lived slightly longer than those treated with carboplatin-based doublet regimens, but also utilized more hospital-based care following treatment. The difference in overall survival is not clinically significant, and does not appear to justify the added toxicity.
Understanding the impact of settings of care and the development of chemotherapy-induced nausea and vomiting within a population of commercially insured patients.
Authors: Inocencio Timothy J , Faria Claudio , Knoth Russell L. , Chapman Richard H. , Agatep Barnabie C , Johnsrud Michael , Powers Annette 
Published: February 2017

298 Background: Research evaluating the impact of different clinical practice patterns according to settings of care and oncology patient outcomes is limited. This study describes chemotherapy-induced nausea and vomiting (CINV) rates in chemotherapy (CT) naïve cancer patients starting CT in a hospital outpatient (HOP) or community outpatient (COP) setting. Methods: Using the Optum Normative Health Information Database, patients with a new claim of CT and ≥1 outpatient cancer diagnosis claim between 1/1/06 – 6/30/12 were identified. Patients with previous inpatient cancer diagnoses, multi-day CT regimens or Medicare/Medicaid patients were excluded. CINV was defined using relevant claims-based ICD-9-CM diagnosis and procedure codes or a prescription claim for antiemetics within days 2-7 of 1st 8 CT cycles or 1st 6 months following the index CT claim. CINV events were evaluated descriptively and using regression models Results: Patients receiving CT in HOP vs. COP were similar in age. Patients receiving CT in COP vs. HOP setting were more likely to be female (78.7% vs. 62.8%), breast cancer patients (66.8% vs. 46.7%), live in the South region (49.7% vs. 44.1%) and have higher baseline healthcare costs (mean $24,950 vs. $24,629) (all p<0.05). Patients in the HOP vs. COP settings had higher Charlson Comorbidity Index scores (mean 3.9 vs. 3.3, p < 0.05). More CINV events were reported for patients in COP vs. those in HOP settings (p < 0.05) (Table). After adjusting for clinical and demographic factors, number of CINV events remained higher for COP vs. HOP settings. However, we were unable to control for antiemetic prophylaxis use or CT emetogenic potential, due to coding irregularities. Conclusions: Results suggest cancer patients starting CT in COP vs. HOP settings may have more CINV events. However, further analyses are needed to explore the impact of antiemetic prophylaxis use or CT emetogenic potential on CINV events between settings of care. [Table: see text]
Evaluate algorithms for identifying treatment patterns for patients with metastatic colorectal cancer using administrative claims data.
Authors: Zhong Yue , Kamalakar Rajesh , Asche Carl V , Anderson Sibyl , Seal Brian S. 
Published: February 2017

299 Background: Administrative claims data are widely used to identify treatment patterns. However, as new drugs are brought to clinical practice, treatment regimens become more complicated for cancer patients receiving both chemotherapy and biologic agents. We evaluated the influence of using different treatment length algorithms on identification of treatment patterns for patients with metastatic colorectal cancer (mCRC). Methods: We identified patients aged 18 or older with at least one primary CRC diagnosis between 01/01/2008 and 03/31/2012 in the MarketScan databases. mCRC patients were included if claims indicated the presence of distant metastases (ICD-9-CM codes: 196.x, 197.0 to 197.4, 197.6 to 197.8, 198.x, and 199.0). All treatment claims were extracted and patients were followed for more than 6 months, until end of enrollment or study end date (03/01/2013). We identified all chemotherapy and/or biologic drugs given to a patient during 30, 60, or 90 days after initiation of treatment and compared differences in type and number of treatment lines (TLs). Results: A total of 2,046 mCRC patients received at least one TL. Using a 30-day cutoff period, 30% patients received 1 TL; 30% received 2 TLs; and 40% received ≥3 TLs. Results changed after using a 60-day cutoff period: 39% patients with 1 TL, 33% with 2 TLs, and 28% with ≥3 TLs. If using 90 days as a cutoff period, 44% received 1 TL; 35% received 2 TLs; and 22% received ≥3 TLs. For all cutoff periods, the most common first TL prescribed were FOLFOX +/- bevacizumab and 5-FU/LV. For patients receiving a second TL, FOLFOX was most frequently prescribed if using a 30-day or 60-day cutoff, while FOLFIRI/bevacizumab had a higher prescription rate with a 90-day cutoff. Regimens varied in third and fourth-line therapy using different cutoff periods and FOLFIRI +/- bevacizumab was more frequently used than other regimens. Conclusions: The cutoff period did not significantly influence treatment regimens detected for first and second TL. Using a 30-day cutoff period resulted in 30% patients with one TL and 40% with three or more TLs, while with a 90-day cutoff, 44% patients received one TL and only 22% received three or more TLs.
Performance of a low-dose computed tomography (LDCT) lung cancer screening program: Findings from a registry study.
Authors: Goulart Bernardo , Madtes David , Koepl Lisel , Karnopp Andrew , Nelson Judy Ann , Ramsey Scott David 
Published: February 2017

304 Background: Many centers are establishing LDCT lung cancer screening programs after the 2013 grade B recommendation from the United States Preventive Services Task Force (USPSTF). Uncertainty remains regarding the extent to which new programs will adhere to recommended selection criteria, as well as screening program performance. We analyzed adherence to selection criteria, rate of positive screens, and prevalence of incidental findings in a single-center LDCT screening registry study. Methods: We established a prospective, longitudinal registry study of patients undergoing LDCT screening at the Seattle Cancer Care Alliance. Baseline data include socio-demographic characteristics and eligibility for LDCT screening. We conduct chart reviews at 6 and 12 months to determine screening results (based on NLST definitions); lung cancer diagnosis; and incidental findings. Results: From August 2012 to April 2014, 62 out of 105 (59%) screened patients enrolled in the registry. Mean age is 62 years; 38 (61%) are male; 52 (84%) are white; mean household income is $97,363; 31 (50%) are current smokers; and 39 (63%) have a smoking history ≥ 30 pack-years. A total of 28 (45%), 31 (50%), and 31 (50%) of patients were eligible for screening based on criteria used in the NLST or recommended by the NCCN or USPSTF guidelines, respectively. Sixteen patients (26%) were not eligible for screening based on any of these criteria. For fourteen (88%) of these patients, LDCT screening was ordered by a primary care provider as opposed to a lung cancer specialist. Initial screening results were positive in 7 (13%) patients, with 1 patient diagnosed with lung cancer. At least one incidental finding was reported in 40 (74%) patients, including cardiac and pulmonary abnormalities in 28 (70%) and 25 (63%) patients. Conclusions: About one quarter of patients undergoing LDCT screening do not meet recommended criteria, with primary care providers most commonly ordering the LDCT screen for these patients. Primary care provider education may improve adherence to screening guidelines. Incidental findings were more frequently reported than in the NLST; their impact on healthcare outcomes and costs deserves further investigation.
Chemotherapy use in the treatment of glioblastoma multiforme: Comparing patient characteristics using the National Cancer Data Base (NCDB).
Authors: Inserra Christopher J. , Khanal Nabin , Silberstein Peter T. 
Published: February 2017

305 Background: Glioblastoma Multiforme (GBM) is the most common and most deadly type of human glioma. Nearly half of all gliomas are diagnosed as GBM at which point the median survival of patients is approximately one year and the two-year survival rates are approximately 10%. Current treatment options for GBM include surgical resection, external beam radiation, and oral temozolomide chemotherapy. However, the patterns of chemotherapy use in GBM as well as the patient characteristics that determine its use have yet to be investigated. Methods: This is a retrospective study of glioblastoma patients (n = 96,966, making this the largest trial ever on glioblastoma) diagnosed between 2000 and 2011 in the NCDB. The NCDB contains nearly 70% of new cancer cases diagnosed in the United States and consists of data from over 1,500 cancer programs across the country. A chi-squared test was used to determine any differences in the characteristics of patients who did or did not receive chemotherapy. Results: Patients who were younger than 70 years of age, male, white, had private/managed insurance, no comorbidities, household income greater than $49,000, were receiving radiation therapy, and diagnosed between 2004 and 2011 were significantly more likely to have received chemotherapy to treat glioblastoma (see Table). Conclusions: Understanding any potential barriers in the use of chemotherapy to treat glioblastoma can help improve its utilization among people of diverse socioeconomic backgrounds. [Table: see text]