bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute hospitalizations in cancer patients treated with definitive radiotherapy: A retrospective cohort study with implications for an urgent care clinic.
Authors: Berman Abigail T. , Gabriel Peter Edward , Owen Daniel , Xu Melody Ju , Simone Charles B. , Plastaras John Peter , Christodouleas John Paul , Hwang Wei-Ting , Vapiwala Neha 
Published: February 2017

312 Background: Reasons for hospitalizations in patients undergoing curative-intent radiotherapy (RT) have not been well characterized previously. Implementation of urgent cancer care clinics could decrease rates of hospitalization, but the reasons for acute visits must be better understood. This retrospective cohort study investigates emergency department (ED) visits or admissions in patients treated with definitive RT. Methods: Under an IRB-approved protocol, the cohort was defined as all consecutive patients >=18 yo who began RT (RTSTART) between 7/1/11 and 12/31/13 for nonmetastatic disease with curative intent. An acute encounter was defined as an ED visit or inpatient admission during RT or 30 days after the conclusion of RT (30DA). Results: A total of 1852 unique RT courses from 1823 patients were identified, within which there were 666 RT unique courses (657 patients) who had at least one acute encounter. There were 1006 acute encounters, comprising 287 ER and 719 inpatient visits. The number of admissions per RT course ranged from 1 to 9, with <13% with >3. The mean difference between post- and pre-RT ECOG performance status was greater for patients with acute encounters than those without (0.47 vs. 0.06). For those admitted, the median days from RTSTART to admission were 36 (0-81) and 68.2% received concurrent chemotherapy. Conclusions: In this large analysis from a single quaternary cancer center,over one-third of patients receiving curative-intent RT had an acute encounter, a high percentage of whom received chemotherapy. Further investigations are needed to classify which admissions were unanticipated, which in turn would guide design of urgent cancer care centers for RT patients and improve quality of care. [Table: see text]
The effect of obesity on operating room (OR) utilization in breast surgery.
Authors: Dunderdale Julie , Jovanovic Borko , Kulkarni Swati 
Published: February 2017

36 Background: More than one-third of adults in the United States are obese. Studies have shown that obesity-related comorbidities increase health care costs, but the effect of obesity on operating room utilization has not been completely evaluated. The purpose of our study was to examine how operative time (OPT) for common procedures in breast surgery is affected by patient weight. We expected that weight affected OPT more so for extensive procedures, such as axillary lymph node dissection (ALND) and mastectomy, than for minimally invasive procedures, such as lumpectomy and sentinel lymph node biopsy (SLNB). Methods: OPT and weight for ten breast surgeries were analyzed from the American College of Surgeons 2010 National Surgical Quality Improvement Project database. Only women were included, and those who underwent additional procedures or had incomplete data were excluded. Patients were divided into three groups based on their weight (<135 lbs, 135-199 lbs, and ≥200 lbs). Using the two-sample t-test, OPT for the procedures was compared among the lowest and highest weight categories. We specifically looked at lumpectomy, lumpectomy plus SLNB, ALND, mastectomy, and modified radical mastectomy (MRM). Results: In all, 16,077 patients were included in the analysis. When the lowest and highest weight groups (<135 lbs and ≥200 lbs) were compared for all procedures, a significant difference of 13 min was seen (p<0.0001). For these same groups, a significant, but not relevant for scheduling, difference in OPT was noted for lumpectomy alone (37 vs. 41 min, p<0.0001) and lumpectomy plus SLNB (71 vs. 80 min, p<0.0001). However, weight affected ALND and mastectomy more drastically. The difference for lumpectomy plus ALND was 22 min (93 vs. 115 min, p=0.0004), while the differences for simple mastectomy and mastectomy plus SLNB were 24 min (89 vs. 113 min, p<0.0001) and 23 min (102 vs. 125 min, p<0.0001), respectively. In addition, the difference for MRM was 22 min (104 vs. 126 min, p<0.0001). Conclusions: Patient weight does significantly affect OPT for lumpectomy and SLNB, but the difference is much greater for ALND, mastectomy, and MRM. Therefore, when scheduling more extensive procedures for obese patients, additional time should be allotted to improve OR utilization.
Achieving the triple aim in cancer care through a tri-part research collaboration.
Authors: Patel Manali I. , Ramirez David , Nguyen Andrew , Hagan Caroline , Asch Steven M , Agajanian Hilda H. , Agajanian Richy , Milstein Arnold , Blayney Douglas W. 
Published: February 2017

52 Background: Curbing rising cancer care costs require models that safely lower expenditures and improve experience and outcomes. We developed a care delivery model integrating lay health workers to address early goals of care and symptoms (JOP 2015). We then created a research-collaboration with a health plan (which paid for care and processed claims), a contracted oncology group (which implemented the model), and a university research center (which designed the intervention and conducted the evaluation) to test effects on patient satisfaction, utilization, and costs. Methods: All patients newly diagnosed with cancer, referred to the contracted oncology group, and who were beneficiaries of the health plan from 11/17/13 through 9/30/15 were enrolled. We analyzed descriptive statistics and pre-intervention and 5-month post-intervention surveys to assess satisfaction with care and decision-making. Results: There were a total of 412 patients with cancer enrolled over the study period. The mean age of enrollees was 76 years; 53% were women. The mean risk adjustment score was 2.5 (www.CMS.gov). Gastrointestinal malignancies were the highest proportion of cancer diagnoses (26%) followed by breast (23%) and genitourinary cancers (13%). Thirty-one percent of patients were diagnosed with stage IV disease; 22% with stage I; 18% with stages II and III; and 10% with unknown stage. Twenty-two percent of patients died during the study period. In comparison to pre-intervention surveys, there were statistically significant improvements in overall mental and emotional health (p < 0.05) and improvements in satisfaction with care and decision-making (p < 0.05). Conclusions: Research collaborations can help to rapidly implement and test novel strategies of care delivery. These collaborations are needed to align stakeholder priorities to improve cancer care and reduce healthcare spending. Our collaboration demonstrates the feasibility of an all-stakeholder approach to designing and implementing innovative high-value cancer care delivery strategies. Our early findings demonstrate improvements in patient emotional and mental health and satisfaction with care and decision-making.
Data-driven quality improvement in an oncology patient-centered medical home.
Authors: Sprandio John David , Lowry Maureen , Flounders Brian , Tofani Susan Higman 
Published: February 2017

54 Background: In a 2012 abstract, Data driven transformation for an Oncology Patient-Centered Medical Home, Consultants in Medical Oncology (CMOH) demonstrated that standardized processes and enhanced IT capabilities (IRIS software app) provided a rapid learning system for the practice. Iris aggregated data became the basis for Quality Improvement Projects (QIPs) allowing CMOH to continue to improve in quality and cost measures. Deviation from performance trend is readily identifiable, providing operational direction. Methods: A review of 2012 data identified an increase in the rate of hospitalizations, initiating a QIP. We identified inconsistent processes in Telephone Triage Symptom Management at one of the three practice locations. It was determined that symptom calls in the early to mid afternoon were being directed to the ER, and a higher percentage of these evaluations resulted in admissions. Steps to restructure roles and internal processes and reinforced training followed, resulting in improvement. Results: After analysis of site specific performance, we centralized Telephone Triage services to reduce variability in execution. We addressed staffing issues, streamlined nursing and physician education around Triage related processes, revised algorithms, and improved education materials to enhance patient engagement. This resulted in resetting our trend in ER utilization and admissions, increasing the number of calls into the telephone triage service, increasing the percentage of symptoms managed at home and decreasing the number of office visits within 24 hours. Conclusions: Aggregated real-time data provides the tools to rapidly identify opportunities for improvement and conduct QIPs to enhance the quality and value of delivered services. Supportive software apps like Iris are foundational for practice transformation to future value-based cancer care models. [Table: see text]
Impact of a best practice alert on transfusion practices for solid tumor oncology patients.
Authors: Buck Ryan , Wachsberg Kelley , Weaver Charlotta , Dombrowski Lyndsey , Ma Madeleine , Lee Jungwha , O'Leary Kevin 
Published: February 2017

57 Background: Recent evidence supports a restrictive transfusion strategy in the majority of hospitalized patients, though transfusion practices for oncology patients remain highly variable. We evaluated whether use of a best practice alert for solid tumor oncology inpatients would result in more restrictive transfusion practices and impact patient outcomes. Methods: We conducted a retrospective, historical control analysis at a large academic hospital in Chicago, IL. We compared transfusion utilization among solid tumor oncology patients before and after implementation of a transfusion alert. Patients with active bleeding, hematologic malignancies and those undergoing surgical procedures were excluded. A best practice alert with clinical decision support encouraging use of a restrictive transfusion strategy (Hgb < 7 g/dL) was implemented 6/14 with phase-in completed by 9/14. We abstracted PRE intervention medical records of patients hospitalized from 5/1/13 to 4/30/14 and POST intervention records from 9/1/14 to 8/31/15. Readmission rates, incidence of ICU transfer and inpatient mortality were also compared using multiple linear regression. Outcomes were adjusted for age, gender, race, BMI, smoking status and Charlson comorbidity index. Results: 1296 total patients were included in the analysis (PRE, n = 685; POST, n = 611). There were no differences in age, gender, BMI or Charlson comorbidity index among cohorts, although the PRE cohort included more Caucasians (60.2% vs. 46.8%, p < 0.0001) and smokers (6.0% vs. 2.5%, p = 0.002). Packed red blood cells transfused per 100 patient-days were significantly lower in the POST-intervention cohort (3.8 vs. 6.4, p = 0.01). The POST-intervention cohort also had fewer 30-day emergency department visits (3.3% vs. 5.1%, p = 0.03). There were no significant differences in rates of 30-day readmission (34.6 % vs. 37.3%, p = 0.19), ICU transfer (0.5% vs. 1.1%, p = 0.08) or inpatient mortality (1.7% vs. 1.8%, p = 0.96). Conclusions: Implementation of a best practice alert among solid tumor oncology patients effectively reduced utilization of packed red blood cells without affecting patient outcomes.
Quality of life (QoL) by response: An interim analysis of patients (pts) with squamous (SCC) NSCLC treated with nab-paclitaxel/carboplatin (nab-P/C) induction therapy in the phase III ABOUND.sqm study.
Authors: Langer Corey J. , Hirsh Vera , Amiri Katayoun , Ko Amy , Knoble Jeanna L. , Johnson Melissa Lynne , Jotte Robert M. , McCleod Michael , Ong Teng Jin , Page Ray D. , Spigel David R. , West Howard Jack 
Published: February 2017

63 Background: The correlation of radiological response and pt-reported outcomes (PROs) in advanced NSCLC remains underreported. This interim analysis evaluated QoL by response (RECIST v1.1) in SCC NSCLC pts treated with nab-P/C during the induction part of the ABOUND.sqm study. Methods: In the ongoing phase III ABOUND.sqm study, pts with advanced SCC NSCLC are treated with first-line nab-P 100 mg/m2 d 1, 8, 15 and C AUC 6 mg•min/mL d 1 (21-d cycles) for 4 cycles (induction). Pts not progressing are randomized 2:1 to maintenance nab-P 100 mg/m2d 1 and 8 of each 21-d cycle + best supportive care (BSC) or BSC alone until progression. The primary endpoint is PFS from randomization to maintenance. QoL, an exploratory endpoint, was assessed with predefined PRO instruments, LCSS and EQ-5D-5L, on d 1 of each cycle. Pts with a radiological CR/ PR are considered responders (R) in this analysis (57% of evaluable pts). As the study is ongoing, this pre-planned analysis included QoL and tumor response data that were reported up to the cutoff date. Results: Baseline (BL) characteristics were similar for Rs (n = 73) and non-Rs (n = 55). Over 80% of pts completed BL + ≥ 1 post-BL PRO assessments. For LCSS, average total score and symptom burden index improved during induction chemotherapy; a higher percentage of Rs vs non-Rs had clinically meaningful improvements (≥ 10 mm [VAS]) from BL in composite LCSS cough, shortness of breath, & hemoptysis (56% vs 38%). Of pts reporting BL EQ-5D-5L dimension problem(s), a higher percentage of Rs vs non-Rs reported complete resolution at least once during treatment (Table). Conclusions: These results indicate that Rs and non-Rs maintained/improved QoL during induction therapy with nab-P/C. Rs appeared to have greater improvements in LCSS and EQ-5D-5L. Radiological response translates into meaningful QoL improvement. Clinical trial information: NCT02027428. [Table: see text]
Engaging patients with their self-reported symptom outcomes trended data.
Authors: Hartman Scott , Denny Diane , Greene Carmon , Hannaford Morgan , Markman Maurie 
Published: February 2017

69 Background: Cancer Treatment Centers of America, Inc. (CTCA) is a national network of hospitals that specialize in the treatment of patients fighting complex or advanced-stage cancer. The Symptom Inventory Tool (SIT) is an assessment tool that captures the patients’ perceived symptom burden for real-time clinical intervention. Patients take a baseline SIT assessment at new patient intake and are eligible to take the SIT every 21 days. The SIT is comprised of the M.D. Anderson Symptom Inventory tool, a validated assessment instrument, along with additional questions and a free text box that were created by CTCA. The SIT became an integral part of patient care at CTCA beginning in 2012. Recognizing the value of the SIT data in real time patient intervention, a project was undertaken to engage the patient with his/her results and facilitate dialogue with his/her care team. Methods: Upon completing the SIT, patients were provided with their Symptoms-At-a-Glance (SAG) report, which is a graphical representation of trended outcomes of their SIT data, along with education on how to interpret the document. Patients were encouraged to review the SAG with their care team as a communication facilitation tool promoting open dialog on those symptoms identified as the most severe and or frequent. Pre and post evaluations of the process were completed via a brief questionnaire for patients and staff to evaluate efficacy of the exchange. Results: A total of 272 patients completed the SIT during the initial 30 days. 80.5% of patients utilized the SAG report during their Medical Oncology appointments and/or took their report with them for subsequent reference. Utilization of the SAG report by interdisciplinary teams for patient intervention showed an increase of 103%. Patients responded favorably to the project and reported that the SAG is a valuable tool which will be shared with their primary care physician and used to update family members. Conclusions: The project was successful in creating improved integration of the SIT outcomes and driving more focused and complete discussions between patients and their providers on a wide spectrum of quality of life issues.
What is the health-related quality of life for women with metastatic breast cancer?
Authors: Lalla Deepa , Tevaarwerk Amye , Goertz Hans-Peter , Smith Mary Lou , Bajaj Preeti S. , Railey Elda , Reyes Carolina 
Published: February 2017

70 Background: Metastatic breast cancer (MBC) and its treatments can have a significant impact on patients’ health-related quality of life (HRQoL) and daily functioning. To better assess the impact of MBC on HRQoL, we conducted an online survey among women with MBC. Methods: We developed and administered a cross-sectional, web-based survey, and invited registered members of three advocacy groups currently living with MBC to participate. Respondents completed an informed consent and completed assessments on symptom burden using an overall QOL question (1 item), the MD Anderson Symptom Inventory Survey (MDASI), activities of daily living (ADLs, Rotterdam Scale), and impacts on work productivity. Results: We received 1285 complete responses to the survey. Over half the respondents were between 40-49yrs (37%) or 30-39 yrs (26%). The majority were white (87.7%), well-educated (70.7% had a bachelor’s degree or higher), and working at the time of the survey (55%), with private health insurance (63%). After diagnosis with MBC, most patients had received endocrine therapy (44.2% aromatase inhibitors, 27.3% fulvestrant). The most common chemotherapy agents received after diagnosis with MBC were capecitabine (30.1%) and docetaxel (26.9%). The overall mean HRQoL score was 74 (0-100, higher is better). Mean respondent-reported MDASI scores for symptom severity (SS) and symptom interference (SI) were 4.2 and 4.5 (0-10, higher is worse). Mean Rotterdam scale scores to assess ADLs were 23.7 (0-32, higher better). On average, working women with MBC missed 9.3 hours of work in the past 7 days due to their MBC. As symptom burden increased, respondents reported a lower ability to perform ADLs (p < 0.0001) and lower overall HRQoL (p < 0.0001). The ability to perform ADLs decreased with increase in the total number of agents received (p < 0.0001) and time since diagnosis (p < 0.0001). Conclusions: This survey provides valuable insights into health status, ability to perform ADLs, and lost productivity among patients with MBC. Future analyses will present results by tumor subtypes and drug treatments received.
Does oncology patient-reported healthcare experience vary by site of care (SOC)?
Authors: Drzayich Jankus Dana , Casebeer Adrianne Waldman , Hopson Sari , Dye Joseph , Tao Zhuliang , Howe Andrew M. , Stemkowski Stephen , Patton Jeffrey , Small Art , Masaquel Anthony 
Published: February 2017

71 Background: Patients with cancer are increasingly receiving chemotherapy infusions in a hospital outpatient (HO) as compared to the physician practice setting (PO). Previous research has focused on SOC differences in economic measures, such as healthcare costs, in commercially insured populations. This study investigates SOC differences in patients’ reported healthcare experience for a mostly Medicare population. Methods: A convenience sample of 2,604 Humana members with cancer of the breast, lung, colon/rectum or NHL/CLL and treated in 2014 received a survey by mail to capture patient reported healthcare experiences. We implemented the Consumer Assessment of Health Care Providers and Systems (CAHPS) for Cancer Care survey’s 5 domains (“affective” communication, shared decision making, patient self-management, exchanging information and access to care and information) and ad hoc travel and wait time questions. Average composite scores for each CAHPS domain were weighted and adjusted by age and health status (1 = excellent - 5 = poor). Differences in responses were tested using chi-square and t-tests. Results: The response rate was 25.0% (N = 651). Survey respondents were mostly female (75.0%) and Medicare beneficiaries (87.9%) with a mean age of 68.7. HO patients reported slightly worse health status than PO patients (2.9 vs 3.0, p= 0.028) CAHPS for cancer domain scores indicated a similar patient perceived experience across all domains except for access to care and information (1-3 scale): HO = 2.6 vs PO = 2.5, p= 0.007. This difference was driven mainly by items related to contacting the health care team for certain symptoms and after hours care. More HO patients traveled > 30 minutes for treatment (39.0% vs 25.9%, p= 0.004) and reported wait times > 15 minutes (72.2% vs 63.8%, p= .054). Patient perceived acceptability of these travel and wait times were similar (HO: 61.9% vs PO: 66.7%, p= .782 and HO: 60.4% vs PO: 63.1%, p= .919). Conclusions: Analysis of the new CAHPS for cancer care survey showed comparable patient perceived experiences by site of care. However, access to the health care team for certain symptoms and after hours care was better for HO patients, though HO patients also had longer travel and waiting time.
Patient uptake and satisfaction with advanced genomic technologies offered through an employee benefit program.
Authors: Kieran Shannon M. , Knickelbein Kelly Z. , Goldstein Julie , Riordan Sara , Billings Paul 
Published: February 2017

72 Background: Access to advanced genomic technologies for the diagnosis and treatment of cancer is important. As part of an employee benefit program, we offered genomic technologies, such as somatic tumor and inherited germline genetic testing, as well as clinical trial information, medical second opinions, and genetic counseling, as appropriate, to enrollees with cancer. Genetic counselors served as cancer navigators through the process. The study aimed to assess uptake of the services offered and satisfaction with the program. Methods: Established benefit enrollment criteria included a diagnosis of cancer and company status (employee, spouse, dependent child). All data and communications were tracked in an online Patient Resource Management (PRM) system. Data was pulled directly from the PRM system logs. To measure satisfaction, participants were asked to complete an anonymous exit survey following completion of the program. Results: The data set included 131 individuals who inquired about program services. Eighty of the 131 (61%) met criteria and enrolled. Thirty-six of the 80 (45%) had complete data available for analysis. Cancer types varied but mostly included breast, colon, lung, leukemia and lymphoma. The table below shows the specific service uptake rates for the cohort. Seven participants completed the exit survey and all responded that the information gained from the program was useful and that the program increased satisfaction with their employer. Conclusions: Patients with cancer do not always have access to genomic technologies, nor understand the technology applications for their prognosis and treatment. Our experience in developing this program is that enrollees were interested in pursuing services that supported the use of genomic technologies, and satisfaction was high amongst those that provided feedback. Overall, the program directly engaged participants in their care and empowered them through education provided by genetic counselor navigators in ways that are not typically available in most cancer care settings. [Table: see text]