bluuebunny/crossref_metadata_2025_split huggingface dataset:
A schematic case episode format to aid in “Choosing Wisely."
Authors: Hoverman J. Russell , Mann B. Brooke , Hayes Jad , Wilfong Lalan S. , Neubauer Marcus A. 
Published: February 2017

181 Background: The recommendations of the Choosing Wisely campaign are evidence –based strategies to reduce cost without sacrificing outcomes. Yet tying the recommendations to indicators of use at the physician and case level has been challenging. As practices become responsible for total cost of care, an easy to use analytic method to determine appropriate use will be critical. We here describe a tool for rapid assessment of individual cases to achieve that objective. Methods: The population was a payer defined cohort of lung cancer patients treated at Texas Oncology (TxO). TxO maintains a payer patient list, updated daily with demographics and diagnosis details for all enrolled patients. The list of lung cancer patients was cross-referenced against billing data from TxO's financial data warehouse (FDW). The FDW data is generated monthly, based on billing details from TxO's practice management system, and includes procedure codes and dates of service. Radiation therapy, chemotherapy, and GCSF administrations for each enrolled lung cancer patient were identified in the FDW data based on CPT codes. SAS software (version 9.4 for Windows) was used to generate a time series plot for each patient, based on date of service for each procedure. The time series plots were inserted into an Excel report template, along with general patient information, using a Visual Basic script, for review by TxO's medical director and quality committees. Results: Each patient-specific time series schematic displays elapsed weeks on the x-axis, beginning with week 1 to end of treatment. Three variables are displayed on the y-axis, using distinct colors and symbols: dates of radiation therapy (orange #), dates of GCSF administration (red x), and dates of chemotherapy administration (green ^). Each of the three y-axis variables is assigned a constant value that is plotted along a straight line. A graphic representation for a patient with stage III lung cancer could look as shown in the Table. Conclusions: Treatment episodes can be distilled into a meaningful format that allows rapid case review and the opportunity for continuous learning. Additional diseases and graphics will be available for presentation. [Table: see text]
An interactive video-based approach to diet education for patients posthematopoietic stem cell transplantation.
Authors: Close Sara , Emmert Amy , Soiffer Robert , Alyea Edwin , Antin Joseph Harry , Glotzbecker Brett 
Published: February 2017

183 Background: Hematopoietic stem cell transplantation (HCT) is a complex process in which patient education is increasingly recognized as a critical element to enhance patient preparedness and survivorship. Diet-related education to prevent infectious complications is an essential part of HCT care. Current teaching methods include one-on-one clinician/patient discussion supported with printed materials. Video based teaching may strengthen the learning process of patients and their caregivers. The audio and interactive components may be particularly useful in older patients as sensory ability declines with age. Methods: Focus group methodology was utilized. Four groups of patients, nurses, physicians, pharmacists and dietitians were asked semi-structured questions to allow for collection of systematic data. Multiple rounds of content analysis were used to eliminate duplicates and identify common themes. An interactive video based on items identified and institutional protocols was developed. After refinement of both content and usability, the video was presented to 10 patients and their caregivers admitted to the hospital for HCT. They were instructed on its use and given unlimited time to view it. A survey was conducted by a member of the HCT team to collect feedback regarding length and content of the program. Results: All patients felt the program was a helpful supplement to the written materials. They also felt that the content was consistent and the program was easy to use. Two patients said the video was long, though commented positively on how comprehensive it was. One patient preferred printed materials to have during food preparation. All patients requested that the video be available to view after discharge. Conclusions: Feedback from a multidisciplinary team was instrumental in the development of an interactive tool reviewing post-HCT nutrition guidelines. Feedback from an initial cohort of patients has been positive in regards to usability and knowledge gained. This video will enhance patient and caregiver education and allow them the ability to take an active role in their HCT care. Next steps include a more formal evaluation of clinical outcomes related to this method of learning.
Changing physician compensation and implementing new technology to enhance pathways compliance.
Authors: Wilfong Lalan S. , Hoverman John Russell , Gosse Nate , Neubauer Marcus A. , Torres Vanessa 
Published: February 2017

187 Background: Pathways have shown to decrease cost of care while maintaining efficacy of treatment. In 2005, The US Oncology Network, which includes Texas Oncology, P.A. (TOPA) developed physician-led clinical pathways based on national guidelines, cost and efficacy. This abstract reviews the impact of changes TOPA initiated to improve pathway compliance Methods: Since 2011, TOPA has assessed pathways compliance using the iKnowMed (iKM) electronic medical record. Individual compliance was reported to each physician, but no incentives were tied to this. In 2015, the TOPA annual productivity bonus structure (2% of compensation) was changed to introduce pathways compliance and exception documentation thresholds, with penalties for sub-threshold performance. Additionally, TOPA sought to improve on iKM-based data collection and assessment. Previously, there were data challenges with pathways assessed retrospectively, offering limited visibility at the time of decision-making. In September 2015, new technology (Clear Value Plus – CVP) was embedded within iKM, which allowed prospective pathways assessment and provided real-time compliance reporting. Results: Introduction of individual incentives and improved decision support increased pathways compliance. For the initial yearly bonus measurement period, TOPA pathways compliance was 78%. After implementation of the new bonus structure, compliance increased significantly to 83% (p<0.0001). Implementation of CVP further improved pathway compliance for comparable reporting periods from 78% in September 2014 to 90% in September of 2015 (p<0.0001) Conclusions: We have shown that even a small change in compensation significantly influences physician pathways compliance. Additionally, technology to assist physicians with documentation and real-time assessment also significantly improves pathway compliance. [Table: see text] [Table: see text]
Cancer communication in the social media age: Could Twitter help clinical trial accrual?
Authors: Sedrak Mina Samir , Cohen Roger B. , Merchant Raina M. , Schapira Marilyn M. 
Published: February 2017

194 Background: Twitter, a social networking site, is transforming communication. Effective use of Twitter might be one way to communicate with the public about cancer clinical trials and increase awareness and perhaps enrollment. We conducted a content analysis of tweets about lung cancer, describing dialogues specific to lung cancer clinical trials and seeing where embedded-links in tweets about therapeutic trials are leading the public. Methods: We used the Twitter search engine to identify a cohort of 26,059 tweets with the keyword “lung cancer” from January 5 - 21, 2015. Tweets were captured and prepared using Nvivo qualitative data analysis software. Duplicate and non-English tweets were excluded. Of the remaining 15,346 unique tweets, 1,516 (10%) were randomly selected for detailed content analysis (kappa = 0.71). Tweets related to clinical trials underwent further analysis to categorize the trial type and embedded-links. University of Pennsylvania IRB exempted this study from review. Results: Most, 83% (1,260/1,516) of tweets in our sample contained lung cancer-specific content and 17% (256/1,516) were categorized as miscellaneous (e.g., extraneous content, non-sequiturs). Table 1 shows the distribution of content categories of lung cancer related tweets by frequency. Most of the tweets focused on support or prevention. Among the lung cancer related tweets, 18% (221/1,260) related to clinical trials. Of clinical trial tweets, 83% (183/221) concerned therapeutic trials, 13% (28/221) non-therapeutic, and 4% (10/221) basic research. Among the therapeutic clinical trial tweets, 79% (144/183) concerned immunotherapy and 86% (158/183) had embedded-links directing users to news articles. Only 1 tweet linked to a patient recruitment website. Conclusions: A significant proportion of lung cancer tweets are about clinical trials, but virtually none direct patients to enrollment sites. Twitter is a new communication medium for the cancer community, and further research is needed to test its potential to promote clinical trial accrual. [Table: see text]
Assessing the quality of chemotherapy in an episode-based funding model in Ontario.
Authors: Kaizer Leonard , Simanovski Vicky , Tariq Huma , Lalonde Carlin , Blais Irene , Evans William K. 
Published: February 2017

1 Background: On April 1, 2014, the delivery of systemic treatment in Ontario transitioned to an episode-based funding model, which provides bundled payments for a full course of therapy delivered with adjuvant/curative intent and a monthly bundled payment for palliative intent. Disease Site Teams have defined treatment options and “best practice” for each funded adjuvant/curative regimen. Methods: The utilization of treatment according to disease and intent was analyzed for 35 systemic treatment facilities in Ontario, comparing actual practice (AP) with “best practice” (BP) (dose/schedule/cycle number), for common adjuvant/curative regimens. Variation in the choice of chemotherapy regimen was also reviewed. Results: Cases were included if they started a new course of adjuvant/curative therapy after January 1, 2014, and completed their treatment before July 31, 2015 (17,341 cases). For all disease sites and facilities, AP was equal to BP in 34.6% of cases, AP < BP in 57.5%, and AP > BP in 7.8% (Table). There was significant variation by disease site and facility. As a specific example, 1,368 courses of adjuvant mFOLFOX were completed for colorectal cancer: AP = BP (12 cycles) in 34% (range 7-70%), AP < BP in 66% (range 30-93%), and AP > BP in 1% (range 0-4%). Variation in choice of adjuvant regimen for breast cancer was also observed. Provincially, 21.5% of patients received non-anthracycline containing therapy, but the range in the 20 largest volume centers was 0% to 39.8%. Conclusions: With the administration of potentially curative therapy, it might be assumed that BP would be administered in the majority of cases. However, initial results demonstrate significant variation in practice in an episode based funding model. There is a need to understand the reasons for this variation and to identify potential opportunities to drive efficiency and to increase standardization by engaging clinical experts and practitioners. [Table: see text]
Patient activation measures, distress levels, and causes of distress in chronic lymphocytic leukemia.
Authors: Halilova Karina I. , Van Laar Emily , Borate Uma , Jackson Bradford E. , Pisu Maria , Peters Pamela M. , Butler Thomas Wayne , Davis Randall S. , Mehta Amitkumar , Acemgil Aras , Knight Sara J. , Safford Monika M. , Rocque Gabrielle Betty 
Published: February 2017

201 Background: Patients with chronic lymphocytic leukemia (CLL) reporting high levels of distress due to knowledge gaps and emotional concerns can have negative outcomes and suffer from lower quality of life. Understanding patients’ activation levels, causes of distress, knowledge gaps, and psychosocial needs are crucial in high quality care. Optimally activated, educated and empowered patients are better positioned to communicate effectively with providers regarding selection of, and adherence to, CLL treatment protocols and long-term care plans, and potentially improving quality of life. Methods: We recruited 44 adults with CLL from the University of Alabama at Birmingham Health System Cancer Community Network from April to July of 2015 as part of an educational and quality improvement initiative. Patient-reported distress assessments were collected to evaluate distress levels and causes of distress. The Patient Activation Measure (PAM 13) was used to evaluate patient activation (1-4 scale with 4 maximally activated). Results: The median participant age was 69 years old (range 50-89 years). Thirty percent had completed ≤ 12 years of education, 20% had some college education. Thirty-nine percent were on active treatment, 59% were in observation; 2% were uncertain of treatment. Fifty seven percent of participants were maximally activated (level 4); 11% had an activation level of 3; 20% had a level of 2; and 11% had the lowest level of activation (level 1). Twenty-five percent reported moderate distress (≥ 4) and 5% reported severe distress (≥ 8); 34% reported distress due to psychosocial concerns and 25% due to knowledge gaps. Conclusions: This project demonstrates a need to improve patient activation levels and minimize patient distress related to knowledge gaps and psychosocial concerns related to CLL. Well-designed, easily accessible educational interventions and multi-level quality improvement programs may be helpful in improving patient engagement by providing necessary knowledge to improve patient-provider communication and optimize patient outcomes.
End-of-life care for glioblastoma multiforme patients at an academic institution.
Authors: Kuchinad Kamini , Strowd Roy E , Evans Anne , Knight Louise , Riley W. Anthony , Smith Thomas J. 
Published: February 2017

202 Background: End of life care for glioblastoma patients has not been studied in the United States. We studied 100 patients with GBM to examine use of advance directives (AD), symptom assessments, hospitalizations, chemotherapy use, and hospice use. Methods: A single center retrospective cohort study of adult patients actively treated for GBM at Johns Hopkins Hospital from 2009-2014. 100 patients were randomly chosen from the group of 317 GBM patients. Information included documentation of AD, code status, hospitalizations, chemotherapy use, code status and symptom assessments. A secondary analysis of all JHH GBM patients who received hospice care at Gilchrist Hospice during this time period was analyzed using the electronic medical record and hospice records to evaluate date of referral to hospice, length of stay in hospice and location of death. Results: Of 100 patients, 76 were referred to hospice. Only 40% of individuals had documentation of code status and only 17% had any documentation of ADs in the outpatient chart. Formal symptom, spiritual, or psychosocial assessments were seldom documented in the outpatient record. Only 17% used chemotherapy in their last month of life. 37% were hospitalized in the last month of life for an average of 9 days. Of the Gilchrist Hospice patients, the median length of stay in hospice was 21 days and 64% of these patients died in their residence with hospice services. Conclusions: More formalized palliative care utilization and structure could improve end of life care for GBM patients, especially in the use of ADs; formal symptom, spiritual, and psychosocial assessments; and earlier use of hospice to prevent end of life hospitalizations.
Preoperative triage and multidisciplinary consultation for patients with breast cancer: A pilot study between surgery and medical oncology.
Authors: Adilman Rachel , Simmons Christine E. , Eslami Maryam , Illmann Caroline , Warburton Rebecca , McKevitt Elaine 
Published: February 2017

208 Background: Breast cancer management has become exceedingly collaborative across specialties. Preoperative multidisciplinary input in particular is increasingly needed as indications for neoadjuvant therapy (NAT) continue to expand. In British Columbia, as in many other regions, breast cancer surgery is typically performed by community surgeons working in settings away from medical and radiation oncologists, making preoperative multidisciplinary input challenging. Methods: This prospective pilot study was designed to enhance and streamline preoperative breast cancer care at the BC Cancer Agency Vancouver Centre (BCCA) and Mount Saint Joseph’s Hospital (MSJ). Patients with a new diagnosis of breast cancer at the MSJ Breast Clinic are included in this pilot triage project if tumors meet one or more of the following criteria: triple negative, HER2+, clinically palpable ≥ 2cm, or present with positive/palpable nodes. Before the patient has consulted with a surgeon, the pathology, imaging, and GP’s assessment is faxed by a MSJ nurse navigator to BCCA for preoperative triage by a medical oncologist. A BCCA navigator facilitates this confidential electronic triage process, and communicates the medical oncologist’s recommendation [a) urgent referral for NAT, or b) upfront surgery] back to MSJ for appropriate booking and management. Results: Since inception in November 2014, 42 patients have undergone electronic preoperative triage through this pilot project. Of those, 47.6% were recommended to have, and did have, a preoperative medical oncology consult to discuss NAT. 90% of patients who had a NAT consult ultimately received NAT compared to a 66% uptake of NAT through the traditional referral process (P = 0.029). Median wait time from ‘biopsy result’ to ‘start of chemotherapy’ was significantly reduced by 9 days through this novel triage process (P = 0.047). Conclusions: This preoperative multidisciplinary triage project has significantly reduced treatment wait times and improved patient selection for and uptake of NAT for breast cancer. Breast cancer care benefits from increased preoperative navigation to help streamline and expedite care for high-risk patients.
Prophylactic use of Granulocyte-colony stimulating factors (G-CSF) in cancer patients: Adherence to NCCN guidelines.
Authors: Khanna Rashi , Alva Venur Vyshak , Narechania Shraddha , Elson Paul , Daw Hamed , Spiro Timothy Peter , Haddad Abdo 
Published: February 2017

209 Background: G-CSF are used for prophylactic and therapeutic treatment of febrile neutropenia (FN). NCCN guidelines (version 1.2015) recommend prophylactic use of G-CSF based on the chemotherapy regimen and patient related risk factors, especially for the high (> 20%) and intermediate (10-20%) risk groups for developing FN. This study investigates the practice patterns and adherence to NCCN guidelines for use of G-CSF at a community based academic outpatient facility. Methods: Cleveland Clinic IRB was obtained. Charts of all patients with underlying non-small cell lung cancer, small cell lung cancer, and breast cancer, treated in the year 2013, were reviewed for G-CSF use on their initial chemotherapy encounter. Risk assessment for developing FN was assessed based on individual risk factors and chemotherapy regimen. Analysis was obtained for appropriate guideline based use of G-CSF. Results: A total of 172 (n = 172) patients were included in the study. Overall, 63% (108/172) of patients had breast cancer; 81% (140/172) were female, most patients (64%, 108/170) were aged < 65 years; 29% (49/172) had metastatic disease; and almost all patients (91%, 106/117) had good ECOG performance status (0 or 1). The overall risk of FN was estimated to be low (< 10%) for 9% (16/172) of patients, intermediate (10-20%) for 45% (77/172) of patients, and high (> 20%) for 45%. Overall, 5% (8/172) of patients did not follow the NCCN guidelines. Only 86% of the patients in metastatic group were adherent to NCCN guidelines compared to 99% of patients in non-metastatic group (p< .01). Among patients with metastatic disease, 14% (7/49) did not follow NCCN guidelines; in a univariable analysis, among patients with metastatic disease - risk of neutropenia (p < .0001), age (p < .01), and prior chemotherapy and or radiation (p = .04), were associated with whether or not the NCCN guidelines were followed. Conclusions: In our limited study population, more use of G-CSF was seen among patients with metastatic cancer with a higher number of metastatic patients being non-adherent to NCCN guidelines. Further research is required to elucidate the potential benefit and cost-effectiveness of G-CSF use in the palliative setting.
Understanding the comorbidome and its effect on survival in colorectal cancer.
Authors: Hahn Erin Elizabeth , Shen Ernest , Lee Janet S. , Munoz-Plaza Corrine E. , Parry Carly , Gould Michael K 
Published: February 2017

210 Background: Effectively managing comorbidities is an essential component of high-quality cancer care. Evidence suggests colorectal cancer (CRC) patients with multiple comorbid conditions are less likely to complete standard treatments and can have lower rates of survival. In order to provide personalized care, it is critical to understand how comorbid conditions cluster within CRC patients. Methods: We identified Kaiser Permanente Southern California CRC patients diagnosed with first malignancy between 01/01/2008 - 12/31/2013. We used latent class analysis to identify clinically useful phenotypes defined by combinations of comorbidities at diagnosis, and compared survival using the Kaplan-Meier method. Results: The cohort included 7803 patients: 52% male; average age at diagnosis 66 years (SD: 13); 22% Hispanic, 15% Black, 9% Asian, 52% White; 42% Stage I, 22% Stage II, 22% Stage III, and 14% Stage IV. One-fifth of patients had a Charlson comorbidity index score of ≥ 4. We found 4 distinct classes (Lo-Mendell-Rubin p<0.001). Class 1 was relatively healthy with few comorbidities (Table). Class 2 included individuals with cardiovascular diseases; those in Class 3 had complicated diabetes. Class 4 members had multiple chronic conditions, including diabetes with micro- and macrovascular complications. Kaplan-Meier estimates revealed a statistically significant difference in overall survival by class (log rank p<0.001). Conclusions: We identified 4 clinically distinct classes of comorbid conditions in CRC patients. These data can be used to inform personalized care for CRC patients throughout the cancer care continuum. [Table: see text]