tbuckley/cabot-search huggingface dataset:
Engaging support staff to redesign and improve the process to communicate with outside physicians.
Authors: Sarah Kadish, Ashley Malins, Nadine Jackson McCleary, Taneisha Bullock, Alexia Malouf, Kimberly White, Stephanie Gauthier, Bridget McLaughlin, Danielle Johnson, Gina Krier, Lauren Brady, Andrew J. Wagner
Journal: Journal of Clinical Oncology (2018)

280 Background: Communicating with a patient’s primary care physician and other specialists is a key component of collaborative patient care across organizations. This includes identifying and maintaining a current list of care team members and distributing consult and progress notes. Recently, after transitioning to a new EMR, referring physicians noted a reduction in notes about their patients seen at the Dana-Farber Cancer Institute. The process in the new EMR was more burdensome than the automated system in the legacy application: physicians were now required to populate a recipient list, manually attach a note, and arrange for mailing of a printed letter if no fax number was available in the directory. The system did not require notes to be sent, and consequently many physicians chose not to adopt this new administrative work. Methods: A multidisciplinary team was formed to reduce the administrative burden of sending notes from providers and to enhance communication with outside physicians. All adult medical, surgical and radiation oncology exam appointments were in scope. A standardized process was developed in which at each exam visit clinic assistants worked with patients to update the care team list and asked patients which physicians should be sent copies of the note. The clinic assistant prepared the outgoing communication, added the patient’s identified recipients and PCP, and set the communication to automatically send upon the provider completing his/her documentation. The clinical assistants were trained on each clinical floor and held daily debriefs with the project team during the first week to address any issues. Providers were educated on how to change the recipient list or the outgoing communication if desired. Results: In the five months after implementation, the percent of exam appointments with notes sent increased from 42% to 79% (P &lt; 0.001) without significant impact on the time to place patients in exam rooms. Conclusions: Redesigning workflow through engaging support staff can improve communication and coordination with external providers, while reducing the administrative work assigned to providers.[Table: see text]
Abstract 13157: Relationship Between Body Mass Index and Mortality in the African-American Heart Failure Trial
Authors: Oludamilola Oluleye, Khyati Baxi, Thomas Rector, Phuong Ngo, Alan Miller, Inder S Anand
Journal: Circulation (2016)

Introduction: In patients with heart failure and reduced ejection fraction (HFrEF), increasing body mass index (BMI) is not associated with worsening prognosis, termed the obesity paradox. Although this phenomenon has been studied extensively, data on the African-American population are limited. The aim of this study was to examine the relationship between BMI and all-cause mortality in African Americans with HFrEF. Methods and Results: The African-American Heart Failure Trial (A-HeFT) database was utilized to conduct a retrospective analysis. In A-HeFT, 1050 self-identified black patients with BMI range of 15.7 to 69.4 kg/m 2 (median 30.3 kg/m 2 ) were followed for a median of 15 months, with 86 deaths. BMI was modeled as a curvilinear continuous variable using restricted cubic splines. Unadjusted Cox regression analysis of the relationship between BMI and all-cause mortality revealed a significant (p = 0.001) inverse relationship, with an increase in mortality risk below the median BMI of approximately 30 kg/m 2 (HR&gt; 1.0) without an upward trend in mortality risk above a BMI &gt; 30 kg/m 2 (Figure1). Adjustment for other variables including age, sex, comorbidities, and clinical assessments did not reveal an increase in HR above the median BMI. Conclusion: Consistent with the obesity paradox, the mortality risk increased with decreasing BMI and did not increase when the BMI exceeded the definition of obesity. Until the mechanisms of the obesity paradox are better understood, these results question whether weight reduction would be beneficial in the African American population with HFrEF.
Implementation of a hepatitis B screening process prior to CD20 therapy treatment in an oncology practice.
Authors: Ali McBride, Emad Elquza, Abhijeet Kumar, Daniel Oscar Persky, Cindy Cho, Yvonne Ng, Koanhee Rim
Journal: Journal of Clinical Oncology (2018)

287 Background: Reactivation of hepatitis B virus (HBV) during or after chemotherapy is a serious complication of cancer treatment. Guidelines suggest hepatitis B testing prior to the initiation of CD20 based therapies. Black box warnings mandate clinicians screen patients for HBV before starting immunosuppressive therapy due to the risk of hepatitis B reactivation. We conducted a workflow implementation change at our infusion center sites to improve hepatitis B serological testing in patients receiving CD20 agents at our cancer center. Methods: For baseline evaluation, patients at The University of Arizona Cancer Center who were treated with CD20 agents between the years 2013 to April 2014 were retrospectively evaluated for HBV serology results prior to the initiation of first treatment. We implemented a pharmacy and nursing workflow process regarding chemotherapy orders and lab testing through the integrated EMR technology. Presence of Hepatitis B Surface Antigen (HBsAg) and Hepatitis B Core Antibody (HBcAb) were considered complete; absence of all 2 was ‘not done’ with remaining being incomplete. We focused on improving our screening process during our analysis post-intervention from April 2014 to November 2017. Results: In our baseline study, 35% (n = 17) out of 48 patients had been tested for hepatitis B for hematologic malignancies. Post-implementation yielded 89 patients with 63 lymphoma patients, and 11 leukemia and 15 other hematological-associated diagnosis. Ninety one percent (n = 81) had been tested post-implementation for Hepatitis B labs prior to starting CD20 treatment. No Hepatitis B reactivation was identified in either study arms. Conclusions: Prior to implementation less than 35% of our patients were tested and our implementation process more than doubled our testing percentages to 91%. This process allows for an integrated workflow between pharmacy and nursing to mitigate required lab testing for CD20 agents in hematologic malignancies. The utilization of this workflow process is now being implemented with other CD20 agents for non-oncologic diagnosis.
Improving radiotherapy quality of care: Examining practice patterns in regional centers.
Authors: Jordan Stosky, Jackson S.Y. Wu, Alysa M. Fairchild, Marc Kerba
Journal: Journal of Clinical Oncology (2018)

53 Background: Radiotherapy (RT) is a resource intensive cancer treatment. Benefits may take weeks to realize, whereas side effects are more immediate. RT is commonly delivered with palliative intent often near the end of life (EOL). In patients with limited life expectancy, single fractions (sf) may substitute for multi-fraction (mf) treatments. Objectives were to document RT courses delivered to patients with cancer at EOL, with the goal of informing treatment practices, developing a clinical decision-making tool and reducing potentially futile treatment and side effects for patients. Methods: Cancer Registry data was examined with ethics approval. Patient and prospective treatment data were collected and analyzed to determine the number of RT courses starting within 90 days of death (EOL) among those with cancer diagnoses who died between January 1, 2016, and July 31, 2017. Data was stratified by demographics, disease factors, RT center and prescription factors. Results are reported in aggregate and explored using tests of association (Stata 11.1). Results: Among 1874 patients who died, 2448 RT courses were identified across 4 RT centers. Of those prescribed RT at the EOL, there were 442 sf courses 100% completed, 1267 2-5 fraction courses 90% completed, 552 6-10 fraction courses 77% completed, and 187 11+ fraction courses 57% completed. Among patients prescribed RT 14 days prior to death, 24% had been prescribed a sf of RT compared to 18% of those within 90 days of death (Chi2 17.92, p &lt; 0.001). Among patients prescribed RT 90 days prior to death, 25% of patients in tertiary Centre A were prescribed a sf compared to 13% of patients in tertiary Centre B (Chi2 121.90, p &lt; 0.001). Patients were half as likely (RR = 0.47, 95% CI [0.39, 0.56], p &lt; 0.001) to complete a mf treatment within 14 days of their death as compared to within 90 days. Patients who had a diagnosis to death interval of under a year were less likely to complete RT than those over a year (RR = 0.82, 95% CI [0.79, 0.85], p &lt; 0.001). Conclusions: Multi-fraction RT is often not completed prior to death. Treating RT center is associated with differences in prescribing patterns. Better understanding of factors influencing RT practice patterns may lessen the proportion of potentially futile RT.
Evolving best practice for take-home cancer drugs in Ontario.
Authors: Aliya Pardhan, Kathy Vu, Daniela Gallo-Hershberg, Leta Marie Forbes, Scott Gavura, Vishal Kukreti
Journal: Journal of Clinical Oncology (2018)

246 Background: Take-home cancer drugs (THCD) have become a standard treatment for many cancers and present opportunities and challenges for patients, providers and administrators. Ontario’s system has been described as two-tiered, with intravenous cancer drugs (IVCD) viewed as more comprehensive, organized, safer, and more patient-centred. Cancer Care Ontario (CCO) is the Ontario government’s principal cancer advisor. In April 2017, CCO established an Oncology Pharmacy Task Force to develop consensus-based recommendations on best practices for THCD to ensure that all patients are receiving consistent high-quality care regardless of the method of delivery of treatment. Methods: The Task Force included 34 members with representation from patient advocacy groups, pharmacy and pharmacist associations, regulatory and standard setting organizations, and subject matter experts. Standards, guidelines and recommendations from leading authorities were extracted by CCO’s Evidence Search and Review Service and synthesized by a core working group to develop 29 statements. The consensus process included a three-step modified Delphi method with two electronic surveys and a face-to-face meeting. Seventy percent agreement was required to include a recommendation. Thereafter, an extensive review process was conducted with relevant CCO programs and committees as well as subject matter experts, stakeholders and standard setting bodies at the local-regional and national levels. Results: Sixteen consensus-based recommendations were developed: training and education for providers (2); drug access (1); prescribing (4); patient, family/caregiver education (3); communication (1); dispensing (3); monitoring for adherence, identification and management of symptoms/adverse effect (1); and incident reporting (1) . This guidance will have most relevance for patients receiving THCD that require routine monitoring and for clinicians involved in delivering systemic treatment, and associated medications. Conclusions: Through the rigorous use of the Delphi technique, the Task Force developed a robust set of recommendations for THCD delivery in Ontario. Further work will be required to understand implementation enablers and barriers
Re: Jean-Philippe Lucot, Michel Cosson, Georges Bader, et al. Safety of Vaginal Mesh Surgery Versus Laparoscopic Mesh Sacropexy for Cystocele Repair: Results of the Prosthetic Pelvic Floor Repair Randomized Controlled Trial. Eur Urol 2018;74:167–76
Authors: Maurizio Bologna, Amerigo Vitagliano, Mauro Cervigni
Journal: European Urology (2018)
Abstract 17470: The Effectiveness of Ethanol Infusion in the Vein of Marshall for Bidirectional Mitral Isthmus Block in Unsuccessful Cases With Conventional Ablation
Authors: Kaeko Hirai, Hajime Fujimoto, Masaki Naito, Hiroki Yano, Takaaki Kosugi, Yukihiro Hashimoto, Takuya Isojima, Megumi Suzuki, Hajime Iwama, Takehito Nakai, Naofumi Doi
Journal: Circulation (2015)

2015 AHA Effectiveness of Ethanol Infusion in the Vein of Marshall for Bidirectional Mitral Isthmus Block in Unsuccessful Cases with Conventional Ablation [Introduction] Treatment of mitral isthmus dependent atrial tachycardia (AT) requires bidirectional mitral isthmus (MI) block. It is usually difficult to achieve bidirectional MI block by endocardial linear ablation. When MI block is incomplete, additional ablation inside the coronary sinus (CS) is often required. The vein of Marshall (VOM) is located in the epicardial aspect of MI. The purpose of this study is to determine whether complete bidirectional MI block is obtained by ethanol infusion in the VOM in cases with incomplete MI block by conventional ablation. [Method] This study consisted of 38 consecutive patients who underwent conventional ablation to obtain bidirectional MI block from October 2013 to September 2014. [Results] In 24 patients (63%), bidirectional MI block was achieved by conventional ablation. In 11 patients (29%) of the other 14 patients, the CS venogram was performed to assess the presence or absence of the VOM. The VOM was imaged in 9 patients (24%), into which 100% ethanol was injected (2ml, 2-3times). After ethanol infusion in the VOM, bidirectional MI block was obtained in all cases (Figure). [Conclusion] Ethanol infusion in the VOM is an effective treatment in cases with incomplete MI block by conventional ablation.
Efficacy of paclitaxel plus cisplatin in advanced esophageal squamous cell cancer: Further analysis of single center, prospective study.
Authors: Jifang Gong, Xiaodong Zhang, Ming Lu, Yan Li, Jie Li, Jian Li, Xiaotian Zhang, Jun Zhou, Zhihao Lu, Lin Shen
Journal: Journal of Clinical Oncology (2013)

e15174 Background: To evaluate efficacy and toxicity of paclitaxel plus cisplatin in advanced esophageal squamous cell carcinoma (ESCC). Methods: In this single-center, prospective study, chemo-naïve patients with metastastic and recurred ESCC received paclitaxel 175mg/m2 d1 and cisplatin was given on day 1, 2, at a total dose of 75 mg/m 2 over 60 minutes, repeated every 21 days. Efficacy was evaluated every 2 cycles. Results: 133 patients were enrolled between June 2006 and November 2010. The median cycles of chemotherapy accepted were only 3. The objective response rate(RR) of paclitaxel and cisplatin in ESCC patients was 34.2%. After a median follow-up of 24.2 months, the progression free survival (PFS) was limited to 7.0 months (95%CI 5.68-8.32), meanwhile the median overall survival (mOS) was 12.0 months (95%CI 9.93-14.07). In the multivariate Cox regression analysis, distant organ metastasis remained an independent predictor of OS with a hazard ratio of 1.460 (95% CI 0.871-2.446, P = 0.041). 31 patients received radiotherapy after chemotherapy with significantly longer PFS than those without (6.8 months vs. 10 months, p = 0.037), but no difference in OS was observed (12.0 vs. 13.0 months, p = 0.23).Adverse events were tolerable. Conclusions: The efficacy of paclitaxel plus cisplatin in esophageal squamous cell carcinoma is promising. Sequencial chemoradiotherapy could release local progression but no help to overall survival.
Opioid-associated deaths in patients with cancer: A population study of the opioid epidemic over the past 10 years.
Authors: Fumiko Ladd Chino, Arif Kamal, Junzo P. Chino
Journal: Journal of Clinical Oncology (2018)

230 Background: Over 40,000 Americans died due to opioid overdose in 2016; the epidemic is a top public health concern. Opioids are commonly used for cancer associated pain but it is unknown what risks for overdose exist in this vulnerable population. Methods: De-identified death certificate data was obtained via the National Center for Health Statistics. Death certificates contain 1 underlying cause of death and up to 20 contributing causes, as well as demographic data. All deaths due to opioids were included from 2006-2016; if present, cancer was noted as a contributing cause. Opioid death incidence was calculated from both the US and estimated cancer survivor population. Chi and R squared tests assessed for differences. Results: From 2006-2016, there were 895 deaths due to opioids in cancer patients compared to 193,500 in the non-cancer population. Opioid deaths increased from 5.33 to 8.97 per 100,000 people in the general population (significant time trend, p &lt; 0.001, polynomial fit, R 2 0.99). Opioid deaths increased in the cancer population from 0.52 to 0.66 per 100,000 (significant time trend, p &lt; 0.001, linear fit, R 2 0.24, slope = 0.018). Cancer patients who died due to opioid use were different from those who died due to opioids in the general population including: higher education (12.7 vs 6.9% at least a college degree), more women (38.5 vs 29.2%), fewer whites (82.3 vs 84.2%), more Hispanics (94.5 vs 91.3%), and fewer single patients (24.2 vs 48.1%) [all p &lt; 0.001, except race p = 0.027]. Cancer patients also had older median age (57 years, IQR 50-65 vs median 42 years, IQR 31-51). 22% of opioid deaths were in lung cancer patients, followed by GI (21%), head &amp; neck (12%), hematological (11%), and GU cancers (10%). Conclusions: Death from opioids as the primary cause noted on death certificates are 10 times less likely to occur in cancer patients versus the general population. There was a slight increase in opioid deaths in cancer patients; however, overall, there was not the sharp growth seen in the general population. Cancer patients at risk for opioid overdose are different than those at risk in the general population and care should be taken when planning effective treatment of cancer-related pain.
Malnutrition screening: A screening tool for outpatient oncology patients, leveraging EMR data.
Authors: Jeannine B. Mills, Alice C. Shapiro, Colleen Spees, Elaine Trujillo, Elise Cushman, Natalie Stephens, Sarah Johnson, Alexandra Wood, Kimberly Duffy
Journal: Journal of Clinical Oncology (2018)

275 Background: The provision of adequate nutritional care in outpatient cancer centers was the focus of a 2016 NAS Workshop, “Assessing Nutrition Care in Outpatient Oncology.” Here we report our internal project evaluating ongoing documentation of a malnutrition screening tool (MST) at 3 national cancer centers (CC). Methods: Screening scores from a validated 2 question MST scale were entered into the EMR. Questions probe for: 1) unintentional weight loss; and 2) eating poorly because of a decreased appetite. A score of ≥ 2 indicated nutrition risk. De-identified oncology clinic visit data were examined monthly to assess MST utilization and scores for radiation and medical oncology patients across the CC’s. Results: Approximately two-thirds (67%) of unique medical oncology patients that visited the CC’s had documented MST data with 9% (n = 144,129) scoring at nutritional risk. MST completion rates were higher in radiation oncology clinics secondary to staff education. Of those that had a valid MST score in radiation clinics, 13% (n = 23,202) of MST scores indicated nutritional risk. Conclusions: The MST is a valid malnutrition screening tool for outpatient oncology patients, yet this tool is not uniformly being utilized nationally. Consistent use of the MST in the electronic medical record and leveraging data on utilization are needed to inform staff compliance, consistency in care, future dietitian staffing patterns, cost/benefit analysis, and health outcomes for oncology patients. [Table: see text][Table: see text]
Abstract 20412: Growing Burden of Recognized Atrial Fibrillation in a Large Health Care System: Temporal Trends in the Incidence, Prevalence, and Survival of Atrial Fibrillation From 2004-2016
Authors: Brent A Williams, Ashley Honushefsky, Peter Berger
Journal: Circulation (2017)

Introduction: A growing epidemic of atrial fibrillation (AF) in the United States (US) has been predicted, though no data on the clinical or community burden of AF has been reported for the US sinc...
Oral chemotherapy adherence tracking program implementation at a medically underserved comprehensive community cancer center.
Authors: Abhinav Binod Chandra, Mary Sweigart, Angelic Alvarez, Vivek Kumar
Journal: Journal of Clinical Oncology (2018)

294 Background: The field of oncology has witnessed a significant increase in the number of oral antineoplastic agents over the last several years and their utilization is expected to grow. Several deficiencies in procedures for safe management and monitoring of oral chemotherapy regimens remain unaddressed. Rates of adherence to oral antineoplastic agents have varied in literature and not widely studied. There is paucity of data on impact of oral chemotherapy adherence to patient outcomes or emergency room visits. Methods: Baseline oral chemotherapy adherence was tracked in new oral treatment plans. This was supplemented with education of staff to run reports and increase chemotherapy tracking with special focus on education and follow ups. Over 9 month period, the oral chemotherapy tracking process was implemented with the goal of 80% tracking being achieved. Emergency room (ER) visits were calculated on patients having active oral chemotherapy care plans during a 3-month period before and after implementation of the program. Results: Reporting metric for compliance with oral tracking showed improvement from 5% completed reports to 84% completed reports over 9 months. The goal set to achieve 80% tracking was reached. The program was successfully implemented from January 2017 – September 2017. Prior to implementation of the program, over a 3-month period, 55 patients were receiving active oral chemotherapy care, with 56 encounters of ER visits by 30 patients related to their cancer. After successful implementation of the program and with consistent 80% chemotherapy tracking in place, we analyzed data for another 3-month period. During this 3-month period, 108 patients were receiving active oral chemotherapy, with 31 encounters of ER visits by 17 patients for their cancer. Conclusions: Implementation of a tracking program for oral chemotherapy led to 72% reduction in emergency room visits by patients on oral chemotherapy care plans. We were successfully able to implement an oral chemotherapy adherence tracking program in a medically underserved comprehensive community cancer program. A prospective study can further validate the findings of this study.
Abstract 19600: Pulmonary Hypertension-Induced Right Ventricular Pressure Overload Triggers Acute Epigenetic Reprogramming of Pro-Inflammatory Cardiac Fibroblasts
Authors: Danielle R Bruns, Stephen F Thoemmes, Kurt R Stenmark, Peter M Buttrick, Lori A Walker
Journal: Circulation (2016)

Right ventricular (RV) function is a strong predictor of survival in a variety of clinical contexts including pulmonary hypertension (PH), highlighting the importance of delineating signaling pathw...