tbuckley/cabot-search huggingface dataset:
The challenges of implementing the CMS oncology care model (OCM) in a large multi-center community oncology practice.
Authors: John Brown, Kelly King, Brian Hunis
Journal: Journal of Clinical Oncology (2018)

115 Background: Our oncology practice has participated in the OCM program since July 2016. The purpose was to build improvement in quality care delivery and create methodology to reduce costs. We peered our work with ten cancer centers from ten states along the east coast. Methods: For all performance periods, we focused on building our strengths via five teams: Access, Care Mgmt., Post-acute transition, Finance, and Reporting. A registry was created in Epic. Data was collated and categorized as “OCM Eligible” and “OCM patients.” The Care Team worked with IT to create beneficiary identifications, discrete chart elements, financial estimations, and reports. Results: From Oct. to Dec. 2017 (latest quarter review), 589 patients were attributable. Our black and Hispanic population was +72.9% and +413.3% v. OCM (+76.6% and +381.2% v. all). We were categorized as high risk in the hierarchal condition category: +14% v. OCM, +17.7% v. all at the 25 th percentile; +21.6% and +32.6% at the 50 th percentile, +14.2% and +17.5 % at the 75 th percentile respectively. Our dually enrolled, Medicare / Medicaid was 29% (+113% v. OCM). ED visit utilization was +2.6% (not leading to admits or observations (Obs). IP admits were utilized at a rate of 27.3 per 100 beneficiaries v. 25.8 for OCM (+5.9%) and 26.1 for all (+4.9%). Those that resulted from ED visits only were 15.8 v. 16.2 (-2.5%). Those resulted from Obs were 0.8 v. 0.3 OCM (+142.4%). Unplanned readmits within 30 days were 6.4 (per 100) v. 5.7 OCM (+13.9%). Imaging utilization was -35.2% v. OCM and -38.5% v. all. Hospice use was 3.7% v. a 5% median OCM rate. Home health was +26% v. OCM and +15.8% v. all. Risk-adjusted four Qtr. avg. expenditures were +14.5% per beneficiary v. OCM (Jan. – Dec. 2017); however, mortality rates were -10.9% v. OCM. Conclusions: Our practice data led us to identify and prioritize PI initiatives, helped us engage providers, and educate stakeholders. While certain costs were lower, drug utilization remains high. The ED and IP admits from Obs have been a challenge, even with phone triage assistance developed previously as participants of the ASCO Quality Training Program. Our PI plan is to develop oncology expanded care clinics to reduce ED and Obs utilization.
Abstract 19963: Inferior Vena Cava in Patients With Vasovagal Syncope, a New Guest Actor
Authors: Jose E Herrera
Journal: Circulation (2015)

Introduction: Vasovagal Syncope presents prodromes due to autonomic activation and it can be brought by prolonged standing. This fact may be associated with failure in the venous return; therefore the object of this study is the evaluation of Inferior Vena Cava (IVC) and its flow. Hypothesis: IVC flow velocity is associated, with vasovagal syncope. Methods: Two groups were evaluated with echocardiography. Group A 12 healthy individuals, 10 women aged 39 ± 17 and 2 men aged 33 ± 11. Group B, 10 patients with Vasovagal Syncope, 8 women aged 29 ± 8 and 2 men aged 23 ± 3. IVC Echocardiography was performed according to ASE criteria. Standing sub costal view was obtained with cervical flexion. IVC diameter was measured 2 cm from right atrium entry; flow velocity was evaluated sub and post diaphragmatic, supine and standing, during expiration. Results: Table 1. IVC Variables Comparison between groups A and B. Conclusions: Group B Syncope, showed AP IVC diameter and an area significantly larger in supine and standing, sub diaphragmatic position. This fact could explain lower velocities in sub diaphragmatic supine and standing position in Group B which could explain the cause of syncope.
Infant Dietary Exposures to Environmental Chemicals and Infant/Child Health: A Critical Assessment of the Literature
Authors: Judy S. LaKind, Geniece M. Lehmann, Matthew H. Davis, Erin P. Hines, Satori A. Marchitti, Cecilia Alcala, Matthew Lorber
Journal: Environmental Health Perspectives (2018)

Background: The benefits of breastfeeding to the infant and mother have been well documented. It is also well known that breast milk contains environmental chemicals, and numerous epidemiological studies have explored relationships between background levels of chemicals in breast milk and health outcomes in infants and children. Objectives: In this paper, we examine epidemiological literature to address the following question: Are infant exposures to background levels of environmental chemicals in breast milk and formula associated with adverse health effects? We critically review this literature a) to explore whether exposure–outcome associations are observed across studies, and b) to assess the literature quality. Methods: We reviewed literature identified from electronic literature searches. We explored whether exposure–outcome associations are observed across studies by assessing the quality (using a modified version of a previously published quality assessment tool), consistency, and strengths and weaknesses in the literature. The epidemiological literature included cohorts from several countries and examined infants/children either once or multiple times over weeks to years. Health outcomes included four broad categories: growth and maturation, morbidity, biomarkers, and neurodevelopment. Results: The available literature does not provide conclusive evidence of consistent or clinically relevant health consequences to infants exposed to environmental chemicals in breast milk at background levels. Conclusions: It is clear that more research would better inform our understanding of the potential for health impacts from infant dietary exposures to environmental chemicals. A critical data gap is a lack of research on environmental chemicals in formula and infant/child health outcomes. https://doi.org/10.1289/EHP1954
A patient-derived conceptual framework of lung cancer care priorities.
Authors: Urvi Mujumdar, Victoria Lanzarini, Maria Lowe, Bjorn Bolinder, Yunes Doleh
Journal: Journal of Clinical Oncology (2018)

206 Background: Patient-centric healthcare delivery, where patients are the ultimate decision-makers, warrants care evaluated based on patient priorities. A heterogeneous lung cancer patient population fosters variation in care priorities. This study identified care concept domains in a wholly patient-driven manner. Methods: Group concept mapping was used to assess priorities among patients invited from the PatientsLikeMe online community aged ≥18, US residents, and self-reporting lung cancer. In Phase I, 26 patients generated ideas based on the focus prompt: “ What do you want to achieve when it comes to the treatment you are receiving or are considering receiving for your lung cancer?”. 78 ideas were generated over 2 weeks. Supplementation from literature, editing for relatability, independence, and consistency yielded 78 concepts. In Phase II 67 patients used CSGlobalMax® (Concept Systems, 2018) to rate the concepts for importance (1 = not important to 5 = very important); 64 of which grouped and named the ideas into categories of unrestricted size. Multidimensional scaling and hierarchical cluster analysis generated visual maps, average importance, and categorized concept domains. Domains were compared across all patients and by treatment experience (≤1 or &gt; 1 systemic regimens) and stage at diagnosis. Results: Patients were female (78%), white (93%), and mean age of 62 (SD 8.9). 93% reported non-small cell lung cancer, 70% reported Stage III or IV diagnosis, and 58% were classified as early in treatment experience. 11 unique domains were visually represented. In order of average importance the domains were: managing lifestyle (4.52), care team quality, active participation in treatment, treatment goals, treatment options, side effects, social well-being, physical well-being, future options, fulfillment in daily living, and supportive environment (4.01). There was strong correlation between treatment subgroups (r = 0.89), although relative importance of domains shifted. Generalizability is limited. Conclusions: In this patient-driven research approach, patients developed the focus prompt, generated ideas, and structured concepts. The unique domains may help evaluate care value in patient-centric healthcare delivery.
Semaphorin 7A Promotes Macrophage-Mediated Lymphatic Remodeling during Postpartum Mammary Gland Involution and in Breast Cancer
Authors: Alan M. Elder, Beth A.J. Tamburini, Lyndsey S. Crump, Sarah A. Black, Veronica M. Wessells, Pepper J. Schedin, Virginia F. Borges, Traci R. Lyons
Journal: Cancer Research (2018)

Abstract Postpartum mammary gland involution is a tissue remodeling event that occurs in all mammals in the absence of nursing or after weaning to return the gland to the pre-pregnant state. The tissue microenvironment created by involution has proven to be tumor promotional. Here we report that the GPI-linked protein semaphorin 7A (SEMA7A) is expressed on mammary epithelial cells during involution and use preclinical models to demonstrate that tumors induced during involution express high levels of SEMA7A. Overexpression of SEMA7A promoted the presence of myeloid-derived podoplanin (PDPN)-expressing cells in the tumor microenvironment and during involution. SEMA7A drove the expression of PDPN in macrophages, which led to integrin- and PDPN-dependent motility and adherence to lymphatic endothelial cells to promote lymphangiogenesis. In support of this mechanism, mammary tissue from SEMA7A-knockout mice exhibited decreased myeloid-derived PDPN-expressing cells, PDPN-expressing endothelial cells, and lymphatic vessel density. Furthermore, coexpression of SEMA7A, PDPN, and macrophage marker CD68 predicted for decreased distant metastasis-free survival in a cohort of over 600 cases of breast cancer as well as in ovarian, lung, and gastric cancers. Together, our results indicate that SEMA7A may orchestrate macrophage-mediated lymphatic vessel remodeling, which in turn drives metastasis in breast cancer. Signficance: SEMA7A, which is expressed on mammary cells during glandular involution, alters macrophage biology and lymphangiogenesis to drive breast cancer metastasis. Cancer Res; 78(22); 6473–85. ©2018 AACR.
Feasibility of a patient-reported outcomes quality-of-life instrument to improve care in underserved, ethnic minority patients with cancer.
Authors: Nandita Khera, Gilbert Ramos, Briant Fruth, Waqas Arslan, Ian K. Komenaka, Rahma M. Warsame, Donald W. Northfelt, Joan M. Griffin, Jeff A. Sloan
Journal: Journal of Clinical Oncology (2018)

65 Background: We need better methods to understand the social determinants of health and integrate psychosocial and economic sequelae of cancer and its treatment into healthcare delivery for ethnoculturally diverse population. A Patient-Reported Outcomes Quality of Life (PROQOL) instrument has been developed to capture less commonly discussed patient concerns (Personal Relationships, Emotional health, Physical health, Cancer diagnosis and treatment, Money and Care planning) and improve patient-provider communication. We sought to adapt this instrument and pilot it in underserved, ethnically diverse solid tumor and hematological malignancies patients at Maricopa Integrated Health System (MIHS) in Phoenix, AZ. Methods: Two focus groups (FG) were conducted to understand patient perspectives of an adapted Spanish version of PROQOL. This version was then piloted among patients on active cancer treatment. Patients also completed a Linear Analog Scale Assessment (from 1-10) for quality of life (QOL) and its domains (higher scores indicate better QOL). Results: All participants in both FG (11/12 female) were Hispanics, with a median age of 53 years. Participants agreed that the domains covered in the PROQOL represented the most important psychosocial needs in their cancer continuum. No difficulty in understanding the individual domains or questions for delving deeper into each domain was noted. Median age of 34 pilot study participants (74% female) was 48 years, 79% were Hispanic, 10% were African Americans and median household income was $ 43,924 (range 23,002-98,382). 28/34 completed the Spanish version. Most common concerns were ‘Money’ (32%): difficulty paying medical bills and non-medical expenses and ‘Cancer Diagnosis, Treatment and Survivorship’ (32%): type of cancer and treatment concerns. Median overall QOL was 8 (range 3-10). Conclusions: PROQOL is feasible for systematic capture of patient concerns in underserved, ethnic minority cancer patients. A better understanding of these challenges can help design interventions to improve psychosocial and financial outcomes for the vulnerable groups and decrease disparities in care delivery.
Chemotherapy wait times in a network of pediatric oncology clinics.
Authors: Carolyn Lucille Russo, Jennifer Morgan, Mohamed Elsaid
Journal: Journal of Clinical Oncology (2018)

127 Background: Optimizing care delivery is a satisfier for patients and providers alike. Inadequate clinic flow may also drive up costs, as staff are more likely to utilize overtime hours. We noted in our network of outpatient pediatric oncology clinics that the lowest scores in patient satisfaction surveys were the category of waiting time in the chemotherapy area. We aimed to reduce wait time in the chemotherapy area for patients receiving outpatient, lab-dependent, intravenous push chemotherapy by 5% within 9 months. Methods: A team consisting of a nurse team leader and core members (physician, nurse and pharmacist) from affiliate clinics in 3 states (AL, MO, OK) obtained baseline data over 2 weeks. Data included 1) patient arrival time, 2) lab collection time, 3) lab result time, 4) chemotherapy order time, 5) chemotherapy delivery time to clinic, 6) chemotherapy administration time. Each clinic created their individual process map and cause/effect diagram. Additional measures collected were patient satisfaction scores, parent and staff surveys before and after the intervention. Each clinic site met weekly and the network of the 3 clinics met monthly to review all results. Using the baseline data, each clinic identified points in care where interventions could reduce chemotherapy wait time based on reviewing their own and other clinics’ data. Interventions included moving lab collection earlier in the visit, additional pharmacy staff to deliver chemotherapy and placing an electronic monitor to alert providers when lab resulted. Results: Within 4 months of the interventions all sites had a reduction in chemotherapy wait times (Site A 144m-pre, 134m-post; Site B 163m-pre, 140m-post; Site C 137m-pre, 116m-post). Parent and staff surveys are in process. Conclusions: Each clinic was able to reduce chemotherapy times using different interventions depending on their internal process, moreover each clinic learned how to improve from each other’s processes.
Improving support for smoking cessation in medical oncology patients: A quality improvement initiative.
Authors: William Raskin, Cameron Phillips, Kirstin Perdrizet, Michael J. Raphael, Michael Herman, Joseph Del Paggio, Monica Panetta, Sonal Gandhi, Katherine Enright
Journal: Journal of Clinical Oncology (2018)

148 Background: Smoking cessation is integral to cancer care. Active smoking is associated with increased toxicity of treatment, poorer response to therapy and is associated with worse overall survival. Patients who quit smoking at diagnosis have better survival outcomes. Cancer Care Ontario has aimed to improve rates of smoking screening and referral to smoking cessation programs based on the validated Ottawa model. Methods: We aimed to implement an “opt-out” referral process for recent or current smokers to a smoking cessation program at the Credit Valley Hospital. We aimed to achieve a referral rate of 20%, based on an institutional baseline of 8.5% and a provincially defined target of 20%. Key stakeholders targeted included nursing, administration, physicians, smoking cessation counsellors and patients. Sequential education interventions were delivered to address gaps in patient and provider knowledge; these included grand rounds, an informal lecture and an educational pamphlet. Results: After the initiative was launched, the referral rate increased from 8.5% to 14.3%. The impact of each intervention is summarized in Table 1. Conclusions: Smoking cessation referrals increased with new process but not to target. Patient refusals lead to a low rate of referral, warranting efforts aimed at addressing patient barriers. Future outcome measures may include smoking cessation rates. [Table: see text]
The influence of patient engagement on the design and implementation of a clinical trial to improve cancer care delivery.
Authors: Sarah Barger, Sean D Sullivan, Gary H. Lyman, Dawn L. Hershman, Ari Bell-Brown, Kate Watabayashi, Kathryn Egan, Karma L. Kreizenbeck, Annemarie Ciccarella, Mark Gorman, Brad Bott, Guneet Walia, Judy Johnson, Carole Seigel, Elda Railey, Ginny Mason, Robert L. Erwin, Florence Kurttila, Barbara Segarra-Vazquez, Scott David Ramsey
Journal: Journal of Clinical Oncology (2018)

223 Background: We have engaged 10 patient partners in the development and implementation of S1415CD, a five-year pragmatic clinical trial currently in year 3 assessing the effectiveness of a guideline-based colony stimulating factor standing order intervention (NCT02728596). Patient partners serve as part of a 21-person External Stakeholder Advisory Group (ESAG), which also includes providers, payers and guidelines experts. This abstract explores the influence of patient partners on the design, tools and implementation of S1415CD Methods: Patient partners advise the study team on protocol development, patient-facing materials and implementation challenges over four teleconferences each year, annual in-person meetings and targeted email communication. All patient partner input from 2014-2017 was tracked, collected and reviewed for impact on the trial. Results: Input from patient partners led to the refinement of the study’s patient-reported outcome (PRO) survey questions, the creation of a highly utilized patient brochure, and the formation of talking points for clinic staff to help explain the study. Patient partners in conjunction with high performing sites helped develop strategies for sites with lower patient accrual to optimize the approach and consent of study participants. Conclusions: The sustained engagement of patient partners in S1415CD ensured patient-centeredness in trial design and guided the development of PRO surveys and relevant, high quality patient-facing materials. Drawing on experiential knowledge and insights from their roles as caregivers and advocates, patient partners provided valuable feedback that influenced patient approach and engagement in the study. Embedding patient partners in the research continuum has catalyzed critical discussions and problem solving among the patient partners and study team, which has led to patient-centered solutions to study challenges. Clinical trial information: NCT02728596.
Decreased survival and increased rate of fibrotic progression in essential thrombocythemia chronicled after the FDA approval date of anagrelide
Authors: Ayalew Tefferi, Natasha Szuber, Rangit R. Vallapureddy, Kebede H. Begna, Mrinal M. Patnaik, Michelle A. Elliott, C. Christopher Hook, Alexandra P. Wolanskyj, Curtis A. Hanson, Rhett P. Ketterling, Animesh Pardanani, Naseema Gangat
Journal: American Journal of Hematology (2018)

Abstract First‐line cytoreductive drug of choice in high risk essential thrombocythemia (ET) is currently hydroxyurea, a practice based on the results of a randomized study; second‐line drugs of choice include pegylated interferon‐α, busulfan and anagrelide. Anagrelide clinical trials were pioneered by the late Murray N. Silverstein (1928‐1998) of the Mayo Clinic whose studies led to FDA approval in March 1997. The current study represents a retrospective examination of the potential impact of anagrelide therapy on survival and disease complications in ET. 1076 patients with ET were considered (median age 58 years; females 63%); risk distribution, according to the international prognostic score for ET (IPSET), was 28% high, 42% intermediate, and 30% low. Overall (OS), myelofibrosis‐free (MFFS) and thrombosis‐free survival data were compared for ET patients diagnosed before and after the 1997 FDA approval date for anagrelide; a significant difference was apparent in OS ( P = .006; HR 1.4, 95% CI 1.1‐1.7) and MFFS ( P &lt; .001; HR 4.2, 95% CI 2.7‐6.5), in favor of patients diagnosed prior to 1997; the difference was sustained during multivariable analysis that included IPSET. Similarly stratified survival data in polycythemia vera ( n = 665) and primary myelofibrosis ( n = 1282) showed no similar impact on survival ( P = .3 and .17, respectively). The current study represents a retrospective analysis and suggests significantly decreased OS and MFFS in ET patients diagnosed after the FDA approval date of anagrelide. Whether or not anagrelide therapy was to blame for the worsening of OS and MFFS over time cannot be assumed and requires validation in a prospective study.
Investigating unilateral pleural effusions: the role of cytology
Authors: David T. Arnold, Duneesha De Fonseka, Siobhan Perry, Anna Morley, John E. Harvey, Andrew Medford, Mary Brett, Nick A. Maskell
Journal: European Respiratory Journal (2018)

The vast majority of undiagnosed unilateral pleural effusions have fluid sent for cytological analysis. Despite widespread use, there is uncertainty about its sensitivity to diagnose malignant pleural effusions (MPEs). Our aim was to ascertain the utility of cytology using a large prospective cohort. Consecutive patients presenting with an undiagnosed unilateral pleural effusion were recruited to this UK-based study. All had pleural fluid sent for cytological analysis. Cytological sensitivity was based on the final diagnosis at 12 months, confirmed by two consultants. Over 8 years, 921 patients were recruited, of which 515 had a MPE. Overall sensitivity of fluid cytology to diagnose malignancy was 46% (95% CI 42–58%). There was variation in sensitivity depending on cancer primary, with mesothelioma (6%) and haematological malignancies (40%) being significantly lower than adenocarcinomas (79%). MPEs secondary to ovarian cancer had high pick-up rates (95%). In asbestos-exposed males with exudative effusions, the risk of MPE was 60%, but cytological sensitivity was 11%. This is the largest prospective study of pleural fluid cytology and informs discussions with patients about the likely requirement for investigations following thoracentesis. In patients presenting with a clinical suspicion of mesothelioma, cytological sensitivity is low, so more definitive investigations could be performed sooner.