Douglas W. Blayney
Professor of Medicine (Oncology), Emeritus
Medicine - Oncology
Web page: http://web.stanford.edu/people/dblayney
Bio
Douglas W. Blayney, MD is a Professor of Medicine (Oncology), Emeritus, former Medical Director of Stanford Cancer Center, and specializes in the treatment of breast cancer. He has a special interest in the quality and value of cancer care. Dr. Blayney is a past president of the American Society of Clinical Oncology (ASCO), a founder of the ASCO Quality Symposium, a co-author of the ASCO value framework descriptions, and instigated the ASCO clinical "big data" effort, which is now CancerLinQ. He received the inaugural Ellen Stovall Award for Leadership in Patient Centered Care from the National Coalition for Cancer Survivorship in 2016. He was previously a Professor of Internal Medicine and Medical Director of the Comprehensive Cancer Center at the University of Michigan, and prior to that practiced and led Wilshire Oncology Medical Group, Inc. a physician owned multidisciplinary oncology practice in southern California. He has expertise on clinical trial development, use of oncology drugs in clinical practice, reimbursement and marketing strategies and information technology use.
Dr. Blayney's research interests include breast cancer, febrile neutropenia mitigation, and the use big data to improve cancer care quality and value. He has over 90 scientific publications. Dr. Blayney has served on the Food and Drug Administration's Oncologic Drugs Advisory Committee, and is Founding Editor-in-Chief and Editor-in-Chief Emeritus of ASCO's Journal of Oncology Practice. He has a degree in electrical engineering from Stanford, is a graduate of the University of California, San Diego School of Medicine, and received post graduate training at UCSD and at the National Cancer Institute in Bethesda, Maryland.
He is married, and has three grown daughters, one of whom is also a physician.
Academic Appointments
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Emeritus Faculty - University Medical Line, Medicine - Oncology
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Member, Stanford Cancer Institute
Administrative Appointments
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President, Wilshire Oncology Medical Group, Inc. (1996 - 2003)
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Medical Director, University of Michigan Comprehensive Cancer Center (2003 - 2010)
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Medical Director, Stanford Cancer Center (2010 - 2015)
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Medical Director for Quality, Stanford Cancer Institute (2015 - 2022)
Honors & Awards
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Joseph V. Simone Award for Excellence in Quality and Safety in the Care of Patients with Cancer, American Society of Clinical Oncology (2018)
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The Ellen Stovall Award for Leadership in Patient-Centered Care, National Coalition for Cancer Survivorship (2016)
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President, American Society of Clinical Oncology (2009-10)
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Best Doctors in America, . (2007 - current)
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Fellow, American Society of Clinical Oncology (2007)
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Fellow, American College of Physicians (1991)
Professional Education
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Medical Education: University of California San Diego School of Medicine (1977) CA
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Residency: UCSD Internal Medicine Residency (1980) CA
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Fellowship: National Cancer Institute - Center Cancer Research (1983) MD
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Board Certification: American Board of Internal Medicine, Medical Oncology (1983)
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Board Certification: American Board of Internal Medicine, Internal Medicine (1980)
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Fellowship, Medicine Branch, National Cancer Institute, Bethesda, Maryland (1983)
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Fellowship, Environmental Epidemiology Branch, National Cancer Institute, Bethesda, Maryland (1983)
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Resident, University of California Hospitals, San Diego (1980)
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M.D., University of California, San Diego (1977)
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B.S.E.E., Stanford University (1972)
Current Research and Scholarly Interests
During my tenure as Medical Director of the Stanford Cancer Institute (2010-15)
The Patient Experience, as measured by the Press-Ganey question “Likelihood to Recommend the Institution” for care, increased from the ninth percentile to consistently above the 90 percentile.
I co-led a task force that developed a strategic plan for the clinical operations of SCI, which was incorporated into a larger plan to transform cancer care at Stanford and nationwide. This plan resulted in a large gift, a substantial portion of which is allocated to Transform Cancer Care at Stanford and the nation (“the Transformation”).
Growth, as measured by new patient visits, increased by eleven percent year over year starting in fiscal year 2012, the year in which we set a goal to grow by fifty percent by 2017.
Stanford’s Cancer Program has increased its ranking to number 10 in the nation for 2014 in the US News and World Report’s (USNWR) latest ranking of cancer programs. Stanford ranked 14th in 2011. Cancer is the highest ranked Stanford Program in the USNWR system.
Clinical Trials
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A Study Evaluating Talazoparib (BMN 673), a PARP Inhibitor, in Advanced and/or Metastatic Breast Cancer Patients With BRCA Mutation (EMBRACA Study)
Not Recruiting
The purpose of this open-label, 2:1 randomized phase III trial is to compare the safety and efficacy of talazoparib (also known as BMN 673) versus protocol-specific physician's choice in patients who have locally advanced and/or metastatic breast cancer with germline BRCA mutations.
Stanford is currently not accepting patients for this trial. For more information, please contact Cancer Clinical Trials Office (CCTO), 650-498-7061.
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A Study of Abemaciclib (LY2835219) Combined With Fulvestrant in Women With Hormone Receptor Positive HER2 Negative Breast Cancer
Not Recruiting
The main purpose of this study is to compare progression-free survival for women with hormone receptor positive (HR+), human epidermal growth factor receptor (HER2) negative advanced breast cancer receiving either abemaciclib + fulvestrant or fulvestrant alone. Participants will be randomized to abemaciclib or placebo in a 2:1 ratio. The study will last about 9 months for each participant. For the endocrine naïve cohort, all participants will received abemaciclib + fulvestrant.
Stanford is currently not accepting patients for this trial. For more information, please contact Annabel Castaneda, 650-498-7977.
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A Study of Atezolizumab and Paclitaxel Versus Placebo and Paclitaxel in Participants With Previously Untreated Locally Advanced or Metastatic Triple Negative Breast Cancer (TNBC)
Not Recruiting
This Phase 3, multicenter, randomized, double-blind, placebo controlled study is designed to evaluate the efficacy and safety of atezolizumab (MPDL3280A, an anti-programmed death-ligand 1 \[PD-L1\] antibody) administered in combination with paclitaxel compared with placebo in combination with paclitaxel in participants with previously untreated, inoperable locally advanced or metastatic, centrally confirmed TNBC. Participants will be randomized in a 2:1 ratio to receive atezolizumab or placebo plus paclitaxel until disease progression or unacceptable toxicity or end of study, whichever occurs first (maximum up to approximately 40 months). In addition, the Sponsor may decide to terminate the study at any time.
Stanford is currently not accepting patients for this trial. For more information, please contact Cancer Clinical Trials Office (CCTO), 650-498-7061.
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A Study of Palbociclib in Addition to Standard Endocrine Treatment in Hormone Receptor Positive Her2 Normal Patients With Residual Disease After Neoadjuvant Chemotherapy and Surgery
Not Recruiting
The PENELOPEB study is designed to demonstrate that, in the background of standard anti-hormonal therapy, palbociclib provides superior invasive disease-free survival (iDFS) compared to placebo in pre- and postmenopausal women with HR-positive/HER2-normal early breast cancer at high risk of relapse after showing less than pathological complete response to neoadjuvant taxane- containing chemotherapy. Considering the high risk of recurrence in patients after neoadjuvant chemotherapy and a high CPS-EG score, palbociclib appears to be an attractive option with a favourable safety profile for these patients.
Stanford is currently not accepting patients for this trial. For more information, please contact Amy Isaacson, 650-723-0501.
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A Study of Trastuzumab Emtansine (Kadcyla) Plus Pertuzumab (Perjeta) Following Anthracyclines in Comparison With Trastuzumab (Herceptin) Plus Pertuzumab and a Taxane Following Anthracyclines as Adjuvant Therapy in Participants With Operable HER2-Positive Primary Breast Cancer
Not Recruiting
This two-arm, randomized, open-label, multicenter study will evaluate the efficacy and safety of trastuzumab emtansine in combination with pertuzumab versus trastuzumab in combination with pertuzumab and a taxane as adjuvant therapy in participants with human epidermal growth (HER) factor 2 (HER2)-positive primary invasive breast cancer. Following surgery and anthracycline-based chemotherapy, participants will receive either trastuzumab emtansine at a dose of 3.6 milligrams per kilogram (mg/kg) and pertuzumab at a dose of 420 milligrams (mg) intravenously (IV) every 3 weeks (q3w) or trastuzumab at a dose of 6 mg/kg and pertuzumab at a dose of 420 mg IV q3w in combination with a taxane.
Stanford is currently not accepting patients for this trial. For more information, please contact Annabel Castaneda, 650-498-7977.
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Brief Behavioral Intervention for Insomnia During Chemotherapy
Not Recruiting
PRIMARY OBJECTIVE(S): To evaluate the efficacy of the Brief Behavioral Therapy for Insomnia (BBT-I) in treating insomnia among breast cancer patients receiving chemotherapy. SECONDARY OBJECTIVE(S): * To evaluate the efficacy of the BBT-I in treating cancer-related symptoms such as cancer-related fatigue and cognitive difficulties in breast cancer patients receiving chemotherapy. * To examine potential moderators and mediators of BBT-I intervention effects on insomnia, cognitive difficulties, and fatigue. In particular, we are interested in age, depression and anxiety and side effects (hot flashes) as potential moderators of the intervention effects as well as evaluating modifiable behavioral and physiological mechanisms as hypothesized mediators
Stanford is currently not accepting patients for this trial. For more information, please contact Oxana Palesh, 650-725-7011.
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Chemotherapy With or Without Trastuzumab After Surgery in Treating Women With Invasive Breast Cancer
Not Recruiting
This randomized phase III clinical trial studies chemotherapy with or without trastuzumab after surgery to see how well they work in treating women with invasive breast cancer. Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving more than one drug (combination chemotherapy) and giving chemotherapy after surgery may kill more tumor cells. Monoclonal antibodies, such as trastuzumab, can block cancer growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. It is not yet known whether combination chemotherapy is more effective with trastuzumab in treating breast cancer.
Stanford is currently not accepting patients for this trial. For more information, please contact Amy Isaacson, 650-723-0501.
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Docetaxel, Carboplatin, Trastuzumab, and Pertuzumab With or Without Estrogen Deprivation in Treating Patients With Hormone Receptor-Positive, HER2-Positive Operable or Locally Advanced Breast Cancer
Not Recruiting
This randomized phase III trial studies docetaxel, carboplatin, trastuzumab, and pertuzumab with estrogen deprivation to see how they work compared to docetaxel, carboplatin, trastuzumab, and pertuzumab without estrogen deprivation in treating patients with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-positive breast cancer that is operable or has spread from where it started to nearby tissue or lymph nodes (locally advanced). Drugs used in chemotherapy, such as docetaxel, carboplatin, trastuzumab, and pertuzumab, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving more than one drug (combination chemotherapy) may kill more tumor cells. Estrogen can cause the growth of breast cancer cells. Hormone therapy using goserelin acetate and aromatase inhibition therapy may fight breast cancer by blocking the use of estrogen by the tumor cells. Radiation therapy uses high energy x rays to kill tumor cells. Giving combination chemotherapy and radiation therapy with or without hormone therapy may be an effective treatment for hormone receptor-positive, HER2-positive, operable or locally advanced breast cancer.
Stanford is currently not accepting patients for this trial. For more information, please contact Amy Isaacson, 650-723-0501.
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Olaparib as Adjuvant Treatment in Patients With Germline BRCA Mutated High Risk HER2 Negative Primary Breast Cancer
Not Recruiting
Olaparib treatment in patients with germline BRCA1/2 mutations and high risk HER2 negative primary breast cancer who have completed definitive local treatment and neoadjuvant or adjuvant chemotherapy
Stanford is currently not accepting patients for this trial. For more information, please contact Amy Isaacson, 650-723-0501.
2023-24 Courses
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Independent Studies (5)
- Directed Reading in Medicine
MED 299 (Aut, Win, Spr, Sum) - Early Clinical Experience in Medicine
MED 280 (Aut, Win, Spr, Sum) - Graduate Research
MED 399 (Aut, Win, Spr, Sum) - Medical Scholars Research
MED 370 (Aut, Win, Spr, Sum) - Undergraduate Research
MED 199 (Aut, Win, Spr, Sum)
- Directed Reading in Medicine
All Publications
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Automated patient selection and care coaches to increase advance care planning for cancer patients.
Journal of the National Cancer Institute
2024
Abstract
Advance care planning/serious illness conversations can help clinicians understand patients' values and preferences. There are limited data on how to increase these conversations, and their effect on care patterns. We hypothesized that using a machine learning survival model to select patients for serious illness conversations, along with trained care coaches to conduct the conversations, would increase uptake in cancer patients at high risk of short-term mortality.We conducted a cluster-randomized stepped wedge study on the physician level. Oncologists entered the intervention condition in a random order over six months. Adult patients with metastatic cancer were included. Patients with <2 year computer-predicted survival and no prognosis documentation were classified as high-priority for serious illness conversations. In the intervention condition, providers received automated weekly emails highlighting high-priority patients and were asked to document prognosis for them. Care coaches reached out to these patients to conduct the remainder of the conversation. The primary endpoint was proportion of visits with prognosis documentation within 14 days.6,372 visits in 1,825 patients were included in the primary analysis. The proportion of visits with prognosis documentation within 14 days was higher in the intervention condition than control condition: 2.9% vs 1.1% (adjusted odds ratio 4.3, p < .0001). The proportion of visits with advance care planning documentation was also higher in the intervention condition: 7.7% vs 1.8% (adjusted odds ratio 14.2, p < .0001). In high-priority visits, advance care planning documentation rate in intervention/control visits was 24.2% vs 4.0%.The intervention increased documented conversations, with contributions by both providers and care coaches.
View details for DOI 10.1093/jnci/djae243
View details for PubMedID 39348179
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Acceptance and usability testing of a visual care-navigation tool for patients, survivors, caregivers, nurses, and oncologists
LIPPINCOTT WILLIAMS & WILKINS. 2024
View details for Web of Science ID 001275557403180
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Long-Term Engagement of Patients With Advanced Cancer: Results From the EPAC Randomized Clinical Trial.
JAMA oncology
2024
Abstract
The long-term effect of interventions that assist patients with establishing their end-of-life care preferences among patients with cancer remain relatively unknown.To evaluate the association of a long-term intervention of a lay health worker-led advance care planning intervention among patients with advanced stages of cancer with overall survival and end-of-life health care use and costs.This follow-up study of the EPAC randomized clinical trial conducted between August 2013 and February 2015 used data from 9.4 years after the first patient was enrolled with a data cut-off date of February 1, 2023. Overall, 213 participants with stage 3 or 4 or recurrent cancer in the US Veterans Affairs Palo Alto Health Care System were included.A 6-month lay health worker-led education and support intervention to assist patients with establishing their end-of-life preferences vs usual care.The outcomes of interest were overall survival, risk of death, restricted mean survival time, and palliative care, hospice, and acute care use in the final 30 days before death for participants who died.Among 213 participants randomized and included in the intention-to-treat analysis, the mean (SD) age was 69.3 (9.1) years; 211 (99.1%) were male, 2 (0.90%) were female. There were no demographic or clinical characteristic imbalances at enrollment. As of February 1, 2023, 188 had died. The intervention group had a 25% reduction in risk of death (hazard ratio, 0.75; 95% CI, 0.56-0.98); more palliative care (44 [50.0%] vs 35 [35.0%]) and hospice use (64 [72.7%] vs 53 [53.0%]); and lower emergency department use (20 [22.7%] vs 47 [47.0%]), hospitalizations (17 [19.3%] vs 46 [46.0%]), and median (IQR) total health care costs (median [IQR], $1637 [$383-$9026] vs $18 520 [$4790-$50 729]) than control group participants.The effects of the lay health worker-led intervention remain durable, with nearly complete follow-up, supporting integration into routine cancer care.ClinicalTrials.gov Identifier: NCT02966509.
View details for DOI 10.1001/jamaoncol.2024.1221
View details for PubMedID 38814627
View details for PubMedCentralID PMC11140577
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Evidence of compensatory neural hyperactivity in a subgroup of chemotherapy-treated breast cancer survivors and its association with brain aging.
medRxiv : the preprint server for health sciences
2024
Abstract
Chemotherapy-related cognitive impairment (CRCI) remains poorly understood in terms of the mechanisms of cognitive decline. Neural hyperactivity has been reported on average in cancer survivors, but it is unclear which patients demonstrate this neurophenotype, limiting precision medicine in this population. We evaluated a retrospective sample of 80 breast cancer survivors and 80 non-cancer controls, age 35-73, for which we had previously identified and validated three data-driven, biological subgroups (biotypes) of CRCI. We measured neural activity using the z-normalized percent amplitude of fluctuation from resting state functional magnetic resonance imaging (MRI). We tested established, quantitative criteria to determine if hyperactivity can accurately be considered compensatory. We also calculated brain age gap by applying a previously validated algorithm to anatomic MRI. We found that neural activity differed across the three CRCI biotypes and controls (F = 13.5, p < 0.001), with Biotype 2 demonstrating significant hyperactivity compared to the other groups (p < 0.004, corrected), primarily in prefrontal regions. Alternatively, Biotypes 1 and 3 demonstrated significant hypoactivity (p < 0.02, corrected). Hyperactivity in Biotype 2 met several of the criteria to be considered compensatory. However, we also found a positive relationship between neural activity and brain age gap in these patients (r = 0.45, p = 0.042). Our results indicated that neural hyperactivity is specific to a subgroup of breast cancer survivors and, while it seems to support preserved cognitive function, it could also increase the risk of accelerated brain aging. These findings could inform future neuromodulatory interventions with respect to the risks and benefits of up or downregulation of neural activity.
View details for DOI 10.1101/2024.04.22.24306190
View details for PubMedID 38712178
View details for PubMedCentralID PMC11071584
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Predicting Depression Risk in Patients With Cancer Using Multimodal Data: Algorithm Development Study.
JMIR medical informatics
2024; 12: e51925
Abstract
BACKGROUND: Patients with cancer starting systemic treatment programs, such as chemotherapy, often develop depression. A prediction model may assist physicians and health care workers in the early identification of these vulnerable patients.OBJECTIVE: This study aimed to develop a prediction model for depression risk within the first month of cancer treatment.METHODS: We included 16,159 patients diagnosed with cancer starting chemo- or radiotherapy treatment between 2008 and 2021. Machine learning models (eg, least absolute shrinkage and selection operator [LASSO] logistic regression) and natural language processing models (Bidirectional Encoder Representations from Transformers [BERT]) were used to develop multimodal prediction models using both electronic health record data and unstructured text (patient emails and clinician notes). Model performance was assessed in an independent test set (n=5387, 33%) using area under the receiver operating characteristic curve (AUROC), calibration curves, and decision curve analysis to assess initial clinical impact use.RESULTS: Among 16,159 patients, 437 (2.7%) received a depression diagnosis within the first month of treatment. The LASSO logistic regression models based on the structured data (AUROC 0.74, 95% CI 0.71-0.78) and structured data with email classification scores (AUROC 0.74, 95% CI 0.71-0.78) had the best discriminative performance. The BERT models based on clinician notes and structured data with email classification scores had AUROCs around 0.71. The logistic regression model based on email classification scores alone performed poorly (AUROC 0.54, 95% CI 0.52-0.56), and the model based solely on clinician notes had the worst performance (AUROC 0.50, 95% CI 0.49-0.52). Calibration was good for the logistic regression models, whereas the BERT models produced overly extreme risk estimates even after recalibration. There was a small range of decision thresholds for which the best-performing model showed promising clinical effectiveness use. The risks were underestimated for female and Black patients.CONCLUSIONS: The results demonstrated the potential and limitations of machine learning and multimodal models for predicting depression risk in patients with cancer. Future research is needed to further validate these models, refine the outcome label and predictors related to mental health, and address biases across subgroups.
View details for DOI 10.2196/51925
View details for PubMedID 38236635
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Computing the Cost of Care per Patient per Day for Patients With Metastatic Neuroendocrine Neoplasms.
JCO oncology practice
2023: OP2300433
Abstract
PURPOSE: Patients with well-differentiated, low-grade metastatic neuroendocrine neoplasms (NENs) usually have a long median survival and require complex, expensive care over many years at multidisciplinary centers. The cost burden for patients and institutions serves as a barrier to care. Understanding the drivers of these costs and whether intense monitoring adds value will help to optimize value-based care.METHODS: We adapted the cost of care per patient per day (CCPD) validated methodology to measure cost while accounting for varying follow-up duration. We queried the Stanford NEN Database, which aggregates data from the electronic health record and other electronic sources, to study patients with metastatic NENs receiving regular care at Stanford. Current Procedural Terminology codes for services incurred during the monitoring period for each patient were mapped to the corresponding cost conversion factor and date in the Medicare fee schedule.RESULTS: Two hundred two patients between 2010 and 2017 were studied with a mean CCPD of $119.11 in US dollars (USD); NEN-specific systemic therapy made up 55% of this cost. Somatostatin analogs were the costliest systemic therapy. Systemic therapy was the driver of cost differences among patients with various primary tumor types, stage of disease, tumor differentiation and grade, and functional hormone status. Patients in the most expensive CCPD group did not have a significant survival benefit (P = .66).CONCLUSION: The CCPD methodology was effective in studying cancer care value in NENs. Systemic therapy, specifically somatostatin analogs, was the primary driver of cost, and intense monitoring and higher-cost care did not improve survival outcomes.
View details for DOI 10.1200/OP.23.00433
View details for PubMedID 38096469
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Real-World Impact of Prophylactic Growth Factor Use on Timing of Febrile Neutropenia and Infection After High-Risk Chemotherapy.
Journal of the National Comprehensive Cancer Network : JNCCN
2023; 21 (9): 945-950.e16
Abstract
Prophylactic growth-factor therapy with granulocyte colony-stimulating factor (G-CSF) reduces the risk of febrile neutropenia (FN) in patients with breast cancer initiating myelosuppressive chemotherapy. However, little is known about the protective benefit early in the chemotherapy cycle.To assess the relationship between G-CSF prophylaxis and incidence of FN/infection in week 1 versus beyond week 1 of the first chemotherapy cycle, a retrospective study was conducted using Medicare claims from 2005 through 2020 among patients with breast cancer initiating high-risk chemotherapy. Two cohorts were compared based on G-CSF prophylaxis within 3 days following chemotherapy initiation. The primary outcome was FN or infection, defined as hospitalization with neutropenia, fever, or infection diagnosis. Secondary outcomes were a stricter definition of FN and infection-related hospitalization. Unadjusted and regression-adjusted proportions of patients experiencing each outcome during week 1 versus beyond week 1 of the first chemotherapy cycle were compared.Of 78,810 patients meeting all inclusion criteria (>98% female; mean age, 69 years), 79% initiated TC (docetaxel/cyclophosphamide), 14% TCH (docetaxel/carboplatin/trastuzumab), and 7% TAC (docetaxel/doxorubicin/cyclophosphamide). Among patients receiving G-CSF (74%), incidence of first-cycle FN/infection was lower compared with patients not receiving G-CSF (overall, 6% vs 13%; TAC, 12% vs 19%; TC, 6% vs 12%; TCH, 5% vs 15%). However, patients who received G-CSF were generally more likely to experience FN/infection in week 1 (adjusted odds ratio [aOR], 1.24 for all; 1.73 for TAC; 1.35 for TC; and 0.76 for TCH). Results were similar for strictly defined FN (overall aOR, 1.29 for week 1 and 0.12 for beyond week 1) and infection-related hospitalization (overall aOR, 1.33 for week 1 and 0.27 for beyond week 1).Overall, the rates of chemotherapy-related FN and infection in week 1 of the first chemotherapy cycle are similar for patients receiving and not receiving G-CSF, suggesting continued risk in week 1 despite prophylactic G-CSF.
View details for DOI 10.6004/jnccn.2023.7044
View details for PubMedID 37673111
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Engagement of Patients with Advanced Cancer (EPAC) randomized clinical trial: Long-term effects on survival and healthcare use
LIPPINCOTT WILLIAMS & WILKINS. 2023
View details for Web of Science ID 001053772000235
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Prevention of chemotherapy-induced neutropenia (CIN) with plinabulin (Plin) vs placebo (Plac) in patients (pts) with non-small cell lung cancer (NSCLC) treated with docetaxel (Doc): A pooled analysis from 3 randomized trials
LIPPINCOTT WILLIAMS & WILKINS. 2023
View details for Web of Science ID 001053772004886
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Safety, tolerability, and quality of life (QoL) of single-agent plinabulin (Plin) for the prevention of docetaxel (Doc) chemotherapy (chemo)-induced neutropenia (CIN) in non-small cell lung cancer (NSCLC) patients (pts) from two randomized trials
LIPPINCOTT WILLIAMS & WILKINS. 2023
View details for Web of Science ID 001053772004889
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Predicting Depression Risk in Patients with Cancer Using Multimodal Data.
Studies in health technology and informatics
2023; 302: 817-818
Abstract
When patients with cancer develop depression, it is often left untreated. We developed a prediction model for depression risk within the first month after starting cancer treatment using machine learning and Natural Language Processing (NLP) models. The LASSO logistic regression model based on structured data performed well, whereas the NLP model based on only clinician notes did poorly. After further validation, prediction models for depression risk could lead to earlier identification and treatment of vulnerable patients, ultimately improving cancer care and treatment adherence.
View details for DOI 10.3233/SHTI230274
View details for PubMedID 37203503
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Grade 4 Neutropenia Frequency as a Binary Risk Predictor for Adverse Clinical Consequences of Chemotherapy‑Induced Neutropenia: A Meta-analysis.
Cancer investigation
2023: 1-23
Abstract
Neutropenia is the major toxicity of myelosuppressive cancer chemotherapy. Grade 4 neutropenia (Gr4N) is a measure of chemotherapy-induced neutropenia (CIN) severity.We conducted a meta-analysis of CIN data. Gr4N incidence was significantly correlated with febrile neutropenia (FN), days of severe neutropenia (DSN), and nadir absolute neutrophil count (ANC), which are all important predictors of morbidity. With a Gr4N threshold of 65%, both FN and DSN were below levels for low risk of adverse CIN outcomes. Gr4N was highly predictive for adverse CIN outcomes, and a 65% threshold demarcated low vs. high risk for FN and other adverse CIN outcomes.
View details for DOI 10.1080/07357907.2023.2179064
View details for PubMedID 36856462
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Prevention of Docetaxel (Doc)-Induced Neutropenia (DIN) with Single Agent Plinabulin (Plin) Versus (vs) Control (No-Treatment or Placebo) in Non-Small Cell Lung Cancer (NSCLC) in Two Randomized Trials
AMER SOC HEMATOLOGY. 2022: 2610-2611
View details for DOI 10.1182/blood-2022-166861
View details for Web of Science ID 000893223202269
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A Bioinformatic Approach to the Clinical Evaluation of Linear Commitment Versus Cloud (Continuum of Low Primed UnDifferentiated) Models for Hematopoiesis Using Plinabulin Clinical Trial Data
AMER SOC HEMATOLOGY. 2022: 11165-11166
View details for DOI 10.1182/blood-2022-167277
View details for Web of Science ID 000893230304091
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Superior single agent effectiveness with plinabulin (Plin) versus (vs) placebo (Plac) for docetaxel (Doc)-induced neutropenia (DIN) prevention in non-small cell lung cancer (NSCLC) patients (pts)
ELSEVIER. 2022: 1541
View details for DOI 10.1016/j.annonc.2022.10.303
View details for Web of Science ID 000897943700274
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Clinical evaluation of plinabulin's granulocyte-monocyte progenitor (GMP) stem cell effects for the prevention of chemotherapy-induced neutropenia (CIN)
ELSEVIER. 2022: S1271
View details for DOI 10.1016/j.annonc.2022.07.1681
View details for Web of Science ID 000866211602140
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Chemotherapy-induced neutropenia and emerging agents for prevention and treatment: A review.
Cancer treatment reviews
2022; 109: 102427
View details for DOI 10.1016/j.ctrv.2022.102427
View details for PubMedID 35785754
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Reducing inpatient mortality in patients with cancer through multidisciplinary review and targeted interventions.
LIPPINCOTT WILLIAMS & WILKINS. 2022
View details for Web of Science ID 000863680300580
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Real-world effectiveness of prophylactic granulocyte colony-stimulating factor (G-CSF) early (week 1) and late (weeks 2-3) in the cycle for the prevention of febrile neutropenia (FN) among patients (pts) with breast cancer (BC) after high FN-risk chemotherapy (chemo).
LIPPINCOTT WILLIAMS & WILKINS. 2022
View details for Web of Science ID 000863680301697
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Surgical solution for a paraneoplastic neurodegenerative disorder
TRAUMA SURGERY & ACUTE CARE OPEN
2022; 7 (1)
View details for DOI 10.1136/tsaco-2022-000928
View details for Web of Science ID 000790371200001
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PREDICTIVE ENRICHMENT TO IDENTIFY RESPONSE TO SLEEP INTERVENTION IN CANCER SURVIVORS WITH HEADACHE - A PRECISION MEDICINE STUDY
OXFORD UNIV PRESS INC. 2022: S523
View details for Web of Science ID 000788118601467
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Cancer Biosimilars-A Regulatory Success So Far, but Value Still to Be Determined.
JAMA oncology
1800
View details for DOI 10.1001/jamaoncol.2021.6979
View details for PubMedID 35113156
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Efficacy of Plinabulin vs Pegfilgrastim for Prevention of Docetaxel-Induced Neutropenia in Patients With Solid Tumors: A Randomized Clinical Trial.
JAMA network open
1800; 5 (1): e2145446
Abstract
Importance: Prevention of chemotherapy-induced neutropenia (CIN) and its clinical consequences is an unmet need for which plinabulin, a selective immunomodulating microtubule-binding agent, is being tested.Objective: To demonstrate noninferiority between plinabulin and pegfilgrastim for days of severe neutropenia in cycle 1 in patients with solid tumors treated with docetaxel.Design, Setting, and Participants: The Plinabulin vs Pegfilgrastim for the Prevention of Docetaxel-Induced Neutropenia in Patients With Solid Tumors (PROTECTIVE-1) double-blind phase 3 randomized clinical trial was performed in multiple centers in China, Russia, Ukraine, and the US. Participants included patients with breast, prostate, or non-small cell lung cancer treated with single-agent docetaxel chemotherapy. Data were collected from June 1, 2018, to January 31, 2019. The database was locked on February 18, 2021. Data analysis was based on intention to treat and safety and performed from October 5, 2018, to February 23, 2021.Interventions: Plinabulin, 40 mg,plusplacebo or pegfilgrastim, 6 mg,plus placebo.Main Outcomes and Measures: The primary end point was day of severe neutropenia in cycle 1. Additional end points included clinical consequences of CIN (febrile neutropenia, hospitalizations, infections, antibiotic use, and modifications of chemotherapy dose), patient-reported outcomes for bone pain score, markers for immune suppression (neutrophil-to-lymphocyte ratio [NLR] of >5), immature neutrophils (band, promyelocyte, and myelocyte counts >0), and safety.Results: Among the 105 patients included in the analysis (65 [6.19%] women; median age, 59 [range, 31-81] years), the primary end point was met within a noninferiority margin of 0.65 days, with a mean difference of 0.52 days (98.52% CI, 0.40-0.65 days). Grade 4 neutropenia frequency in cycle 1 was not significantly different. Plinabulin had earlier onset of action with less grade 4 neutropenia in week 1 of cycle 1. Plinabulin had fewer adverse clinical consequences with rates of febrile neutropenia (0 of 52 vs 1 of 53 [1.9%]), infections (4 of 52 [7.7%] vs 8 of 53 [15.1%]), chemotherapy dose delay of more than 7 days (2 of 52 [3.8%] vs 3 of 53 [5.7%]), and permanent chemotherapy discontinuation (7 of 52 [13.5%] vs 14 of 53 [26.4%]). Patients receiving plinabulin had significantly less bone pain (difference,-0.67 [95% CI, -1.17 to -0.16]; P=.01) and a better immunosuppressive profile (NLR >5 at day 8, 2 of 52 [3.8%] vs 24 of 51 [46.0%]; P<.001). Plinabulin was well tolerated, with comparable safety to pegfilgrastim.Conclusions and Relevance: Plinabulin has comparable efficacy to pegfilgrastim for the prevention of CIN, with better safety and a better immunosuppressive profile. Plinabulin's same-day dosing compared with pegfilgrastim's next-day dosing offers distinct advantages, including reducing use of health care services.Trial Registration: ClinicalTrials.gov Identifier: NCT03102606.
View details for DOI 10.1001/jamanetworkopen.2021.45446
View details for PubMedID 35084480
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Plinabulin Rapidly (within 24 Hours) Reverses Myelosuppression Induced By Chemotherapy
AMER SOC HEMATOLOGY. 2021
View details for DOI 10.1182/blood-2021-150920
View details for Web of Science ID 000736413900057
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Association of treatment type with patient-reported quality of life in cancer distress screening
LIPPINCOTT WILLIAMS & WILKINS. 2021
View details for DOI 10.1200/JCO.2020.39.28_suppl.178
View details for Web of Science ID 000707130200177
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Preventing 30-day readmissions for patients with cancer: A root-cause analysis
LIPPINCOTT WILLIAMS & WILKINS. 2021
View details for DOI 10.1200/JCO.2020.39.28_suppl.226
View details for Web of Science ID 000707130200222
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Spotlight on International Quality: COVID-19 and Its Impact on Quality Improvement in Cancer Care.
JCO global oncology
2021; 7: 1513-1521
Abstract
This report from ASCO's International Quality Steering Group summarizes early learnings on how the COVID-19 pandemic and its stresses have disproportionately affected cancer care delivery and its delivery systems across the world. This article shares perspectives from eight different countries, including Austria, Brazil, Ghana, Honduras, Ireland, the Philippines, South Africa, and the United Arab Emirates, which provide insight to their unique issues, challenges, and barriers to quality improvement in cancer care during the pandemic. These perspectives shed light on some key recommendations applicable on a global scale and focus on access to care, importance of expanding and developing new treatments for both COVID-19 and cancer, access to telemedicine, collecting and using COVID-19 and cancer registry data, establishing measures and guidelines to further enhance quality of care, and expanding communication among governments, health care systems, and health care providers. The impact of the COVID-19 pandemic on cancer care and quality improvement has been and will continue to be felt across the globe, but this report aims to share these experiences and learnings and to assist ASCO's international members and our global fight against the pandemic and cancer.
View details for DOI 10.1200/GO.21.00281
View details for PubMedID 34714666
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Health management via telemedicine: Learning from the COVID-19 experience.
Journal of the American Medical Informatics Association : JAMIA
2021
Abstract
At the onset of the COVID-19 (coronavirus disease 2019) pandemic, telemedicine was rapidly implemented to protect patients and healthcare providers from infection. It is unlikely that care delivery will fully return to the pre-COVID form. Telemedicine offers many opportunities to improve care efficiency, accessibility, and patient outcomes, but many challenges exist related to technology interoperability, the digital divide, and usability. We propose that telemedicine evolve to support continuity of care throughout the patient journey, including multidisciplinary care teams and the seamless integration of data into the clinical workflow to support a learning healthcare system. Importantly, evidence is needed to support this paradigm shift in care delivery to ensure the quality and efficacy of care delivered via telemedicine. Here, we highlight gaps and opportunities that need to be addressed by the biomedical informatics community to move forward with safe and effective healthcare delivery via telemedicine.
View details for DOI 10.1093/jamia/ocab145
View details for PubMedID 34459475
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Headache outcomes of a sleep behavioral intervention in breast cancer survivors: Secondary analysis of a randomized clinical trial.
Cancer
2021
Abstract
BACKGROUND: Breast cancer survivors often have persisting headache. In a secondary analysis of the Brief Behavioral Therapy for Cancer-Related Insomnia (BBT-CI) clinical trial (ClinicalTrials.gov identifier NCT02165839), the authors examined the effects of BBT-CI on headache outcomes in patients with breast cancer.METHODS: Patients with breast cancer who were receiving chemotherapy were randomly assigned to receive either the BBT-CI intervention or the Healthy EAting Education Learning for healthy sleep (HEAL) control intervention, and both were delivered over 6 weeks by trained staff. Headache outcomes and heart rate variability (HRV) were measured at baseline, 6 weeks, 6 months, and 12 months. Mixed-effects models were used to examine longitudinal headache outcomes in the groups according to the intention to treat. Principal component analysis and agglomerative hierarchical clustering were conducted to reduce 16 variables for data-driven phenotyping.RESULTS: Patients in the BBT-CI arm (n = 73) exhibited a significant reduction in headache burden over time (P = .02; effect size [Cohen d] = 0.43), whereas the reduction was not significant among those in the HEAL arm (n = 66). The first principal component was positively loaded by headache, sleep, fatigue, and nausea/vomiting and was negatively loaded by cognitive, physical, and emotional functioning. Agglomerative hierarchical clustering revealed 3 natural clusters. Cluster I (n = 58) featured the highest burden of headache, insomnia, and nausea/vomiting; cluster II (n = 50) featured the lowest HRV despite a low burden of headache and insomnia; and cluster III (n = 31) showed an inverse relation between HRV and headache-insomnia, signifying autonomic dysfunction.CONCLUSIONS: BBT-CI is efficacious in reducing headache burden in breast cancer survivors. Patient phenotyping demonstrates a headache type featuring sleep disturbance, nausea/vomiting, and low physical functioning-revealing similarities to migraine.LAY SUMMARY: Breast cancer survivors often have persisting headache symptoms. In patients with cancer, treatment of chronic headache disorders using daily medications may be challenging because of drug interactions with chemotherapy and other cancer therapies as well as patients' reluctance to add more drugs to their medicine list. Headache and sleep disorders are closely related to each other. This study demonstrates that a sleep behavioral therapy reduced headache burden in breast cancer survivors. In addition, the majority of headache sufferers had a headache type with similarities to migraine-featuring sleep disturbance, nausea/vomiting, and low physical functioning.
View details for DOI 10.1002/cncr.33844
View details for PubMedID 34357593
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Diverse patient trajectories during cytotoxic chemotherapy: Capturing longitudinal patient-reported outcomes.
Cancer medicine
2021
Abstract
BACKGROUND: High-value cancer care balances effective treatment with preservation of quality of life. Chemotherapy is known to affect patients' physical and psychological well-being negatively. Patient-reported outcomes (PROs) provide a means to monitor declines in a patients' well-being during treatment.METHODS: We identified 741 oncology patients undergoing chemotherapy in our electronic health record (EHR) system who completed Patient-Reported Outcomes Measurement Information System (PROMIS) surveys during treatment at a comprehensive cancer center, 2013-2018. PROMIS surveys were collected before, during, and after chemotherapy treatment. Linear mixed-effects models were performed to identify predictors of physical and mental health scores over time. A k-mean cluster analysis was used to group patient PROMIS score trajectories.RESULTS: Mean global physical health (GPH) scores were 48.7 (SD 9.3), 47.7 (8.8), and 48.6 (8.9) and global mental health (GMH) scores were 50.4 (8.6), 49.5 (8.8), and 50.6 (9.1) before, during, and after chemotherapy, respectively. Asian race, Hispanic ethnicity, public insurance, anxiety/depression, stage III cancer, and palliative care were predictors of GPH and GMH decline. The treatment time period was also a predictor of both GPH and GMH decline relative to pre-treatment. Trajectory clustering identified four distinct PRO clusters associated with chemotherapy treatment.CONCLUSIONS: Patient-reported outcomes are increasingly used to help monitor cancer treatment and are now a part of care reimbursement. This study leveraged routinely collected PROMIS surveys linked to EHRs to identify novel patient trajectories of physical and mental well-being in oncology patients undergoing chemotherapy and potential predictors. Supportive care interventions in high-risk populations identified by our study may optimize resource deployment.NOVELTY AND IMPACT: This study leveraged routinely collected patient-reported outcome (PROMIS) surveys linked to electronic health records to characterize oncology patients' quality of life during chemotherapy. Important clinical and demographic predictors of declines in quality of life were identified and four novel trajectories to guide personalized interventions and support. This work highlights the utility of monitoring patient-reported outcomes not only before and after, but during chemotherapy to help advert adverse patient outcomes and improve treatment adherence.
View details for DOI 10.1002/cam4.4124
View details for PubMedID 34254459
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Identification of patients at high risk for preventable emergency department visits and inpatient admissions after starting chemotherapy: Machine learning applied to comprehensive electronic health record data.
LIPPINCOTT WILLIAMS & WILKINS. 2021
View details for DOI 10.1200/JCO.2021.39.15_suppl.1511
View details for Web of Science ID 000708120600211
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Impact of adding plinabulin to pegfilgrastim for the prevention of TAC chemotherapy (Chemo) induced neutropenia (CIN), on patient quality of life (QoL).
LIPPINCOTT WILLIAMS & WILKINS. 2021
View details for DOI 10.1200/JCO.2021.39.15_suppl.e24031
View details for Web of Science ID 000708120306061
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Clinical trial testing superiority of combination plinabulin (Plin) and pegfilgrastim (Peg) versus peg alone in breast cancer treated with high-risk febrile neutropenia risk chemotherapy (chemo): Final results of the phase 3 protective-2 in chemo-induced neutropenia (CIN) prevention.
LIPPINCOTT WILLIAMS & WILKINS. 2021
View details for DOI 10.1200/JCO.2021.39.15_suppl.533
View details for Web of Science ID 000708120600045
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Head-to-head comparison of single agent (SA) plinabulin (Plin) versus pegfilgrastim (Peg) for the prevention of chemotherapy-induced neutropenia (CIN) in the phase 3 trial PROTECTIVE-1.
LIPPINCOTT WILLIAMS & WILKINS. 2021
View details for DOI 10.1200/JCO.2021.39.15_suppl.547
View details for Web of Science ID 000708120600059
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Chemotherapy induced profound neutropenia (PN) in patients (pt) with breast cancer (BC) after chemotherapy and plinabulin (Plin) plus pegfilgrastim (Peg) combination versus (vs) peg alone: Final phase 3 results from protective-2 (BPI-2358-106).
LIPPINCOTT WILLIAMS & WILKINS. 2021
View details for DOI 10.1200/JCO.2021.39.15_suppl.546
View details for Web of Science ID 000708120600058
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EFFICACY OF BRIEF BEHAVIORAL THERAPY FOR HEADACHE MANAGEMENT IN BREAST CANCER PATIENTS RECEIVING CHEMOTHERAPY
OXFORD UNIV PRESS INC. 2021: S182
View details for Web of Science ID 000648922700370
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Differential efficacy of pegfilgrastim (Peg) in patients (pts) with breast cancer (BC) versus other cancer types for the prevention of docetaxel (Doc) chemotherapy-induced neutropenia (CIN)
AMER ASSOC CANCER RESEARCH. 2021
View details for Web of Science ID 000618737700445
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Plinabulin and pegfilgrastim (Plin plus Peg) versus peg monotherapy (Peg) after TAC: A comparison of efficacy, safety, relative dose intensity (RDI) and bone pain
AMER ASSOC CANCER RESEARCH. 2021
View details for Web of Science ID 000618737700341
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Protective-2 (bpi-2358-106): A confirmatory trial to demonstrate superiority of the plinabulin plus pegfilgrastim (plin/peg) combination versus standard of care pegfilgrastim for the prevention of chemotherapy-induced neutropenia (cin) in breast cancer (bc) patients (pts)
AMER ASSOC CANCER RESEARCH. 2021
View details for Web of Science ID 000618737700049
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Real-world Evidence to Estimate Prostate Cancer Costs for First-line Treatment or Active Surveillance.
European urology open science
2021; 23: 20–29
Abstract
Background: Prostate cancer is the most common cancer in men and second leading cause of cancer-related deaths. Changes in screening guidelines, adoption of active surveillance (AS), and implementation of high-cost technologies have changed treatment costs. Traditional cost-effectiveness studies rely on clinical trial protocols unlikely to capture actual practice behavior, and existing studies use data predating new technologies. Real-world evidence reflecting these changes is lacking.Objective: To assess real-world costs of first-line prostate cancer management.Design setting and participants: We used clinical electronic health records for 2008-2018 linked with the California Cancer Registry and the Medicare Fee Schedule to assess costs over 24 or 60 mo following diagnosis. We identified surgery or radiation treatments with structured methods, while we used both structured data and natural language processing to identify AS.Outcome measurements and statistical analysis: Our results are risk-stratified calculated cost per day (CCPD) for first-line management, which are independent of treatment duration. We used the Kruskal-Wallis test to compare unadjusted CCPD while analysis of covariance log-linear models adjusted estimates for age and Charlson comorbidity.Results and limitations: In 3433 patients, surgery (54.6%) was more common than radiation (22.3%) or AS (23.0%). Two years following diagnosis, AS ($2.97/d) was cheaper than surgery ($5.67/d) or radiation ($9.34/d) in favorable disease, while surgery ($7.17/d) was cheaper than radiation ($16.34/d) for unfavorable disease. At 5 yr, AS ($2.71/d) remained slightly cheaper than surgery ($2.87/d) and radiation ($4.36/d) in favorable disease, while for unfavorable disease surgery ($4.15/d) remained cheaper than radiation ($10.32/d). Study limitations include information derived from a single healthcare system and costs based on benchmark Medicare estimates rather than actual payment exchanges.Patient summary: Active surveillance was cheaper than surgery (-47.6%) and radiation (-68.2%) at 2 yr for favorable-risk disease, which decreased by 5 yr (-5.6% and -37.8%, respectively). Surgery was less costly than radiation for unfavorable risk for both intervals (-56.1% and -59.8%, respectively).
View details for DOI 10.1016/j.euros.2020.11.004
View details for PubMedID 33367287
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Pioneering Cancer Quality: Lessons From Dr Joe Simone.
JCO oncology practice
2021: OP2100358
View details for DOI 10.1200/OP.21.00358
View details for PubMedID 34264751
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Severe neutropenia (grade 4, Gr4N) as a population-based predictor for adverse clinical outcome of chemotherapy induced neutropenia (CIN)
ELSEVIER. 2021: S1189-S1190
View details for DOI 10.1016/j.annonc.2021.08.1680
View details for Web of Science ID 000700527703253
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Prediction of febrile neutropenia (FN), hospitalization (Hosp) rates, and infection (Inf) rates in chemotherapy-induced neutropenia (CIN) patients (pts) treated with the plinabulin and pegfilgrastim combination (Plin plus Peg) using a meta-analysis (MA)-based tool
ELSEVIER. 2021: S1190
View details for DOI 10.1016/j.annonc.2021.08.1681
View details for Web of Science ID 000700527703254
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Impact of adding plinabulin to pegfilgrastim for the prevention of chemotherapy induced neutropenia (CIN) on patient quality of life (QoL)
ELSEVIER. 2021: S1190
View details for DOI 10.1016/j.annonc.2021.08.1682
View details for Web of Science ID 000700527703255
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Distress Screening Through Patient-Reported Outcomes Measurement Information System (PROMIS) at an Academic Cancer Center and Network Site: Implementation of a Hybrid Model.
JCO oncology practice
2021: OP2000473
Abstract
Cancer care guidelines recommend regular distress screening of patients, with approximately one in three patients with cancer experiencing significant distress. However, the implementation of such programs is variable and inconsistent. We sought to assess the feasibility of implementing a hybrid electronic and paper screening tool for distress in all patients coming to a large academic cancer center and an associated integrated network site.Patients at an academic cancer center (Stanford Cancer Center) and its associated integrated network site received either an electronic or on-paper modified Patient-Reported Outcomes Measurement Information System-Global Health questionnaire, to assess overall health and distress. We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance implementation framework to test and report on the feasibility of using this questionnaire. Iterative workflow changes were made to implement the questionnaire throughout the healthcare system, including processes to integrate with existing electronic health records.From June 2015 to December 2017, 53,954 questionnaires representing 26,242 patients were collected. Approximately 30% of the questionnaires were completed before the visit on an electronic patient portal. The number of patients meeting the positive screen threshold remained around 40% throughout the study period. Following assessment, there were 3,763 referrals to cancer supportive services. Of note, those with a positive screen were more likely to have a referral to supportive care (odds ratio, 6.4; 95% CI, 5.8 to 6.9; P < .0001).The hybrid electronic and on-paper use of a commonly available patient-reported outcome tool, Patient-Reported Outcomes Measurement Information System-Global Health, as a large-scale distress screening method, is feasible at a large integrated cancer center.
View details for DOI 10.1200/OP.20.00473
View details for PubMedID 33830852
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Machine Learning Applied to Electronic Health Records: Identification of Chemotherapy Patients at High Risk for Preventable Emergency Department Visits and Hospital Admissions.
JCO clinical cancer informatics
2021; 5: 1106-1126
Abstract
Acute care use (ACU) is a major driver of oncologic costs and is penalized by a Centers for Medicare & Medicaid Services quality measure, OP-35. Targeted interventions reduce preventable ACU; however, identifying which patients might benefit remains challenging. Prior predictive models have made use of a limited subset of the data in the electronic health record (EHR). We aimed to predict risk of preventable ACU after starting chemotherapy using machine learning (ML) algorithms trained on comprehensive EHR data.Chemotherapy patients treated at an academic institution and affiliated community care sites between January 2013 and July 2019 who met inclusion criteria for OP-35 were identified. Preventable ACU was defined using OP-35 criteria. Structured EHR data generated before chemotherapy treatment were obtained. ML models were trained to predict risk for ACU after starting chemotherapy using 80% of the cohort. The remaining 20% were used to test model performance by the area under the receiver operator curve.Eight thousand four hundred thirty-nine patients were included, of whom 35% had preventable ACU within 180 days of starting chemotherapy. Our primary model classified patients at risk for preventable ACU with an area under the receiver operator curve of 0.783 (95% CI, 0.761 to 0.806). Performance was better for identifying admissions than emergency department visits. Key variables included prior hospitalizations, cancer stage, race, laboratory values, and a diagnosis of depression. Analyses showed limited benefit from including patient-reported outcome data and indicated inequities in outcomes and risk modeling for Black and Medicaid patients.Dense EHR data can identify patients at risk for ACU using ML with promising accuracy. These models have potential to improve cancer care outcomes, patient experience, and costs by allowing for targeted, preventative interventions.
View details for DOI 10.1200/CCI.21.00116
View details for PubMedID 34752139
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Treatment and Monitoring Variability in US Metastatic Breast Cancer Care.
JCO clinical cancer informatics
2021; 5: 600-614
Abstract
Treatment and monitoring options for patients with metastatic breast cancer (MBC) are increasing, but little is known about variability in care. We sought to improve understanding of MBC care and its correlates by analyzing real-world claims data using a search engine with a novel query language to enable temporal electronic phenotyping.Using the Advanced Cohort Engine, we identified 6,180 women who met criteria for having estrogen receptor-positive, human epidermal growth factor receptor 2-negative MBC from IBM MarketScan US insurance claims (2007-2014). We characterized treatment, monitoring, and hospice usage, along with clinical and nonclinical factors affecting care.We observed wide variability in treatment modality and monitoring across patients and geography. Most women received first-recorded therapy with endocrine (67%) versus chemotherapy, underwent more computed tomography (CT) (76%) than positron emission tomography-CT, and were monitored using tumor markers (58%). Nearly half (46%) met criteria for aggressive disease, which were associated with receiving chemotherapy first, monitoring primarily with CT, and more frequent imaging. Older age was associated with endocrine therapy first, less frequent imaging, and less use of tumor markers. After controlling for clinical factors, care strategies varied significantly by nonclinical factors (median regional income with first-recorded therapy and imaging type, geographic region with these and with imaging frequency and use of tumor markers; P < .0001).Variability in US MBC care is explained by patient and disease factors and by nonclinical factors such as geographic region, suggesting that treatment decisions are influenced by local practice patterns and/or resources. A search engine designed to express complex electronic phenotypes from longitudinal patient records enables the identification of variability in patient care, helping to define disparities and areas for improvement.
View details for DOI 10.1200/CCI.21.00031
View details for PubMedID 34043432
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Reply to Ritzwoller et al.
JCO clinical cancer informatics
2021; 5: 1026-1027
View details for DOI 10.1200/CCI.21.00145
View details for PubMedID 34637331
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Limited English Proficiency and Disparities in Health Care Engagement Among Patients With Breast Cancer.
JCO oncology practice
2021: OP2001093
Abstract
Race and ethnicity have been shown to affect quality of cancer care, and patients with low English proficiency (LEP) have increased risk for serious adverse events. We sought to assess the impact of primary language on health care engagement as indicated by clinical trial screening and engagement, use of genetic counseling, and communication via an electronic patient portal.Clinical and demographic data on patients with breast cancer diagnosed and treated from 2013 to 2018 within the Stanford University Health Care system were compiled via linkage of electronic health records, an internal clinical trial database, and the California Cancer Registry. Logistic and linear regression models were used to evaluate for association of clinical trial engagement and patient portal message rates with primary language group.Patients with LEP had significantly lower rates of clinical trial engagement compared with their English-speaking counterparts (adjusted odds ratio [OR], 0.29; 95% CI, 0.16 to 0.51). Use of genetic counseling was similar between language groups. Rates of patient portal messaging did not differ between English-speaking and LEP groups on multivariable analysis; however, patients with LEP were less likely to have a portal account (adjusted OR, 0.89; 95% CI, 0.83 to 0.96). Among LEP subgroups, Spanish speakers were significantly less likely to engage with the patient portal compared with English speakers (estimated difference in monthly rate: OR, 0.43; 95% CI, 0.24 to 0.77).We found that patients with LEP had lower rates of clinical trial engagement and odds of electronic patient portal enrollment. Interventions designed to overcome language and cultural barriers are essential to optimize the experience of patients with LEP.
View details for DOI 10.1200/OP.20.01093
View details for PubMedID 33844591
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Development and Use of Natural Language Processing for Identification of Distant Cancer Recurrence and Sites of Distant Recurrence Using Unstructured Electronic Health Record Data.
JCO clinical cancer informatics
2021; 5: 469–78
Abstract
Large-scale analysis of real-world evidence is often limited to structured data fields that do not contain reliable information on recurrence status and disease sites. In this report, we describe a natural language processing (NLP) framework that uses data from free-text, unstructured reports to classify recurrence status and sites of recurrence for patients with breast and hepatocellular carcinomas (HCC).Using two cohorts of breast cancer and HCC cases, we validated the ability of a previously developed NLP model to distinguish between no recurrence, local recurrence, and distant recurrence, based on clinician notes, radiology reports, and pathology reports compared with manual curation. A second NLP model was trained and validated to identify sites of recurrence. We compared the ability of each NLP model to identify the presence, timing, and site of recurrence, when compared against manual chart review and International Classification of Diseases coding.A total of 1,273 patients were included in the development and validation of the two models. The NLP model for recurrence detects distant recurrence with an area under the curve of 0.98 (95% CI, 0.96 to 0.99) and 0.95 (95% CI, 0.88 to 0.98) in breast and HCC cohorts, respectively. The mean accuracy of the NLP model for detecting any site of distant recurrence was 0.9 for breast cancer and 0.83 for HCC. The NLP model for recurrence identified a larger proportion of patients with distant recurrence in a breast cancer database (11.1%) compared with International Classification of Diseases coding (2.31%).We developed two NLP models to identify distant cancer recurrence, timing of recurrence, and sites of recurrence based on unstructured electronic health record data. These models can be used to perform large-scale retrospective studies in oncology.
View details for DOI 10.1200/CCI.20.00165
View details for PubMedID 33929889
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Benchmark Method for Cost Computations across Healthcare Systems: Cost of Care per Patient per Day in Breast Cancer Care
JCO Oncology Practice
2021
View details for DOI 10.1200/OP.20.00462
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Efficacy of Plinabulin vs Pegfilgrastim for Prevention of Chemotherapy-Induced Neutropenia in Adults With Non-Small Cell Lung Cancer: A Phase 2 Randomized Clinical Trial.
JAMA oncology
2020
Abstract
Importance: Plinabulin is a novel, non-granulocyte colony-stimulating factor (GCSF) small molecule with both anticancer and neutropenia-prevention effects.Objective: To assess the efficacy and safety of plinabulin compared with pegfilgrastim for the prevention of chemotherapy-induced neutropenia following docetaxel chemotherapy in patients with non-small lung cancer.Design, Setting, and Participants: This was a randomized, open-label, phase 2 clinical trial of 4 treatment arms that was conducted in 19 cancer treatment centers in the United States, China, Russia, and Ukraine. Participants were adult patients with non-small cell lung cancer whose cancer had progressed after platinum-based chemotherapy. Data were collected from April 2017 through March 2018 and analyzed from August 2019 through February 2020.Interventions: All patients received docetaxel 75 mg/m2 on day 1 and were randomly assigned to 1 of 3 doses of plinabulin (5, 10, or 20 mg/m2) on day 1 or to pegfilgrastim 6 mg on day 2. Patients were treated every 21 days for 4 chemotherapy cycles.Main Outcomes and Measures: The primary end point was the determination of the recommended phase 3 dose of plinabulin based on the days of severe neutropenia during chemotherapy cycle 1. Daily complete blood cell counts and absolute neutrophil counts were drawn during times of anticipated neutropenia during cycle 1.Results: Of the 55 patients randomized and evaluated, the mean (SD) age was 61.3 (10.2) years, and 38 (69.1%) were men. With each escalation of the plinabulin dose, the incidence of any grade of neutropenia decreased. There were no significant differences in mean (SD) days of severe neutropenia among those treated with pegfilgrastim (0.15 [0.38] days) when dosed at day 2 vs plinabulin 20 mg/m2 (0.36 [0.93] days; P=.76) when dosed at day 1, and no safety signals were detected.Conclusions and Relevance: Single dose-per-cycle plinabulin has a similar neutropenia protection benefit as pegfilgrastim. Plinabulin 40 mg fixed dose, which is pharmacologically equivalent to 20 mg/m2, will be compared with pegfilgrastim 6 mg in the phase 3 portion of this trial. Noninferior days of severe neutropenia will be the primary end point, and bone pain reduction, thrombocytopenia reduction, and quality of life maintenance will be secondary end points.Trial Registration: ClinicalTrials.gov Identifier: NCT03102606.
View details for DOI 10.1001/jamaoncol.2020.4429
View details for PubMedID 32970104
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Plinabulin (Plin) is a more favorable option for the prevention of chemotherapy induced neutropenia (CIN) than pegfilgrastim (Peg) during the COVID-19 pandemic
ELSEVIER. 2020: S1008
View details for DOI 10.1016/j.annonc.2020.08.1779
View details for Web of Science ID 000573469102300
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Real-world outcomes of patients with metastatic breast cancer (BC) treated with osteoclast inhibitors (OIs).
LIPPINCOTT WILLIAMS & WILKINS. 2020
View details for Web of Science ID 000560368307247
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Development and validation of natural language processing (NLP) algorithm for detection of distant versus local breast cancer recurrence and metastatic site.
AMER SOC CLINICAL ONCOLOGY. 2020
View details for Web of Science ID 000560368301153
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Four distinct patient-reported outcome (PRO) trajectories in longitudinal responses collected before, during, and after chemotherapy.
AMER SOC CLINICAL ONCOLOGY. 2020
View details for Web of Science ID 000560368301127
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Distress screening through PROMIS at an academic cancer center and network site: Implementation of a hybrid model.
AMER SOC CLINICAL ONCOLOGY. 2020
View details for Web of Science ID 000560368301136
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A comparison of CD34+mobilization effects of standard dose pegfilgrastim (Peg) versus low-dose peg combined with plinabulin (Plin).
LIPPINCOTT WILLIAMS & WILKINS. 2020
View details for Web of Science ID 000560368307366
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International Perspective on the Pursuit of Quality in Cancer Care: Global Application of QOPI and QOPI Certification.
JCO global oncology
2020; 6: 697–703
View details for DOI 10.1200/GO.20.00048
View details for PubMedID 32374622
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Computing the Cost of Care Per Day for Patients With Metastatic NETs
LIPPINCOTT WILLIAMS & WILKINS. 2020: 470
View details for Web of Science ID 000526823600061
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Leveraging Digital Data to Inform and Improve Quality Cancer Care.
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
2020
Abstract
BACKGROUND: Efficient capture of routine clinical care and patient outcomes are needed at a population-level, as is evidence on important treatment-related side effects and their effect on well-being and clinical outcomes. The increasing availability of electronic health records (EHRs) offers new opportunities to generate population-level patient-centered evidence on oncological care that can better guide treatment decisions and patient-valued care.METHODS: This study includes patients seeking care at an academic medical center, 2008-2018. Digital data sources are combined to address missingness, inaccuracy, and noise common to EHR data. Clinical concepts were identified and extracted from EHR unstructured data using natural language processing (NLP) and machine/deep learning techniques. All models are trained, tested, and validated on independent data samples using standard metrics.RESULTS: We provide use cases for using EHR data to assess guideline adherence and quality measurements among cancer patients. Pretreatment assessment was evaluated by guideline adherence and quality metrics for cancer staging metrics. Patient outcomes included treatment-related side-effects and patient-reported outcomes.CONCLUSIONS: Advanced technologies applied to EHRs present opportunities to advance population-level quality assessment, to learn from routinely collected clinical data for personalized treatment, and to augment epidemiological and population health studies. The effective use of digital data can inform patient-valued care, quality initiatives and policy guidelines.IMPACT: A comprehensive set of health data analyzed with advanced technologies results in a unique resource that facilitates wide-ranging, innovative, and impactful research on prostate cancer. This work demonstrates novel use of EHRs and technology to advance epidemiological studies and benefit oncological care.
View details for DOI 10.1158/1055-9965.EPI-19-0873
View details for PubMedID 32066619
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Clinical Documentation to Predict Factors Associated with Urinary Incontinence Following Prostatectomy for Prostate Cancer.
Research and reports in urology
2020; 12: 7-14
Abstract
Advances in data collection provide opportunities to use population samples in identifying risk factors for urinary incontinence (UI), which occurs in up to 71% of men with prostate cancer following prostatectomy. Most studies on patient-centered outcomes use surveys or manual chart abstraction for data collection, which can be costly and difficult to scale. We sought to evaluate rates of and risk factors for UI following prostatectomy using natural language processing on electronic health record (EHR) data.We conducted a retrospective analysis of patients undergoing prostatectomy for prostate cancer between January 2008 and August 2018 using EHR data from an academic medical center. UI incidence for each patient in the cohort was assessed using natural language processing from clinical notes generated pre- and postoperatively. Multivariable logistic regression was used to evaluate potential risk factors for postoperative UI at various time points within 2 years following surgery.We identified 3792 patients who underwent prostatectomy for prostate cancer. We found a significant association between preoperative UI and UI in the first (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.24-4.28) and second (OR 2.24, 95% CI 1.04-4.83) years following surgery. Preoperative body mass index was also associated with UI in the second postoperative year (OR 1.11, 95% CI 1.02-1.21).We show that a natural language processing approach using clinical narratives can be used to assess risk for UI in prostate cancer patients. Unstructured clinical narrative text can help advance future population-level research in patient-centered outcomes and quality of care.
View details for DOI 10.2147/RRU.S234178
View details for PubMedID 32158720
View details for PubMedCentralID PMC6986242
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Association between patient-initiated emails and overall 2-year survival in cancer patients undergoing chemotherapy: Evidence from the real-world setting.
Cancer medicine
2020
Abstract
Prior studies suggest email communication between patients and providers may improve patient engagement and health outcomes. The purpose of this study was to determine whether patient-initiated emails are associated with overall survival benefits among cancer patients undergoing chemotherapy.We identified patient-initiated emails through the patient portal in electronic health records (EHR) among 9900 cancer patients receiving chemotherapy between 2013 and 2018. Email users were defined as patients who sent at least one email 12 months before to 2 months after chemotherapy started. A propensity score-matched cohort analysis was carried out to reduce bias due to confounding (age, primary cancer type, gender, insurance payor, ethnicity, race, stage, income, Charlson score, county of residence). The cohort included 3223 email users and 3223 non-email users. The primary outcome was overall 2-year survival stratified by email use. Secondary outcomes included number of face-to-face visits, prescriptions, and telephone calls. The healthcare teams' response to emails and other forms of communication was also investigated. Finally, a quality measure related to chemotherapy-related inpatient and emergency department visits was evaluated.Overall 2-year survival was higher in patients who were email users, with an adjusted hazard ratio of 0.80 (95 CI 0.72-0.90; p < 0.001). Email users had higher rates of healthcare utilization, including face-to-face visits (63 vs. 50; p < 0.001), drug prescriptions (28 vs. 21; p < 0.001), and phone calls (18 vs. 16; p < 0.001). Clinical quality outcome measure of inpatient use was better among email users (p = 0.015).Patient-initiated emails are associated with a survival benefit among cancer patients receiving chemotherapy and may be a proxy for patient engagement. As value-based payment models emphasize incorporating the patients' voice into their care, email communications could serve as a novel source of patient-generated data.
View details for DOI 10.1002/cam4.3483
View details for PubMedID 32986931
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Cortical Brain Age from Pre-treatment to Post-chemotherapy in Patients with Breast Cancer.
Neurotoxicity research
2020
Abstract
Chemotherapy-related cognitive impairment and associated brain changes may reflect accelerated brain aging; however, empirical evidence for this theory is limited. The purpose of this study was to measure brain aging in newly diagnosed patients with breast cancer treated with chemotherapy (n = 43) and compare its longitudinal change to that of controls (n = 50). Brain age indices, derived from cortical measures, were compared between women with breast cancer and matched healthy controls across 3 timepoints (time 1: pre-surgery, time 2: 1 month following chemotherapy completion, and time 3: 1-year post-chemotherapy). The breast cancer group showed a significant decrease in cortical thickness across the 3 timepoints (p < .001) and a trend towards significant increase in predicted brain age especially from pre-treatment (time 1) to post-chemotherapy (time 2) compared to controls (p = 0.08). Greater increase in predicted brain age was related to several clinical factors (HER-2 status, surgery type, and history of neoadjuvant chemotherapy) and greater decrease in cortical thickness was associated with greater decrease in performance on a verbal learning task from time 1 to time 3 (r = - 0.48, p < .01). This study demonstrated evidence of increased cortical brain aging in middle-aged patients with breast cancer following chemotherapy treatment that was associated with decreased verbal memory performance.
View details for DOI 10.1007/s12640-019-00158-z
View details for PubMedID 31900898
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Clinical Documentation to Predict Factors Associated with Urinary Incontinence Following Prostatectomy for Prostate Cancer
RESEARCH AND REPORTS IN UROLOGY
2020; 12: 7–14
View details for DOI 10.2147/RRU.S234178
View details for Web of Science ID 000512137700001
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Clinical Evidence Against the Continuum of Low-Primed Uncommitted Hematopoietic and Progenitor Cells (CLOUD-HSPC) Concept for Hematopoiesis
AMER SOC HEMATOLOGY. 2019
View details for DOI 10.1182/blood-2019-128563
View details for Web of Science ID 000577164604271
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Clinical Evidence of Granulocyte-Monocyte Progenitor (GMP) Stem Cell Involvement in Plinabulin's Mechanism of Action (MoA) for the Prevention of Docetaxel (Doc) Chemotherapy (Chemo)-Induced Neutropenia (CIN)
AMER SOC HEMATOLOGY. 2019
View details for DOI 10.1182/blood-2019-127227
View details for Web of Science ID 000577164604272
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A Randomized Phase 3 Clinical Trial of the Combination of Plinabulin (plin) plus Pegfilgrastim (peg) Versus (vs) Peg Alone for Tac (docetaxel, doxorubicin, cyclophosphamide) Induced Neutropenia (cin)
AMER SOC HEMATOLOGY. 2019
View details for DOI 10.1182/blood-2019-127310
View details for Web of Science ID 000577164600170
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Impact of mortality reviews on supportive care utilization, end-of-life care, and inpatient mortality.
AMER SOC CLINICAL ONCOLOGY. 2019
View details for DOI 10.1200/JCO.2019.37.31_suppl.45
View details for Web of Science ID 000518224200044
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Quality of Life in NSCLC Patients Treated with Docetaxel and Either Plinabulin or Pegfilgrastim for Prevention of Neutropenia
ELSEVIER SCIENCE INC. 2019: S359
View details for Web of Science ID 000492162202055
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The effect of increasing doses of pegfilgrastim (Peg) on thrombocytopenia (T) in breast cancer (BC) patients (pts) receiving taxotere (Doc), doxorubicin, cyclophosphamide (TAC) and plinabulin (Plin)
OXFORD UNIV PRESS. 2019: 737
View details for Web of Science ID 000491295505082
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Extracting Patient-Centered Outcomes from Clinical Notes in Electronic Health Records: Assessment of Urinary Incontinence After Radical Prostatectomy.
EGEMS (Washington, DC)
2019; 7 (1): 43
Abstract
Objective: To assess documentation of urinary incontinence (UI) in prostatectomy patients using unstructured clinical notes from Electronic Health Records (EHRs).Methods: We developed a weakly-supervised natural language processing tool to extract assessments, as recorded in unstructured text notes, of UI before and after radical prostatectomy in a single academic practice across multiple clinicians. Validation was carried out using a subset of patients who completed EPIC-26 surveys before and after surgery. The prevalence of UI as assessed by EHR and EPIC-26 was compared using repeated-measures ANOVA. The agreement of reported UI between EHR and EPIC-26 was evaluated using Cohen's Kappa coefficient.Results: A total of 4870 patients and 716 surveys were included. Preoperative prevalence of UI was 12.7 percent. Postoperative prevalence was 71.8 percent at 3 months, 50.2 percent at 6 months and 34.4 and 41.8 at 12 and 24 months, respectively. Similar rates were recorded by physicians in the EHR, particularly for early follow-up. For all time points, the agreement between EPIC-26 and the EHR was moderate (all p < 0.001) and ranged from 86.7 percent agreement at baseline (Kappa = 0.48) to 76.4 percent agreement at 24 months postoperative (Kappa = 0.047).Conclusions: We have developed a tool to assess documentation of UI after prostatectomy using EHR clinical notes. Our results suggest such a tool can facilitate unbiased measurement of important PCOs using real-word data, which are routinely recorded in EHR unstructured clinician notes. Integrating PCO information into clinical decision support can help guide shared treatment decisions and promote patient-valued care.
View details for DOI 10.5334/egems.297
View details for PubMedID 31497615
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Comparison of orthogonal NLP methods for clinical phenotyping and assessment of bone scan utilization among prostate cancer patients
JOURNAL OF BIOMEDICAL INFORMATICS
2019; 94
View details for DOI 10.1016/j.jbi.2019.103184
View details for Web of Science ID 000525692600015
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Comparison of pegfilgrastim (Peg), plinabulin (Plin), and the combination for chemotherapy (Chemo) induced neutropenia (CIN) prevention: Rationale for the combination.
AMER SOC CLINICAL ONCOLOGY. 2019
View details for DOI 10.1200/JCO.2019.37.15_suppl.e12030
View details for Web of Science ID 000487345800026
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Real-world efficacy of bone modifying agents (BMAs) in patients with breast cancer (BC) treated in an academic health system: Use of the "green button.
AMER SOC CLINICAL ONCOLOGY. 2019
View details for DOI 10.1200/JCO.2019.37.15_suppl.e18054
View details for Web of Science ID 000487345802051
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REDUCTION IN PATIENT REPORTED BONE PAIN WITH PLINABULIN VS PEGFILGRASTIM IN NON SMALL CELL LUNG CANCER PATIENTS TREATED FOR THE PREVENTION OF DOCETAXEL-INDUCED NEUTROPENIA
ELSEVIER SCIENCE INC. 2019: S109
View details for Web of Science ID 000472670100349
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Distribution of Global Health Measures From Routinely Collected PROMIS Surveys in Patients With Breast Cancer or Prostate Cancer
CANCER
2019; 125 (6): 943–51
View details for DOI 10.1002/cncr.31895
View details for Web of Science ID 000461693200015
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A phase II trial with the combination of plinabulin (plin) pegfilgrastim (peg): Evaluation of the reversal of peg's immune-suppressive potential by the addition of plin to peg.
AMER SOC CLINICAL ONCOLOGY. 2019
View details for DOI 10.1200/JCO.2019.37.8_suppl.4
View details for Web of Science ID 000489109600022
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Utilization of Prostate Cancer Quality Metrics for Research and Quality Improvement: A Structured Review
JOINT COMMISSION JOURNAL ON QUALITY AND PATIENT SAFETY
2019; 45 (3): 217–26
Abstract
The shift toward value-based care in the United States emphasizes the role of quality measures in payment models. Many diseases, such as prostate cancer, have a proliferation of quality measures, resulting in resource burden and physician burnout. This study aimed to identify and summarize proposed prostate cancer quality measures and describe their frequency and use in peer-reviewed literature.The PubMed database was used to identify quality measures relevant to prostate cancer care, and included articles in English through April 2018. A gray literature search for other documents was also conducted. After the selection process of the pertinent articles, measure characteristics were abstracted, and uses were summarized for the 10 most frequently utilized measures in the literature.A total of 26 articles were identified for review. Of the 71 proposed prostate cancer quality measures, only 47 were used, and less than 10% of these were endorsed by the National Quality Forum. Process measures were most frequently reported (84.5%). Only 6 outcome measures (8.5%) were proposed-none of which were among the most frequently utilized.Although a high number of proposed prostate cancer quality measures are reported in the literature, few were assessed, and the majority of these were non-endorsed process measures. Process measures were most commonly assessed; outcome measures were rarely evaluated. In a step to close the quality chasm, a "top 5" core set of quality measures for prostate cancer care, including structure, process, and outcomes measures, is suggested. Future studies should consider this comprehensive set of quality measures.
View details for DOI 10.1016/j.jcjq.2018.06.004
View details for Web of Science ID 000461797400013
View details for PubMedID 30236510
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A randomized clinical trial of the combination of Plinabulin (Plin) plus Pegfilgrastim (Peg) versus (vs) Peg alone for TAC (docetaxel, doxorubicin, cyclophosphamide) induced Neutropenia (CIN)
CHURCHILL LIVINGSTONE. 2019: S21
View details for Web of Science ID 000461694000046
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"DID YOU FEEL THE EARTH SHAKE?" AN ONLINE CANCER COMMUNITY INTERPRETS RESULTS OF A PRACTICE-CHANGING TRIAL
OXFORD UNIV PRESS INC. 2019: S39
View details for Web of Science ID 000473349400080
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PSA Testing Use and Prostate Cancer Diagnostic Stage After the 2012 U.S. Preventive Services Task Force Guideline Changes.
Journal of the National Comprehensive Cancer Network : JNCCN
2019; 17 (7): 795–803
Abstract
Most patients with prostate cancer are diagnosed with low-grade, localized disease and may not require definitive treatment. In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against prostate cancer screening to address overdetection and overtreatment. This study sought to determine the effect of guideline changes on prostate-specific antigen (PSA) screening and initial diagnostic stage for prostate cancer.A difference-in-differences analysis was conducted to compare changes in PSA screening (exposure) relative to cholesterol testing (control) after the 2012 USPSTF guideline changes, and chi-square test was used to determine whether there was a subsequent decrease in early-stage, low-risk prostate cancer diagnoses. Data were derived from a tertiary academic medical center's electronic health records, a national commercial insurance database (OptumLabs), and the SEER database for men aged ≥35 years before (2008-2011) and after (2013-2016) the guideline changes.In both the academic center and insurance databases, PSA testing significantly decreased for all men compared with the control. The greatest decrease was among men aged 55 to 74 years at the academic center and among those aged ≥75 years in the commercial database. The proportion of early-stage prostate cancer diagnoses (
View details for DOI 10.6004/jnccn.2018.7274
View details for PubMedID 31319390
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Predicting Patient Reported Outcomes of Cognitive Function Using Connectome-Based Predictive Modeling in Breast Cancer.
Brain topography
2019
Abstract
Being able to predict who will likely experience cancer related cognitive impairment (CRCI) could enhance patient care and potentially reduce economic and human costs associated with this adverse event. We aimed to determine if post-treatment patient reported CRCI could also be predicted from baseline resting state fMRI in patients with breast cancer. 76 newly diagnosed patients (n = 42 planned for chemotherapy; n = 34 not planned for chemotherapy) and 50 healthy female controls were assessed at 3 times points [T1 (prior to treatment); T2 (1 month post chemotherapy); T3 (1 year after T2)], and at yoked intervals for controls. Data collection included self-reported executive dysfunction, memory function, and psychological distress and resting state fMRI data converted to connectome matrices for each participant. Statistical analyses included linear mixed modeling, independent t tests, and connectome-based predictive modeling (CPM). Executive dysfunction increased over time in the chemotherapy group and was stable in the other two groups (p < 0.001). Memory function decreased over time in both patient groups compared to controls (p < 0.001). CPM models successfully predicted executive dysfunction and memory function scores (r > 0.31, p < 0.002). Support vector regression with a radial basis function (SVR RBF) showed the highest performance for executive dysfunction and memory function (r = 0.68; r = 0.44, p's < 0.001). Baseline neuroimaging may be useful for predicting patient reported cognitive outcomes which could assist in identifying patients in need of surveillance and/or early intervention for treatment-related cognitive effects.
View details for DOI 10.1007/s10548-019-00746-4
View details for PubMedID 31745689
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Machine Learning Approaches for Extracting Stage from Pathology Reports in Prostate Cancer.
Studies in health technology and informatics
2019; 264: 1522–23
Abstract
Clinical and pathological stage are defining parameters in oncology, which direct a patient's treatment options and prognosis. Pathology reports contain a wealth of staging information that is not stored in structured form in most electronic health records (EHRs). Therefore, we evaluated three supervised machine learning methods (Support Vector Machine, Decision Trees, Gradient Boosting) to classify free-text pathology reports for prostate cancer into T, N and M stage groups.
View details for DOI 10.3233/SHTI190515
View details for PubMedID 31438212
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Comparison of Orthogonal NLP Methods for Clinical Phenotyping and Assessment of Bone Scan Utilization among Prostate Cancer Patients.
Journal of biomedical informatics
2019: 103184
Abstract
Clinical care guidelines recommend that newly diagnosed prostate cancer patients at high risk for metastatic spread receive a bone scan prior to treatment and that low risk patients not receive it. The objective was to develop an automated pipeline to interrogate heterogeneous data to evaluate the use of bone scans using a two different Natural Language Processing (NLP) approaches.Our cohort was divided into risk groups based on Electronic Health Records (EHR). Information on bone scan utilization was identified in both structured data and free text from clinical notes. Our pipeline annotated sentences with a combination of a rule-based method using the ConText algorithm (a generalization of NegEx) and a Convolutional Neural Network (CNN) method using word2vec to produce word embeddings.A total of 5,500 patients and 369,764 notes were included in the study. A total of 39% of patients were high-risk and 73% of these received a bone scan; of the 18% low risk patients, 10% received one. The accuracy of CNN model outperformed the rule-based model one (F-measure = 0.918 and 0.897 respectively). We demonstrate a combination of both models could maximize precision or recall, based on the study question.Using structured data, we accurately classified patients' cancer risk group, identified bone scan documentation with two NLP methods, and evaluated guideline adherence. Our pipeline can be used to provide concrete feedback to clinicians and guide treatment decisions.
View details for PubMedID 31014980
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Is it possible to automatically assess pretreatment digital rectal examination documentation using natural language processing? A single-centre retrospective study.
BMJ open
2019; 9 (7): e027182
Abstract
To develop and test a method for automatic assessment of a quality metric, provider-documented pretreatment digital rectal examination (DRE), using the outputs of a natural language processing (NLP) framework.An electronic health records (EHR)-based prostate cancer data warehouse was used to identify patients and associated clinical notes from 1 January 2005 to 31 December 2017. Using a previously developed natural language processing pipeline, we classified DRE assessment as documented (currently or historically performed), deferred (or suggested as a future examination) and refused.We investigated the quality metric performance, documentation 6 months before treatment and identified patient and clinical factors associated with metric performance.The cohort included 7215 patients with prostate cancer and 426 227 unique clinical notes associated with pretreatment encounters. DREs of 5958 (82.6%) patients were documented and 1257 (17.4%) of patients did not have a DRE documented in the EHR. A total of 3742 (51.9%) patient DREs were documented within 6 months prior to treatment, meeting the quality metric. Patients with private insurance had a higher rate of DRE 6 months prior to starting treatment as compared with Medicaid-based or Medicare-based payors (77.3%vs69.5%, p=0.001). Patients undergoing chemotherapy, radiation therapy or surgery as the first line of treatment were more likely to have a documented DRE 6 months prior to treatment.EHRs contain valuable unstructured information and with NLP, it is feasible to accurately and efficiently identify quality metrics with current documentation clinician workflow.
View details for DOI 10.1136/bmjopen-2018-027182
View details for PubMedID 31324681
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Better, Safer, Cheaper: Joseph V. Simone Award and Lecture.
Journal of oncology practice
2018; 14 (12): 763–66
View details for PubMedID 30537453
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Better, Safer, Cheaper: Joseph V. Simone Award and Lecture
JOURNAL OF ONCOLOGY PRACTICE
2018; 14 (12): 763-+
View details for DOI 10.1200/JOP.18.00654
View details for Web of Science ID 000453466500015
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Plinabulin, a Novel Small Molecule in Development for Chemotherapy-Induced-Neutropenia (CIN) Prevention, Mobilizes CD34+Cells through a Mechanism of Action (MoA) Different from G-CSF and from CXCR4 Inhibition
AMER SOC HEMATOLOGY. 2018
View details for DOI 10.1182/blood-2018-99-113569
View details for Web of Science ID 000454837606061
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Plinabulin (Plin), a novel non-G-CSF molecule for the revention of chemotherapy-induced neutropenia (CIN), has the potential to positively impact tumor micro environment
OXFORD UNIV PRESS. 2018
View details for Web of Science ID 000459277304054
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Can measuring quality lead to improvement? Evidence from international participants of ASCO's quality oncology practice initiative (QOPI) during 2015-2017.
Annals of oncology : official journal of the European Society for Medical Oncology
2018; 29 Suppl 8: viii571
View details for DOI 10.1093/annonc/mdy297.029
View details for PubMedID 32137512
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Plinabulin (Plin), a novel non-G-CSF molecule for the revention of chemotherapy-induced neutropenia (CIN), has the potential to positively impact tumor micro environment.
Annals of oncology : official journal of the European Society for Medical Oncology
2018; 29 Suppl 8: viii604
View details for DOI 10.1093/annonc/mdy300.003
View details for PubMedID 32137611
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Plinabulin, a Novel Immuno-Oncology Agent Mitigates Docetaxel Chemotherapy -Induced-Neutropenia and -Thrombocytopenia in NSCLC Patients
ELSEVIER SCIENCE INC. 2018: S461
View details for DOI 10.1016/j.jtho.2018.08.562
View details for Web of Science ID 000454014501196
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Can measuring quality lead to improvement? Evidence from international participants of ASCO's quality oncology practice initiative (QOPIV (R)) during 2015-2017
OXFORD UNIV PRESS. 2018: 571
View details for Web of Science ID 000459277303356
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Oncologists' Views on Using Value to Guide Cancer Treatment Decisions
VALUE IN HEALTH
2018; 21 (8): 931–37
Abstract
Cancer costs have increased substantially in the past decades, prompting specialty societies to urge oncologists to consider value in clinical decision making. Despite oncologists' crucial role in guiding cancer care, current literature is sparse with respect to the oncologists' views on value. Here, we evaluated oncologists perceptions of the use and measurement of value in cancer care.We conducted in-depth, open-ended interviews with 31 US oncologists practicing nationwide in various environments. Oncologists discussed the definition, measurement, and implementation of value. Transcripts were analyzed using matrix and thematic analysis.Oncologists' definitions of value varied greatly. Some described versions of the standard health economic definition of value, that is, cost relative to health outcomes. Many others did not include cost in their definition of value. Oncologists considered patient goals and quality of life as important components of value that they perceived were missing from current value measurement. Oncologists prioritized a patient-centric view of value over societal or other perspectives. Oncologists were inclined to consider the value of a treatment only if they perceived treatment would pose a financial burden to patients. Oncologists had differing opinions regarding who should be responsible for determining whether care is low value but generally felt this should remain within the purview of the oncology community.Oncologists agreed that cost was an important issue, but disagreed about whether cost was involved in value as well as the role of value in guiding treatment. Better clarity and alignment on the definition of and appropriate way to measure value is critical to the success of efforts to improve value in cancer care.
View details for PubMedID 30098670
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Architecture and Implementation of a Clinical Research Data Warehouse for Prostate Cancer.
EGEMS (Washington, DC)
2018; 6 (1): 13
Abstract
Background: Electronic health record (EHR) based research in oncology can be limited by missing data and a lack of structured data elements. Clinical research data warehouses for specific cancer types can enable the creation of more robust research cohorts.Methods: We linked data from the Stanford University EHR with the Stanford Cancer Institute Research Database (SCIRDB) and the California Cancer Registry (CCR) to create a research data warehouse for prostate cancer. The database was supplemented with information from clinical trials, natural language processing of clinical notes and surveys on patient-reported outcomes.Results: 11,898 unique prostate cancer patients were identified in the Stanford EHR, of which 3,936 were matched to the Stanford cancer registry and 6153 in the CCR. 7158 patients with EHR data and at least one of SCIRDB and CCR data were initially included in the warehouse.Conclusions: A disease-specific clinical research data warehouse combining multiple data sources can facilitate secondary data use and enhance observational research in oncology.
View details for PubMedID 30094285
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Plinabulin (Plin), a small molecule with anti-cancer activity and a novel mechanism of action (MoA) in docetaxel (Tax)-induced neutropenia: Phase (phi) 2 results from a head-to-head comparison with Pegfilgrastim (Peg).
AMER SOC CLINICAL ONCOLOGY. 2018
View details for DOI 10.1200/JCO.2018.36.15_suppl.2528
View details for Web of Science ID 000442916001308
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CHANGES IN PROSTATE SPECIFIC ANTIGEN SCREENING AND PROSTATE CANCER DIAGNOSIS AFTER GUIDELINE CHANGES
ELSEVIER SCIENCE INC. 2018: E520
View details for Web of Science ID 000429166601401
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Computing the cost of care per day of breast cancer survivor care.
AMER SOC CLINICAL ONCOLOGY. 2018
View details for DOI 10.1200/JCO.2018.36.7_suppl.10
View details for Web of Science ID 000443285600010
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Efficacy of Medicaid for Patients With Cancer in California
JAMA ONCOLOGY
2018; 4 (3): 323–25
View details for PubMedID 29192302
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Practice-based evidence for factors associated with urinary incontinence following prostate cancer care.
AMER SOC CLINICAL ONCOLOGY. 2018
View details for DOI 10.1200/JCO.2018.36.6_suppl.106
View details for Web of Science ID 000436179500102
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Critical Lessons From High-Value Oncology Practices
JAMA ONCOLOGY
2018; 4 (2): 164–71
Abstract
Cancer care is expensive. Cancer care provided by practice organizations varies in total spending incurred by patients and payers during treatment episodes and in quality of care, and this unnecessary variation contributes to the high cost.To use the variation in total spending and quality of care to assess oncology practice attributes distinguishing "high value" that may be tested and adopted by others to produce similar results."Positive deviance" was used in this exploratory mixed-methods (quantitative and qualitative) analysis of interview results. To quantify value, oncology practices located near the US Pacific Northwest and Midwest with low mean insurer-allowed spending were identified. Among those, practices with high quality were selected. A team then conducted site visits to interview practice personnel from June 2, 2015, through October 3, 2015, and to probe for attributes of high-value care. A qualitative analysis of their interview results was performed, and a panel of experienced oncologists was convened to review attributes occurring uniquely or frequently in low-spending practices for their contribution to value improvement and ease of implementation. Four positive deviant (ie, low-spending) oncology practices and 3 oncology practices that ranked near the middle of the spending distribution were studied.Thematic saturation in a qualitative analysis of high-value care attributes.From the 7 oncology practices studied, 13 attributes within the following 5 themes emerged: treatment planning and goal setting, services supporting the patient journey, technical support and physical layout, care team organization and function, and external context. Five attributes (ie, conservative use of imaging, early discussion of treatment limitations and consequences, single point of contact, maximal use of registered nurses for interventions, and a multicomponent health care system) most sharply distinguished the high-value practice sites. The expert oncologist panel judged 3 attributes (ie, early and normalized palliative care, ambulatory rapid response, and early discussion of treatment limitations and consequences) to carry the highest immediate potential for lowering spending without compromising the quality of care.Oncology practice attributes warranting further testing were identified that may lower total spending for high-quality oncology care.
View details for PubMedID 29145584
View details for PubMedCentralID PMC5838576
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Developing a non-hormonal treatment for vaginal dryness for breast cancer survivors: A pilot study of a therapeutic ultrasound device
AMER ASSOC CANCER RESEARCH. 2018
View details for Web of Science ID 000425489402199
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Distribution of global health measures from routinely collected PROMIS surveys in patients with breast cancer or prostate cancer.
Cancer
2018
Abstract
The collection of patient-reported outcomes (PROs) is an emerging priority internationally, guiding clinical care, quality improvement projects and research studies. After the deployment of Patient-Reported Outcomes Measurement Information System (PROMIS) surveys in routine outpatient workflows at an academic cancer center, electronic health record data were used to evaluate survey completion rates and self-reported global health measures across 2 tumor types: breast and prostate cancer.This study retrospectively analyzed 11,657 PROMIS surveys from patients with breast cancer and 4411 surveys from patients with prostate cancer, and it calculated survey completion rates and global physical health (GPH) and global mental health (GMH) scores between 2013 and 2018.A total of 36.6% of eligible patients with breast cancer and 23.7% of patients with prostate cancer completed at least 1 survey, with completion rates lower among black patients for both tumor types (P < .05). The mean T scores (calibrated to a general population mean of 50) for GPH were 48.4 ± 9 for breast cancer and 50.6 ± 9 for prostate cancer, and the GMH scores were 52.7 ± 8 and 52.1 ± 9, respectively. GPH and GMH were frequently lower among ethnic minorities, patients without private health insurance, and those with advanced disease.This analysis provides important baseline data on patient-reported global health in breast and prostate cancer. Demonstrating that PROs can be integrated into clinical workflows, this study shows that supportive efforts may be needed to improve PRO collection and global health endpoints in vulnerable populations.
View details for PubMedID 30512191
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Myeloid Growth Factors, Version 2.2017 Clinical Practice Guidelines in Oncology
JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK
2017; 15 (12): 1520-+
View details for DOI 10.6004/jnccn.2017.0175
View details for Web of Science ID 000418536600012
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Predicting Long-Term Cognitive Outcome Following Breast Cancer with Pre-Treatment Resting State fMRI and Random Forest Machine Learning
FRONTIERS IN HUMAN NEUROSCIENCE
2017; 11: 555
Abstract
We aimed to determine if resting state functional magnetic resonance imaging (fMRI) acquired at pre-treatment baseline could accurately predict breast cancer-related cognitive impairment at long-term follow-up. We evaluated 31 patients with breast cancer (age 34-65) prior to any treatment, post-chemotherapy and 1 year later. Cognitive testing scores were normalized based on data obtained from 43 healthy female controls and then used to categorize patients as impaired or not based on longitudinal changes. We measured clustering coefficient, a measure of local connectivity, by applying graph theory to baseline resting state fMRI and entered these metrics along with relevant patient-related and medical variables into random forest classification. Incidence of cognitive impairment at 1 year follow-up was 55% and was predicted by classification algorithms with up to 100% accuracy (p < 0.0001). The neuroimaging-based model was significantly more accurate than a model involving patient-related and medical variables (p = 0.005). Hub regions belonging to several distinct functional networks were the most important predictors of cognitive outcome. Characteristics of these hubs indicated potential spread of brain injury from default mode to other networks over time. These findings suggest that resting state fMRI is a promising tool for predicting future cognitive impairment associated with breast cancer. This information could inform treatment decision making by identifying patients at highest risk for long-term cognitive impairment.
View details for PubMedID 29187817
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Therapeutic Ultrasound as a Novel, Non-hormonal Treatment of Vulvo-vaginal Atrophy: A Pilot Phase II Study
ACADEMIC PRESS INC ELSEVIER SCIENCE. 2017: 235
View details for DOI 10.1016/j.ygyno.2017.07.115
View details for Web of Science ID 000412623500136
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Redesigning Cancer Care Delivery: Views From Patients and Caregivers.
Journal of oncology practice
2017; 13 (4): e291-e302
Abstract
Cancer is a leading cause of death in the United States. Although treatments have improved, patients and caregivers continue to report significant gaps in their care. The objective of this study was to examine the views of patients and caregivers on their experiences with current cancer care delivery and identify key strategies to improve the delivery of care.Semistructured interviews were conducted with 75 patients and 45 caregivers across the United States. The interviews were recorded, transcribed, and analyzed using constant comparative method of qualitative analysis.Participants reported multiple gaps in care delivery, including barriers in health communication with health care providers, lack of elucidation of care goals, lack of care coordination, and challenges in accessing care. Participants identified that greater use of nonphysician providers and alternative formats, such as telephone-based care and home and community-based care, would narrow these gaps.Understanding patients' and caregivers' experiences with gaps in cancer care delivery can inform cancer care delivery redesign efforts and lead to targeted interventions that result in patient-centered and family-oriented care.
View details for DOI 10.1200/JOP.2016.017327
View details for PubMedID 28399387
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The Appropriate Provision of Primary versus Specialist Palliative Care to Cancer Patients: Oncologists' Perspectives
JOURNAL OF PALLIATIVE MEDICINE
2017; 20 (4): 395-403
Abstract
Many cancer patients do not receive recommended palliative care (PC). Oncologists' perspectives about PC have not been adequately described qualitatively and may explain some of the gaps in the delivery of PC.To characterize U.S. oncologists' perceptions of: primary and specialist PC; experiences interacting with PC specialists; and the optimal interface of PC and oncology in providing PC.In-depth interviews with practicing oncologists.Oncologists working in: the general community, academic medical centers (AMC), and Veterans Health Administration.Semistructured telephone interviews with 31 oncologists analyzed using matrix and thematic approaches.Seven major themes emerged: PC was perceived as appropriate throughout the disease trajectory but due to resource constraints was largely provided at end of life; oncologists had three schools of thought on primary versus specialist PC; there was an under-availability of outpatient PC; poor communication about prognosis and care plans created tension between providers; PC was perceived as a "team of outsiders"; PC had too narrow a focus of care; and AMC-based PC evidence did not generalize to community practices. Oncologists noted three ways to improve the interface between oncologists and PC providers: a clear division of responsibility, in-person collaboration, and sharing of nonphysician palliative team members.Oncologists in our sample were supportive of PC, but they reported obstacles related to care coordination and inpatient PC. Inpatient PC posed some unique challenges with respect to conflicting prognoses and care practices that would be mitigated through the increased availability and use of outpatient PC.
View details for DOI 10.1089/jpm.2016.0399
View details for Web of Science ID 000398452000016
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A natural language processing algorithm to measure quality prostate cancer care.
AMER SOC CLINICAL ONCOLOGY. 2017
View details for Web of Science ID 000443301600231
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Quality, clinician and information technology (IT) partnership for metric reporting.
AMER SOC CLINICAL ONCOLOGY. 2017
View details for Web of Science ID 000443301600127
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Increasing Epic staging module adherence in an academic cancer center
AMER SOC CLINICAL ONCOLOGY. 2017
View details for Web of Science ID 000443301600064
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Improving care with portfolio of physician-led cancer quality measures at an academic center
AMER SOC CLINICAL ONCOLOGY. 2017
View details for Web of Science ID 000443301600049
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Disrupted brain network functional dynamics and hyper-correlation of structural and functional connectome topology in patients with breast cancer prior to treatment
BRAIN AND BEHAVIOR
2017; 7 (3)
Abstract
Several previous studies have demonstrated that cancer chemotherapy is associated with brain injury and cognitive dysfunction. However, evidence suggests that cancer pathogenesis alone may play a role, even in non-CNS cancers.Using a multimodal neuroimaging approach, we measured structural and functional connectome topology as well as functional network dynamics in newly diagnosed patients with breast cancer. Our study involved a novel, pretreatment assessment that occurred prior to the initiation of any cancer therapies, including surgery with anesthesia. We enrolled 74 patients with breast cancer age 29-65 and 50 frequency-matched healthy female controls who underwent anatomic and resting-state functional MRI as well as cognitive testing.Compared to controls, patients with breast cancer demonstrated significantly lower functional network dynamics (p = .046) and cognitive functioning (p < .02, corrected). The breast cancer group also showed subtle alterations in structural local clustering and functional local clustering (p < .05, uncorrected) as well as significantly increased correlation between structural global clustering and functional global clustering compared to controls (p = .03). This hyper-correlation between structural and functional topologies was significantly associated with cognitive dysfunction (p = .005).Our findings could not be accounted for by psychological distress and suggest that non-CNS cancer may directly and/or indirectly affect the brain via mechanisms such as tumor-induced neurogenesis, inflammation, and/or vascular changes, for example. Our results also have broader implications concerning the importance of the balance between structural and functional connectome properties as a potential biomarker of general neurologic deficit.
View details for DOI 10.1002/brb3.643
View details for Web of Science ID 000397564200014
View details for PubMedID 28293478
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Implementing a Method for Evaluating Patient-Reported Outcomes Associated With Oral Oncolytic Therapy.
Journal of oncology practice
2017: JOP2016018390-?
Abstract
The paradigm shift in health care toward value-based reimbursement has brought emphasis to providing better quality of care to patients with chronic diseases, including patients with cancer. In accordance with providing better quality of care to patients, there has been a growing interest in evaluating quality of life through patient-reported outcomes (PROs). The revised Edmonton Symptom Assessment Scale (ESAS-r) is a tool that can be used to assess PROs and has been validated for use in patients with cancer. This initiative sought to use this standard assessment tool to acquire PROs concerning symptom burden from patients prescribed oral oncolytics.Eight oncology practices in the state of Michigan used a modified ESAS-r to evaluate symptom burden of patients prescribed oral oncolytics before each outpatient visit. Thirteen symptoms were categorized as mild (0 to 3), moderate (4 to 6), or severe (7 to 10).A total of 1,235 modified ESAS-r surveys were collected and analyzed; 82.5% of symptoms were categorized as mild, 11.9% of symptoms were categorized as moderate, and 5.6% of symptoms were categorized as severe.PROs can be evaluated through the use of a standardized tool, such as the ESAS-r, in oncology patients receiving oral oncolytic therapy. Implementing such a tool in both community and academic practices is feasible and may facilitate improvements in the quality of care.
View details for DOI 10.1200/JOP.2016.018390
View details for PubMedID 28195813
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Survivorship care plan: Use of the 'Oncology History' (OncHx) feature of the Epic electronic health record (EHR).
AMER SOC CLINICAL ONCOLOGY. 2017
View details for Web of Science ID 000443300500047
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Patient reported symptom severity in cancer survivors.
AMER SOC CLINICAL ONCOLOGY. 2017
View details for Web of Science ID 000443300500134
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Establishing a Core Set of Performance Measures to Improve Value in Cancer Care: ASCO Consensus Conference Recommendation Report
JOURNAL OF ONCOLOGY PRACTICE
2017; 13 (2): 135-+
View details for DOI 10.1200/JOP.2016.017954
View details for Web of Science ID 000397282900022
View details for PubMedID 28029299
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Mining Electronic Health Records to Extract Patient-Centered Outcomes Following Prostate Cancer Treatment.
AMIA ... Annual Symposium proceedings. AMIA Symposium
2017; 2017: 876–82
Abstract
The clinical, granular data in electronic health record (EHR) systems provide opportunities to improve patient care using informatics retrieval methods. However, it is well known that many methodological obstacles exist in accessing data within EHRs. In particular, clinical notes routinely stored in EHR are composed from narrative, highly unstructured and heterogeneous biomedical text. This inherent complexity hinders the ability to perform automated large-scale medical knowledge extraction tasks without the use of computational linguistics methods. The aim of this work was to develop and validate a Natural Language Processing (NLP) pipeline to detect important patient-centered outcomes (PCOs) as interpreted and documented by clinicians in their dictated notes for male patients receiving treatment for localized prostate cancer at an academic medical center.
View details for PubMedID 29854154
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Choosing Wisely in Oncology: Are We Ready For Value-Based Care?
Journal of oncology practice
2017; 13 (11): e935–e943
Abstract
In 2012, ASCO created the Top Five Choosing Wisely (CW) list of low-value tests and procedures for which there is little evidence of benefit. ASCO's Quality Oncology Practice Initiative, an oncologist-led practice-based quality assessment program, includes measures on the basis of these recommendations.CW test measures from spring and fall 2013, spring 2014, and spring 2015 were evaluated for concordance rates, change in the concordance over time, and variability by practice characteristics. Practice characteristics recorded included geographic location, academic affiliation, number of new cases, number of medical oncologists, and rounds of participation in Quality Oncology Practice Initiative. Medians, interquartile ranges, and percentages were calculated for concordance with recommendations and practice characteristics. Change in recommendation concordance over time was assessed using linear regression models.From 2013 to 2015, 341 unique oncology practices abstracted the CW measures. Performance varied for specific recommendations. The median concordance was best for measure 1 (patients with low or undocumented performance status who received chemotherapy), where concordance ranged from 78.4% to 83.3%. The lowest concordance was for measure 3 (use of biomarkers or advanced imaging tests for surveillance in early breast cancer), where concordance ranged from 67.7% to 74.2%. Performance on CW measures varied markedly by individual practice. Variability over time and by practice characteristics was observed.Performance on ASCO's CW demonstrates room for improvement. Concordance rates varied substantially by practice. Further education on CW measures is needed to improve patient care and enhance value.
View details for PubMedID 28783425
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Improving Care With a Portfolio of Physician-Led Cancer Quality Measures at an Academic Center
Improving Care With a Portfolio of Physician-Led Cancer Quality Measures at an Academic Center
2017; 13 (8): e673-e682
Abstract
Development and implementation of robust reporting processes to systematically provide quality data to care teams in a timely manner is challenging. National cancer quality measures are useful, but the manual data collection required is resource intensive, and reporting is delayed. We designed a largely automated measurement system with our multidisciplinary cancer care programs (CCPs) to identify, measure, and improve quality metrics that were meaningful to the care teams and their patients.Each CCP physician leader collaborated with the cancer quality team to identify metrics, abiding by established guiding principles. Financial incentive was provided to the CCPs if performance at the end of the study period met predetermined targets. Reports were developed and provided to the CCP physician leaders on a monthly or quarterly basis, for dissemination to their CCP teams.A total of 15 distinct quality measures were collected in depth for the first time at this cancer center. Metrics spanned the patient care continuum, from diagnosis through end of life or survivorship care. All metrics improved over the study period, met their targets, and earned a financial incentive for their CCP.Our quality program had three essential elements that led to its success: (1) engaging physicians in choosing the quality measures and prespecifying goals, (2) using automated extraction methods for rapid and timely feedback on improvement and progress toward achieving goals, and (3) offering a financial team-based incentive if prespecified goals were met.
View details for DOI 10.1200/JOP.2017.021139
View details for PubMedCentralID PMC5880618
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Plinabulin, a Novel Small Molecule That Ameliorates Chemotherapy-Induced Neutropenia, Is Administered on the Same Day of Chemotherapy and Has Anticancer Efficacy
AMER SOC HEMATOLOGY. 2016
View details for Web of Science ID 000394446809011
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Where Does Dynamic Value Assessment Fit Into Our Role as Agents Advising Our Patients With Cancer?
JOURNAL OF ONCOLOGY PRACTICE
2016; 12 (12): 1211–13
View details for DOI 10.1200/JOP.2016.016022
View details for Web of Science ID 000392383200005
View details for PubMedID 27943682
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Subtype-Dependent Relationship Between Young Age at Diagnosis and Breast Cancer Survival.
Journal of clinical oncology
2016; 34 (27): 3308-3314
Abstract
Young women are at increased risk for developing more aggressive subtypes of breast cancer. Although previous studies have shown a higher risk of breast cancer recurrence and death among young women with early-stage breast cancer, they have not adequately addressed the role of tumor subtype in outcomes.We examined data from women with newly diagnosed stage I to III breast cancer presenting to one of eight National Comprehensive Cancer Network centers between January 2000 and December 2007. Multivariable Cox proportional hazards models were used to assess the relationship between age and breast cancer-specific survival.A total of 17,575 women with stage I to III breast cancer were eligible for analysis, among whom 1,916 were ≤ 40 years of age at diagnosis. Median follow-up time was 6.4 years. In a multivariable Cox proportional hazards model controlling for sociodemographic, disease, and treatment characteristics, women ≤ 40 years of age at diagnosis had greater breast cancer mortality (hazard ratio [HR], 1.4; 95% CI, 1.2 to 1.7). In stratified analyses, age ≤ 40 years was associated with statistically significant increases in risk of breast cancer death among women with luminal A (HR, 2.1; 95% CI, 1.4 to 3.2) and luminal B (HR 1.4; 95% CI, 1.1 to 1.9) tumors, with borderline significance among women with triple-negative tumors (HR, 1.4; 95% CI, 1.0 to 1.8) but not among those with human epidermal growth factor receptor 2 subtypes (HR, 1.2; 95% CI, 0.8 to 1.9). In an additional model controlling for detection method, young age was associated with significantly increased risk of breast cancer death only among women with luminal A tumors.The effect of age on survival of women with early breast cancer seems to vary by breast cancer subtype. Young age seems to be particularly prognostic in women with luminal breast cancers.
View details for DOI 10.1200/JCO.2015.65.8013
View details for PubMedID 27480155
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Updating the American Society of Clinical Oncology Value Framework: Revisions and Reflections in Response to Comments Received.
Journal of clinical oncology
2016; 34 (24): 2925-2934
View details for DOI 10.1200/JCO.2016.68.2518
View details for PubMedID 27247218
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What role should value play in cancer care?
AMER SOC CLINICAL ONCOLOGY. 2016
View details for DOI 10.1200/JCO.2016.34.15_suppl.6629
View details for Web of Science ID 000404711503150
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The ideal interface between oncology and palliative care: Views from the field.
AMER SOC CLINICAL ONCOLOGY. 2016
View details for DOI 10.1200/JCO.2016.34.15_suppl.10034
View details for Web of Science ID 000404712500022
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Using technology to improve patient-provider communication and delivery of quality care.
AMER SOC CLINICAL ONCOLOGY. 2016
View details for DOI 10.1200/jco.2016.34.7_suppl.76
View details for Web of Science ID 000378109900075
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Using a web analytic tool to evaluate Pathways program engagement in 36 Michigan oncology practices.
AMER SOC CLINICAL ONCOLOGY. 2016
View details for DOI 10.1200/jco.2016.34.7_suppl.198
View details for Web of Science ID 000378109900194
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Choosing Wisely in oncology: Are we ready for value-based care?
AMER SOC CLINICAL ONCOLOGY. 2016
View details for DOI 10.1200/jco.2016.34.7_suppl.275
View details for Web of Science ID 000378109900265
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Using technology to improve quality metric adherence
AMER SOC CLINICAL ONCOLOGY. 2016
View details for DOI 10.1200/jco.2016.34.7_suppl.257
View details for Web of Science ID 000378109900247
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Achieving the triple aim in cancer care through a tri-part research collaboration.
AMER SOC CLINICAL ONCOLOGY. 2016
View details for DOI 10.1200/jco.2016.34.7_suppl.52
View details for Web of Science ID 000378109900051
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Neurotoxic Effects of Anthracycline- vs Nonanthracycline-Based Chemotherapy on Cognition in Breast Cancer Survivors.
JAMA oncology
2016; 2 (2): 185-192
Abstract
Chemotherapy exposure is a known risk factor for cancer-related cognitive impairments. Anthracycline-based regimens are commonly used chemotherapies that have been shown to be associated with cognitive impairment and brain changes in clinical studies.To directly compare the effects of anthracycline and nonanthracycline regimens on cognitive status and functional brain connectivity.In this observational study, we retrospectively examined cognitive and resting state functional magnetic resonance imaging data acquired from 62 primary breast cancer survivors (mean [SD] age, 54.7 [8.5] years) who were more than 2 years off-therapy, on average. Twenty of these women received anthracycline-based chemotherapy as part of their primary treatment, 19 received nonanthracycline regimens, and 23 did not receive any chemotherapy. Participants were enrolled at a single academic institution (Stanford University) from 2008 to 2014, and the study analyses were performed at this time.Cognitive status was measured using standardized neuropsychological tests, and functional brain connectivity was evaluated using resting state functional magnetic resonance imaging with a focus on the brain's default mode network.The anthracycline group demonstrated significantly lower verbal memory performance including immediate recall (F = 3.73; P = .03) and delayed recall (F = 11.11; P < .001) as well as lower left precuneus connectivity (F = 7.48; P = .001) compared with the other 2 groups. Patient-reported outcomes related to cognitive dysfunction (F = 7.27; P = .002) and psychological distress (F = 5.64; P = .006) were similarly elevated in both chemotherapy groups compared with the non-chemotherapy-treated controls.These results suggest that anthracyclines may have greater negative effects than nonanthracycline regimens on particular cognitive domains and brain network connections. Both anthracycline and nonanthracycline regimens may have nonspecific effects on other cognitive domains as well as certain patient reported outcomes. Further research is needed to identify potential methods for protecting the brain against the effects of various chemotherapeutic agents.
View details for DOI 10.1001/jamaoncol.2015.4333
View details for PubMedID 26633037
View details for PubMedCentralID PMC4838415
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New Paradigms for Patient-Centered Outcomes Research in Electronic Medical Records: An Example of Detecting Urinary Incontinence Following Prostatectomy.
EGEMS (Washington, DC)
2016; 4 (3): 1231-?
Abstract
National initiatives to develop quality metrics emphasize the need to include patient-centered outcomes. Patient-centered outcomes are complex, require documentation of patient communications, and have not been routinely collected by healthcare providers. The widespread implementation of electronic medical records (EHR) offers opportunities to assess patient-centered outcomes within the routine healthcare delivery system. The objective of this study was to test the feasibility and accuracy of identifying patient centered outcomes within the EHR.Data from patients with localized prostate cancer undergoing prostatectomy were used to develop and test algorithms to accurately identify patient-centered outcomes in post-operative EHRs - we used urinary incontinence as the use case. Standard data mining techniques were used to extract and annotate free text and structured data to assess urinary incontinence recorded within the EHRs.A total 5,349 prostate cancer patients were identified in our EHR-system between 1998-2013. Among these EHRs, 30.3% had a text mention of urinary incontinence within 90 days post-operative compared to less than 1.0% with a structured data field for urinary incontinence (i.e. ICD-9 code). Our workflow had good precision and recall for urinary incontinence (positive predictive value: 0.73 and sensitivity: 0.84).Our data indicate that important patient-centered outcomes, such as urinary incontinence, are being captured in EHRs as free text and highlight the long-standing importance of accurate clinician documentation. Standard data mining algorithms can accurately and efficiently identify these outcomes in existing EHRs; the complete assessment of these outcomes is essential to move practice into the patient-centered realm of healthcare.
View details for DOI 10.13063/2327-9214.1231
View details for PubMedID 27347492
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Is screening enough? Implications of a pilot utilizing standard screening criteria for early palliative referral
AMER SOC CLINICAL ONCOLOGY. 2015
View details for DOI 10.1200/jco.2015.33.29_suppl.119
View details for Web of Science ID 000378107000115
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From PRO screening to improved wellness: A nurse-led intervention
AMER SOC CLINICAL ONCOLOGY. 2015
View details for DOI 10.1200/jco.2015.33.29_suppl.72
View details for Web of Science ID 000378107000071
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American Society of Clinical Oncology Statement: A Conceptual Framework to Assess the Value of Cancer Treatment Options.
Journal of clinical oncology
2015; 33 (23): 2563-2577
View details for DOI 10.1200/JCO.2015.61.6706
View details for PubMedID 26101248
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American Society of Clinical Oncology Statement: A Conceptual Framework to Assess the Value of Cancer Treatment Options.
Journal of clinical oncology
2015; 33 (23): 2563-2577
View details for DOI 10.1200/JCO.2015.61.6706
View details for PubMedID 26101248
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Brain network alterations and vulnerability to simulated neurodegeneration in breast cancer
NEUROBIOLOGY OF AGING
2015; 36 (8): 2429-2442
Abstract
Breast cancer and its treatments are associated with mild cognitive impairment and brain changes that could indicate an altered or accelerated brain aging process. We applied diffusion tensor imaging and graph theory to measure white matter organization and connectivity in 34 breast cancer survivors compared with 36 matched healthy female controls. We also investigated how brain networks (connectomes) in each group responded to simulated neurodegeneration based on network attack analysis. Compared with controls, the breast cancer group demonstrated significantly lower fractional anisotropy, altered small-world connectome properties, lower brain network tolerance to systematic region (node), and connection (edge) attacks and significant cognitive impairment. Lower tolerance to network attack was associated with cognitive impairment in the breast cancer group. These findings provide further evidence of diffuse white matter pathology after breast cancer and extend the literature in this area with unique data demonstrating increased vulnerability of the post-breast cancer brain network to future neurodegenerative processes.
View details for DOI 10.1016/j.neurobiolaging.2015.04.015
View details for Web of Science ID 000355771100010
View details for PubMedID 26004016
View details for PubMedCentralID PMC4464941
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Racial and Ethnic Differences in Breast Cancer Survival: Mediating Effect of Tumor Characteristics and Sociodemographic and Treatment Factors.
Journal of clinical oncology
2015; 33 (20): 2254-2261
Abstract
To evaluate the relationship between race/ethnicity and breast cancer-specific survival according to subtype and explore mediating factors.Participants were women presenting with stage I to III breast cancer between January 2000 and December 2007 at National Comprehensive Cancer Network centers with survival follow-up through December 2009. Cox proportional hazards regression was used to compare breast cancer-specific survival among Asians (n = 533), Hispanics (n = 1,122), and blacks (n = 1,345) with that among whites (n = 14,268), overall and stratified by subtype (luminal A like, luminal B like, human epidermal growth factor receptor 2 type, and triple negative). Model estimates were used to derive mediation proportion and 95% CI for selected risk factors.In multivariable adjusted models, overall, blacks had 21% higher risk of breast cancer-specific death (hazard ratio [HR], 1.21; 95% CI, 1.00 to 1.45). For estrogen receptor-positive tumors, black and white survival differences were greatest within 2 years of diagnosis (years 0 to 2: HR, 2.65; 95% CI, 1.34 to 5.24; year 2 to end of follow-up: HR, 1.50; 95% CI, 1.12 to 2.00). Blacks were 76% and 56% more likely to die as a result of luminal A-like and luminal B-like tumors, respectively. No disparities were observed for triple-negative or human epidermal growth factor receptor 2-type tumors. Asians and Hispanics were less likely to die as a result of breast cancer compared with whites (Asians: HR, 0.56; 95% CI, 0.37 to 0.85; Hispanics: HR, 0.74; 95% CI, 0.58 to 0.95). For blacks, tumor characteristics and stage at diagnosis were significant disparity mediators. Body mass index was an important mediator for blacks and Asians.Racial disparities in breast cancer survival vary by tumor subtype. Interventions are needed to reduce disparities, particularly in the first 2 years after diagnosis among black women with estrogen receptor-positive tumors.
View details for DOI 10.1200/JCO.2014.57.1349
View details for PubMedID 25964252
View details for PubMedCentralID PMC4486344
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Racial and Ethnic Differences in Breast Cancer Survival: Mediating Effect of Tumor Characteristics and Sociodemographic and Treatment Factors.
Journal of clinical oncology
2015; 33 (20): 2254-2261
View details for DOI 10.1200/JCO.2014.57.1349
View details for PubMedID 25964252
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Do Wise Choices Translate Into Cost Savings and Improved Outcomes?
Journal of oncology practice / American Society of Clinical Oncology
2015; 11 (4): 344-345
View details for DOI 10.1200/JOP.2015.004937
View details for PubMedID 26060226
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Association of high symptom burden with oral oncolytic agents
AMER SOC CLINICAL ONCOLOGY. 2015
View details for Web of Science ID 000358036902108
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Choosing wisely: Treatment recommendations from 36 Michigan Oncology Clinical Treatment Pathways practices
AMER SOC CLINICAL ONCOLOGY. 2015
View details for DOI 10.1200/jco.2015.33.15_suppl.6584
View details for Web of Science ID 000358036901498
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Transforming data from information to quality improvement: a panel discussion with electronic health record vendors.
Journal of oncology practice / American Society of Clinical Oncology
2015; 11 (3): 174-175
View details for DOI 10.1200/JOP.2015.004267
View details for PubMedID 25829523
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American society of clinical oncology third quality care symposium.
Journal of oncology practice / American Society of Clinical Oncology
2015; 11 (3): 167-?
View details for DOI 10.1200/JOP.2015.004119
View details for PubMedID 25804987
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Detecting unplanned care from clinician notes in electronic health records.
Journal of oncology practice / American Society of Clinical Oncology
2015; 11 (3): e313-9
Abstract
Reduction in unplanned episodes of care, such as emergency department visits and unplanned hospitalizations, are important quality outcome measures. However, many events are only documented in free-text clinician notes and are labor intensive to detect by manual medical record review.We studied 308,096 free-text machine-readable documents linked to individual entries in our electronic health records, representing care for patients with breast, GI, or thoracic cancer, whose treatment was initiated at one academic medical center, Stanford Health Care (SHC). Using a clinical text-mining tool, we detected unplanned episodes documented in clinician notes (for non-SHC visits) or in coded encounter data for SHC-delivered care and the most frequent symptoms documented in emergency department (ED) notes.Combined reporting increased the identification of patients with one or more unplanned care visits by 32% (15% using coded data; 20% using all the data) among patients with 3 months of follow-up and by 21% (23% using coded data; 28% using all the data) among those with 1 year of follow-up. Based on the textual analysis of SHC ED notes, pain (75%), followed by nausea (54%), vomiting (47%), infection (36%), fever (28%), and anemia (27%), were the most frequent symptoms mentioned. Pain, nausea, and vomiting co-occur in 35% of all ED encounter notes.The text-mining methods we describe can be applied to automatically review free-text clinician notes to detect unplanned episodes of care mentioned in these notes. These methods have broad application for quality improvement efforts in which events of interest occur outside of a network that allows for patient data sharing.
View details for DOI 10.1200/JOP.2014.002741
View details for PubMedID 25980019
View details for PubMedCentralID PMC4438112
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Leveraging state cancer registries to measure and improve the quality of cancer care: a potential strategy for California and beyond.
Journal of the National Cancer Institute
2015; 107 (5)
Abstract
Despite recent increased attention to healthcare performance and the burden of disease from cancer, measures of quality of cancer care are not readily available. In 2013, the California HealthCare Foundation convened an expert workgroup to explore the potential for leveraging data in the California Cancer Registry (CCR), one of the world's largest population-based cancer registries, for measuring and improving the quality of cancer care. The workgroup assessed current registry operations, the value to be gained by linking CCR data with health insurance claims or encounter data and clinical data contained in health system electronic health records, and potential barriers to these linkages. The workgroup concluded that: 1) The CCR mandate should be expanded to include use of its data for quality of cancer care measurement and public reporting; and 2) a system should be developed to support linkage of registry data with both claims data and provider electronic health record data.
View details for DOI 10.1093/jnci/djv047
View details for PubMedID 25766400
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Administration of oral chemotherapy: results from three rounds of the quality oncology practice initiative.
Journal of oncology practice / American Society of Clinical Oncology
2015; 11 (2): e255-62
Abstract
Although use of oral chemotherapy is becoming more prevalent, little is known about the quality of care that patients receive when these agents are prescribed. Moreover, few practice-level systems are in place to ensure safe management of oral chemotherapy in the vulnerable population of patients with cancer.We analyzed results from 155 practices that were voluntarily participating in the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) program on 17 test measures of oral chemotherapy administration and management in at least one of three collection periods: spring or fall of 2012, or spring of 2013. The 17 test measures cover three domains: treatment plan documentation, patient education, and adherence/toxicity monitoring. We defined composite scores for each of the three domains. We analyzed the composite scores by secular trend and tested the difference in composite scores for the three domains. Additionally, we tested change in scores over time among practices that participated at least twice.The majority of data was provided by QOPI-certified practices. Overall, mean practice composite scores ranged from 66% to 68% for treatment plan documentation, 51% to 57% for patient education, and 75% to 81% for adherence/toxicity monitoring. Composite scores for practices that participated more than once did not improve significantly.The collection of oral chemotherapy test measure data is feasible. Composite scores for treatment plan documentation and patient education were not only lower, but had greater variability compared with adherence/toxicity monitoring. Improvement opportunities exist for patients who are prescribed oral chemotherapy.
View details for DOI 10.1200/JOP.2014.001842
View details for PubMedID 25784581
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Are Patients With Thoracic Malignancies at Risk for Uncontrolled Symptoms?
Journal of oncology practice / American Society of Clinical Oncology
2015; 11 (1): e98-e102
Abstract
Patients with cancer often develop symptoms and contact their oncologists and care teams after normal clinic operating hours. Better understanding of these after-hours telephone calls can inform efforts to improve cancer care and to reduce health care spending. We sought to evaluate after-hours calls at Stanford Cancer Institute (SCI) Thoracic Oncology Clinic.We retrospectively analyzed content of telephone call notes made to SCI during weekends and from 5 pm to 8 am on weekdays. Chief complaint, caller and patient demographics, patient diagnosis, advice given, and disposition were analyzed. χ(2) tests were used to analyze differences in proportions.There were a total of 263 after-hours telephone calls during the 6 months of the study. After exclusions, there were 241 telephone calls for analysis. The majority of calls occurred between 5 pm to 11 pm (n = 175 [73%]; P < .001), followed by daytime calls on weekends (n = 157 [65%]; P < .001). Common symptoms were cough (28%) and dyspnea (27%). Of the calls, 62% (150 patients) resulted in emergency department (ED) referral, and 77% of patients (115 of 150) evaluated in the ED were admitted to the hospital.Most after-hours telephone calls from patients with lung cancer are related to symptoms. Many patients were referred to the ED and subsequently required hospitalization. Analysis of call content and prior events leading to after-hours calls may predict hospital admissions in this group of patients and can inform development of proactive interventions to improve quality of care and patient-centered outcomes.
View details for DOI 10.1200/JOP.2014.001502
View details for PubMedID 25271246
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Development and Future of the American Society of Clinical Oncology's Quality Oncology Practice Initiative
JOURNAL OF CLINICAL ONCOLOGY
2014; 32 (35): 3907-U174
View details for DOI 10.1200/JCO.2014.56.8899
View details for Web of Science ID 000345905100002
View details for PubMedID 25225418
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Using a statewide collaborative approach to improve tobacco cessation referral rates for cancer patients
AMER ASSOC CANCER RESEARCH. 2014
View details for DOI 10.1158/1538-7445.AM2014-5042
View details for Web of Science ID 000349910203499
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Reply to L.k. Griffeth et Al and j.e. Battley et Al.
Journal of clinical oncology
2014; 32 (25): 2812-2813
View details for DOI 10.1200/JCO.2014.55.2349
View details for PubMedID 25024078
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Measurement of urinary incontinence after prostate surgery from data-mining electronic health records (EHR).
AMER SOC CLINICAL ONCOLOGY. 2014
View details for Web of Science ID 000358613203796
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Improved access to tobacco cessation services for cancer patients using a statewide collaborative approach.
AMER SOC CLINICAL ONCOLOGY. 2014
View details for DOI 10.1200/jco.2014.32.15_suppl.6613
View details for Web of Science ID 000358613203797
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Survivorship care plan: Use of the "Oncology History" (OncHx) feature of the Epic electronic health record (EHR).
AMER SOC CLINICAL ONCOLOGY. 2014
View details for DOI 10.1200/jco.2014.32.15_suppl.e20609
View details for Web of Science ID 000358613201590
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Oral chemotherapy performance indicators: Early results from three rounds of Quality Oncology Practice Initiative (QOPI) data
AMER SOC CLINICAL ONCOLOGY. 2014
View details for DOI 10.1200/jco.2014.32.15_suppl.6532
View details for Web of Science ID 000358613203718
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Mobile cognitive assessment battery (MCAB) for assessment of cancer-related cognitive changes.
AMER SOC CLINICAL ONCOLOGY. 2014
View details for DOI 10.1200/jco.2014.32.15_suppl.9571
View details for Web of Science ID 000358613204455
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Transforming cancer care: are transdisciplinary approaches using design-thinking, engineering, and business methodologies needed to improve value in cancer care delivery?
Journal of oncology practice / American Society of Clinical Oncology
2014; 10 (2): e51-4
View details for DOI 10.1200/JOP.2013.000928
View details for PubMedID 24371302
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Breast Cancer Treatment Across Health Care Systems
CANCER
2014; 120 (1): 103-111
Abstract
Understanding of cancer outcomes is limited by data fragmentation. In the current study, the authors analyzed the information yielded by integrating breast cancer data from 3 sources: electronic medical records (EMRs) from 2 health care systems and the state registry.Diagnostic test and treatment data were extracted from the EMRs of all patients with breast cancer treated between 2000 and 2010 in 2 independent California institutions: a community-based practice (Palo Alto Medical Foundation; "Community") and an academic medical center (Stanford University; "University"). The authors incorporated records from the population-based California Cancer Registry and then linked EMR-California Cancer Registry data sets of Community and University patients.The authors initially identified 8210 University patients and 5770 Community patients; linked data sets revealed a 16% patient overlap, yielding 12,109 unique patients. The percentage of all Community patients, but not University patients, treated at both institutions increased with worsening cancer prognostic factors. Before linking the data sets, Community patients appeared to receive less intervention than University patients (mastectomy: 37.6% vs 43.2%; chemotherapy: 35% vs 41.7%; magnetic resonance imaging: 10% vs 29.3%; and genetic testing: 2.5% vs 9.2%). Linked Community and University data sets revealed that patients treated at both institutions received substantially more interventions (mastectomy: 55.8%; chemotherapy: 47.2%; magnetic resonance imaging: 38.9%; and genetic testing: 10.9% [P < .001 for each 3-way institutional comparison]).Data linkage identified 16% of patients who were treated in 2 health care systems and who, despite comparable prognostic factors, received far more intensive treatment than others. By integrating complementary data from EMRs and population-based registries, a more comprehensive understanding of breast cancer care and factors that drive treatment use was obtained.
View details for DOI 10.1002/cncr.28395
View details for Web of Science ID 000328443000017
View details for PubMedCentralID PMC3867595
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Patients with systemic lupus erythematosus and haematological malignancy at a tertiary care centre: timing, histopathology and therapy.
Lupus science & medicine
2014; 1 (1)
Abstract
Patients with systemic lupus erythematosus (SLE) are at higher risk of haematological malignancies (HMs) than the general population. Most reports have focused on HM diagnosed after SLE, and have excluded concurrent and preceding diagnoses. Information on response to therapy is also limited.We identified 13 296 cases of HM and 10 539 potential patients with SLE at our centre; 45 patients were confirmed to have HM and SLE. Our retrospective case series was based on these 45 patients.Of the 45 patients, 64% were diagnosed with HM ≥1 year after diagnosis with SLE, and 36% with HM before or concurrent with SLE. Of the 29 patients with HM after SLE, 13 had diffuse large B cell lymphoma (DLBCL), 6 indolent lymphoma, 4 leukaemia, 3 Hodgkin's disease, and 1 each Burkitt's lymphoma, T cell lymphoma and multiple myeloma. Eleven patients with DLBCL were treated with cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone (CHOP) or rituximab-CHOP; hydroxydaunorubicin, oncovin and prednisone; only four achieved durable remission. Of the 16 patients diagnosed with HM before or concurrent with SLE, 9 were diagnosed with HM more than 2 years before SLE and tended to be in remission prior to SLE diagnosis. Seven patients were diagnosed with HM and SLE concurrently; in terms of their HM, six achieved remission or stable disease.In summary, DLBCL was the most common type of lymphoma in patients diagnosed with HM after SLE; these patients presented with advanced-stage disease and had poor outcomes. In contrast, patients diagnosed with HM before or concurrent with SLE had early stage disease and typically achieved remission.
View details for DOI 10.1136/lupus-2014-000051
View details for PubMedID 25452880
View details for PubMedCentralID PMC4246917
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Breast cancer treatment across health care systems: linking electronic medical records and state registry data to enable outcomes research.
Cancer
2014; 120 (1): 103-111
Abstract
Understanding of cancer outcomes is limited by data fragmentation. In the current study, the authors analyzed the information yielded by integrating breast cancer data from 3 sources: electronic medical records (EMRs) from 2 health care systems and the state registry.Diagnostic test and treatment data were extracted from the EMRs of all patients with breast cancer treated between 2000 and 2010 in 2 independent California institutions: a community-based practice (Palo Alto Medical Foundation; "Community") and an academic medical center (Stanford University; "University"). The authors incorporated records from the population-based California Cancer Registry and then linked EMR-California Cancer Registry data sets of Community and University patients.The authors initially identified 8210 University patients and 5770 Community patients; linked data sets revealed a 16% patient overlap, yielding 12,109 unique patients. The percentage of all Community patients, but not University patients, treated at both institutions increased with worsening cancer prognostic factors. Before linking the data sets, Community patients appeared to receive less intervention than University patients (mastectomy: 37.6% vs 43.2%; chemotherapy: 35% vs 41.7%; magnetic resonance imaging: 10% vs 29.3%; and genetic testing: 2.5% vs 9.2%). Linked Community and University data sets revealed that patients treated at both institutions received substantially more interventions (mastectomy: 55.8%; chemotherapy: 47.2%; magnetic resonance imaging: 38.9%; and genetic testing: 10.9% [P < .001 for each 3-way institutional comparison]).Data linkage identified 16% of patients who were treated in 2 health care systems and who, despite comparable prognostic factors, received far more intensive treatment than others. By integrating complementary data from EMRs and population-based registries, a more comprehensive understanding of breast cancer care and factors that drive treatment use was obtained.
View details for DOI 10.1002/cncr.28395
View details for PubMedID 24101577
View details for PubMedCentralID PMC3867595
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American society of clinical oncology 2013 top five list in oncology.
Journal of clinical oncology
2013; 31 (34): 4362-4370
View details for DOI 10.1200/JCO.2013.53.3943
View details for PubMedID 24170249
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ARE PATIENTS' NEEDS BEING MET AFTER-HOURS? AN EVALUATION OF PHONE CALLS MADE AFTER HOURS FOR PATIENTS WITH THORACIC MALIGNANCIES.
LIPPINCOTT WILLIAMS & WILKINS. 2013: S709
View details for Web of Science ID 000339624903178
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Using a statewide collaborative approach to improve tobacco cessation referral rates for cancer patients
AMER SOC CLINICAL ONCOLOGY. 2013
View details for DOI 10.1200/jco.2013.31.31_suppl.74
View details for Web of Science ID 000335565500074
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Real-time extraction of breast cancer treatment process and outcome measures from an EPIC electronic health record (EHR)
AMER SOC CLINICAL ONCOLOGY. 2013
View details for Web of Science ID 000335565500002
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ASCO's Quality Care Symposium (November 1-2, 2013) Abstracts
JOURNAL OF CLINICAL ONCOLOGY
2013; 31 (31)
View details for Web of Science ID 000335565500001
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PALLIATIVE CARE AND ANTI-CANCER CARE INTEGRATION: DESCRIPTION OF THREE MODELS OF CARE DELIVERY AT A TERTIARY MEDICAL CENTER
LIPPINCOTT WILLIAMS & WILKINS. 2013: S1324
View details for Web of Science ID 000339624906208
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Are patients' needs being met after hours? An evaluation of phone calls made after hours for patients with thoracic malignancies.
AMER SOC CLINICAL ONCOLOGY. 2013
View details for DOI 10.1200/jco.2013.31.31_suppl.46
View details for Web of Science ID 000335565500047
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Myeloid Growth Factors
JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK
2013; 11 (10): 1266-1290
Abstract
Febrile neutropenia, a common side effect of myelosuppressive chemotherapy in patients with cancer, can result in prolonged hospitalization and broad-spectrum antibiotic use, often prompting treatment delays or dose reductions of drug regimens. Prophylactic use of myeloid growth factors (mainly the colony-stimulating factors filgrastim and pegfilgrastim) in patients of heightened risk can reduce the severity and duration of febrile neutropenia. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Myeloid Growth Factors provide recommendations on the use of these agents mainly in the oncology setting based on clinical evidence and expert consensus. This version includes revisions surrounding the issue of timing of pegfilgrastim administration. It also includes new sections on tbo-filgrastim, a recently approved agent that is biologically similar to filgrastim, and the role of myeloid growth factors in the hematopoietic cell transplant setting.
View details for Web of Science ID 000325929600010
View details for PubMedID 24142827
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Computerized prescriber order entry implementation in a physician assistant-managed hematology and oncology inpatient service: effects on workflow and task switching.
Journal of oncology practice / American Society of Clinical Oncology
2013; 9 (4): e103-14
Abstract
Little is known about the impact of computerized prescriber order entry (CPOE) systems on inpatient hematology/oncology services. The objective of this study was to quantify the impact of an inpatient CPOE implementation on workflow, with an emphasis on ordering and direct patient care time.We conducted a direct-observation time-and-motion study of the provider team of a hematology/oncology inpatient service both before and after CPOE implementation, characterizing workflow into 60 distinct activity categories. The provider team comprised physician assistants supervised by attending physicians. Results were adjusted to account for variations in the census. We also conducted an analysis of computer logs to assess CPOE system usage.Study participants were observed for 228.0 hours over 53 observation sessions. There was little change in the proportion of census-adjusted time spent on ordering (10.2% before v 11.4% after) and on direct patient care (50.7% before v 47.8% after). Workflow fragmentation decreased, with providers spending an average of 131.2 seconds on a continuous task before implementation and 218.3 seconds after (P < .01). An eight-fold decrease in the number of pages was observed during the course of the study.CPOE implementation did not negatively affect time available for direct patient care. Workflow fragmentation decreased, which is likely beneficial.
View details for DOI 10.1200/JOP.2012.000655
View details for PubMedID 23942926
View details for PubMedCentralID PMC3710176
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Are needs of stakeholders in cancer care being met? A novel approch to assessing needs to improve value in cancer care
AMER SOC CLINICAL ONCOLOGY. 2013
View details for Web of Science ID 000335419602297
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Measuring and improving quality of care in an academic medical center.
Journal of oncology practice / American Society of Clinical Oncology
2013; 9 (3): 138-141
Abstract
The Donabedian definition of quality—structure, process, and outcome—provides a useful framework. A relentless focus on measuring process adherence and outcome is critical. Systemic improvements usually require teams to plan and to implement them. The lean or Toyota production system for process improvement is one useful method of organizing work, although different approaches are often necessary at the physician, practice unit, and statewide level. Challenges include scalability of the change (ie, rolling them out across the institution or system), tailoring the information technology tools, and building systems for sustainability.
View details for DOI 10.1200/JOP.2013.000991
View details for PubMedID 23942492
View details for PubMedCentralID PMC3651561
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Introduction to the ASCO Quality Care Symposium
JOURNAL OF ONCOLOGY PRACTICE
2013; 9 (3): 113
View details for DOI 10.1200/JOP.2013.000992
View details for Web of Science ID 000214637600007
View details for PubMedID 23942482
View details for PubMedCentralID PMC3651551
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Models That Work: Incorporating Quality Principles in Different Clinical Settings
JOURNAL OF ONCOLOGY PRACTICE
2013; 9 (3): 135–37
View details for DOI 10.1200/JOP.2013.001028
View details for Web of Science ID 000214637600016
View details for PubMedID 23942491
View details for PubMedCentralID PMC3651560
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Measuring the Improving Quality of Outpatient Care in Medical Oncology Practices in the United States
JOURNAL OF CLINICAL ONCOLOGY
2013; 31 (11): 1471-1477
Abstract
The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) has provided a method for measuring process-based practice quality since 2006. We sought to determine whether QOPI scores showed improvement in measured quality over time and, if change was demonstrated, which factors in either the measures or participants were associated with improvement.The analysis included 156 practice groups from a larger group of 308 that submitted data from 2006 to 2010. One hundred fifty-two otherwise eligible practices were excluded, most commonly for insufficient data submission. A linear regression model that controlled for varied initial performance was used to estimate the effect of participation over time and evaluate participant and measure characteristics of improvement.Participants completed a mean of 5.06 (standard deviation, 1.94) rounds of data collection. Adjusted mean quality scores improved from 0.71 (95% CI, 0.42 to 0.91) to 0.85 (95% CI, 0.60 to 0.95). Overall odds ratio of improvement over time was 1.09 (P < .001). The greatest improvement was seen in measures that assessed newly introduced clinical information, in which the mean scores improved from 0.05 (95% CI, 0.01 to 0.17) to 0.69 (95% CI, 0.33 to 0.91; P < .001). Many measures showed no change over time.Many US oncologists have participated in QOPI over the past 6 years. Participation over time was highly correlated with improvement in measured performance. Greater and faster improvement was seen in measures concerning newly introduced clinical information. Some measures showed no change despite opportunity for improvement.
View details for DOI 10.1200/JCO.2012.43.3300
View details for Web of Science ID 000317174400022
View details for PubMedID 23478057
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Tumor Boards (Team Huddles) Aren't Enough to Reach the Goal
JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE
2013; 105 (2): 82-84
View details for DOI 10.1093/jnci/djs523
View details for Web of Science ID 000314865100005
View details for PubMedID 23274389
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The use of a palliative care tool in a community private practice
AMER SOC CLINICAL ONCOLOGY. 2012
View details for DOI 10.1200/jco.2012.30.34_suppl.95
View details for Web of Science ID 000208943900095
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Time to diagnosis and breast cancer stage by race/ethnicity
BREAST CANCER RESEARCH AND TREATMENT
2012; 136 (3): 813-821
Abstract
We examined differences in time to diagnosis by race/ethnicity, the relationship between time to diagnosis and stage, and the extent to which it explains differences in stage at diagnosis across racial/ethnic groups. Our analytic sample includes 21,427 non-Hispanic White (White), Hispanic, non-Hispanic Black (Black) and non-Hispanic Asian/Pacific Islander (Asian) women diagnosed with stage I to IV breast cancer between January 1, 2000 and December 31, 2007 at one of eight National Comprehensive Cancer Network centers. We measured time from initial abnormal mammogram or symptom to breast cancer diagnosis. Stage was classified using AJCC criteria. Initial sign of breast cancer modified the association between race/ethnicity and time to diagnosis. Among symptomatic women, median time to diagnosis ranged from 36 days among Whites to 53.6 for Blacks. Among women with abnormal mammograms, median time to diagnosis ranged from 21 days among Whites to 29 for Blacks. Blacks had the highest proportion (26 %) of Stage III or IV tumors. After accounting for time to diagnosis, the observed increased risk of stage III/IV breast cancer was reduced from 40 to 28 % among Hispanics and from 113 to 100 % among Blacks, but estimates remained statistically significant. We were unable to fully account for the higher proportion of late-stage tumors among Blacks. Blacks and Hispanics experienced longer time to diagnosis than Whites, and Blacks were more likely to be diagnosed with late-stage tumors. Longer time to diagnosis did not fully explain differences in stage between racial/ethnicity groups.
View details for DOI 10.1007/s10549-012-2304-1
View details for Web of Science ID 000312071000019
View details for PubMedID 23099438
View details for PubMedCentralID PMC3513497
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Measuring the improving quality of outpatient care in medical oncology practices in the United States
AMER SOC CLINICAL ONCOLOGY. 2012
View details for DOI 10.1200/jco.2012.30.34_suppl.66
View details for Web of Science ID 000208943900066
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Clinicopathologic Features, Patterns of Recurrence, and Survival Among Women With Triple-Negative Breast Cancer in the National Comprehensive Cancer Network
CANCER
2012; 118 (22): 5463-5472
Abstract
The objective of this study was to describe clinicopathologic features, patterns of recurrence, and survival according to breast cancer subtype with a focus on triple-negative tumors.In total, 15,204 women were evaluated who presented to National Comprehensive Cancer Network centers with stage I through III breast cancer between January 2000 and December 2006. Tumors were classified as positive for estrogen receptor (ER) and/or progesterone receptor (PR) (hormone receptor [HR]-positive) and negative for human epidermal growth factor receptor 2 (HER2); positive for HER2 and any ER or PR status (HER2-positive); or negative for ER, PR, and HER2 (triple-negative).Subtype distribution was triple-negative in 17% of women (n = 2569), HER2-positive in 17% of women (n = 2602), and HR-positive/HER2-negative in 66% of women (n = 10,033). The triple-negative subtype was more frequent in African Americans compared with Caucasians (adjusted odds ratio, 1.98; P < .0001). Premenopausal women, but not postmenopausal women, with high body mass index had an increased likelihood of having the triple-negative subtype (P = .02). Women with triple-negative cancers were less likely to present on the basis of an abnormal screening mammogram (29% vs 48%; P < .0001) and were more likely to present with higher tumor classification, but they were less likely to have lymph node involvement. Relative to HR-positive/HER2-negative tumors, triple-negative tumors were associated with a greater risk of brain or lung metastases; and women with triple-negative tumors had worse breast cancer-specific and overall survival, even after adjusting for age, disease stage, race, tumor grade, and receipt of adjuvant chemotherapy (overall survival: adjusted hazard ratio, 2.72; 95% confidence interval, 2.39-3.10; P < .0001). The difference in the risk of death by subtype was most dramatic within the first 2 years after diagnosis (overall survival for 0-2 years: OR, 6.10; 95% confidence interval, 4.81-7.74).Triple-negative tumors were associated with unique risk factors and worse outcomes compared with HR-positive/HER2-negative tumors.
View details for DOI 10.1002/cncr.27581
View details for Web of Science ID 000310483800002
View details for PubMedID 22544643
View details for PubMedCentralID PMC3611659
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The anemia impact measure (AIM): development and content validation of a patient-reported outcome measure of anemia symptoms and symptom impacts in cancer patients receiving chemotherapy
QUALITY OF LIFE RESEARCH
2012; 21 (7): 1255-1266
Abstract
To develop a patient-reported outcome instrument for measuring anemia symptoms and their impact in patients with chemotherapy-induced anemia (CIA).Qualitative research was conducted using six focus groups and 24 interviews with 46 CIA patients, eight interviews in patients receiving chemotherapy with no CIA history and two interviews in patients successfully treated for CIA. Atlas.ti 5.0 was used to organize key concepts. Cognitive interviews with 16 CIA patients and assessment of relevance of each item to CIA by 10 clinicians were also conducted to evaluate content validity.Most CIA patients were white (76%) and female (83%), and the average age was 60 years. The most common cancer types were breast cancer (54%) and lung cancer (17%). Tiredness was the most prevalent symptom and rated as the most important by 83% of CIA patients; weakness, shortness of breath, lightheadedness, and dizziness were ranked next in importance. The final anemia impact measure (AIM) contains: (1) daily CIA symptom diary (9 items), and (2) impact of CIA-related tiredness (29 items covering daily living activities, social activities, cognitive function, and emotions). Cognitive interviews found that the AIM was relevant and easy to understand.The AIM assesses important patient-perceived CIA symptoms and their impact and was developed using extensive patient qualitative data.
View details for DOI 10.1007/s11136-011-0034-1
View details for Web of Science ID 000314910300016
View details for PubMedID 21987032
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Adoption of Gene Expression Profile Testing and Association With Use of Chemotherapy Among Women With Breast Cancer
JOURNAL OF CLINICAL ONCOLOGY
2012; 30 (18): 2218-2226
Abstract
Gene expression profile (GEP) testing is a relatively new technology that offers the potential of personalized medicine to patients, yet little is known about its adoption into routine practice. One of the first commercially available GEP tests, a 21-gene profile, was developed to estimate the benefit of adjuvant chemotherapy for hormone receptor-positive breast cancer (HR-positive BC).By using a prospective registry data set outlining the routine care provided to women diagnosed from 2006 to 2008 with HR-positive BC at 17 comprehensive and community-based cancer centers, we assessed GEP test adoption and the association between testing and chemotherapy use.Of 7,375 women, 20.4% had GEP testing and 50.2% received chemotherapy. Over time, testing increased (14.7% in 2006 to 27.5% in 2008; P < .01) and use of chemotherapy decreased (53.9% in 2006 to 47.0% in 2008; P < .01). Characteristics independently associated with lower odds of testing included African American versus white race (odds ratio [OR], 0.70; 95% CI, 0.54 to 0.92) and high school or less versus more than high school education (OR, 0.63; 95% CI, 0.52 to 0.76). Overall, testing was associated with lower odds of chemotherapy use (OR, 0.70; 95% CI, 0.62 to 0.80). Stratified analyses demonstrated that for small, node-negative cancers, testing was associated with higher odds of chemotherapy use (OR, 11.13; 95% CI, 5.39 to 22.99), whereas for node-positive and large node-negative cancers, testing was associated with lower odds of chemotherapy use (OR, 0.11; 95% CI, 0.07 to 0.17).There has been a progressive increase in use of this GEP test and an associated shift in the characteristics of and overall reduction in the proportion of women with HR-positive BC receiving adjuvant chemotherapy.
View details for DOI 10.1200/JCO.2011.38.5740
View details for Web of Science ID 000305413200014
View details for PubMedID 22585699
View details for PubMedCentralID PMC3397718
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The Effect of Age on Delay in Diagnosis and Stage of Breast Cancer
ONCOLOGIST
2012; 17 (6): 775-782
Abstract
Young women with breast cancer are more likely to present with more advanced disease and are more likely to die as a result of breast cancer than their older counterparts. We sought to examine the relationship among young age (≤40 years), the likelihood of a delay in diagnosis, and stage.We examined data from women with newly diagnosed stage I-IV breast cancer presenting to one of eight National Comprehensive Cancer Network centers in January 2000 to December 2007. Delay in diagnosis was defined as time from initial sign or symptom to breast cancer diagnosis >60 days.Among 21,818 women with breast cancer eligible for analysis, 2,445 were aged ≤40 years at diagnosis. Young women were not more likely to have a delay in diagnosis >60 days (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.98-1.19) after adjustment for type of initial sign or symptom. Young women were only modestly more likely to present with higher stage disease after a similar adjustment (OR, 1.18; 95% CI, 1.07-1.31). Women presenting with symptomatic disease, more common in younger women, were more likely to have a delay in diagnosis (OR, 3.31; 95% CI, 3.08-3.56) and higher stage (OR, 4.31; 95% CI 4.05-4.58).Young age is not an independent predictor of delay in diagnosis of breast cancer and only modestly is associated with higher stage disease. Presenting with symptoms of breast cancer predicts delay and higher stage at diagnosis.
View details for DOI 10.1634/theoncologist.2011-0469
View details for Web of Science ID 000306147200009
View details for PubMedID 22554997
View details for PubMedCentralID PMC3380876
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American Society of Clinical Oncology Identifies Five Key Opportunities to Improve Care and Reduce Costs: The Top Five List for Oncology
JOURNAL OF CLINICAL ONCOLOGY
2012; 30 (14): 1715-1724
View details for DOI 10.1200/JCO.2012.42.8375
View details for Web of Science ID 000303914800027
View details for PubMedID 22493340
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Michigan Oncology Practices Showed Varying Adherence Rates To Practice Guidelines, But Quality Interventions Improved Care
HEALTH AFFAIRS
2012; 31 (4): 718-728
Abstract
Despite improvements in care for patients with cancer, and in their survival rates, it is not clear that best practices are uniformly delivered to patients. We measured the quality of outpatient cancer care, using validated quality measures, in a consortium of thirty-six outpatient oncology practices in Michigan. We discovered that throughout the measurement period, for breast and colorectal cancer care, there was a more than 85 percent rate of adherence to quality care processes. For end-of-life care processes, the adherence rate was 73 percent, and for symptom and toxicity management care processes, adherence was 56 percent. In particular, we found variations in care around the fundamental oncologic task of management of cancer pain. To address quality gaps, we developed interventions to improve adherence to treatment guidelines, improve pain management, and incorporate palliative care into oncology practice. We concluded that statewide consortia that assume much of the cost burden of quality improvement activities can bring together oncology providers and payers to measure quality and design interventions to improve care.
View details for DOI 10.1377/hlthaff.2011.1295
View details for Web of Science ID 000302777400009
View details for PubMedID 22492888
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Comparative outcome of initial therapy for younger patients with mantle cell lymphoma: an analysis from the NCCN NHL Database
BLOOD
2012; 119 (9): 2093-2099
Abstract
Few randomized trials have compared therapies in mantle cell lymphoma (MCL), and the role of aggressive induction is unclear. The National Comprehensive Cancer Network (NCCN) Non-Hodgkin Lymphoma (NHL) Database, a prospective cohort study collecting clinical, treatment, and outcome data at 7 NCCN centers, provides a unique opportunity to compare the effectiveness of initial therapies in MCL. Patients younger than 65 diagnosed between 2000 and 2008 were included if they received RHCVAD (rituximab fractionated cyclophosphamide, vincristine, adriamycin, and dexamethasone), RCHOP+HDT/ASCR (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone + high-dose therapy/autologous stem cell rescue), RHCVAD+HDT/ASCR, or RCHOP. Clinical parameters were similar for patients treated with RHCVAD (n = 83, 50%), RCHOP+HDT/ASCR (n = 34, 20%), RCHOP (n = 29, 17%), or RHCVAD+HDT/ASCR (n = 21, 13%). Overall, 70 (42%) of the 167 patients progressed and 25 (15%) expired with a median follow-up of 33 months. There was no difference in progression-free survival (PFS) between aggressive regimens (P > .57), which all demonstrated superior PFS compared with RCHOP (P < .004). There was no difference in overall survival (OS) between the RHCVAD and RCHOP+HDT/ASCR (P = .98). RCHOP was inferior to RHCVAD and RCHOP+HDT/ASCR, which had similar PFS and OS. Despite aggressive regimens, the median PFS was 3 to 4 years. Future trials should focus on novel agents rather than comparing current approaches.
View details for DOI 10.1182/blood-2011-07-369629
View details for Web of Science ID 000300949500019
View details for PubMedID 22234679
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Age and Survival in Women with Early Stage Breast Cancer: An Analysis Controlling for Tumor Subtype.
AMER ASSOC CANCER RESEARCH. 2011
View details for DOI 10.1158/0008-5472.SABCS11-P1-08-05
View details for Web of Science ID 000209699800159
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The impact of obesity on receipt of adjuvant chemotherapy for breast cancer in the National Comprehensive Cancer Network (NCCN) centers
BREAST CANCER RESEARCH AND TREATMENT
2011; 130 (3): 897-904
Abstract
Disparities in the receipt of adjuvant chemotherapy for early stage breast cancer is an important factor influencing mortality. We investigated whether greater body mass index (BMI) decreases receipt of adjuvant chemotherapy among women with operable breast cancer. In the NCCN breast cancer outcomes database, we identified women aged ≤ 70 with newly diagnosed stage I, II, or III breast cancer between 1997 and 2007, for whom use of adjuvant chemotherapy was classified as either standard-of-care or discretionary based on their clinical characteristics. Body mass index was assessed in categories (<18.5 kg/m(2) [underweight], 18.5 to <25 kg/m(2) [normal], 25 to <30 kg/m(2) [overweight], 30-39 kg/m(2) [obese], ≥ 40 kg/m(2) [extreme obese]). Multivariable logistic regression analysis was used to examine the association between BMI and receipt of chemotherapy in each classification group. 9,527 women were eligible for the study; 40% normal weight or less; 31% overweight; 24% obese; and 5% extremely obese. In multivariable analysis, there was no significant association between BMI and receipt of chemotherapy in either classification group. Among women for whom chemotherapy would be considered standard-of-care, older age (P < 0.001), comorbidity (P < 0.001), and non-Hispanic black ethnicity (P = 0.002) were associated with a lower likelihood of receipt of chemotherapy; however, the effect of ethnicity was not modified by obesity. Among women treated for operable breast cancer in the NCCN centers, BMI had no impact on receipt of adjuvant chemotherapy and did not modify the lower likelihood of chemotherapy among non-Hispanic black patients. Further investigation is needed into other factors that contribute to patient disparities in the receipt of chemotherapy in major academic centers.
View details for DOI 10.1007/s10549-011-1516-0
View details for Web of Science ID 000297225600018
View details for PubMedID 21809116
View details for PubMedCentralID PMC3436594
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Commentary: six years of trends in oncology practice data.
Journal of oncology practice / American Society of Clinical Oncology
2011; 7 (5): 291-293
View details for DOI 10.1200/JOP.2011.000412
View details for PubMedID 22211123
View details for PubMedCentralID PMC3170059
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Myeloid Growth Factors
JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK
2011; 9 (8): 914-?
View details for Web of Science ID 000293583500007
View details for PubMedID 21900221
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Institutional Variation in the Surgical Treatment of Breast Cancer A Study of the NCCN
ANNALS OF SURGERY
2011; 254 (2): 339-345
Abstract
To investigate the relationship between supply of subspecialty care and type of procedure preferentially performed for early stage breast cancer.Three surgical options exist for early stage breast cancer: (1) breast conserving surgery (BCS), (2) mastectomy with reconstruction (RECON), and (3) mastectomy alone. Current guidelines recommend that surgical treatment decisions should be based on patient preference if a patient is eligible for all 3. However, studies demonstrate persistent variation in the use of BCS and RECON.Patients undergoing an operation for DCIS or stage I or II breast cancer at NCCN institutions between 2000 and 2006 were identified. Institutional procedure rates were determined. Spearman correlations measured the association between procedure types. Patient-level logistic regression models investigated predictors of procedure type and association with institutional supply of subspecialty care.Among 10,607 patients, 19% had mastectomy alone, 60% BCS, and 21% RECON. The institutional rate of BCS and RECON were strongly correlated (r = -0.80, P = 0.02). Institution was more important than all patient factors except age in predicting receipt of RECON or BCS. RECON was more likely for patients treated at an institution with a greater supply of reconstructive surgeons or where patients live further from radiation facilities. RECON was less likely at institutions with longer waiting times for surgery with reconstruction.Even within the NCCN, a consortium of multidisciplinary cancer centers, the use of BCS and mastectomy with reconstruction substantially varies by institution and correlates with the supply of subspecialty care.
View details for DOI 10.1097/SLA.0b013e3182263bb0
View details for Web of Science ID 000292908700023
View details for PubMedID 21725233
View details for PubMedCentralID PMC3428030
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Continued Use of Trastuzumab Beyond Disease Progression in the National Comprehensive Cancer Network: Should We Practice Ahead of the Evidence?
ONCOLOGIST
2011; 16 (5): 559-565
Abstract
The role of continued trastuzumab after progression in women with human epidermal growth factor receptor (HER)-2+ metastatic breast cancer is controversial. Controlled clinical trials that establish a benefit from continued trastuzumab have been difficult to complete.In the National Comprehensive Cancer Center Network (NCCN) Breast Cancer Outcomes Database, we identified women treated with trastuzumab for metastatic or relapsed HER-2+ breast cancer at eight NCCN centers who subsequently progressed. Patients were eligible for this analysis if they initiated treatment at an NCCN institution between July 1997 and December 2004, received trastuzumab-containing treatment, and progressed while on therapy. We calculated the proportion of patients who received trastuzumab after progression, and in a multivariate analysis assessed the association of patient and provider characteristics with continued trastuzumab therapy.Our final cohort consisted of 218 women who experienced disease progression while on trastuzumab-containing therapy. Of these, 168 (77%) continued trastuzumab. Of these, 36 patients (17%) received therapy as part of a clinical trial. The only factors significantly associated with continuation of trastuzumab beyond progression were the presence of bone metastases and more recent year of development of progressive disease.Prior to the availability of any high-quality evidence supporting this practice, over three quarters of patients treated with trastuzumab for HER-2+ metastatic breast cancer at eight NCCN centers continued therapy beyond progression. Further work is needed to understand how physicians adopt new treatments when there is ambiguity surrounding their benefit.
View details for DOI 10.1634/theoncologist.2010-0360
View details for Web of Science ID 000290661900005
View details for PubMedID 21450786
View details for PubMedCentralID PMC3228199
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Expansion of cancer care and control in countries of low and middle income: a call to action
LANCET
2010; 376 (9747): 1186-1193
Abstract
Substantial inequalities exist in cancer survival rates across countries. In addition to prevention of new cancers by reduction of risk factors, strategies are needed to close the gap between developed and developing countries in cancer survival and the effects of the disease on human suffering. We challenge the public health community's assumption that cancers will remain untreated in poor countries, and note the analogy to similarly unfounded arguments from more than a decade ago against provision of HIV treatment. In resource-constrained countries without specialised services, experience has shown that much can be done to prevent and treat cancer by deployment of primary and secondary caregivers, use of off-patent drugs, and application of regional and global mechanisms for financing and procurement. Furthermore, several middle-income countries have included cancer treatment in national health insurance coverage with a focus on people living in poverty. These strategies can reduce costs, increase access to health services, and strengthen health systems to meet the challenge of cancer and other diseases. In 2009, we formed the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, which is composed of leaders from the global health and cancer care communities, and is dedicated to proposal, implementation, and evaluation of strategies to advance this agenda.
View details for DOI 10.1016/S0140-6736(10)61152-X
View details for Web of Science ID 000282915700035
View details for PubMedID 20709386
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Enhancing Quality Through Innovation: American Society of Clinical Oncology Presidential Address 2010
JOURNAL OF CLINICAL ONCOLOGY
2010; 28 (28): 4283-4288
View details for DOI 10.1200/JCO.2010.31.1696
View details for Web of Science ID 000282272700024
View details for PubMedID 20697071
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Impact of CPOE on workflow and direct patient care time in an inpatient hematology/oncology service.
AMER SOC CLINICAL ONCOLOGY. 2010
View details for DOI 10.1200/jco.2010.28.15_suppl.6142
View details for Web of Science ID 000208852004421
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Gene expression profile testing for breast cancer: Patterns and predictors of use and impact on chemotherapy.
AMER SOC CLINICAL ONCOLOGY. 2010
View details for DOI 10.1200/jco.2010.28.15_suppl.566
View details for Web of Science ID 000208852002400
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The effect of age on delay in diagnosis and stage of breast cancer
AMER SOC CLINICAL ONCOLOGY. 2010
View details for DOI 10.1200/jco.2010.28.15_suppl.1580
View details for Web of Science ID 000208852002747
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Use of a 21-gene reverse transcriptase-polymerase chain reaction (RT-PCR) assay to guide therapy in 14 Michigan Breast Oncology Quality Initiative (MiBOQI) sites
AMER SOC CLINICAL ONCOLOGY. 2010
View details for DOI 10.1200/jco.2010.28.15_suppl.6039
View details for Web of Science ID 000208852004318
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Challenges to National Cancer Institute-Supported Cooperative Group Clinical Trial Participation: An ASCO Survey of Cooperative Group Sites.
Journal of oncology practice / American Society of Clinical Oncology
2010; 6 (3): 114-117
Abstract
Anecdotal information regarding clinical research sites limiting participation in NCI-funded cooperative group studies prompted ASCO to collect data on and investigate the reasons behind this trend.
View details for DOI 10.1200/JOP.200028
View details for PubMedID 20808551
View details for PubMedCentralID PMC2868633
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Variations in Surveillance Imaging for Patients with Treated Diffuse Large B-Cell Lymphoma in the National Comprehensive Cancer Network (NCCN) Lymphoma Database
AMER SOC HEMATOLOGY. 2009: 565
View details for Web of Science ID 000272725801567
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R-CHOP, Followed by High Dose Therapy and Autologous Stem Cell Rescue (HDT/ASCR), and R-Hypercvad Have Equivalent Progression-Free Survival and Are Superior to R-CHOP Alone in Younger Patients with Mantle Cell Lymphoma: a Comparative Effectiveness Analysis From the National Comprehensive Cancer Network (NCCN) Non-Hodgkin's Lymphoma Outcomes Database Project
AMER SOC HEMATOLOGY. 2009: 167-168
View details for Web of Science ID 000272725800404
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Partnering with payers for success: quality oncology practice initiative, blue cross blue shield of michigan, and the michigan oncology quality consortium.
Journal of oncology practice / American Society of Clinical Oncology
2009; 5 (6): 281-284
Abstract
More than 16% of the total sites participating nationally in the QOPI survey are in Michigan. A significant component of the growth in QOPI participation in Michigan can be attributed to the involvement and quality improvement efforts of Blue Cross Blue Shield of Michigan.
View details for DOI 10.1200/JOP.091043
View details for PubMedID 21479071
View details for PubMedCentralID PMC2869184
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Implementation of the Quality Oncology Practice Initiative at a University Comprehensive Cancer Center
44th Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO)
AMER SOC CLINICAL ONCOLOGY. 2009: 3802–7
Abstract
The Quality Oncology Practice Initiative (QOPI) is a voluntary program developed by the American Society of Clinical Oncology (ASCO) to aid oncology practices in quality self-assessment. Few academic cancer centers have been QOPI participants.We implemented the QOPI process at the University of Michigan Comprehensive Cancer Center, a large, hospital-based academic cancer center, and report our experience with five rounds of data collection. Patient medical records were selected using QOPI-specified procedures and abstracted locally; results were entered into an ASCO-maintained database and analyzed.Abstractors who were not directly involved with patient care required an average of 62.3 minutes per medical record (4.7 minutes per data element) to abstract data. We found that compliance with quality measures was uniformly high when measures were structured into our electronic medical record. Results from other measures, including those measuring chemotherapy administration in the last 2 weeks of life, were initially markedly different from those reported by other QOPI participants. Our practice changed toward the QOPI national practice norm after a presentation of the results at a faculty research conference. We found that other measures were consistently greater than 90%, including disease-specific diagnosis and treatment measures.Measuring and showing performance data to physicians was sufficient to change some aspects of physician behavior. Improvement in other measures requires structural practice changes. QOPI, an oncologist-developed system, can be adapted for use in practice improvement at an academic medical center.
View details for DOI 10.1200/JCO.2008.21.6770
View details for Web of Science ID 000268769900013
View details for PubMedID 19487377
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Lymphoma After Solid Organ Transplantation: Risk, Response to Therapy, and Survival at a Transplantation Center
49th Annual Meeting of the American-Society-of-Hematology
AMER SOC CLINICAL ONCOLOGY. 2009: 3354–62
Abstract
We studied the incidence, risk factors, treatment, and outcomes of post-transplantation lymphoproliferative disorder (PTLD) that occurred at the University of Michigan since 1964.We identified 7,040 patients who received solid organ transplantation (SOT) and post-transplantation immunosuppressive therapy. Seventy-eight patients developed PTLD.Diffuse large B-cell lymphoma (n = 43), polymorphic PTLD (n = 10), Hodgkin's lymphoma (n = 7), Burkitts lymphoma (n = 6), plasmacytoma (n = 5), and mucosa-associated lymphoid tissue lymphoma (n = 3) were all over-represented in the SOT population compared with a population sample from the Surveillance, Epidemiology, and End Results (SEER) database; follicular lymphoma (n = 0) was underrepresented. Negative pretransplantation Epstein-Barr virus (EBV) serology was a risk factor for PTLD. Available histologic analysis of tumor tissue showed that 75% were CD20 positive and that 62% were EBV positive; EBV-positive tumors occurred sooner after SOT than EBV-negative tumors (mean, 29 v 66 months). Extralymphatic disease (79%), poor performance status (68%), elevated lactate dehydrogenase (LDH; 71%), and advanced stage (68%) disease were all common at the time of lymphoma diagnosis. Two thirds of patients had a complete response when treated with cyclophosphamide, doxorubicin, vincristine, and prednisone-like chemotherapy (either with or without rituximab). Median overall survival in all patients with PTLD was 8.23 years (95% CI, 2.28 to 30.0 years).EBV-naïve patients who receive a donor organ from an EBV-infected donor are in the highest-risk situation for PTLD development. Most of these lymphomas are CD20 positive. Follicular lymphoma is unusual. With treatment, survival of patients with PTLD was indistinguishable from that of the SEER population sample.
View details for DOI 10.1200/JCO.2008.20.0857
View details for Web of Science ID 000267821400016
View details for PubMedID 19451438
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Introduction of computerized provider order entry (CPOE) and time impact in an inpatient hematology/oncology service: Serial time and motion studies
AMER SOC CLINICAL ONCOLOGY. 2009
View details for Web of Science ID 000276606604488
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Clinicopathological features and sites of recurrence according to breast cancer subtype in the National Comprehensive Cancer Network (NCCN)
AMER SOC CLINICAL ONCOLOGY. 2009
View details for Web of Science ID 000276606601252
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Quality of breast cancer care in NCCN centers as assessed by the ASCO/NCCN quality measures: Overall performance and reasons for nonconcordance
AMER SOC CLINICAL ONCOLOGY. 2009
View details for Web of Science ID 000276606604355
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The impact of obesity on adherence to the National Comprehensive Cancer Network (NCCN) guidelines recommending chemotherapy for patients with operable breast cancer
AMER SOC CLINICAL ONCOLOGY. 2009
View details for Web of Science ID 000276606604366
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Chemotherapy Use for Hormone Receptor-Positive, Lymph Node-Negative Breast Cancer
Breast Cancer Symposium of the American-Society-of-Clinical-Oncology
AMER SOC CLINICAL ONCOLOGY. 2008: 5553–60
Abstract
To describe the frequency of chemotherapy use for hormone receptor (HR)-positive, lymph node (LN)-negative breast cancer from 1997 to 2004 at eight National Comprehensive Cancer Network institutions, to explore whether chemotherapy use varied over time and between institutions, and to identify factors associated with the decision to forego chemotherapy.Among women younger than age 70 years with HR-positive, LN-negative breast cancer measuring more than 1 cm, we analyzed the frequency of chemotherapy use on a yearly basis. A multivariable logistic regression model assessed the relationship between receipt of chemotherapy and year of diagnosis, institution, tumor features, and patient characteristics. Interaction terms were added to the model, and stratified analyses were conducted to further explore the determinants of chemotherapy use.Fifty-five percent of 3,190 women received chemotherapy. Chemotherapy use was less common for patients with 1.1- to 2-cm tumors than for patients tumors greater 2 cm (47% v 87%, respectively; P < .01) and for women age 60 to 69 years versus women younger than age 50 years (24% v 76%, respectively; P < .01). On multivariable analysis, predictors independently associated with receiving chemotherapy included larger tumor size, higher grade, human epidermal growth factor receptor 2 overexpression, younger age, and institution (P < .01 for all). Institutions exhibited dramatically different rates of chemotherapy use (from 46% to 65%) and patterns of change in chemotherapy use over time (from a 79% relative increase to a 22% relative decrease).Although institutions seemed to agree that not all women with HR-positive, LN-negative breast cancer need chemotherapy, there did not seem to be consensus regarding which women should get chemotherapy. Only prospective randomized controlled trials will conclusively establish which subtypes of HR-positive, LN-negative breast cancer benefit from chemotherapy.
View details for DOI 10.1200/JCO.2008.17.9705
View details for Web of Science ID 000261199700012
View details for PubMedID 18955448
View details for PubMedCentralID PMC2651096
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Development of the Anemia Impact Measure (AIM): A Disease-Specific Patient Reported outcome (PRO) Instrument to Measure Anemia Symptoms and Their Impact on Functioning in Cancer Patients Receiving Chemotherapy
AMER SOC HEMATOLOGY. 2008: 250
View details for Web of Science ID 000262104700669
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Continued use of trastuzumab (TRZ) beyond disease progression in the National Comprehensive Cancer Network (NCCN)
AMER SOC CLINICAL ONCOLOGY. 2008
View details for DOI 10.1200/jco.2008.26.15_suppl.6522
View details for Web of Science ID 000208457402376
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Eighty-five cases of lymphoma in a solid organ transplant (SOT) population: Risk, treatment, and histologic subtype
AMER SOC HEMATOLOGY. 2007: 411A
View details for DOI 10.1182/blood.V110.11.1367.1367
View details for Web of Science ID 000251100801635
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The registry case finding engine: An automated tool to identify cancer cases from unstructured, free-text pathology reports and clinical notes.
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
2007; 205 (5): 690-697
Abstract
The American College of Surgeons mandates the maintenance of a cancer registry for hospitals seeking accreditation. At the University of Michigan Health System, more than 90% of all registry patients are identified by manual review, a method common to many institutions. We hypothesized that an automated computer system could accurately perform this time- and labor-intensive task. We created a tool to automatically scan free-text medical documents for terms relevant to cancer.We developed custom-made lists containing approximately 2,500 terms and phrases and 800 SNOMED codes. Text is processed by the Case Finding Engine (CaFE), and relevant terms are highlighted for review by a registrar and used to populate the registry database. We tested our system by comparing results from the CaFE to those by trained registrars who read through 2,200 pathology reports and marked relevant cases for the registry. The clinical documentation (eg, electronic chart notes) of an additional 476 patients was also reviewed by registrars and compared with the automated process by the CaFE.For pathology reports, the sensitivity for automated case identification was 100%, but specificity was 85.0%. For clinical documentation, sensitivity was 100% and specificity was 73.7%. Types of errors made by the CaFE were categorized to direct additional improvements. Use of the CaFE has resulted in a considerable increase in the number of cases added to the registry each month.The system has been well accepted by our registrars. CaFE can improve the accuracy and efficiency of tumor registry personnel and helps ensure that cancer cases are not overlooked.
View details for DOI 10.1016/j.jamcollsurg.2007.05.014
View details for Web of Science ID 000250649800009
View details for PubMedID 17964445
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Chemotherapy use for hormone receptor-positive, node-negative breast cancer
AMER SOC CLINICAL ONCOLOGY. 2007
View details for Web of Science ID 000455043703104
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Measuring quality with the Quality Oncology Practice Initiative (QOPI) at a university comprehensive cancer center
AMER SOC CLINICAL ONCOLOGY. 2007
View details for Web of Science ID 000455043701503
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Who Will Do the Work? What Work Will They Do?
JOURNAL OF ONCOLOGY PRACTICE
2007; 3 (2): 53
View details for DOI 10.1200/JOP.0720501
View details for Web of Science ID 000213770500001
View details for PubMedID 20859373
View details for PubMedCentralID PMC2793737
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Apoptosis and Bcl-2 expression in circulating tumor cells (CTC) from women being treated for metastatic breast cancer
WICHTIG EDITORE. 2007: 81
View details for Web of Science ID 000246637300059
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Defining Quality: QOPI Is a Start.
Journal of oncology practice / American Society of Clinical Oncology
2006; 2 (5): 203-?
View details for PubMedID 20859337
View details for PubMedCentralID PMC2793620
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The Registry Case Finding Engine (CaFE): An automated approach for cancer patient identification from unstructured, free-text pathology reports.
AMER SOC CLINICAL ONCOLOGY. 2006: 320S
View details for Web of Science ID 000239009402150
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Making the Choice Between Academic Oncology and Community Practice: The Big Picture and Details About Each Career
JOURNAL OF ONCOLOGY PRACTICE
2006; 2 (3): 132-136
View details for DOI 10.1200/JOP.2.3.132
View details for Web of Science ID 000213707200016
View details for PubMedID 29443588
View details for PubMedCentralID PMC2794583
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The detection of apoptosis and Bcl-2 expression in circulating tumor cells (CTCs) from women being treated for metastatic breast cancer
AMER ASSOC CANCER RESEARCH. 2006
View details for Web of Science ID 000454606201446
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Implementation of the quality oncology practice initiative in a hospital-based, University Comprehensive Cancer Center.
SPRINGER. 2006: S236
View details for Web of Science ID 000242047101255
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From the Editor's Desk
JOURNAL OF ONCOLOGY PRACTICE
2006; 2 (1): 1
View details for DOI 10.1007/s10278-006-0929-5
View details for Web of Science ID 000213696200001
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From the editor's desk
MATRIX BIOLOGY
2006; 25 (1): 1-2
View details for DOI 10.1016/j.matbio.2006.01.001
View details for Web of Science ID 000236069300001
View details for PubMedID 17016756
View details for PubMedCentralID PMC3045167
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Apoptosis and Bcl-2 expression in circulating tumor cells from women being treated for metastatic breast cancer.
SPRINGER. 2006: S214
View details for Web of Science ID 000242047101191
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From the Editor's Desk
JOURNAL OF ONCOLOGY PRACTICE
2005; 1 (2)
View details for Web of Science ID 000213686200001
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Efficacy of darbepoetin alfa in chemotherapy-induced anemia in gastrointestinal cancers.
AMER SOC CLINICAL ONCOLOGY. 2005: 781S
View details for Web of Science ID 000230326605169
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Efficacy of darbepoetin alfa in the treatment of chemotherapy-induced anemia in Non-Hodgkin's Lymphoma
AMER SOC HEMATOLOGY. 2004: 900A-901A
View details for DOI 10.1182/blood.V104.11.3296.3296
View details for Web of Science ID 000225127503298
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Baseline (BL) covariates of response to darbepoetin alfa (DA) every 2 weeks (Q2W) in patients (pts) with chemotherapy-induced anemia (CIA).
AMER SOC CLINICAL ONCOLOGY. 2004: 744S
View details for Web of Science ID 000223512402952
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The relationships between FACT-Fatigue (FACT-F) scores and physical function (PF) in patients (pts) with chemotherapy-induced anemia treated with darbepoetin alfa (DA).
AMER SOC CLINICAL ONCOLOGY. 2004: 744S
View details for Web of Science ID 000223512402951
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Every-2-week darbepoetin alfa improves hemoglobin in anemic patients with cancer undergoing chemotherapy: A stratified analysis by tumor type.
AMER SOC HEMATOLOGY. 2003: 19B-20B
View details for Web of Science ID 000186537100070
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An investigation into the impact of weight on the efficacy of darbepoetin alfa administered as a fixed dose of 200 mcg every 2 weeks (Q2W).
AMER SOC HEMATOLOGY. 2003: 11B
View details for Web of Science ID 000186537100034
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Dose-intense chemotherapy every 2 weeks with dose-intense cyclophosphamide, doxorubicin, vincristine, and prednisone may improve survival in intermediate- and high-grade lymphoma: A phase II study of the Southwest Oncology Group (SWOG 9349)
JOURNAL OF CLINICAL ONCOLOGY
2003; 21 (13): 2466-2473
Abstract
To test the hypothesis that therapy of intermediate- and high-grade (excluding Burkitt lymphoblastic) lymphoma with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) could be safely dose-intensified with routine filgrastim support.Eligible patients were those who were previously untreated and who had either bulky stage II, or stage III or IV lymphoma with working formulation histology D, E, F, G, H, or J; performance status < or = 2; and acceptable end organ function. No upper age limit was specified. Therapy was dose-intensified CHOP (CHOP-DI) with filgrastim support. Each course was repeated every 14 days for six planned courses.Eighty-eight eligible patients were treated with CHOP-DI and had a median follow-up of 5.1 years on this phase II study, designated Southwest Oncology Group (SWOG) 9349. The progression-free survival was 51% at 2 years and 41% at 5 years. The overall survival was 60% at 5 years. Three fatal treatment-related events occurred. One patient with myelodysplastic syndrome was reported.Treatment with CHOP-DI can be safely administered in the cooperative group setting and results in improved survival. Estimated overall survival at 5 years was 14% better than that of patients treated with standard-dose CHOP in an earlier SWOG study, although progression-free survival of 60% at 2 years-the prespecified end point-was not achieved. CHOP-DI, given every 2 weeks at escalated doses, is a strategy that should be tested in a future randomized clinical trial in lymphoma.
View details for DOI 10.1200/JCO.2003.06.137
View details for Web of Science ID 000183818800005
View details for PubMedID 12829664
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Darbepoetin alfa 3.0 mcg/kg every 2 weeks improves hemoglobin and quality of life in a subset of breast cancer patients in a community-based trial of patients with chemotherapy-induced anemia.
KLUWER ACADEMIC PUBL. 2003: S154
View details for Web of Science ID 000186783100488
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Optimal use of antiemetics in the outpatient setting - The Grunberg article reviewed
ONCOLOGY-NEW YORK
2002; 16 (10): 1407-1408
View details for Web of Science ID 000179117200024
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Dose-intense CHOPx2 therapy of intermediate grade lymphoma - A phase II study of the southwest oncology group (SWOG).
AMER SOC HEMATOLOGY. 2001: 343A
View details for Web of Science ID 000172134101452
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Reduction of skeletal related complications in breast cancer patients with osteolytic bone metastases receiving chemotherapy (CT), by monthly pamidronate sodium (PAM) (Aredia(R)) infusion
STOCKTON PRESS. 1996: 6
View details for Web of Science ID A1996UX77600028
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DOSE INTENSE MOPP/ABV WITH PROPHYLACTIC FILGRASTIM (G-CSF) TREATMENT OF ADVANCED HODGKINS-DISEASE (HD) - A PILOT-STUDY
W B SAUNDERS CO. 1994: A638
View details for Web of Science ID A1994PR75402534
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LEUKEMIA AFTER TREATMENT OF OVARIAN-CANCER OR HODGKINS-DISEASE
NEW ENGLAND JOURNAL OF MEDICINE
1990; 322 (25): 1818
View details for Web of Science ID A1990DJ23200021
View details for PubMedID 2345570
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TUMOR TRAPPING OF 5-FLUOROURACIL - INVIVO F-19 NMR SPECTROSCOPIC PHARMACOKINETICS IN TUMOR-BEARING HUMANS AND RABBITS
PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA
1990; 87 (1): 492-496
Abstract
The pharmacokinetics of 5-fluorouracil (5FU) were studied in vivo in patients with discrete tumors and in rabbits bearing VX2 tumors by using 19F NMR spectroscopy. The human studies were conducted in a 1.5-T Magnetom magnetic resonance imager (Siemens), and the rabbit studies were conducted in a 4.7-T GE/Nicolet 33-cm bore magnet. Free 5FU was detected in the tumors of four of the six patients and in all VX2 tumors but not in normal rabbit tissues. No other metabolites were seen in these tumors, contrary to the extensive catabolism we had previously documented using 19F NMR spectroscopy in both human and animal livers. The tumor pool of free 5FU in those human tumors that trapped 5FU was determined to have a half-life of 0.4-2.1 hr, much longer than expected and significantly longer than the half-life of 5FU in blood (5-15 min), whereas the half-life of trapped 5FU in the VX2 tumors ranged from 1.05 to 1.22 hr. In this initial experience, patient response to chemotherapy may correlate with extent of trapping free 5FU in the human tumors. These studies document that NMR spectroscopy is clinically feasible in vivo, allows noninvasive pharmacokinetic analyses at a drug-target tissue in real time, and may produce therapeutically important information at the time of drug administration. Demonstration of the trapping of 5FU in tumors provides both a model for studying metabolic modulation in experimental tumors (in animals) and a method for testing modulation strategies clinically (in patients).
View details for DOI 10.1073/pnas.87.1.492
View details for Web of Science ID A1990CH19000104
View details for PubMedID 2296605
View details for PubMedCentralID PMC53290
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EARLY DETECTION OF CISPLATIN RESISTANCE IN FRESH HUMAN CARCINOMA-CELLS BY INVITRO ENZYMATIC AMPLIFICATION ASSAY
AMER ASSOC CANCER RESEARCH. 1988: 292
View details for Web of Science ID A1988N264701159
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DECREASING RISK OF LEUKEMIA WITH PROLONGED FOLLOW-UP AFTER CHEMOTHERAPY AND RADIOTHERAPY FOR HODGKINS-DISEASE - REPLY
NEW ENGLAND JOURNAL OF MEDICINE
1987; 317 (11): 708-709
View details for Web of Science ID A1987J905600015
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DECREASING RISK OF LEUKEMIA WITH PROLONGED FOLLOW-UP AFTER CHEMOTHERAPY AND RADIOTHERAPY FOR HODGKINS-DISEASE
NEW ENGLAND JOURNAL OF MEDICINE
1987; 316 (12): 710-714
Abstract
Acute nonlymphocytic leukemia is a recognized complication of combined chemotherapy and radiation treatment of patients with Hodgkin's disease. Previous studies have suggested that the risk of leukemia in these patients increases with time after treatment. We analyzed the occurrence of second neoplasms among 192 patients with Hodgkin's disease who were followed for a median of over 15 years. We originally planned to identify prospectively the morphologic changes in bone marrow that precede the development of acute leukemia. All 63 patients consenting to bone marrow aspiration had normal marrow morphology, and no case of acute leukemia occurred more than 11 years after treatment. Actuarial analysis revealed that the peak onset of leukemia-related complications was between three and nine years after first treatment. We conclude that there appears to be a period of increased risk in patients treated with chemotherapy and radiation, after which the risk of secondary leukemia decreases. Patients surviving for more than 11 years after treatment appear to be at no increased risk of acute leukemia.
View details for Web of Science ID A1987G405500003
View details for PubMedID 3821809
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ANTIGENICALLY DEFINED SUBGROUPS OF LYMPHOBLASTIC LYMPHOMA - THEIR RELATIONSHIP TO CLINICAL PRESENTATION AND BIOLOGIC BEHAVIOR
NATURE PUBLISHING GROUP. 1987: A72
View details for Web of Science ID A1987F618700442
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RECOMBINANT INTERLEUKIN-2 (IL2) THERAPY PRODUCES AZOTEMIA, SODIUM RETENTION, HYPOALBUMINEMIA AND EDEMA
BLACKWELL SCIENCE INC. 1987: 220
View details for Web of Science ID A1987F483800270
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DISTRIBUTION OF LYMPHOCYTES WITH INTERLEUKIN 2 RECEPTORS (TACANTIGENS) IN REACTIVE LYMPHOPROLIFERATIVE PROCESSES, HODGKINS-DISEASE, AND NON-HODGKINS-LYMPHOMAS - AN IMMUNOHISTOLOGIC STUDY OF 300 CASES
NATURE PUBLISHING GROUP. 1987: A72
View details for Web of Science ID A1987F618700441
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PHASE-II TRIAL OF 4'DEOXYDOXORUBICIN (DXDX) IN ADVANCED GASTRIC (GCA) AND PANCREATIC (PCA) CANCER
AMER ASSOC CANCER RESEARCH. 1986: 179
View details for Web of Science ID A1986C539700710
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PHARMACOKINETICS OF HIGH-DOSE FOLINIC ACID (DL-CF) ADMINISTERED BY CONTINUOUS INTRAVENOUS (IV) INFUSION
AMER ASSOC CANCER RESEARCH. 1985: 158
View details for Web of Science ID A1985AGD9400627
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SCREENING FOR HUMAN T-CELL LEUKEMIA-LYMPHOMA VIRUS - REPLY
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
1984; 251 (12): 1555
View details for DOI 10.1001/jama.1984.03340360023018
View details for Web of Science ID A1984SH73000015
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THE HUMAN T-CELL LEUKEMIA-LYMPHOMA VIRUS IN THE SOUTHEASTERN UNITED-STATES
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
1983; 250 (8): 1048-1052
Abstract
The human T-cell leukemia-lymphoma virus (HTLV) is a recently described RNA tumor virus associated with human T-cell malignant neoplasms. In two geographic areas, Japan and the Caribbean basin, clusters of adult T-cell leukemia-lymphoma are "sentinel diseases" and have suggested an underlying prevalence of HTLV infection in both family members of the index cases and in the population. Four cases of lymphoma from the United States are described as illustrative of the sentinel disease. Serological studies of families and of a small population sample suggest that HTLV infection is endemic in certain parts of the southeastern United States at rates similar to those seen in Caribbean blacks but at a lower rate than that observed in southwestern Japan.
View details for Web of Science ID A1983RD90600015
View details for PubMedID 6308290
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THE HUMAN T-CELL LEUKEMIA LYMPHOMA VIRUS - TIS ASSOCIATION WITH DISEASE IN THE UNITED-STATES
WILLIAMS & WILKINS. 1983: A40
View details for Web of Science ID A1983PY29400148
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ADULT T-CELL LYMPHOMA IN THE UNITED-STATES - A HIGH-GRADE NON-HODGKINS LYMPHOMA ASSOCIATED WITH HUMAN T-CELL LYMPHOMA VIRUS
SLACK INC. 1983: A404
View details for Web of Science ID A1983QL28801446
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EVIDENCE FOR HUMAN T-LEUKEMIA VIRUS DEFECTION IN PATIENTS WITH THE ACQUIRED IMMUNE-DEFICIENCY SYNDROME
SLACK INC. 1983: A508
View details for Web of Science ID A1983QL28802069
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THE HUMAN T-CELL LEUKEMIA LYMPHOMA VIRUS, LYMPHOMA, LYTIC BONE-LESIONS, AND HYPERCALCEMIA
ANNALS OF INTERNAL MEDICINE
1983; 98 (2): 144-151
Abstract
The human T-cell lymphoma (HTL) virus is a type C RNA tumor virus isolated from patients with malignancies of mature T cells. We report three patients with peripheral T-cell lymphoma, hypercalcemia, and antibodies to HTL virus. One patient presented with idiopathic hypercalcemia of 6 months' duration, two with striking lytic bone lesions, and two with circulating malignant lymphocytes. Malignant cells from all patients had surface markers characteristic of thymic-derived lymphocytes (T cells), and all patients had natural serum antibodies to disrupted HTL virus and to one or both viral structural proteins p19 and p24. Patients with adult peripheral T-cell lymphomas, particularly those that present with hypercalcemia and lytic bone lesions, may have antibodies to the type C RNA human tumor virus, HTL virus.
View details for Web of Science ID A1983QB56900004
View details for PubMedID 6600592
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THE HUMAN T-CELL LEUKEMIA LYMPHOMA VIRUS ASSOCIATED WITH AMERICAN ADULT T-CELL LEUKEMIA LYMPHOMA
BLOOD
1983; 62 (2): 401-405
Abstract
The human T-cell leukemia/lymphoma virus (HTLV) is a novel type-C retrovirus isolated from patients with T-lymphoproliferative malignancies. Thirteen cases of HTLV-associated malignancy from US centers were studied in detail. Ten of these cases share common clinical features and define a typical virus-associated adult T-cell leukemia/lymphoma (ATL). All ten patients presented with Ann Arbor stage IV lymphoma because of skin involvement, bone marrow involvement, or lymphomatous leptomeningitis. Lymphadenopathy occurred in 7 of 10 patients at presentation, and the malignant cells were cytologically pleomorphic. Leukemia occurred in 60% of the patients at presentation. Hypercalcemia was found initially in two-thirds of the patients, with lytic bone lesions or positive bone scans in 7 of 10. Complete remission occurred in 40%, but all have relapsed. These cases closely resemble those virus-positive cases of adult T-cell leukemia/lymphoma (ATL) reported from Japan and the Caribbean. Three additional virus-positive patients had atypical presentations and diagnoses (acute lymphocytic leukemia, Sézary's syndrome, leukemic reticuloendotheliosis), usually with less aggressive clinical courses and atypical demographic and laboratory features. Presence of HTLV serum antibodies in cases of ATL (with hypercalcemia and circulating malignant cells) appears to define a distinct clinicopathologic entity that may occur in geographic clusters.
View details for Web of Science ID A1983RC87400025
View details for PubMedID 6223675
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A NEW SUBTYPE OF HUMAN T-CELL LEUKEMIA-VIRUS (HTLV-II) ASSOCIATED WITH A T-CELL VARIANT OF HAIRY-CELL LEUKEMIA
SCIENCE
1982; 218 (4572): 571-573
Abstract
Human T-cell leukemia virus (HTLV) is a human type-C RNA tumor virus (retrovirus) previously identified in and isolated from several patients with T-cell leukemias or lymphomas. The known virus isolates from the United States and Japan are closely related and are found in adults with an acute malignancy of mature T cells. A related retrovirus has been found in a patient (Mo) with a somewhat different disease (a T-cell variant of relatively benign hairy cell leukemia). Serum from Mo contains antibodies to the major internal core protein (p24) of HTLV. A T-cell line established from the spleen of Mo expresses HTLV antigens. However, HTLV from Mo is significantly different from all previous HTLV isolates in immunological cross-reactivity tests of p24. The usual prototype HTLV isolate is represented as HTLV-I, and the HTLV from Mo is represented as HTLV-II. Individual members of each subgroup may then be identified by subscript initials of the patient [for example, HTLV-I(CR), HTLV-I(MB), and HTLV-II(Mo)].
View details for Web of Science ID A1982PM84400028
View details for PubMedID 6981847
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CASE 44-1981 - RADIATION-INDUCED PERICARDITIS
NEW ENGLAND JOURNAL OF MEDICINE
1982; 306 (9): 550
View details for Web of Science ID A1982ND27300030
View details for PubMedID 7057867