Building a provider network based on quality: The Moffitt Oncology Network initiative.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 49-49
Author(s):  
Timothy Edward Kubal ◽  
Douglas D. Letson ◽  
Karen K. Fields ◽  
Richard M. Levine ◽  
Charles F. Andrews ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Clinical Performance ◽  
Clinical Pathways ◽  
Clinical Care ◽  
Geographical Area ◽  
High Standard ◽  
Standard Of Care ◽  
Cancer Center ◽  
Provider Network

49 Background: Before entering into risk bearing contracts with payors, ACOs are challenged to find a basis for forming partnerships. Specialty ACO networks, in particular, must find ways to provide a common, high standard of care among a typically varied set of partners. The Moffitt Oncology Network (MON) Initiative demonstrates a possible solution to forming a value based ACO network across a broad geographical area that is based upon using clinical pathways. Methods: Moffitt Cancer Center (MCC) has developed more than 24 different disease specific pathways. The MCC pathways translate evidence-based guidelines into personalized cancer care throughout the continuum of care from evaluation to treatment. MCC is using these pathways with other hospital systems and physician groups throughout the MON. To enhance the use of pathways in the MON, MCC uses Clinical Performance and Value (CPV) Vignettes. CPV’s, are virtual patient cases related to the specific clinical pathways. The report herein is on pathway implementation in several disease areas (breast, lung and gastrointestinal (GI) cancers) across multiple sites: Lehigh Valley Hospital (Pennsylvania), Norton Cancer Institute (Kentucky), and Space Coast Cancer Center (Florida). Results: Pathway based clinical care was measured at baseline using CPVs across disease and site (Table). A total of 67 breast cancer providers took 131 breast cancer vignettes; 35 lung cancer providers took 104 lung cancer vignettes; and to date 27 GI cancer providers have taken 54 GI vignettes. There is statistically significant variation in performance among providers and between sites. This is manifest in pathway-specified areas of work-up, diagnosis, and treatment. Conclusions: Fostering adoption of clinical pathways is a practical objective that can help guide the formation of an ACO oncology network. This may be useful for forming specialty ACOs that establish a standard of care and set the stage for adopting new payment models with payors. [Table: see text]

Quality of care improvement in breast and lung cancer.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 252-252
Author(s):  
Douglas D. Letson ◽  
Johnathan M. Lancaster ◽  
Alberto Chiappori ◽  
John W. Peabody ◽  
Lisa DeMaria ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Clinical Decision Making ◽  
Clinical Performance ◽  
Clinical Pathways ◽  
Clinical Care ◽  
Simulated Patients ◽  
Cancer Center ◽  
Serial Measurement

252 Background: Despite the growing call for use of guidelines in cancer care, adherence to clinical pathways and clinical care transformation is a challenge. Moffitt Cancer Center (MCC) has addressed this challenge, in multiple service lines, using its clinical pathways and serial measurement in a broad-based initiative to improve quality of clinical care. Methods: Moffitt launched an initiative focused on quality and improvements in care using Clinical Performance and Value (CPV) vignettes to measure multiple aspects of quality including: clinical decision-making, pathway adherence and appropriate utilization of tests/procedures. The CPVs—simulated patients cared for by providers on-line—are based upon the Moffitt Clinical Pathways. CPVs are given serially to benchmark, motivate providers, and provide confidential individual feedback. Data have been collected every 4 months since mid-2013. We report on three rounds in breast cancer and two rounds in lung cancer. Results: A total of 18 providers at MCC completed the breast cancer CPVs and 19 providers at MCC completed the lung cancer CPVs. Overall scores improved significantly and pathway adherence improved significantly for staging work-up and chemotherapy between rounds 1 and 3 for breast cancer (Table). Conclusions: Adherence to Moffitt Clinical Pathways for breast and lung cancer, using serial measurement and feedback with CPVs, improved across multiple providers and two diseases. This may have potential to transform practice. [Table: see text]

The feasibility of same day pegfilgrastim-cbqv administration in breast cancer patients receiving myelosuppressive chemotherapy regimens at a northern Virginia cancer center.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18687-e18687
Author(s):  
Maya Leiva ◽  
Angela Pennisi ◽  
Kathleen Kiernan Harnden ◽  
Patricia Conrad Rizzo ◽  
Lauren Ann Mauro
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Small Sample Size ◽  
Standard Of Care ◽  
Secondary Prophylaxis ◽  
Small Sample ◽  
Cancer Center ◽  
Breast Cancer Patients ◽  
Curative Intent ◽  
Myelosuppressive Chemotherapy

e18687 Background: The long-acting injectable G-CSF, pegfilgrastim and its biosimilars have historically been given to patients 24 hours following the administration of myelosuppressive chemotherapy for either primary or secondary prophylaxis of febrile neutropenia (FN). Previous literature has indicated that pegfilgrastim administration prior to 24 hours post chemotherapy, may result in a deepened and prolonged neutropenia due to the increase in circulating granulocytes exposed to chemotherapy. With the onset of the COVID-19 pandemic and to reduce potential SAR-CoV-2 exposure to cancer patients on therapy, we implemented same day administration of injectable pegfilgrastim-cbqv among select breast cancer patients receiving myelosuppressive chemotherapy regimens from March 2020 – February 2021. Methods: Utilizing retrospective EHR chart reviews, 55 patients among 4 medical oncologists in our breast cancer group were identified as meeting the criteria of same day pegfilgrastim-cbqv administration. Inclusion was based on completion of at least 2 consecutive cycles of same day pegfilgrastim-cbqv 6 mg subcutaneous injection for primary or secondary prophylaxis. The selected patient charts were reviewed for the incidence and severity of FN. Among the patients who had documented FN, further subgroup analyses were done regarding baseline characteristics, timing of neutropenia, regimens, regimen sequence, and reported ADRs associated with pegfilgrastim-cbqv. Results: 9 (16.4%) of the 55 patients experienced FN (Grades 3-4) and 6 (10.9%) patients were hospitalized. There were no Grade 5 events and none had therapy discontinued due to FN. 8 (88.9%) of the patients experienced FN between cycles 1 and 2. Of note, there were no cases of COVID-19 among the 9 patients who had an episode of FN. 52 (94.5%) of the 55 patients received treatment with curative intent and 3 (5.5%) had metastatic disease on a subsequent line of therapy. The median age was 49.1 years (range 29-71) and patients were 56.4% Caucasian, 18.1% Black or African American, 12.7% Asian, and 12.7% Hispanic/Latina. Conclusions: Based on the retrospective data analysis, same day pegfilgrastim-cbqv appears to be a safe and effective option in the primary and secondary prophylaxis of FN with myelosuppressive standard of care chemotherapy used in breast cancer treatment. Though our review was limited by a relatively small sample size and confined to younger (49.1 median age) breast cancer patients, this opens the door to further re-evaluation of same day pegfilgrastim-cbqv administration in other patient populations. In a post pandemic treatment world, this slight change in practice has the potential to reduce patient financial toxicity associated with multiple medical visits, provide an alternative to on-body injector formulations, and ensure treatment adherence.

Vascular toxicities of endocrine therapy in early-stage breast cancer: Encouraging observations in a nontrial setting.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 68-68
Author(s):  
Susan Faye Dent ◽  
Freya L. Crawley ◽  
Nadine A. Graham ◽  
Michelle M. Campbell
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Life Experience ◽  
Early Stage ◽  
Real Life ◽  
Standard Of Care ◽  
T Test ◽  
Early Stage Breast Cancer ◽  
Cancer Center ◽  
Increased Risk

68 Background: Endocrine therapy (ET) is the standard of care for postmenopausal (PM) women with early stage breast cancer (EBC). Studies suggest higher risk of vascular toxicities (VT) on aromatase inhibitor (AI) therapy. We report incidence/discontinuation rates of VTs in a cardiac clinic. Methods: PM women with hormone receptor positive EBC treated with ET (tamoxifen (T) ± AI) at Ottawa Hospital Cancer Center 01/99-2/06. Data included: demographics, vascular co-morbidities (VCM), ET, duration, VTs. Results: 626 pts, median age 59 years (r: 30-92), median follow-up 98 months (m), stage: I (196 pts), II (341 pts) III (89 pts) EBC. Majority (52.5%) pts had VCM at ET initiation; hypertension (HTN) (36%), hyperlipidemia (HYLP) (17%), coronary disease (12%), thrombosis (9%), angina (6%) TIA (6%). Treatment discontinued due to VT 3x more with T vs. AI. Most common VTs: edema, arrhythmias (ARR), cardiovascular (CVS) event, and HYLP. With Letrozole and T, previous VCM significantly increased risk of developing VT (chi-square: P=0.022 and 0.009). Time to develop VT shortest for T and exemestane. Previous VCM did not affect this interval. Longer exposure to T correlated with higher VT rate (t-test: p=0.046) not seen with AIs. Exposure to multiple AIs associated with higher VT rate (t-test: p=0.009). Conclusions: This cohort study reports similar VT rates with AI therapy as reported in the literature. T was associated with higher discontinuation rates (10.5%) due to VTs compared to AIs (2.8-3.3%). Longer duration of AI therapy was not associated with increased risk of VTs. These encouraging results reflect the real-life experience of women exposed to ET. [Table: see text]

Factors influencing treatment of inflammatory breast cancer in the United States.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 118-118
Author(s):  
Heather Y. Lin ◽  
Gildy Babiera ◽  
Isabelle Bedrosian ◽  
Simona Flora Shaitelman ◽  
Henry Mark Kuerer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Inflammatory Breast Cancer ◽  
Standard Of Care ◽  
High Volume ◽  
The United States ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Cancer Data ◽  
Number Of Patients ◽  
Facility Level

118 Background: Guidelines for treating inflammatory breast cancer (IBC) using trimodality (chemotherapy, surgery and radiation) therapy (TT) remain largely unchanged since 2000. However, many such patients did not receive TT. It is unknown how patient-level (PL) and facility-level (FL) factors contribute to TT utilization. Methods: Using the National Cancer Data Base (NCDB), patients who underwent surgical treatment of locoregional IBC from 2003-2011 were identified. We correlated patient, tumor, and treatment data with TT. An observed to expected (O/E) ratio of number of patients treated with TT was calculated for each hospital by adjusting for PL factors. Hierarchical mixed effects models were used to assess the proportion of variation in the use of TT attributable to PL and FL factors, respectively. Results: Among 5,537 patients who met the study criteria, the use of TT fluctuated annually (67.3%-75.7%) and was less likely for patients who were over 70, had a lower income or had an N0 tumor (all p < 0.05). By insurance type, TT use was lowest among Medicare patients. Of the 542 hospitals examined, 55 (10.1%) and 24 (4.4%) were identified as significantly low and high outliers for the use of TT (p < 0.05), respectively. While comprehensive cancer centers represented the majority of high outliers, the TT use by facility type overall was not significantly different demonstrating variability within comprehensive cancer center practice. The percentage of the total variance in the use of TT attributable to facility (11%) was almost triple the variance attributable to the measured PL factors (3.4%). Conclusions: The use of standard of care TT varied widely across facilities with some high volume centers clearly underutilizing TT. To improve clinical outcomes for this rare and aggressive malignancy, it is critical to identify facility level factors impacting the use of TT to ensure the guideline adherence of IBC treatment.

Prevalence of Different Types of Cancer Among Patient in Najaf Province/ Iraq

2021 ◽  
Vol 2 (2) ◽  
pp. 71-75
Author(s):  
Noor I. Abdul-Zahra ◽  
Zahraa K. Taiban
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Bladder Cancer ◽  
Brain Cancer ◽  
Cancer Epidemiology ◽  
The Other ◽  
Cancer Center ◽  
Different Types ◽  
Holy City

This study was carried out in Middle Euphrates cancer center, laboratories department, Al-Najaf holy city - Iraq; Iraqi patients have been recorded during period January 2018 until December 2018. This  study has demonstrated that four different types of the following cancers: Breast cancer, brain cancer, lung cancer and Bladder cancer were registered in this study. Comparison was occured  among each type of cancer was regarded in sex,  age and number. The highest levels of cancer among all the other types were  breast and lung cancer , the majority results in cancer epidemiology for this  study, which showed 22% and 8 % respectively. While in other types, the result has showed 6%, 4.7%,for Bladder cancer, and braian cancer, respectively

scholarly journals The RXR Agonist MSU42011 Is Effective for the Treatment of Preclinical HER2+ Breast Cancer and Kras-Driven Lung Cancer

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 5004
Author(s):  
Ana S. Leal ◽  
Jessica A. Moerland ◽  
Di Zhang ◽  
Sarah Carapellucci ◽  
Beth Lockwood ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Tumor Microenvironment ◽  
Xenograft Model ◽  
Standard Of Care ◽  
The United States ◽  
Tumor Burden ◽  
Her2 Positive ◽  
Cell Functions ◽  
Her2 Breast Cancer

(1) Background: Notwithstanding numerous therapeutic advances, 176,000 deaths from breast and lung cancers will occur in the United States in 2021 alone. The tumor microenvironment and its modulation by drugs have gained increasing attention and relevance, especially with the introduction of immunotherapy as a standard of care in clinical practice. Retinoid X receptors (RXRs) are members of the nuclear receptor superfamily and upon ligand binding, function as transcription factors to modulate multiple cell functions. Bexarotene, the only FDA-approved RXR agonist, is still used to treat cutaneous T-cell lymphoma. (2) Methods: To test the immunomodulatory and anti-tumor effects of MSU42011, a new RXR agonist, we used two different immunocompetent murine models (MMTV-Neu mice, a HER2 positive model of breast cancer and the A/J mouse model, in which vinyl carbamate is used to initiate lung tumorigenesis) and an immunodeficient xenograft lung cancer model. (3) Results: Treatment of established tumors in immunocompetent models of HER2-positive breast cancer and Kras-driven lung cancer with MSU42011 significantly decreased the tumor burden and increased the ratio of CD8/CD4, CD25 T cells, which correlates with enhanced anti-tumor efficacy. Moreover, the combination of MSU42011 and immunotherapy (anti-PDL1 and anti-PD1 antibodies) significantly (p < 0.05) reduced tumor size vs. individual treatments. However, MSU42011 was ineffective in an athymic human A549 lung cancer xenograft model, supporting an immunomodulatory mechanism of action. (4) Conclusions: Collectively, these data suggest that the RXR agonist MSU42011 can be used to modulate the tumor microenvironment in breast and lung cancer.

Development and implementation of clinical pathways in lung cancer at an academic comprehensive cancer center.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 98-98
Author(s):  
Sally Tan ◽  
Julie M. Porter ◽  
Constance Barysauskas ◽  
Stacy L. Mach ◽  
Ed Rodgers ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Pathways ◽  
Performance Status ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Community Settings ◽  
Main Campus ◽  
Potential Factors ◽  
Unwarranted Variation ◽  
Patient Performance

98 Background: Clinical pathways (CP) is an emerging tool aiming to reduce unwarranted variation and maximize value in cancer care. We describe the preliminary experiences and challenges of developing, implementing and testing pathways at a comprehensive cancer center. Methods: Dana-Farber Cancer Institute (DFCI) partnered with Via Oncology to develop and pilot institution-derived CP in lung cancer. The Via platform tracks usage rate, adherence to the DFCI-designed CP (on-pathway rate), and reasons why off-pathway treatments were chosen. An online satisfaction survey was conducted among providers participating in the pilot. Results: Between 1/27/14 and 5/30/14, 277 chemotherapy treatments were initiated, with 124 new patients. CP was used to generate 98% of new chemotherapy orders; 63% were on-pathway. The most common off-pathway reasons were 1) poor patient performance status and 2) treatment beyond 3rd line. 22 of 41 specialists who participated in the CP pilot at DFCI’s main campus responded to the survey (54% response rate). Respondents ranked the Institute as the stakeholder who most benefits from CP, followed by payers, DFCI network community physicians, DFCI main campus physicians, and patients. Respondents recognized CP reflects appropriate care but are concerned about workflow (Table). Conclusions: Implementation of an institution-derived CP is feasible at a comprehensive cancer center. Physician input into pathway design is essential to build buy-in. Academic specialists perceived more benefit of CP for their community peers and raised concerns about workflow. On-pathway rates were lower than those reported in community settings, due to many potential factors (to be explored with updated data for final presentation). [Table: see text]

Review of next generation sequencing outcomes in patients with metastatic breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12558-e12558
Author(s):  
Irene Kang ◽  
Anishka D'souza ◽  
Darcy V. Spicer ◽  
Christy Ann Russell ◽  
Julie E. Lang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Next Generation Sequencing ◽  
Clinical Care ◽  
Metastatic Breast ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Tumor Type ◽  
Next Generation ◽  
Generation Sequencing

e12558 Background: Among patients with newly diagnosed breast cancer in the US, 6-10% will have metastatic disease. With many treatment options to choose from, Next Generation Sequencing (NGS) is a technology that can potentially guide treatment. However studies on the clinical use of NGS are currently limited. Methods: We identified patients with metastatic breast cancer treated at Norris Comprehensive Cancer Center and Los Angeles County Medical Center who underwent NGS with FoundationOne, a clinical-grade NGS tool. Medical records were reviewed for genetic findings, tumor type, treatment outcomes and impact of NGS testing. Results: NGS data derived from FoundationOne testing were analyzed in 27 patients tested between 2013 and 2017. The most commonly occurring mutations were TP53 and PIK3 occurring in 29% of tested patients; followed by MYC, CDH1 and CCND1 (26% each). Clinical data were available for 26 patients:18 patients were hormone receptor (HR) positive Her2 negative, 6 were triple negative, one had HR positive Her2 positive disease, and one had adenoid cystic pathology. A median of 4 mutations per patient (range 0-13) were detected by NGS testing. Twenty-one of 27 patients (78%) were found to have clinically actionable mutations with a median of 1 clinically actionable mutation (range 0-3) per patient. Of these patients, 10 (47%) received treatment directed at their mutation. Five patients were treated on clinical trial as a result of AKT, PTEN or ERBB2 mutations. An additional two patients had received targeted treatments empirically before the time of NGS and three cases are intended for future use. Patients had received on average 5 lines of therapy (range 0-13) at time of study. Conclusions: In patients with metastatic breast cancer, NGS provides data that may drive clinical care. Potential benefits include more precise selection of treatment regimens as well as identifying benefit from drugs that are not yet standard of care in breast cancer. Here we report that clinically actionable mutations are found in a majority of patients tested. Further study is necessary to determine the utility of NGS in this population.

Using cancer registry data to improve adherence with breast cancer pathways.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 127-127
Author(s):  
Karen K. Fields ◽  
Alicia Watson ◽  
Ashley Durand ◽  
Tracy Simpson ◽  
Sandra Stewart ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Registry ◽  
Clinical Pathways ◽  
Cancer Center ◽  
Multiple Primary Cancers ◽  
Multiple Sources ◽  
Cancer Pathways ◽  
Automated Method ◽  
Using Data ◽  
Over Time

127 Background: Evidence-based clinical pathways have been shown to improve quality and cost effectiveness. Moffitt Cancer Center (MCC) has developed clinical pathways for more than 50 cancer sites. Using data derived from multiple sources, we performed a series of measurements of adherence to breast cancer (ca) pathways, provided clinician feedback and evaluated changes over time. Methods: We developed an automated method to evaluate pathway adherence for 1st line systemic treatment (tx) recommendations using data from Stages I-IV analytic breast ca cases presenting to MCC for tx during calendar years (CY) 2013-2015. As a baseline, cases were manually audited for adherence in CY 2012. Data sources included Cancer Registry and electronic health record (EHR). A patient (pt) was considered “On” pathway if the correct tx, including relevant clinical trials, was administered based on various prognostic and clinical factors. Only pts who received all 1st line systemic tx at MCC were included. Pts who refused txor had contraindications, non-applicable histologies or multiple primary cancers were excluded. The EHR was reviewed to assure the accuracy of “Off” pathway determinations. Results: A total of 3727 analytic breast ca cases were seen at MCC between CY 2012-2015; 873 met all criteria and were eligible for analysis. 80% was set as an institutional target for adherence. The following table displays yearly trends for pts “On Pathway” for all applicable chemotherapy, immunotherapy and hormonal tx. Conclusions: Cancer Registry and EHR data can be used to automate surveillance of pathway adherence creating a feedback loop to clinicians who can, in turn, improve adherence over time. [Table: see text]

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