Provision of subspecialized expert oncology (SEO) opinions using Navya Cancer Data Model (NCDM), a technology-based platform: Prospective study to facilitate access to care.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6580-6580
Author(s):  
Tiffany A. Traina ◽  
Philip W. Kantoff ◽  
Matthew J. Matasar ◽  
Lara Dunn ◽  
Claire Frances Friedman ◽  
...  
Keyword(s):  
Decision Making ◽  
Early Stage ◽  
Global Scale ◽  
Mobile App ◽  
Automated System ◽  
Cancer Type ◽  
Cancer Data ◽  
Pertinent Data ◽  
Service To Others ◽  
Survey Responses

6580 Background: Outcomes for patients (pts) with cancer may vary widely based on accessibility and quality of care. Subspecialized expert care is associated with improved outcomes yet access to this scarce resource is limited. Providing SEO opinions in legacy ways is time-consuming and difficult to scale. We hypothesized that summarizing comprehensive pt records could enhance efficiency of a remote opinion process. In this prospective pilot, oncologists (MDs) at Memorial Sloan Kettering (MSK) tested the NCDM, a clinically-validated, semi-automated system which abstracts pertinent data elements from medical records into a structured summary to support SEO decision making for remote opinions. Methods: From July to December 2020, 12 MSK MDs provided remote opinions to consecutive pts from an international second opinion service who were specifically seeking MSK expertise. NCDM summaries, with relevant DICOM imaging, were provided to MDs via web and mobile app. MDs answered a brief survey about their experience after each opinion. Time spent to read and respond to an NCDM summary was tracked electronically. Pt feedback was collected by prospective phone follow up. Results: N = 101 remote opinions. Cancer type (N): breast (24), gastrointestinal (15), heme malignancy (14), prostate (12), renal (8), gynecologic (7), head & neck (11), lung (9) and skin (1). 92% MD response rate. Pt characteristics: median age (60 years, range 17-83); stage of disease (early stage 41%, advanced 59%); 86% of pts had received prior treatment. MDs survey responses: median time to complete record review and render opinion = 4.8 min (IQR 2.7 – 7.9 min); NCDM provided adequate information needed to make a decision in this case = 95.7% (89/93); Decision making was easy in this case with data presented in the NCDM format = 96.8% (90/93). Pt survey responses (71/88): 92% shared recommendation with local MD; 87% received the recommended treatment; 99% stated they would recommend a NCDM enabled remote opinion service to others. Conclusions: NCDM summaries enabled subspecialized MSK cancer experts to provide oncology remote opinions with ease. Patients reported high satisfaction with the experience. Technology assisted abstraction and case summary can facilitate access to subspecialized expert opinions at a global scale.

Changes in Insurance Coverage and Stage at Diagnosis Among Nonelderly Patients With Cancer After the Affordable Care Act

2017 ◽  
Vol 35 (35) ◽  
pp. 3906-3915 ◽  
Author(s):  
Ahmedin Jemal ◽  
Chun Chieh Lin ◽  
Amy J. Davidoff ◽  
Xuesong Han
Keyword(s):  
Affordable Care Act ◽  
Low Income ◽  
Early Stage ◽  
Significant Shift ◽  
Cancer Type ◽  
Medicaid Expansion ◽  
Newly Diagnosed ◽  
Difference In Differences ◽  
Cancer Data ◽  
The Affordable Care Act

Purpose To examine change in the percent uninsured and early-stage diagnosis among nonelderly patients with newly diagnosed cancer after the Affordable Care Act (ACA). Patients and Methods By using the National Cancer Data Base, we estimated absolute change (APC) and relative change in percent uninsured among patients with newly diagnosed cancer age 18 to 64 years between 2011 to the third quarter of 2013 (pre-ACA implementation) and the second to fourth quarter of 2014 (post-ACA) in Medicaid expansion and nonexpansion states by family income level. We also examined demographics-adjusted difference in differences in APC between Medicaid expansion and nonexpansion states. We similarly examined changes in insurance and early-stage diagnosis for the 15 leading cancers in men and women (top 17 cancers total). Results Between the pre-ACA and post-ACA periods, percent uninsured among patients with newly diagnosed cancer decreased in all income categories in both Medicaid expansion and nonexpansion states. However, the decrease was largest in low-income patients who resided in expansion states (9.6% to 3.6%; APC, −6.0%; 95% CI, −6.5% to −5.5%) versus their counterparts who resided in nonexpansion states (14.7% to 13.3%; APC, −1.4%; 95% CI, −2.0% to −0.7%), with an adjusted difference in differences of −3.3 (95% CI, −4.0 to −2.5). By cancer type, the largest decrease in percent uninsured occurred in patients with smoking- or infection-related cancers. A small but statistically significant shift was found toward early-stage diagnosis for colorectal, lung, female breast, and pancreatic cancer and melanoma in patients who resided in expansion states. Conclusion Percent uninsured among nonelderly patients with newly diagnosed cancer declined substantially after the ACA, especially among low-income people who resided in Medicaid expansion states. A trend toward early-stage diagnosis for select cancers in expansion states also was found. These results reinforce the importance of policies directed at providing affordable coverage to low-income, vulnerable populations.

Hope-Colored Glasses: Perceptions of Prognosis Among Pediatric Oncology Patients and Their Parents

2021 ◽  
pp. OP.20.00762
Author(s):  
Deena R. Levine ◽  
Andrea Cuviello ◽  
Catherine Nelson ◽  
Zhaohua Lu ◽  
Belinda N. Mandrell ◽  
...  
Keyword(s):  
Decision Making ◽  
Pediatric Oncology ◽  
Medical Decision ◽  
Cancer Type ◽  
Oncology Patients ◽  
Hospital Patients ◽  
Original Survey ◽  
Survey Responses ◽  
Very High ◽  
High Chance

PURPOSE: Cancer patients' belief about prognosis can heavily influence medical decision making and goals of care. It is known that parents of children with cancer tend to be optimistic regarding their child's prognosis; however, little is known about pediatric patients' prognostic beliefs, how physicians' prognostic communication is perceived, and how these perceptions are compared with actual prognoses. PATIENTS AND METHODS: An original survey was administered to 100 pediatric oncology patients, age 10-18 years, and their parents from 2013 to 2015, at St Jude Children's Research Hospital. Patients were eligible for inclusion if they had an oncologic diagnosis, were between 1 month and 1 year from diagnosis, and were English speaking. Survey responses regarding perceived prognosis were compared with actual prognoses as determined from the medical record review and published literature. Analysis included descriptive statistics and association tests. RESULTS: Nearly half of participants (patients = 48.9%, parents = 50.5%) displayed prognostic optimism as compared with the determined objective estimate of curative potential. The majority of both patients (78%) and parents (85%) reported belief in a very high chance of cure, although fewer reported that their physician communicated a very high chance for cure (patients = 57%, parents = 70%), and only 43% were determined to have a very high probability of cure. Significant differences were noted in prognostic optimism by cancer type ( P < .0001); patients with solid tumor were more often optimistic (n = 25, 83.3% optimistic; n = 5, 16.7% accurate), and patients with lymphoma were most often accurate (n = 2, 8.7% optimistic; n = 21, 91.3% accurate). CONCLUSION: Pediatric oncology patients and parents tend to be optimistic about their chance of cure, as compared to both perceived prognostic communication from physicians and objective estimated prognosis. Understanding the nature of prognostic optimism among patients with cancer and caregivers may empower clinicians to guide realistic decision making while supporting hope.

Surveillance or symptom management? Insights from 5 years of caring for survivors.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 44-44
Author(s):  
Amy Elizabeth Shaw ◽  
Peg Jo Jennings-Shaw
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Symptom Management ◽  
Early Stage ◽  
Medical Decision ◽  
Cancer Type ◽  
Survivorship Care ◽  
Care Plans ◽  
Stage Disease ◽  
Cancer Experience

44 Background: One of the most widely held definitions of cancer Survivorship is that it begins "at the time of diagnosis and for the balance of life" (NCCS). An emphasis on providing Survivorship Care Plans (SCP), pushes many Survivorship Programs toward long-term surveillance and care planning for patients who have completed treatment. The needs of survivors who are in the period between diagnosis and completion of treatment are not addressed by SCP. In 2011, our multidisciplinary oncology group hired a board-certified Family Physician to develop a Survivorship Program that would serve the needs of cancer patients at the time of diagnosis and for the balance of life. We report here on what we have learned about our survivors after the first 5 years of caring for them. Methods: Cancer patients were referred to the program by oncology specialists, community physicians, or by patient self-referral. De-identified data for each case were entered into a database including cancer type, stage, treatment, age at diagnosis and at first visit, and primary reason for referral (surveillance, symptom management, or assistance with complex medical decision making). Results: During the 5-year period, 994 patients were seen, median age 61 years (min 26, max 94). Breast cancer was the most common (86%). Patients were referred for surveillance (46%), symptom management (49%), or decision-making (5%). Patients referred for surveillance decreased from 62 to 22%. Patients referred for symptom management increased from 36 to 57%. Patients referred for decision-making increased from 2 to 21%. Patients referred for symptom management were younger (median age 60 vs 63), more likely to have stage II, III, or IV disease (53 vs 34%), and more recently diagnosed (median 1 vs 4 years) than patients referred for surveillance. Conclusions: Over the past 5 years our patients' needs have forced our program to evolve away from surveillance and prevention for early-stage, lower risk patients at the end of their treatment. We are now focused primarily on managing the adverse treatment-related symptoms for patients with higher stage disease. We have observed that patients require and desire survivorship care throughout their cancer experience, not just at the end of treatment.

scholarly journals A Methodological Framework for Sustainable Office Building Renovation Using Green Building Rating Systems and Cost-Benefit Analysis

2020 ◽  
Vol 12 (15) ◽  
pp. 6156
Author(s):  
Nataša Šuman ◽  
Mojca Marinič ◽  
Milan Kuhta
Keyword(s):  
Decision Making ◽  
Sustainable Development ◽  
Cost Benefit Analysis ◽  
Early Stage ◽  
Cost Benefit ◽  
Green Building ◽  
Office Buildings ◽  
Office Building ◽  
Rating System ◽  
Benefit Analysis

Sustainable development is a priority for the future of our society. Sustainable development is of particular importance to the Architecture, Engineering, and Construction (AEC) industry, both for new buildings and for the renovation of existing buildings. Great potential for sustainable development lies in the renovation of existing office buildings. This paper introduces a new framework for identifying the best set of renovation strategies for existing office buildings. The framework applies selected green building rating system criteria and cost-effective sustainable renovation solutions based on cost-benefit analysis (CBA), and thus provides a novelty in decision-making support for the sustainable renovation of office buildings at an early-stage. The framework covers all necessary steps and activities including data collection, determination of the required level of renovation, selection of the green building rating system, identification of impact categories and criteria, and final evaluation and decision-making using CBA. The framework can be used in conjunction with different systems and according to different regional characteristics. The applicability of the addressing procedure is shown through a case study of a comprehensive renovation of an office building in the city of Maribor.

scholarly journals Lung Cancer Inequalities in Stage of Diagnosis in Ontario, Canada

2021 ◽  
Vol 28 (3) ◽  
pp. 1946-1956
Author(s):  
Aisha K. Lofters ◽  
Evgenia Gatov ◽  
Hong Lu ◽  
Nancy N. Baxter ◽  
Sara J. T. Guilcher ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Relative Risk ◽  
Late Stage ◽  
Early Stage ◽  
Small Cell ◽  
Cancer Type ◽  
Adjusted Relative Risk ◽  
Late Stage Diagnosis ◽  
Adjusted Model

Lung cancer is the most common cancer and cause of cancer death in Canada, with approximately 50% of cases diagnosed at stage IV. Sociodemographic inequalities in lung cancer diagnosis have been documented, but it is not known if inequalities exist with respect to immigration status. We used multiple linked health-administrative databases to create a cohort of Ontarians 40–105 years of age who were diagnosed with an incident lung cancer between 1 April 2012 and 31 March 2017. We used modified Poisson regression with robust standard errors to examine the risk of diagnosis at late vs. early stage among immigrants compared to long-term residents. The fully adjusted model included age, sex, neighborhood-area income quintile, number of Aggregated Diagnosis Group (ADG) comorbidities, cancer type, number of prior primary care visits, and continuity of care. Approximately 62% of 38,788 people with an incident lung cancer from 2012 to 2017 were diagnosed at a late stage. Immigrants to the province were no more likely to have a late-stage diagnosis than long-term residents (63.5% vs. 62.0%, relative risk (RR): 1.01 (95% confidence interval (CI): 0.99–1.04), adjusted relative risk (ARR): 1.02 (95% CI: 0.99–1.05)). However, in fully adjusted models, people with more comorbidities were less likely to have a late-stage diagnosis (adjusted relative risk (ARR): 0.82 (95% CI: 0.80–0.84) for those with 10+ vs. 0–5 ADGs). Compared to adenocarcinoma, small cell carcinoma was more likely to be diagnosed at a late stage (ARR: 1.29; 95% CI: 1.27–1.31), and squamous cell (ARR: 0.89; 95% CI: 0.87–0.91) and other lung cancers (ARR: 0.93; 95% CI: 0.91–0.94) were more likely to be diagnosed at an early stage. Men were also slightly more likely to have late-stage diagnosis in the fully adjusted model (ARR: 1.08; 95% CI: 1.05–1.08). Lung cancer in Ontario is a high-fatality cancer that is frequently diagnosed at a late stage. Having fewer comorbidities and being diagnosed with small cell carcinoma was associated with a late-stage diagnosis. The former group may have less health system contact, and the latter group has the lung cancer type most closely associated with smoking. As lung cancer screening programs start to be implemented across Canada, targeted outreach to men and to smokers, increasing awareness about screening, and connecting every Canadian with primary care should be system priorities.

scholarly journals Personalized Decision Making on Genomic Testing in Early Breast Cancer: Expanding the MINDACT Trial with Decision-Analytic Modeling

2021 ◽  
pp. 0272989X2199117
Author(s):  
Ewout W. Steyerberg ◽  
Liesbeth C. de Wreede ◽  
David van Klaveren ◽  
Patrick M. M. Bossuyt
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Genetic Testing ◽  
Early Stage ◽  
Pragmatic Trial ◽  
Genomic Signature ◽  
Genomic Testing ◽  
Analytic Modeling ◽  
Clinical Risk ◽  
Genomic Test

Background Genomic tests may improve upon clinical risk estimation with traditional prognostic factors. We aimed to explore how evidence on the prognostic strength of a genomic signature (clinical validity) can contribute to individualized decision making on starting chemotherapy for women with breast cancer (clinical utility). Methods The MINDACT trial was a randomized trial that enrolled 6693 women with early-stage breast cancer. A 70-gene signature (Mammaprint) was used to estimate genomic risk, and clinical risk was estimated by a dichotomized version of the Adjuvant!Online risk calculator. Women with discordant risk results were randomized to the use of chemotherapy. We simulated the full risk distribution of these women and estimated individual benefit, assuming a constant relative effect of chemotherapy. Results The trial showed a prognostic effect of the genomic signature (adjusted hazard ratio 2.4). A decision-analytic modeling approach identified far fewer women as candidates for genetic testing (4% rather than 50%) and fewer benefiting from chemotherapy (3% rather than 27%) as compared with the MINDACT trial report. The selection of women benefitting from genetic testing and chemotherapy depended strongly on the required benefit from treatment and the assumed therapeutic effect of chemotherapy. Conclusions A high-quality pragmatic trial was insufficient to directly inform clinical practice on the utility of a genomic test for individual women. The indication for genomic testing may be far more limited than suggested by the MINDACT trial.

scholarly journals Opportunities and Challenges for Analyzing Cancer Data at the Inter- and Intra-Institutional Levels

2020 ◽  
pp. 743-756
Author(s):  
Julie Wu ◽  
Jordan Bryan ◽  
Samuel M. Rubinstein ◽  
Lucy Wang ◽  
Michele Lenoue-Newton ◽  
...  
Keyword(s):  
Clinical Data ◽  
Information Exchange ◽  
Cancer Center ◽  
Bipartite Network ◽  
Genotypic Differences ◽  
Cancer Type ◽  
Sample Type ◽  
Metastatic Tumors ◽  
Institutional Level ◽  
Cancer Data

PURPOSE Our goal was to identify the opportunities and challenges in analyzing data from the American Association of Cancer Research Project Genomics Evidence Neoplasia Information Exchange (GENIE), a multi-institutional database derived from clinically driven genomic testing, at both the inter- and the intra-institutional level. Inter-institutionally, we identified genotypic differences between primary and metastatic tumors across the 3 most represented cancers in GENIE. Intra-institutionally, we analyzed the clinical characteristics of the Vanderbilt-Ingram Cancer Center (VICC) subset of GENIE to inform the interpretation of GENIE as a whole. METHODS We performed overall cohort matching on the basis of age, ethnicity, and sex of 13,208 patients stratified by cancer type (breast, colon, or lung) and sample site (primary or metastatic). We then determined whether detected variants, at the gene level, were associated with primary or metastatic tumors. We extracted clinical data for the VICC subset from VICC’s clinical data warehouse. Treatment exposures were mapped to a 13-class schema derived from the HemOnc ontology. RESULTS Across 756 genes, there were significant differences in all cancer types. In breast cancer, ESR1 variants were over-represented in metastatic samples (odds ratio, 5.91; q < 10−6). TP53 mutations were over-represented in metastatic samples across all cancers. VICC had a significantly different cancer type distribution than that of GENIE but patients were well matched with respect to age, sex, and sample type. Treatment data from VICC was used for a bipartite network analysis, demonstrating clusters with a mix of histologies and others being more histology specific. CONCLUSION This article demonstrates the feasibility of deriving meaningful insights from GENIE at the inter- and intra-institutional level and illuminates the opportunities and challenges of the data GENIE contains. The results should help guide future development of GENIE, with the goal of fully realizing its potential for accelerating precision medicine.

scholarly journals Improving Cancer MDT performance in Western Sydney – three years’ experience

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lynleigh Evans ◽  
Yiren Liu ◽  
Brendan Donovan ◽  
Terence Kwan ◽  
Karen Byth ◽  
...  
Keyword(s):  
Decision Making ◽  
Program Improvement ◽  
Multidisciplinary Teams ◽  
Improvement Program ◽  
Annual Survey ◽  
Referral Criteria ◽  
Survey Responses ◽  
Structured Program ◽  
Care Decision ◽  
Generalised Estimating Equations

Abstract Background While multidisciplinary teams (MDTs) are now considered an essential part of cancer care decision-making, how they perform varies widely. The authors hypothesised that a comprehensive, multipronged improvement program, and associated annual member survey, could strengthen MDT performance across a whole cancer service. Methods The study comprised the introduction of a structured program, the Tumour Program Strengthening Initiative (TPSI) linked with an annual survey of member’s perceptions of their performance. Three iterations of the survey have been completed (2017, 2018 and 2019). Generalised estimating equations (GEEs) were used to test for a difference in the proportion of positive survey responses between 2017 and 2019 adjusted for team clustering. Results Twelve teams participated in TPSI. One hundred twenty-nine, 118 and 146 members completed the survey in 2017, 2018 and 2019, respectively. Of the 17 questions that were asked in all three years, nine showed significant improvement and, of these, five were highly significant. Documenting consensus, developing Terms of Reference (TORs), establishing referral criteria and referring to clinical practice guidelines showed most improvement. Questions related to patient considerations, professional development and quality improvement (QI) activities showed no significant change. Conclusions TPSI resulted in sustained and significant improvement. The MDT survey not only allowed MDT members to identify their strengths and weaknesses but also provided insights for management to flag priority areas for further support. Overall program improvement reflected the strengthening of the weakest teams as well as further improvement in highly performing MDTs. Importantly, the initiative has the potential to achieve behaviour change amongst clinicians.

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