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Bell-Brown A, Watabayashi K, Kreizenbeck K, Ramsey SD, Bansal A, Barlow WE, Lyman GH, Hershman DL, Mercurio AM, Segarra-Vazquez B, Kurttila F, Myers JS, Golenski JD, Johnson J, Erwin RL, Walia G, Crawford J, Sullivan SD. An evaluation of stakeholder engagement in comparative effectiveness research: lessons learned from SWOG S1415CD. J Comp Eff Res 2022; 11:1313-1321. [PMID: 36378570 PMCID: PMC9832319 DOI: 10.2217/cer-2022-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: Stakeholder engagement is central to comparative effectiveness research yet there are gaps in definitions of success. We used a framework developed by Lavallee et al. defining effective engagement criteria to evaluate stakeholder engagement during a pragmatic cluster-randomized trial. Methods: Semi-structured interviews were developed from the framework and completed to learn about members' experiences. Interviews were analyzed in a deductive approach for themes related to the effective engagement criteria. Results: Thirteen members participated and described: respect for ideas, time to achieve consensus, access to information and continuous feedback as areas of effective engagement. The primary criticism was lack of diversity. Discussion: Feedback was positive, particularly among themes of respect, trust and competence, and led to development of a list of best practices for engagement. The framework was successful for evaluating engagement. Conclusion: Standardized frameworks allow studies to formally evaluate their stakeholder engagement approach and develop best practices for future research.
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Affiliation(s)
- Ari Bell-Brown
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA,Author for correspondence: Tel.: +1 206 667 7624;
| | - Kate Watabayashi
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Karma Kreizenbeck
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Scott D Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Aasthaa Bansal
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA,CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA 98195, USA
| | - William E Barlow
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA,SWOG Statistics & Data Management Center, Seattle, WA 98109, USA
| | - Gary H Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA,School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Dawn L Hershman
- Hebert Irving Comprehensive Cancer Center, Columbia University Medical Center, NY 10032, USA
| | | | | | | | - Jamie S Myers
- University of Kansas School of Nursing, KS 66160, USA
| | | | - Judy Johnson
- SWOG Patient Advocate Committee, Portland, OR 97201, USA
| | | | | | - Jeffrey Crawford
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
| | - Sean D Sullivan
- CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA 98195, USA
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Ramsey SD, Bansal A, Sullivan SD, Lyman GH, Barlow WE, Arnold KB, Watabayashi K, Bell-Brown A, Kreizenbeck K, Le-Lindqwister NA, Dul CL, Brown-Glaberman UA, Behrens RJ, Vogel V, Alluri N, Hershman DL. Effects of a Guideline-Informed Clinical Decision Support System Intervention to Improve Colony-Stimulating Factor Prescribing: A Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2238191. [PMID: 36279134 PMCID: PMC9593234 DOI: 10.1001/jamanetworkopen.2022.38191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IMPORTANCE Colony-stimulating factors are prescribed to patients undergoing chemotherapy to reduce the risk of febrile neutropenia. Research suggests that 55% to 95% of colony-stimulating factor prescribing is inconsistent with national guidelines. OBJECTIVE To examine whether a guideline-based standing order for primary prophylactic colony-stimulating factors improves use and reduces the incidence of febrile neutropenia. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial, the Trial Assessing CSF Prescribing Effectiveness and Risk (TrACER), involved 32 community oncology clinics in the US. Participants were adult patients with breast, colorectal, or non-small cell lung cancer initiating cancer therapy and enrolled between January 2016 and April 2020. Data analysis was performed from July to October 2021. INTERVENTIONS Sites were randomized 3:1 to implementation of a guideline-based primary prophylactic colony-stimulating factor standing order system or usual care. Automated orders were added for high-risk regimens, and an alert not to prescribe was included for low-risk regimens. Risk was based on National Comprehensive Cancer Network guidelines. MAIN OUTCOMES AND MEASURES The primary outcome was to find an increase in colony-stimulating factor use among high-risk patients from 40% to 75%, a reduction in use among low-risk patients from 17% to 7%, and a 50% reduction in febrile neutropenia rates in the intervention group. Mixed model logistic regression adjusted for correlation of outcomes within a clinic. RESULTS A total of 2946 patients (median [IQR] age, 59.0 [50.0-67.0] years; 2233 women [77.0%]; 2292 White [79.1%]) were enrolled; 2287 were randomized to the intervention, and 659 were randomized to usual care. Colony-stimulating factor use for patients receiving high-risk regimens was high and not significantly different between groups (847 of 950 patients [89.2%] in the intervention group vs 296 of 309 patients [95.8%] in the usual care group). Among high-risk patients, febrile neutropenia rates for the intervention (58 of 947 patients [6.1%]) and usual care (13 of 308 patients [4.2%]) groups were not significantly different. The febrile neutropenia rate for patients receiving high-risk regimens not receiving colony-stimulating factors was 14.9% (17 of 114 patients). Among the 585 patients receiving low-risk regimens, colony-stimulating factor use was low and did not differ between groups (29 of 457 patients [6.3%] in the intervention group vs 7 of 128 patients [5.5%] in the usual care group). Febrile neutropenia rates did not differ between usual care (1 of 127 patients [0.8%]) and the intervention (7 of 452 patients [1.5%]) groups. CONCLUSIONS AND RELEVANCE In this cluster randomized clinical trial, implementation of a guideline-informed standing order did not affect colony-stimulating factor use or febrile neutropenia rates in high-risk and low-risk patients. Overall, use was generally appropriate for the level of risk. Standing order interventions do not appear to be necessary or effective in the setting of prophylactic colony-stimulating factor prescribing. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02728596.
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Affiliation(s)
- Scott D. Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Aasthaa Bansal
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- The Comparative Health Outcomes, Policy, and Economics Institute, School of Pharmacy, University of Washington, Seattle
| | - Sean D. Sullivan
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- The Comparative Health Outcomes, Policy, and Economics Institute, School of Pharmacy, University of Washington, Seattle
| | - Gary H. Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- School of Medicine, University of Washington, Seattle
| | - William E. Barlow
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- SWOG Statistics and Data Management Center, Seattle, Washington
| | - Kathryn B. Arnold
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- SWOG Statistics and Data Management Center, Seattle, Washington
| | - Kate Watabayashi
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ari Bell-Brown
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Karma Kreizenbeck
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nguyet A. Le-Lindqwister
- Illinois CancerCare–Peoria (Heartland Cancer Research National Cancer Institute Community Oncology Research Program), Peoria
| | - Carrie L. Dul
- Ascension St John Hospital (Michigan Cancer Research Consortium National Cancer Institute Community Oncology Research Program), Detroit
| | - Ursa A. Brown-Glaberman
- University of New Mexico Cancer Center (New Mexico Minority Underserved National Cancer Institute Community Oncology Research Program, Albuquerque
| | - Robert J. Behrens
- Medical Oncology and Hematology Associates–Des Moines (Iowa-Wide Oncology Research Coalition National Cancer Institute Community Oncology Research Program), Des Moines
| | - Victor Vogel
- Geisinger Medical Center (Geisinger Cancer Institute National Cancer Institute Community Oncology Research Program), Danville, Pennsylvania
| | - Nitya Alluri
- St Luke’s Cancer Institute–Boise (Pacific Cancer Research Consortium National Cancer Institute Community Oncology Research Program), Boise, Idaho
| | - Dawn L. Hershman
- Department of Medicine and Epidemiology, Columbia University, New York, New York
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3
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Watabayashi KK, Bell-Brown A, Kreizenbeck K, Egan K, Lyman GH, Hershman DL, Arnold KB, Bansal A, Barlow WE, Sullivan SD, Ramsey SD. Successes and challenges of implementing a cancer care delivery intervention in community oncology practices: lessons learned from SWOG S1415CD. BMC Health Serv Res 2022; 22:432. [PMID: 35365139 PMCID: PMC8973954 DOI: 10.1186/s12913-022-07835-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/23/2022] [Indexed: 11/12/2022] Open
Abstract
Background Cancer Care Delivery (CCD) research studies often require practice-level interventions that pose challenges in the clinical trial setting. The SWOG Cancer Research Network (SWOG) conducted S1415CD, one of the first pragmatic cluster-randomized CCD trials to be implemented through the National Cancer Institute (NCI) Community Oncology Program (NCORP), to compare outcomes of primary prophylactic colony stimulating factor (PP-CSF) use for an intervention of automated PP-CSF standing orders to usual care. The introduction of new methods for study implementation created challenges and opportunities for learning that can inform the design and approach of future CCD interventions. Methods The order entry system intervention was administered at the site level; sites were affiliated NCORP practices that shared the same chemotherapy order system. 32 sites without existing guideline-based PP-CSF standing orders were randomized to the intervention (n = 24) or to usual care (n = 8). Sites assigned to the intervention participated in tailored training, phone calls and onboarding activities administered by research team staff and were provided with additional funding and external IT support to help them make protocol required changes to their order entry systems. Results The average length of time for intervention sites to complete reconfiguration of their order sets following randomization was 7.2 months. 14 of 24 of intervention sites met their individual patient recruitment target of 99 patients enrolled per site. Conclusions In this paper we share seven recommendations based on lessons learned from implementation of the S1415CD intervention at NCORP community oncology practices representing diverse geographies and patient populations across the U. S. It is our hope these recommendations can be used to guide future implementation of CCD interventions in both research and community settings. Trial Registration NCT02728596, registered April 5, 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07835-4.
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Affiliation(s)
- Kate K Watabayashi
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. PO Box 19024, Seattle, WA, 98109, USA.
| | - Ari Bell-Brown
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. PO Box 19024, Seattle, WA, 98109, USA
| | - Karma Kreizenbeck
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. PO Box 19024, Seattle, WA, 98109, USA
| | - Kathryn Egan
- Amazon, 410 Terry Ave N., Seattle, WA, 98109, USA
| | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. PO Box 19024, Seattle, WA, 98109, USA.,School of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave East, Seattle, WA, 98109, USA
| | - Dawn L Hershman
- Columbia University Medical Center, 161 Ft. Washington 1068, New York, NY, 10032, USA
| | - Kathryn B Arnold
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. PO Box 19024, Seattle, WA, 98109, USA.,SWOG Statistics and Data Management Center, 1100 Fairview Ave N., Seattle, WA, 98109, USA
| | - Aasthaa Bansal
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. PO Box 19024, Seattle, WA, 98109, USA.,CHOICE Institute, School of Pharmacy, University of Washington, University of Washington Health Sciences Building, 1956 NE Pacific St. H362, Seattle, WA, 98195, USA
| | - William E Barlow
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. PO Box 19024, Seattle, WA, 98109, USA.,SWOG Statistics and Data Management Center, 1100 Fairview Ave N., Seattle, WA, 98109, USA
| | - Sean D Sullivan
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. PO Box 19024, Seattle, WA, 98109, USA.,CHOICE Institute, School of Pharmacy, University of Washington, University of Washington Health Sciences Building, 1956 NE Pacific St. H362, Seattle, WA, 98195, USA
| | - Scott D Ramsey
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. PO Box 19024, Seattle, WA, 98109, USA.,School of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave East, Seattle, WA, 98109, USA
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4
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Shankaran V, Li L, Fedorenko C, Sanchez H, Du Y, Khor S, Kreizenbeck K, Ramsey S. Risk of Adverse Financial Events in Patients With Cancer: Evidence From a Novel Linkage Between Cancer Registry and Credit Records. J Clin Oncol 2022; 40:884-891. [PMID: 34995125 DOI: 10.1200/jco.21.01636] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Although financial toxicity is a growing cancer survivorship issue, no studies have used credit data to estimate the relative risk of financial hardship in patients with cancer versus individuals without cancer. We conducted a population-based retrospective matched cohort study using credit reports to investigate the impact of a cancer diagnosis on the risk of adverse financial events (AFEs). METHODS Western Washington SEER cancer registry (cases) and voter registry (controls) records from 2013 to 2018 were linked to quarterly credit records from TransUnion. Controls were age-, sex-, and zip code-matched to cancer cases and assigned an index date corresponding to the case's diagnosis date. Cases and controls experiencing past-due credit card payments and any of the following AFEs at 24 months from diagnosis or index were compared, using two-sample z tests: third-party collections, charge-offs, tax liens, delinquent mortgage payments, foreclosures, and repossessions. Multivariate logistic regression models were used to evaluate the association of cancer diagnosis with AFEs and past-due credit payments. RESULTS A total of 190,722 individuals (63,574 cases and 127,148 controls, mean age 66 years) were included. AFEs (4.3% v 2.4%, P < .0001) and past-due credit payments (2.6% v 1.9%, P < .0001) were more common in cases than in controls. After adjusting for age, sex, average baseline credit line, area deprivation index, and index/diagnosis year, patients with cancer had a higher risk of AFEs (odds ratio 1.71; 95% CI, 1.61 to 1.81; P < .0001) and past-due credit payments (odds ratio 1.28; 95% CI, 1.19 to 1.37; P < .0001) than controls. CONCLUSION Patients with cancer were at significantly increased risk of experiencing AFEs and past-due credit card payments relative to controls. Studies are needed to investigate the impact of these events on treatment decisions, quality of life, and clinical outcomes.
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Affiliation(s)
- Veena Shankaran
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA.,Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA
| | - Li Li
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Catherine Fedorenko
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Hayley Sanchez
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Sara Khor
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA
| | - Karma Kreizenbeck
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Scott Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
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5
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McDermott CL, Curtis JR, Sun Q, Fedorenko C, Kreizenbeck K, Ramsey SD. Polypharmacy, chemotherapy receipt, and medication-related out-of-pocket costs at end of life among commercially insured adults with advanced cancer. J Oncol Pharm Pract 2021; 28:836-841. [PMID: 33823685 DOI: 10.1177/10781552211006180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Polypharmacy raises the risk of drug-drug interactions and adverse events among patients with cancer. Most polypharmacy research has focused on adults age 65 or older enrolled in Medicare insurance. To better inform pharmacy practice and cancer care delivery, data are needed on polypharmacy among commercially insured patients with cancer and those younger than 65. METHODS We performed a retrospective analysis of insurance enrollment and claims files linked to the Puget Sound Cancer Surveillance System for adults age 18 and older who were commercially insured, diagnosed with stage IV cancer, survived 30+ days after diagnosis, and did not enroll in hospice. We describe the prevalence of polypharmacy, chemotherapy use, and medication-related out-of-pocket (OOP) costs in the last month of life. RESULTS Of 606 patients, 390 (64%) experienced polypharmacy (i.e. 5+ medications) in the last 30 days of life. Almost half (n = 297, 49%) received chemotherapy or targeted agents; chemotherapy was associated with significantly higher odds of polypharmacy (odds ratio (OR) 2.93, 95% confidence interval (CI) 2.04-4.20). The most commonly prescribed medications at end of life were opioids, benzodiazepines and anti-emetics. Among 484 patients (80%) incurring medication-related costs in the last month of life, median total OOP cost was $82 (interquartile range $30-$200). Seven patients (1%) had total costs above $5,000. The median chemotherapy-related OOP cost was $446 (IQR $150-$1896); 32 patients (7%) had chemotherapy-related OOP costs between $1,000 and $5,000. CONCLUSION Most patients with advanced cancer experienced polypharmacy at end of life, although most medications observed herein are commonly used for supportive care. Patients receiving chemotherapy had higher medication-related OOP costs, and chemotherapy was significantly associated with polypharmacy at end of life. Evaluation of polypharmacy at end of life may represent an important opportunity to improve quality of life and reduce costs for patients and families.
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Affiliation(s)
- Cara L McDermott
- Cambia Palliative Care Center of Excellence, Department of Medicine, University of Washington, Seattle, WA, USA.,Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Qin Sun
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Catherine Fedorenko
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Karma Kreizenbeck
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Scott D Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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6
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Ramsey SD, Hall IJ, Smith JL, Ekwueme DU, Fedorenko CR, Kreizenbeck K, Bansal A, Thompson IM, Penson DF. A comparison of general, genitourinary, bowel, and sexual quality of life among long term survivors of prostate, bladder, colorectal, and lung cancer. J Geriatr Oncol 2020; 12:305-311. [PMID: 32739353 DOI: 10.1016/j.jgo.2020.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Studies of local stage prostate cancer survivors suggest that treatments carry risk of persistent impotence, incontinence, and bowel dysfunction. To examine impacts of cancer type and side effects on health-related quality of life (HRQoL) in long-term cancer survivorship, we evaluated 5-year follow-up of patients with prostate cancer and compared results with a matched group of male long-term survivors of other local-stage cancers. MATERIALS AND METHODS We examined genitourinary, bowel and sexual symptoms, and general quality of life. Matched survivors of colorectal, lung, and bladder cancers were recruited via registries in 3 different regions in the United States. Patients were surveyed 3-5 years after diagnosis with the SF-12 and EPIC to evaluate general mental and physical health-related quality of life (HRQoL) and patient function and bother. RESULTS We analyzed responses from long-term prostate (n = 77) and bladder, colorectal, and lung cancer (n = 124) patients. In multivariate analysis, long-term local stage prostate cancer survivors had significantly higher SF-12 physical component scores but did not differ from long-term survivors of other cancers in terms of their SF-12 mental summary scores. Prostate survivors had similar mental, urinary, bowel, and sexual HRQoL compared to long-term survivors of other local stage cancers. CONCLUSION Long-term general and prostate-specific HRQoL was similar between local stage prostate and bladder, colorectal, and lung patients with cancer. Future research focusing on factors other than initial treatment and the cancer type per se may provide more meaningful information regarding factors that predict disparities on HRQoL among longer-term survivors of early stage male cancers.
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Affiliation(s)
- Scott D Ramsey
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MS: M3-B232, Seattle, WA 98109-1024, USA.
| | - Ingrid J Hall
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F76, Chamblee, GA 30341, USA.
| | - Judith Lee Smith
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F76, Chamblee, GA 30341, USA.
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F76, Chamblee, GA 30341, USA.
| | - Catherine R Fedorenko
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MS: M3-B232, Seattle, WA 98109-1024, USA.
| | - Karma Kreizenbeck
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MS: M3-B232, Seattle, WA 98109-1024, USA.
| | - Aasthaa Bansal
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MS: M3-B232, Seattle, WA 98109-1024, USA; University of Washington, Department of Pharmacy, University of Washington, Box 357630, Seattle, WA 98195, USA.
| | - Ian M Thompson
- University of Texas Health Science Center, 7979 Wurzbach Rd, San Antonio, TX 78229, USA; Christus Santa Rosa Hospital and Medical Center, 2827 Babcock Rd, San Antonio, TX 78229, USA.
| | - David F Penson
- Department of Urology and Department of Preventive Medicine, University of Southern California/Norris Cancer Center, 1441 Eastlake Ave, Los Angeles, CA 90033, USA; Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA.
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Bell-Brown A, Sullivan S, Lyman G, Hershman D, Watabayashi K, Kreizenbeck K, Shirley S, Ciccarella A, Walia G, Johnson J, Seigel C, Mason G, Kurttila F, Segarra-Vazquez B, Ramsey S, Lobo Goulart BH. MA22.02 The Impact of Patient Engagement on Study Design and Patient Recruitment in a Pragmatic Trial to Improve Cancer Care Delivery. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Panattoni L, Fedorenko C, Kreizenbeck K, Sun Q, Li L, Conklin T, Lyman GH, Ramsey SD. Lessons From Reporting National Performance Measures in a Regional Setting: Washington State Community Cancer Care Report. J Oncol Pract 2019; 14:e801-e814. [PMID: 30537450 DOI: 10.1200/jop.18.00410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Regional public reporting of performance measures in oncology can facilitate local decision making across stakeholders, but small numbers of patients and clinics pose a challenge to creating statistically robust measures. In this article, we describe our development of the Community Cancer Care in Washington State: Quality and Cost Report, the first publicly available report showing clinic-level quality and cost measures at the regional level. We learned key lessons in how to adapt national performance reporting to our regional setting using a registry-linked multipayer claims database. In short, limited numbers of eligible patients for some nationally recognized metrics led us to group metrics and use a 3-year performance window. After completing clinic attribution and other requirements of metric construction, the final metrics included between 62.9% and 88.4% of the eligible patients. To link total costs to some quality measures, we had to define a treatment and surveillance episode of care. Risk adjustment was challenged by the ability to include a limited number of risk adjustors and their potential concentration in a few clinics. We used a different quality score than national performance reporting to account for variation in the range of risk-standardized rates. Current methodology does not permit us to determine whether clinically meaningful differences in quality or costs exist, which inhibits value comparisons. Stakeholder engagement was critical for providing methodologic feedback. In conclusion, we found that refining national metrics was necessary to facilitate public reporting in a regional setting. Further methodologic development can strengthen public reporting and future applications.
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Affiliation(s)
- Laura Panattoni
- Fred Hutchinson Cancer Research Center, Seattle, WA; Premera Blue Cross, Mountlake Terrace, WA; and University of Washington School of Medicine, Seattle, WA
| | - Catherine Fedorenko
- Fred Hutchinson Cancer Research Center, Seattle, WA; Premera Blue Cross, Mountlake Terrace, WA; and University of Washington School of Medicine, Seattle, WA
| | - Karma Kreizenbeck
- Fred Hutchinson Cancer Research Center, Seattle, WA; Premera Blue Cross, Mountlake Terrace, WA; and University of Washington School of Medicine, Seattle, WA
| | - Qin Sun
- Fred Hutchinson Cancer Research Center, Seattle, WA; Premera Blue Cross, Mountlake Terrace, WA; and University of Washington School of Medicine, Seattle, WA
| | - Lily Li
- Fred Hutchinson Cancer Research Center, Seattle, WA; Premera Blue Cross, Mountlake Terrace, WA; and University of Washington School of Medicine, Seattle, WA
| | - Ted Conklin
- Fred Hutchinson Cancer Research Center, Seattle, WA; Premera Blue Cross, Mountlake Terrace, WA; and University of Washington School of Medicine, Seattle, WA
| | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA; Premera Blue Cross, Mountlake Terrace, WA; and University of Washington School of Medicine, Seattle, WA
| | - Scott D Ramsey
- Fred Hutchinson Cancer Research Center, Seattle, WA; Premera Blue Cross, Mountlake Terrace, WA; and University of Washington School of Medicine, Seattle, WA
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9
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Deverka PA, Bangs R, Kreizenbeck K, Delaney DM, Hershman DL, Blanke CD, Ramsey SD. A New Framework for Patient Engagement in Cancer Clinical Trials Cooperative Group Studies. J Natl Cancer Inst 2019; 110:553-559. [PMID: 29684151 DOI: 10.1093/jnci/djy064] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/09/2018] [Indexed: 11/14/2022] Open
Abstract
For the past two decades, the National Cancer Institute (NCI) has supported the involvement of patient advocates in both internal advisory activities and funded research projects to provide a patient perspective. Implementation of the inclusion of patient advocates has varied considerably, with inconsistent involvement of patient advocates in key phases of research such as concept development. Despite this, there is agreement that patient advocates have improved the patient focus of many cancer research studies. This commentary describes our experience designing and pilot testing a new framework for patient engagement at SWOG, one of the largest cancer clinical trial network groups in the United States and one of the four adult groups in the NCI's National Clinical Trials Network (NCTN). Our goal is to provide a roadmap for other clinical trial groups that are interested in bringing the patient voice more directly into clinical trial conception and development. We developed a structured process to engage patient advocates more effectively in the development of cancer clinical trials and piloted the process in four SWOG research committees, including implementation of a new Patient Advocate Executive Review Form that systematically captures patient advocates' input at the concept stage. Based on the positive feedback to our approach, we are now developing training and evaluation metrics to support meaningful and consistent patient engagement across the SWOG clinical trial life cycle. Ultimately, the benefits of more patient-centered cancer trials will be measured in the usefulness, relevance, and speed of study results to patients, caregivers, and clinicians.
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Affiliation(s)
| | - Rick Bangs
- SWOG Patient Advocate Committee, Portland, OR
| | - Karma Kreizenbeck
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Deborah M Delaney
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - Scott D Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
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Barger S, Sullivan SD, Bell-Brown A, Bott B, Ciccarella AM, Golenski J, Gorman M, Johnson J, Kreizenbeck K, Kurttila F, Mason G, Myers J, Seigel C, Wade JL, Walia G, Watabayashi K, Lyman GH, Ramsey SD. Effective stakeholder engagement: design and implementation of a clinical trial (SWOG S1415CD) to improve cancer care. BMC Med Res Methodol 2019; 19:119. [PMID: 31185918 PMCID: PMC6560751 DOI: 10.1186/s12874-019-0764-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 06/04/2019] [Indexed: 01/21/2023] Open
Abstract
Background The Fred Hutchinson Cancer Research Center has engaged an External Stakeholder Advisory Group (ESAG) in the planning and implementation of the TrACER Study (S1415CD), a five-year pragmatic clinical trial assessing the effectiveness of a guideline-based colony stimulating factor standing order intervention. The trial is being conducted by SWOG through the National Cancer Institute Community Oncology Research Program in 45 clinics. The ESAG includes ten patient partners, two payers, two pharmacists, two guideline experts, four providers and one medical ethicist. This manuscript describes the ESAG’s role and impact on the trial. Methods During early trial development, the research team assembled the ESAG to inform plans for each phase of the trial. ESAG members provide feedback and engage in problem solving to improve trial implementation. Each year, members participate in one in-person meeting, web conferences and targeted email discussion. Additionally, they complete a survey that assesses their satisfaction with communication and collaboration. The research team collected and reviewed stakeholder input from 2014 to 2018 for impact on the trial. Results The ESAG has informed trial design, implementation and dissemination planning. The group advised the trial’s endpoints, regimen list and development of cohort and usual care arms. Based on ESAG input, the research team enhanced patient surveys and added pharmacy-related questions to the component application to assess order entry systems. ESAG patient partners collaborated with the research team to develop a patient brochure and study summary for clinic staff. In addition to identifying recruitment strategies and patient-oriented platforms for publicly sharing results, ESAG members participated as co-authors on this manuscript and a conference poster presentation highlighting stakeholder influence on the trial. The annual satisfaction survey results suggest that ESAG members were satisfied with the methods, frequency and target areas of their engagement in the trial during project years 1–3. Conclusions Diverse stakeholder engagement has been essential in optimizing the design, implementation and planned dissemination of the TrACER Study. The lessons described in the manuscript may assist others to effectively partner with stakeholders on clinical research.
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Affiliation(s)
- Sarah Barger
- Hutchinson Institute for Cancer Outcomes Research, Seattle, WA, USA
| | - Sean D Sullivan
- CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA, 98195, USA.
| | - Ari Bell-Brown
- Hutchinson Institute for Cancer Outcomes Research, Seattle, WA, USA
| | - Brad Bott
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Anne Marie Ciccarella
- Independent Patient Research Partner and SWOG Digital Engagement Committee Member, New York, NY, USA
| | - John Golenski
- Kairoi Healthcare Strategies, San Francisco, CA, USA
| | - Mark Gorman
- Cancer Survivor Advisor, Silver Spring, MD, USA
| | - Judy Johnson
- SWOG Lung Committee Patient Advocate, St. Louis, MO, USA
| | | | | | - Ginny Mason
- SWOG Breast Committee Patient Advocate, West Lafayette, IN, USA
| | - Jamie Myers
- University of Kansas, School of Nursing, Kansas City, KS, USA
| | - Carole Seigel
- SWOG GI (Pancreatic Cancer) Committee, Patient Advocate, Boston, MA, USA
| | | | | | - Kate Watabayashi
- Hutchinson Institute for Cancer Outcomes Research, Seattle, WA, USA
| | - Gary H Lyman
- Hutchinson Institute for Cancer Outcomes Research, Seattle, WA, USA
| | - Scott D Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Seattle, WA, USA
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11
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Panattoni L, Fedorenko C, Greenwood-Hickman MA, Kreizenbeck K, Walker JR, Martins R, Eaton KD, Rieke JW, Conklin T, Smith B, Lyman G, Ramsey SD. Characterizing Potentially Preventable Cancer- and Chronic Disease–Related Emergency Department Use in the Year After Treatment Initiation: A Regional Study. J Oncol Pract 2018; 14:e176-e185. [DOI: 10.1200/jop.2017.028191] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: As new quality metrics and interventions for potentially preventable emergency department (ED) visits are implemented, we sought to compare methods for evaluating the prevalence and costs of potentially preventable ED visits that were related to cancer and chronic disease among a commercially insured oncology population in the year after treatment initiation. Methods: We linked SEER records in western Washington from 2011 to 2016 with claims from two commercial insurers. The study included patients who were diagnosed with a solid tumor and tracked ED utilization for 1 year after the start of chemotherapy or radiation. Cancer symptoms from the Centers for Medicare & Medicaid Services metric and a patient-reported outcome intervention were labeled potentially preventable (PpCancer). Prevention Quality Indicators of the Agency for Healthcare Research and Quality were labeled potentially preventable–chronic disease (PpChronic). We reported the primary diagnosis, all diagnosis field coding (1 to 10), and 2016 adjusted reimbursements. Results: Of 5,853 eligible patients, 27% had at least one ED visit, which yielded 2,400 total visits. Using primary diagnosis coding, 49.8% of ED visits had a PpCancer diagnosis, whereas 3.2% had a PpChronic diagnosis. Considering all diagnosis fields, 45.0%, 9.4%, and 18.5% included a PpCancer only, a PpChronic only, and both a PpCancer and a PpChronic diagnosis, respectively. The median reimbursement per visit was $735 (interquartile ratio, $194 to $1,549). Conclusion: The prevalence of potentially preventable ED visits was generally high, but varied depending on the diagnosis code fields and the group of codes considered. Future research is needed to understand the complex landscape of potentially preventable ED visits and measures to improve value in cancer care delivery.
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Affiliation(s)
- Laura Panattoni
- Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Cambia Health Solutions, Seattle; MultiCare Regional Cancer Center, Tacoma; and Premera Blue Cross, Mountlake Terrace, WA
| | - Catherine Fedorenko
- Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Cambia Health Solutions, Seattle; MultiCare Regional Cancer Center, Tacoma; and Premera Blue Cross, Mountlake Terrace, WA
| | - Mikael Anne Greenwood-Hickman
- Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Cambia Health Solutions, Seattle; MultiCare Regional Cancer Center, Tacoma; and Premera Blue Cross, Mountlake Terrace, WA
| | - Karma Kreizenbeck
- Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Cambia Health Solutions, Seattle; MultiCare Regional Cancer Center, Tacoma; and Premera Blue Cross, Mountlake Terrace, WA
| | - Julia R. Walker
- Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Cambia Health Solutions, Seattle; MultiCare Regional Cancer Center, Tacoma; and Premera Blue Cross, Mountlake Terrace, WA
| | - Renato Martins
- Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Cambia Health Solutions, Seattle; MultiCare Regional Cancer Center, Tacoma; and Premera Blue Cross, Mountlake Terrace, WA
| | - Keith D. Eaton
- Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Cambia Health Solutions, Seattle; MultiCare Regional Cancer Center, Tacoma; and Premera Blue Cross, Mountlake Terrace, WA
| | - John W. Rieke
- Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Cambia Health Solutions, Seattle; MultiCare Regional Cancer Center, Tacoma; and Premera Blue Cross, Mountlake Terrace, WA
| | - Ted Conklin
- Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Cambia Health Solutions, Seattle; MultiCare Regional Cancer Center, Tacoma; and Premera Blue Cross, Mountlake Terrace, WA
| | - Bruce Smith
- Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Cambia Health Solutions, Seattle; MultiCare Regional Cancer Center, Tacoma; and Premera Blue Cross, Mountlake Terrace, WA
| | - Gary Lyman
- Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Cambia Health Solutions, Seattle; MultiCare Regional Cancer Center, Tacoma; and Premera Blue Cross, Mountlake Terrace, WA
| | - Scott D. Ramsey
- Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Cambia Health Solutions, Seattle; MultiCare Regional Cancer Center, Tacoma; and Premera Blue Cross, Mountlake Terrace, WA
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Shankaran V, Leahy T, Steelquist J, Watabayashi K, Linden H, Ramsey S, Schwartz N, Kreizenbeck K, Nelson J, Balch A, Singleton E, Gallagher K, Overstreet K. Pilot Feasibility Study of an Oncology Financial Navigation Program. J Oncol Pract 2017; 14:e122-e129. [PMID: 29272200 DOI: 10.1200/jop.2017.024927] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Few studies have reported on interventions to alleviate financial toxicity in patients with cancer. We developed a financial navigation program in collaboration with our partners, Consumer Education and Training Services (CENTS) and Patient Advocate Foundation (PAF), to improve patient knowledge about treatment costs, provide financial counseling, and to help manage out-of-pocket expenses. We conducted a pilot study to assess the feasibility and impact of this program. METHODS Patients with cancer received a financial education course followed by monthly contact with a CENTS financial counselor and a PAF case manager for 6 months. We measured program adherence, self-reported financial burden and anxiety, program satisfaction, and type of assistance provided. RESULTS Thirty-four patients (median age, 60.5 years) were consented (85% white and 50% commercially insured). Debt, income declines, and loans were reported by 55%, 55%, and 30% of patients, respectively. CENTS counselors assisted most often with budgeting, retirement planning, and medical bill questions. PAF case managers assisted with applications for appropriate insurance coverage, cost of living issues (eg, housing, transportation), and disability applications. High financial burden and anxiety about costs (4 or 5 on a Likert scale) were reported at baseline by 37% and 47% of patients, respectively. Anxiety about costs decreased over time in 33% of patients, whereas self-reported financial burden did not substantially change. CONCLUSION Implementing an oncology financial navigation program is feasible, provides concrete assistance in navigating the cost of care, and mitigates anxiety about costs in a subset of patients. Future work will focus on measuring the program's impact on financial and clinical outcomes.
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Affiliation(s)
- Veena Shankaran
- Fred Hutchinson Cancer Research Center; University of Washington; Consumer Education and Training Services; United States Bankruptcy Court, Western District of WA, Seattle, WA; and Patient Advocate Foundation, Hampton, VA
| | - Tony Leahy
- Fred Hutchinson Cancer Research Center; University of Washington; Consumer Education and Training Services; United States Bankruptcy Court, Western District of WA, Seattle, WA; and Patient Advocate Foundation, Hampton, VA
| | - Jordan Steelquist
- Fred Hutchinson Cancer Research Center; University of Washington; Consumer Education and Training Services; United States Bankruptcy Court, Western District of WA, Seattle, WA; and Patient Advocate Foundation, Hampton, VA
| | - Kate Watabayashi
- Fred Hutchinson Cancer Research Center; University of Washington; Consumer Education and Training Services; United States Bankruptcy Court, Western District of WA, Seattle, WA; and Patient Advocate Foundation, Hampton, VA
| | - Hannah Linden
- Fred Hutchinson Cancer Research Center; University of Washington; Consumer Education and Training Services; United States Bankruptcy Court, Western District of WA, Seattle, WA; and Patient Advocate Foundation, Hampton, VA
| | - Scott Ramsey
- Fred Hutchinson Cancer Research Center; University of Washington; Consumer Education and Training Services; United States Bankruptcy Court, Western District of WA, Seattle, WA; and Patient Advocate Foundation, Hampton, VA
| | - Naomi Schwartz
- Fred Hutchinson Cancer Research Center; University of Washington; Consumer Education and Training Services; United States Bankruptcy Court, Western District of WA, Seattle, WA; and Patient Advocate Foundation, Hampton, VA
| | - Karma Kreizenbeck
- Fred Hutchinson Cancer Research Center; University of Washington; Consumer Education and Training Services; United States Bankruptcy Court, Western District of WA, Seattle, WA; and Patient Advocate Foundation, Hampton, VA
| | - Judy Nelson
- Fred Hutchinson Cancer Research Center; University of Washington; Consumer Education and Training Services; United States Bankruptcy Court, Western District of WA, Seattle, WA; and Patient Advocate Foundation, Hampton, VA
| | - Alan Balch
- Fred Hutchinson Cancer Research Center; University of Washington; Consumer Education and Training Services; United States Bankruptcy Court, Western District of WA, Seattle, WA; and Patient Advocate Foundation, Hampton, VA
| | - Erin Singleton
- Fred Hutchinson Cancer Research Center; University of Washington; Consumer Education and Training Services; United States Bankruptcy Court, Western District of WA, Seattle, WA; and Patient Advocate Foundation, Hampton, VA
| | - Kathleen Gallagher
- Fred Hutchinson Cancer Research Center; University of Washington; Consumer Education and Training Services; United States Bankruptcy Court, Western District of WA, Seattle, WA; and Patient Advocate Foundation, Hampton, VA
| | - Karen Overstreet
- Fred Hutchinson Cancer Research Center; University of Washington; Consumer Education and Training Services; United States Bankruptcy Court, Western District of WA, Seattle, WA; and Patient Advocate Foundation, Hampton, VA
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13
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McDermott CL, Fedorenko C, Kreizenbeck K, Sun Q, Smith B, Curtis JR, Conklin T, Ramsey SD. End-of-Life Services Among Patients With Cancer: Evidence From Cancer Registry Records Linked With Commercial Health Insurance Claims. J Oncol Pract 2017; 13:e889-e899. [PMID: 28723253 DOI: 10.1200/jop.2017.021683] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite guidelines emphasizing symptom management over aggressive treatment, end-of-life care for persons with cancer in the United States is highly variable. In consultation with a regional collaboration of patients, providers, and payers, we investigated indicators of high-quality end-of-life care to describe patterns of care, identify areas for improvement, and inform future interventions to enhance end-of-life care for patients with cancer. METHODS We linked insurance claims to clinical information from the western Washington SEER database. We included persons ≥ 18 years of age who had been diagnosed with an invasive solid tumor between January 1, 2007, and December 31, 2015, and who had a recorded death date, were enrolled in a commercial plan for the last month of life, and made at least one insurance claim in the last 90 days of life. RESULTS In the last month of life, among 6,568 commercially insured patients, 56.3% were hospitalized and 48.6% underwent at least one imaging scan. Among patients younger than 65 years of age, 31.4% were enrolled in hospice; of those younger than 65 years of age who were not enrolled in hospice, 40.5% had received an opioid prescription. Over time, opioid use in the last 30 days of life among young adults not enrolled in hospice dropped from 44.7% in the period 2007 to 2009 to 42.5% in the period 2010 to 2012 and to 36.7% in the period 2013 to 2015. CONCLUSION Hospitalization and high-cost imaging scans are burdensome to patients and caregivers at the end of life. Our findings suggest that policies that facilitate appropriate imaging, opioid, and hospice use and that encourage supportive care may improve end-of-life care and quality of life.
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Affiliation(s)
- Cara L McDermott
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle; Premera Blue Cross, Mountlake Terrace, WA; and Cambia Health Solutions, Portland, OR
| | - Catherine Fedorenko
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle; Premera Blue Cross, Mountlake Terrace, WA; and Cambia Health Solutions, Portland, OR
| | - Karma Kreizenbeck
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle; Premera Blue Cross, Mountlake Terrace, WA; and Cambia Health Solutions, Portland, OR
| | - Qin Sun
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle; Premera Blue Cross, Mountlake Terrace, WA; and Cambia Health Solutions, Portland, OR
| | - Bruce Smith
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle; Premera Blue Cross, Mountlake Terrace, WA; and Cambia Health Solutions, Portland, OR
| | - J Randall Curtis
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle; Premera Blue Cross, Mountlake Terrace, WA; and Cambia Health Solutions, Portland, OR
| | - Ted Conklin
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle; Premera Blue Cross, Mountlake Terrace, WA; and Cambia Health Solutions, Portland, OR
| | - Scott D Ramsey
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle; Premera Blue Cross, Mountlake Terrace, WA; and Cambia Health Solutions, Portland, OR
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Ramsey S, Hershman D, Bell-Brown A, Watabayashi K, Kreizenbeck K, Sullivan S, Bansal A, Barlow W, Arnold K, Lyman G. Abstract 2767: Consistency of standing orders for primary prophylactic CSF within a national network of community oncology practices: SWOG intergroup trial S1415CD. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND
Among the 400,000 individuals undergoing chemotherapy for breast, colorectal and lung cancer in the US, many are at risk of febrile neutropenia (FN). Prophylactic colony stimulating factor (CSF) use reduces the risk of FN, yet studies show that 55%-95% of CSF prescribing is inconsistent with clinical practice guidelines. There is lack of evidence and ambiguous guidelines for CSF use in regimens with an intermediate risk of FN. To address these issues, we are conducting a pragmatic trial to assess CSF prescribing and to generate evidence about CSF efficacy with intermediate risk regimens. To inform the design and sample size needs, we conducted a survey of current CSF order system use within a large network of community oncology practices.
METHODS
The study setting are sites within the NCI Community Oncology Research Program (NCORP), a national network across the U.S. and Puerto Rico that conducts multi-site cancer clinical trials. Between January-September 2016, 58 NCORP practices were surveyed on their existing systems for prescribing CSF prophylaxis.
RESULTS
8 clinics (14%) reported that their sites do not use any standing orders for CSF prophylaxis prescribing. Standing order set characteristics for the remaining 50 practices are shown in Table 1.
Table 1Summary of CSF standing order implementation in 50 surveyed NCORP clinicsBreast Cancer RegimensNon-Small Cell Lung Cancer RegimensColorectal Cancer RegimensOrder Set CharacteristicDose DenseHigh RiskIntermediate RiskLow RiskIntermediate RiskLow RiskIntermediate RiskLow RiskN (%)N (%)N (%)N (%)N (%)N (%)N (%)N (%)Automatically Included in Order Set (Standing Orders)46 (82%)31 (62%)7 (14%)08 (16%)07 (14%)0Automatically Excluded in Order Set 006 (12%)19 (38%)5 (10%)19 (38%)8 (16%)19 (38%)No automatic ordering- up to physician discretion to add or exclude orders4 (8%)19 (38%)37 (74%)31 (62%)37 (74%)31 (62%)35 (670%)31 (62%)
CONCLUSIONS
We observed wide variation in the current application of standing orders. Intermediate risk regimens had the most inconsistent practices, with a near equal number of clinics choosing either actively including or excluding CSF order sets. The majority of clinics using standing orders included CSF for dose dense and high risk regimens but only 19 (38%) actively excluded CSF for low risk regimens. These results support the need for more evidence to inform clearer guidelines on CSF use in intermediate risk regimens and studies that evaluate the effects of existing CSF standing orders on guideline adherence and patient outcomes.
Funding:PCORI (PCS-1402-09988) and NCORP grant (5UG1CA189974)
Citation Format: Scott Ramsey, Dawn Hershman, Ari Bell-Brown, Kate Watabayashi, Karma Kreizenbeck, Sean Sullivan, Aasthaa Bansal, William Barlow, Kathryn Arnold, Gary Lyman. Consistency of standing orders for primary prophylactic CSF within a national network of community oncology practices: SWOG intergroup trial S1415CD [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2767. doi:10.1158/1538-7445.AM2017-2767
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Affiliation(s)
- Scott Ramsey
- 1Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | | | | | | | | | - Gary Lyman
- 1Fred Hutchinson Cancer Research Center, Seattle, WA
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Shankaran V, Linden H, Steelquist J, Watabayashi K, Kreizenbeck K, Leahy T, Overstreet K. Development of a financial literacy course for patients with newly diagnosed cancer. Am J Manag Care 2017; 23:S58-S64. [PMID: 29648736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Although patients with cancer often face serious financial hardships, few studies have reported on strategies to mitigate this burden. Improving literacy about the financial aspects of cancer care may decrease the negative financial impact of cancer diagnosis and treatment. We obtained input from patient stakeholders on the perceived value and optimal design of a financial literacy program in the advanced cancer setting. STUDY DESIGN Prospective cohort survey. METHODS A series of semi-structured interviews were conducted, during which patients with either colorectal or breast cancer were asked to describe the impact of cancer on their finances and employment, to state their preferences about discussing costs with their providers, and to give input on development of a financial literacy course. RESULTS Twenty-one patients (76% Caucasian) completed interviews, the majority of whom had Medicare or commercial insurance (71%). Lost income from early retirement or disability was the most financially burdensome experience for 67% of patients. The majority of patients (76%) reported that a financial literacy course would be helpful in navigating the cost of cancer care. Most preferred the course be administered at diagnosis in a live group format. CONCLUSIONS Feedback from patients with cancer supported the development of a group financial literacy course that addresses barriers to discussing cost concerns, employment changes during cancer, and available resources for financial assistance.
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Affiliation(s)
- Veena Shankaran
- University of Washington, 925 Eastlake Ave E, MS G4-830, Seattle, WA 98109. E-mail:
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Stickney K, Kreizenbeck K, Fedorenko CR, Goulart B, Shankaran V, Curtis JR, Lyman GH, Mera C, Smith B, Ramsey SD. Regional engagement to define, report, and use quality metrics to improve palliative care in oncology. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
282 Background: Palliative care in oncology encompasses a wide array of care, and optimal performance metrics remain uncertain. To address this issue we held a regional meeting that included patient advocates, clinicians, private and public payers and researchers to identify quality indicators for palliative care, discuss palliative care (PC) quality measurement in the region, review preliminary results and metrics for PC, and identify opportunities to improve care. Methods: Regional experts facilitated discussions. Data was presented from a regional insurance claims-cancer registry linked database. Participants were asked to: discuss and prioritize interventions to improve palliative care in oncology and create metric dashboards for healthcare providers. Results: Oncology-specific recommendations for interventions: early and continuous palliative care discussions from diagnosis through EOL; training existing care team on palliative care conversations, through standard certification programs; pair patients with an experienced patient/patient advocate; educate caregivers, patients and providers respectively on how to communicate about PC and care choices; and patient navigation to manage symptoms of advanced cancer. Feedback on prioritization of palliative care/EOL metrics: see Table. Conclusions: A multi-stakeholder approach can be effective for developing metrics and interventions to improve palliative care by providing an understanding of the information needs of the community. [Table: see text]
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Affiliation(s)
| | | | - Catherine R. Fedorenko
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - J. Randall Curtis
- Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA
| | - Gary H. Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Csaba Mera
- Cambia Health Solutions/Regence BlueCross BlueShield of Oregon, Portland, OR
| | | | - Scott David Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
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Ramsey SD, Fedorenko C, Chauhan R, McGee R, Lyman GH, Kreizenbeck K, Bansal A. Baseline Estimates of Adherence to American Society of Clinical Oncology/American Board of Internal Medicine Choosing Wisely Initiative Among Patients With Cancer Enrolled With a Large Regional Commercial Health Insurer. J Oncol Pract 2015; 11:338-43. [DOI: 10.1200/jop.2014.002717] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A structured approach to evaluating adherence and cost impact is needed before developing programs that are aimed at improving adherence to the American Society of Clinical Oncology Choosing Wisely measures.
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Affiliation(s)
- Scott D. Ramsey
- Fred Hutchinson Cancer Research Center; University of Washington; and Premera Blue Cross, Seattle, WA
| | - Catherine Fedorenko
- Fred Hutchinson Cancer Research Center; University of Washington; and Premera Blue Cross, Seattle, WA
| | - Rakesh Chauhan
- Fred Hutchinson Cancer Research Center; University of Washington; and Premera Blue Cross, Seattle, WA
| | - Richard McGee
- Fred Hutchinson Cancer Research Center; University of Washington; and Premera Blue Cross, Seattle, WA
| | - Gary H. Lyman
- Fred Hutchinson Cancer Research Center; University of Washington; and Premera Blue Cross, Seattle, WA
| | - Karma Kreizenbeck
- Fred Hutchinson Cancer Research Center; University of Washington; and Premera Blue Cross, Seattle, WA
| | - Aasthaa Bansal
- Fred Hutchinson Cancer Research Center; University of Washington; and Premera Blue Cross, Seattle, WA
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Klein G, Gold LS, Sullivan SD, Buist DSM, Ramsey S, Kreizenbeck K, Snell K, Loggers ET, Gifford J, Watkins JB, Kessler L. Prioritizing comparative effectiveness research for cancer diagnostics using a regional stakeholder approach. J Comp Eff Res 2014; 1:241-55. [PMID: 23105966 DOI: 10.2217/cer.12.16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS This paper describes our process to engage regional stakeholders for prioritizing comparative effectiveness research (CER) in cancer diagnostics. We also describe a novel methodology for incorporating stakeholder data and input to inform the objectives of selected CER studies. MATERIALS & METHODS As an integrated component to establishing the infrastructure for community-based CER on diagnostic technologies, we have assembled a regional stakeholder group composed of local payers, clinicians and state healthcare representatives to not only identify and prioritize CER topics most important to the western Washington State region, but also to inform the study design of selected research areas. A landscape analysis process combining literature searches, expert consultations and stakeholder discussions was used to identify possible CER topics in cancer diagnostics. Stakeholders prioritized the top topics using a modified Delphi/group-nominal method and a standardized evaluation criteria framework to determine a final selected CER study area. Implementation of the selected study was immediate due to a unique American Recovery and Reinvestment Act funding structure involving the same researchers and stakeholders in both the prioritization and execution phases of the project. Stakeholder engagement was enhanced after study selection via a rapid analysis of a subset of payers' internal claims, coordinated by the research team, to obtain summary data of imaging patterns of use. Results of this preliminary analysis, which we termed an 'internal analysis,' were used to determine with the stakeholders the most important and feasible study objectives. RESULTS Stakeholders identified PET and MRI in cancers including breast, lung, lymphoma and colorectal as top priorities. In an internal analysis of breast cancer imaging, summary data from three payers demonstrated utilization rates of advanced imaging increased between 2002 and 2009 in the study population, with a great deal of variability in use between different health plans. Assessing whether breast MRI affects treatment decisions was the top breast cancer study objective selected by the stakeholders. There were other high-priority research areas including whether MRI use improved survival that were not deemed feasible with the length of follow-up time following MRI adoption. CONCLUSION Continuous stakeholder engagement greatly enhanced their enthusiasm for the project. We believe CER implementation will be more successful when undertaken by regional stakeholders.
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Ramsey S, Blough D, Kirchhoff A, Kreizenbeck K, Fedorenko C, Snell K, Newcomb P, Hollingworth W, Overstreet K. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Millwood) 2013; 32:1143-52. [PMID: 23676531 DOI: 10.1377/hlthaff.2012.1263] [Citation(s) in RCA: 485] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Much has been written about the relationship between high medical expenses and the likelihood of filing for bankruptcy, but the relationship between receiving a cancer diagnosis and filing for bankruptcy is less well understood. We estimated the incidence and relative risk of bankruptcy for people age twenty-one or older diagnosed with cancer compared to people the same age without cancer by conducting a retrospective cohort analysis that used a variety of medical, personal, legal, and bankruptcy sources covering the Western District of Washington State in US Bankruptcy Court for the period 1995-2009. We found that cancer patients were 2.65 times more likely to go bankrupt than people without cancer. Younger cancer patients had 2-5 times higher rates of bankruptcy than cancer patients age sixty-five or older, which indicates that Medicare and Social Security may mitigate bankruptcy risk for the older group. The findings suggest that employers and governments may have a policy role to play in creating programs and incentives that could help people cover expenses in the first year following a cancer diagnosis.
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Affiliation(s)
- Scott Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
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