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Clinical decision support tools to improve quality and practice efficiency across a large network of oncology practices. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.34_suppl.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
294 Background: Electronic health records (EHR) provide opportunities for quality enhancements at various points in care. It can support electronic orders, meaningful use, progress notes, medication and allergy data, electronic prescribing, and vital-signs tracking. Clinical decision support tools (CDST) can facilitate high-quality performance and practice efficiency. These enhancements reduce error, improve quality, and drive practice efficiency. The oncology specific EHR (IKnowMed) incorporates CDST including physician driven level 1 pathways prescribing, chemotherapy regimen order entry, dose calculation, supportive care drugs, and guidelines for safe prescribing. Methods: To understand scope and utilization of CDSTs within a large network of individual oncology practices we characterized (qualitatively and quantitatively) common modalities in our EHR (iKnowMed). Treatment regimens were populated by the network collaborative-care committee. Physicians selected regimens pre-populated w/doses and pre-medications. Antiemetic regimens were pre-populated for emetagenic potential of the chemotherapy regimen. Results: Across the US Oncology Network, 952 physicians used the EHR to deliver services over a 5-month period. During that time, 69,448 cancer treatment regimens were ordered, pre-populated by drug, dose and pre-medications; and 68,268 chemotherapy regimens were pre-populated with antiemetic therapy to mirror emetagenic potential. Conclusions: By enhancing the EHR to include CDSTs, treatment and appropriate antiemetic regimens can be pre-populated across a large network of individual oncology practices that have aligned together using common IT and CDST to drive quality care for their patients. The network is using technology to enhance quality and efficiency in practice.
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Risk of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) after adjuvant chemotherapy (CT) for early breast cancer (BC) in the community setting. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.27_suppl.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
62 Background: AML and MDS complicate adjuvant CT in BC. Incidence Rates of MDS/AML with pegfilgrastim (PGCSF) use and newer adjuvant regimens in large patient (pt) populations are not widely characterized. Methods: We queried the iKnowMed electronic health record from a large network of community oncology practices for pts diagnosed with stage I-III BC from 2007-2010 with at least 5 visits and follow up (f/u) through 2/2012 for our retrospective study. We stratified pts by adjuvant CT utilization (yes/no), regimen type, PGCSF use, age, and characterized the incidence of MDS/AML captured as a secondary diagnosis. Fisher’s exact test and student t-test were used for categorical and continuous variables, respectively; Cox proportional hazard model was used to estimate hazard ratios (HR) for risk factors associated with AML/MDS development. Results: We identified 20,900 pts with median f/u of 2.8 years (yrs) (1.2-5.2 yrs). 11,295 pts (54%) received CT, 41% of whom received anthracyclines (A); 9,605 (46%) did not receive CT. Median age of diagnosis in the CT and non-CT arms was 54 and 64 yrs, respectively (p < 0.01). Among the CT-treated group, 12 pts or 0.11% (95% CI, 0.06-0.19) developed AML/MDS with median time to onset of 1.8 yrs and median f/u of 2.7 yrs. Of these 12 pts, 8 received A and 11 PGCSF. In the non-CT group, 18 pts or 0.19% (95% CI, 0.11-0.30) developed AML/MDS with median time to onset of 2.2 yrs and median f/u of 3 yrs (p=NS). Multivariate analysis of pts who received CT revealed pts ≥70 vs. <70 yrs and those that received A-containing vs. alternate regimens were more likely to develop AML/MDS. Conclusions: Adjuvant CT did not increase risk of AML/MDS compared with those that did not receive CT. However, our findings confirm that increased age and A-containing CT regimens are associated with increased risk. The low event rate in our study population may be due to short f/u, younger age in the CT treated arm, and high utilization of non-A CT. Association with PGCSF warrants further evaluation. [Table: see text]
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Changes in adjuvant breast cancer chemotherapy regimen selection over time in the community. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.6109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6109 Background: Adjuvant breast cancer (BC) chemotherapy (CT) treatment has evolved over time due to improved understanding of risk conveyed by pathology and patient (pt) characteristics, as well as emergence of new and mature data for survival and toxicity. We aimed to evaluate how CT regimen selection has changed in recent years in various subgroups. Methods: Using iKnowMed EHR data from The US Oncology Network, we retrospectively identified female pts diagnosed with stage I-III BC between 1/2007 and 12/2010 at practices with EHR data available at time of diagnosis. Pts with <5 office visits, those with a second primary or previous cancer diagnoses were excluded. Age, ER, HER2, nodal status, stage and year of diagnosis were captured. CT utilization was determined by the number of pts who received CT within 6 months of their diagnosis. Clinical trial pts were included. Regimens were categorized by the initial CT title and drugs assigned. Pts with metastatic regimens were excluded. CT regimens were analyzed by subgroups and trended over time. Results: During the time period, 26,095 stage I-III BC pts were identified. A CT regimen within 6 months of diagnosis was documented in 56% of pts. CT utilization was 83% in HER2+ pts, 85% in ER-/HER2- pts, and 45% in ER+/HER2- pts. CT utilization decreased overall with increasing pt age (71%, 64%, 51%, 33%, and 13% for pts in their 4th, 5th, 6th, 7th and ≥8th decade of life). In HER2+ pts, use of non-anthracycline containing regimens increased from 26 to 62%, and anthracyline-taxane combination regimens decreased from 33 to 15%. In HER2-/ER+ pts, the most used non-anthracycline regimen was docetaxel + cyclophosphamide (TC) at 41%. Anthracycline-taxane combinations were used more often in the HER2-/ER- group (32%). Conclusions: In the 4 year study period, this data suggests that ER and HER2 status may drive chemotherapy choice more than nodal status. Anthracycline containing regimens are being used less often possibly due to similar efficacy but less cardiac toxicity, particularly when combined with trastuzumab. These results suggest a change away from anthracyclines in specific subgroups with the controversy over the benefits of that change unsettled, and cost implications yet unquantitated.
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