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Siegel SD, Zhang Y, Lynch SM, Rowland J, Curriero FC. A Novel Approach for Conducting a Catchment Area Analysis of Breast Cancer by Age and Stage for a Community Cancer Center. Cancer Epidemiol Biomarkers Prev 2024; 33:646-653. [PMID: 38451180 PMCID: PMC11062816 DOI: 10.1158/1055-9965.epi-23-1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/07/2023] [Accepted: 03/05/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The U.S. Preventive Services Task Force recently issued an updated draft recommendation statement to initiate breast cancer screening at age 40, reflecting well-documented disparities in breast cancer-related mortality that disproportionately impact younger Black women. This study applied a novel approach to identify hotspots of breast cancer diagnosed before age 50 and/or at an advanced stage to improve breast cancer detection within these communities. METHODS Cancer registry data for 3,497 women with invasive breast cancer diagnosed or treated between 2012 and 2020 at the Helen F. Graham Cancer Center and Research Institute (HFGCCRI) and who resided in the HFGCCRI catchment area, defined as New Castle County, Delaware, were geocoded and analyzed with spatial intensity. Standardized incidence ratios stratified by age and race were calculated for each hotspot. RESULTS Four hotspots were identified, two for breast cancer diagnosed before age 50, one for advanced breast cancer, and one for advanced breast cancer diagnosed before age 50. Younger Black women were overrepresented in these hotspots relative to the full-catchment area. CONCLUSIONS The novel use of spatial methods to analyze a community cancer center catchment area identified geographic areas with higher rates of breast cancer with poor prognostic factors and evidence that these areas made an outsized contribution to racial disparities in breast cancer. IMPACT Identifying and prioritizing hotspot breast cancer communities for community outreach and engagement activities designed to improve breast cancer detection have the potential to reduce the overall burden of breast cancer and narrow racial disparities in breast cancer.
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Affiliation(s)
- Scott D. Siegel
- Cawley Center for Translational Cancer Research, Helen F. Graham Cancer Center & Research Institute, ChristianaCare, Newark, DE, United States
| | - Yuchen Zhang
- Cawley Center for Translational Cancer Research, Helen F. Graham Cancer Center & Research Institute, ChristianaCare, Newark, DE, United States
- Center for Strategic Information Management, ChristianaCare, Newark, DE, United States
| | - Shannon M. Lynch
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, United States
| | - Jennifer Rowland
- Department of Radiology, Breast Imaging Section, Helen F. Graham Cancer Center & Research Institute, ChristianaCare, Newark, DE, United States
| | - Frank C. Curriero
- Johns Hopkins Spatial Science for Public Health Center, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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Ebrahimi H, Megally S, Plotkin E, Shivakumar L, Salgia NJ, Zengin ZB, Meza L, Chawla N, Castro DV, Dizman N, Bhagat R, Liv S, Li X, Rock A, Liu S, Tripathi A, Dorff T, Oyer RA, Boehmer L, Pal S, Chehrazi-Raffle A. Barriers to Clinical Trial Implementation Among Community Care Centers. JAMA Netw Open 2024; 7:e248739. [PMID: 38683608 PMCID: PMC11059033 DOI: 10.1001/jamanetworkopen.2024.8739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/28/2024] [Indexed: 05/01/2024] Open
Abstract
Importance While an overwhelming majority of patients diagnosed with cancer express willingness to participate in clinical trials, only a fraction will enroll onto a research protocol. Objective To identify critical barriers to trial enrollment to translate findings into actionable practice changes that increase cancer clinical trial enrollment. Design, Setting, and Participants This survey study included designated site contacts at oncology practices with teams who were highly involved with the Association of Community Cancer Centers (ACCC) Community Oncology Research Institute (ACORI) clinical trials activities, all American Society of Clinical Oncology (ASCO)-ACCC collaboration pilot sites, and/or sites providing care to at least 25% African American and Hispanic residents. To determine participation trends among health care practices in oncology-focused research, identify barriers to clinical trial implementation and operation, and establish unmet needs for cancer clinics interested in trial participation, a 34-question survey was designed. Survey questions were defined within 3 categories: cancer center demographic characteristics, clinical trial characteristics, and referral practices. The survey was distributed through email and was open from June 20 through October 5, 2022. Main Outcomes and Measures Participation in and barriers to conducting oncology trials in different community oncology settings. Results The survey was distributed to 100 cancer centers, with completion by 58 centers (58%) across 25 states. Fifty-two centers (88%) reported that they conduct therapeutic clinical trials, of which 33 (63%) were from urban settings, 11 (21%) were from suburban settings, and 8 (15%) were from rural settings. Only 25% of rural practices (2 of 8) offered phase 1 trials, compared with 67% of urban practices (22 of 33) (P = .01). Respondents noted challenges in conducting research, including patient recruitment (27 respondents [52%]), limited staffing (27 [52%]), and nonrelevant trials for their patient population (25 [48%]). Among sites not offering therapeutic trials, barriers to research conduct included limited infrastructure, funding, and staffing. Most centers (46 of 58 [79%]) referred patients to outside centers for clinical trial enrollment, particularly in the context of late-stage disease and/or disease progression. Only 17 of these sites (37%) had established protocols for patient follow-up subsequent to outside referral. Conclusions and Relevance In this national survey study of barriers to clinical trial implementation, most sites offered therapeutic trials, but there were significant disparities in trial availability across care settings. Furthermore, fundamental deficiencies in trial support infrastructure limited research activity, including within programs currently conducting research as well as at sites interested in future clinical research opportunities. These results identify crucial unmet needs for oncology clinics to effectively offer clinical trials to patients seeking care.
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Affiliation(s)
- Hedyeh Ebrahimi
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Sandra Megally
- Association of Community Cancer Centers, Rockville, Maryland
| | - Elana Plotkin
- Association of Community Cancer Centers, Rockville, Maryland
| | | | | | - Zeynep B. Zengin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Luis Meza
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Neal Chawla
- City of Hope Comprehensive Cancer Center, Duarte, California
| | | | - Nazli Dizman
- Department of Internal Medicine, MD Anderson Cancer Center, Houston, Texas
| | - Ruma Bhagat
- Genentech, Inc, South San Francisco, California
| | - Seila Liv
- Genentech, Inc, South San Francisco, California
| | - Xiaochen Li
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Adam Rock
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Sandy Liu
- City of Hope Orange County Lennar Foundation Cancer Center, Irvine, California
| | | | - Tanya Dorff
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Randall A. Oyer
- Penn Medicine Ann B. Barshinger Cancer Institute, Lancaster, Pennsylvania
| | - Leigh Boehmer
- Association of Community Cancer Centers, Rockville, Maryland
| | - Sumanta Pal
- City of Hope Comprehensive Cancer Center, Duarte, California
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Birhiray RE. Clinical research in the community. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:324-331. [PMID: 38066876 PMCID: PMC10727107 DOI: 10.1182/hematology.2023000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Most patients with high-risk hematologic malignancies are treated in community oncology practices near their residence. This is partly due to patients' ardent desire to be closer to home and trust in local caregivers. Treatments are increasingly complex, even as initial therapy, and more so upon relapse. Improved outcomes in the past decade are largely available through clinical trials primarily offered through academic medical centers. Limited availability of clinical trials at community oncology practices is a major contributor to outcome disparities among minorities, rural, and elderly patients, all of whom are underrepresented in clinical trials. Between 2003 and 2023, the National Cancer Institute (NCI) established programs to address these challenges: the Community Clinical Oncology Program, Minority- Based Community Clinical Oncology Program, NCI Community Cancer Centers Program, and NCI Community Oncology Research Program. However, disparities have persisted, particularly for pharmaceutical-directed clinical research. Lack of representation in clinical research results in data absenteeism, data chauvinism and hallucination, and a delay in treatment availability for high-risk hematologic malignancies in community practice. To address this, the US Congress enacted the Food and Drug Administration Omnibus Act in 2022 to help establish diversity plans that would broaden clinical trial patient enrollment in the United States. We recommend using these initiatives in community oncology practices, including the adoption of the DRIVE strategy in collaboration with pharmaceutical companies, as well as using the NCI-established programs to promote clinical trial availability for patients with high-risk malignancies treated in community oncology practices.
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Affiliation(s)
- Ruemu Ejedafeta Birhiray
- Hematology Oncology of Indiana/American Oncology Network, PA, and Marian University College of Osteopathic Medicine, Indianapolis, IN
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McLouth LE, Borger T, Bursac V, Hoerger M, McFarlin J, Shelton S, Shelton B, Shearer A, Kiviniemi MT, Stapleton JL, Mullett T, Studts JL, Goebel D, Thind R, Trice L, Schoenberg NE. Palliative care use and utilization determinants among patients treated for advanced stage lung cancer care in the community and academic medical setting. Support Care Cancer 2023; 31:190. [PMID: 36847880 PMCID: PMC9969037 DOI: 10.1007/s00520-023-07649-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/18/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Despite clinical guidelines, palliative care is underutilized during advanced stage lung cancer treatment. To inform interventions to increase its use, patient-level barriers and facilitators (i.e., determinants) need to be characterized, especially among patients living in rural areas or those receiving treatment outside academic medical centers. METHODS Between 2020 and 2021, advanced stage lung cancer patients (n = 77; 62% rural; 58% receiving care in the community) completed a one-time survey assessing palliative care use and its determinants. Univariate and bivariate analyses described palliative care use and determinants and compared scores by patient demographic (e.g., rural vs. urban) and treatment setting (e.g., community vs. academic medical center) factors. RESULTS Roughly half said they had never met with a palliative care doctor (49.4%) or nurse (58.4%) as part of cancer care. Only 18% said they knew what palliative care was and could explain it; 17% thought it was the same as hospice. After palliative care was distinguished from hospice, the most frequently cited reasons patients stated they would not seek palliative care were uncertainty about what it would offer (65%), concerns about insurance coverage (63%), difficulty attending multiple appointments (60%), and lack of discussion with an oncologist (59%). The most common reasons patients stated they would seek palliative care were a desire to control pain (62%), oncologist recommendation (58%), and coping support for family and friends (55%). CONCLUSION Interventions should address knowledge and misconceptions, assess care needs, and facilitate communication between patients and oncologists about palliative care.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, College of Medicine, University of Kentucky, 760 Press Avenue, 467 Healthy Kentucky Research Building, Lexington, KY, 40536, USA.
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA.
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
| | - Tia Borger
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, KY, USA
| | - Vilma Bursac
- Department of Behavioral Science, College of Medicine, University of Kentucky, 760 Press Avenue, 467 Healthy Kentucky Research Building, Lexington, KY, 40536, USA
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
| | - Michael Hoerger
- Departments of Psychology, Psychiatry, and Medicine, Freeman School of Business and Tulane Cancer Center, Tulane University, New Orleans, LA, USA
- Department of Palliative Medicine and Supportive Care, University Medical Center of New Orleans, New Orleans, LA, USA
| | - Jessica McFarlin
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Shaylla Shelton
- Lincoln Memorial University- DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Brent Shelton
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Departmental of Internal Medicine, Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Andrew Shearer
- Departmental of Internal Medicine, Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Marc T Kiviniemi
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Health, Behavior and Society, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Jerod L Stapleton
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Health, Behavior and Society, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Timothy Mullett
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jamie L Studts
- Department of Medicine, University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, CO, USA
| | - David Goebel
- King's Daughters Health System, Ashland, KY, USA
| | | | | | - Nancy E Schoenberg
- Department of Behavioral Science, College of Medicine, University of Kentucky, 760 Press Avenue, 467 Healthy Kentucky Research Building, Lexington, KY, 40536, USA
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
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Mikhael JR, Sullivan SL, Carter JD, Heggen CL, Gurska LM. Multisite Quality Improvement Initiative to Identify and Address Racial Disparities and Deficiencies in Delivering Equitable, Patient-Centered Care for Multiple Myeloma-Exploring the Differences between Academic and Community Oncology Centers. Curr Oncol 2023; 30:1598-1613. [PMID: 36826084 PMCID: PMC9955622 DOI: 10.3390/curroncol30020123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
Treatment of multiple myeloma (MM) is complex; however, with equal access to care, clinical outcomes for Black patients match those in other patient groups. To reveal and begin to address clinical practice barriers to equitable, patient-centered MM care, this quality improvement (QI) initiative assessed patient electronic medical records (EMRs) and surveyed patients and providers at two large hospital systems and four community-based practices. For the educational intervention, providers participated in feedback-focused grand rounds sessions to reflect on system barriers and develop action plans to improve MM care. EMR reviews revealed infrequent documentation of cytogenetics and disease staging at community-based practices compared to large hospital systems. In surveys, providers from each care setting reported different challenges in MM care. Notably, the goals of treatment for patients and providers aligned at community clinics while providers and patients from large hospital systems had discordant perspectives. However, providers in community settings underreported race-associated barriers to care and identified different factors impacting treatment decision-making than Black patients. Relative to pre-session responses, providers were more likely to report high confidence after the educational sessions in aligning treatment decisions with guidelines and clinical evidence and shared decision-making (SDM). This QI study identified discordant perceptions among providers at large hospital systems and community-based practices in providing quality MM care. Provider education yielded increased confidence in and commitment to patient-centered care.
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Affiliation(s)
- Joseph R. Mikhael
- Translational Genomics Research Institute (TGen), City of Hope Comprehensive Cancer Center, Phoenix, AZ 85004, USA
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Majumdar D, Reynolds Kueny C, Anderson M. Impact of Merging Into a Comprehensive Cancer Center on Health Care Teams and Subsequent Team-Member and Patient Experiences. JCO Oncol Pract 2023; 19:e78-e91. [PMID: 36240476 DOI: 10.1200/op.22.00280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Comprehensive health care centers are increasingly popular as they offer inclusive health care services under one roof. Often, these centers are formed by merging previously separate clinics. However, there is a lack of systematic guidance on the interprofessional, and interteam and intrateam dynamics that may develop during such an organizational change process. Using team process literature, we identify a possible model to explain how merging into a comprehensive cancer center (CCC) might influence health care teams and their subsequent outcomes, including patient experience. METHODS We used a mixed-method research design. Qualitative data were collected via semistructured interviews from 20 health care professionals employed at a recently merged CCC. During the time frame the interviews were collected, quantitative data were collected from 50 patients receiving treatment at the cancer center through anonymous paper-pencil surveys. Qualitative interviews were analyzed using thematic analysis, on the basis of the input-process-output team dynamics framework. Descriptive statistics were calculated for patient experience data. Trends between data collections were identified. RESULTS On the basis of our qualitative analysis, we provide an input-process-output framework that documents positive and negative aspects of interteam and intrateam dynamics associated with the merger process. Additionally, a number of connections were found between health care professional perceptions and quality patient experiences (eg, merger impacts on interteam and patient communication). CONCLUSION Our findings and model may assist in future merging efforts. Future CCCs may use the proposed framework to better understand and visualize their postmerger progress, in particular from the aspects of interprofessional, and interteam and intrateam dynamics.
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Arch JJ, Mitchell JL, Schmiege SJ, Levin ME, Genung SR, Nealis MS, Fink RM, Bright EE, Andorsky DJ, Kutner JS. A randomized controlled trial of a multi-modal palliative care intervention to promote advance care planning and psychological well-being among adults with advanced cancer: study protocol. Palliat Care 2022; 21:198. [PMID: 36384735 PMCID: PMC9668697 DOI: 10.1186/s12904-022-01087-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Up to half of adults with advanced cancer report anxiety or depression symptoms, which can cause avoidance of future planning. We present a study protocol for an innovative, remotely-delivered, acceptance-based, multi-modal palliative care intervention that addresses advance care planning (ACP) and unmet psychological needs commonly experienced by adults with metastatic cancer. Methods A two-armed, prospective randomized controlled trial (RCT) randomizes 240 adults with Stage IV (and select Stage III) solid tumor cancer who report moderate to high anxiety or depression symptoms to either the multi-modal intervention or usual care. The intervention comprises five weekly two-hour group sessions (plus a booster session one month later) delivered via video conferencing, with online self-paced modules and check-ins completed between the group sessions. Intervention content is based on Acceptance and Commitment Therapy (ACT), an acceptance, mindfulness, and values-based model. Participants are recruited from a network of community cancer care clinics, with group sessions led by the network’s oncology clinical social workers. Participants are assessed at baseline, mid-intervention, post-intervention, and 2-month follow-up. The primary outcome is ACP completion; secondary outcomes include anxiety and depression symptoms, fear of dying, and sense of life meaning. Relationships between anxiety/depression symptoms and ACP will be evaluated cross-sectionally and longitudinally and theory-based putative mediators will be examined. Discussion Among adults with advanced cancer in community oncology settings, this RCT will provide evidence regarding the efficacy of the group ACT intervention on ACP and psychosocial outcomes as well as examine the relationship between ACP and anxiety/ depression symptoms. This trial aims to advance palliative care science and inform clinical practice. Trial Registration Clinicaltrials.gov NCT04773639 on February 26, 2021.
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Siegel SD, Brooks MM, Sims-Mourtada J, Schug ZT, Leonard DJ, Petrelli N, Curriero FC. A Population Health Assessment in a Community Cancer Center Catchment Area: Triple negative breast cancer, alcohol use, and obesity in New Castle County, Delaware. Cancer Epidemiol Biomarkers Prev 2021; 31:108-116. [PMID: 34737210 DOI: 10.1158/1055-9965.epi-21-1031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/12/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The National Cancer Institute (NCI) requires designated cancer centers to conduct catchment area assessments to guide cancer control and prevention efforts designed to reduce the local cancer burden. We extended and adapted this approach to a community cancer center catchment area with elevated rates of triple negative breast cancer (TNBC). METHODS Cancer registry data for 462 TNBC and 2,987 Not-TNBC cases diagnosed between 2012 and 2020 at the Helen F. Graham Cancer Center & Research Institute (HFGCCRI), located in New Castle County, Delaware, were geocoded to detect areas of elevated risk ('hot spots') and decreased risk ('cold spots'). Next, electronic health record (EHR) data on obesity and alcohol use disorder (AUD) and catchment-area measures of fast-food and alcohol retailers were used to assess for spatial relationships between TNBC hot spots and potentially modifiable risk factors. RESULTS Two hot and two cold spots were identified for TNBC within the catchment area. The hot spots accounted for 11% of the catchment area but nearly a third of all TNBC cases. Higher rates of unhealthy alcohol use and obesity were observed within the hot spots. CONCLUSIONS The use of spatial methods to analyze cancer registry and other secondary data sources can inform cancer control and prevention efforts within community cancer center catchment areas, where limited resources can preclude the collection of new primary data. IMPACT Targeting community outreach and engagement activities to TNBC hot spots offers the potential to reduce the population-level burden of cancer efficiently and equitably.
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Affiliation(s)
- Scott D Siegel
- Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System
| | | | | | | | - Dawn J Leonard
- Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System
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9
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Haddad T, Helgeson JM, Pomerleau KE, Preininger AM, Roebuck MC, Dankwa-Mullan I, Jackson GP, Goetz MP. Accuracy of an Artificial Intelligence System for Cancer Clinical Trial Eligibility Screening: Retrospective Pilot Study. JMIR Med Inform 2021; 9:e27767. [PMID: 33769304 PMCID: PMC8088869 DOI: 10.2196/27767] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background Screening patients for eligibility for clinical trials is labor intensive. It requires abstraction of data elements from multiple components of the longitudinal health record and matching them to inclusion and exclusion criteria for each trial. Artificial intelligence (AI) systems have been developed to improve the efficiency and accuracy of this process. Objective This study aims to evaluate the ability of an AI clinical decision support system (CDSS) to identify eligible patients for a set of clinical trials. Methods This study included the deidentified data from a cohort of patients with breast cancer seen at the medical oncology clinic of an academic medical center between May and July 2017 and assessed patient eligibility for 4 breast cancer clinical trials. CDSS eligibility screening performance was validated against manual screening. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for eligibility determinations were calculated. Disagreements between manual screeners and the CDSS were examined to identify sources of discrepancies. Interrater reliability between manual reviewers was analyzed using Cohen (pairwise) and Fleiss (three-way) κ, and the significance of differences was determined by Wilcoxon signed-rank test. Results In total, 318 patients with breast cancer were included. Interrater reliability for manual screening ranged from 0.60-0.77, indicating substantial agreement. The overall accuracy of breast cancer trial eligibility determinations by the CDSS was 87.6%. CDSS sensitivity was 81.1% and specificity was 89%. Conclusions The AI CDSS in this study demonstrated accuracy, sensitivity, and specificity of greater than 80% in determining the eligibility of patients for breast cancer clinical trials. CDSSs can accurately exclude ineligible patients for clinical trials and offer the potential to increase screening efficiency and accuracy. Additional research is needed to explore whether increased efficiency in screening and trial matching translates to improvements in trial enrollment, accruals, feasibility assessments, and cost.
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Affiliation(s)
| | | | | | | | | | | | - Gretchen Purcell Jackson
- IBM Watson Health, Cambridge, ME, United States.,Vanderbilt University Medical Center, Nashville, TN, United States
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Geiger AM, O'Mara AM, McCaskill-Stevens WJ, Adjei B, Tuovenin P, Castro KM. Evolution of Cancer Care Delivery Research in the NCI Community Oncology Research Program. J Natl Cancer Inst 2021; 112:557-561. [PMID: 31845965 DOI: 10.1093/jnci/djz234] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/27/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
Research seeking to improve patient engagement with decision-making, use of evidence-based guidelines, and coordination of multi-specialty care has made important contributions to the decades-long effort to improve cancer care. The National Cancer Institute expanded support for these efforts by including cancer care delivery research in the 2014 formation of the National Cancer Institute Community Oncology Research Program (NCORP). Cancer care delivery research is a multi-disciplinary effort to generate evidence-based practice change that improves clinical outcomes and patient well-being. NCORP scientists and community-based clinicians and organizations rapidly embraced the addition of this type of research into the network, resulting in a robust portfolio of observational studies and intervention studies within the first 5 years of funding. This commentary describes the initial considerations in conducting this type of research in a network previously focused on cancer prevention, control, and treatment studies; characterizes the protocols developed to date; and outlines future directions for cancer care delivery research in the second round of NCORP funding.
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Affiliation(s)
- Ann M Geiger
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Ann M O'Mara
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | | | - Brenda Adjei
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Priyanga Tuovenin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Kathleen M Castro
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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McLouth LE, Nightingale CL, Dressler EV, Snavely AC, Hudson MF, Unger JM, Kazak AE, Lee SJC, Edward J, Carlos R, Kamen CS, Neuman HB, Weaver KE. Current Practices for Screening and Addressing Financial Hardship within the NCI Community Oncology Research Program. Cancer Epidemiol Biomarkers Prev 2020; 30:669-675. [PMID: 33355237 DOI: 10.1158/1055-9965.epi-20-1157] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/12/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cancer-related financial hardship is associated with poor care outcomes and reduced quality of life for patients and families. Scalable intervention development to address financial hardship requires knowledge of current screening practices and services within community cancer care. METHODS The NCI Community Oncology Research Program (NCORP) 2017 Landscape Assessment survey assessed financial screening and financial navigation practices within U.S. community oncology practices. Logistic models evaluated associations between financial hardship screening and availability of a cancer-specific financial navigator and practice group characteristics (e.g., safety-net designation, critical access hospital, proportion of racial and ethnic minority patients served). RESULTS Of 221 participating NCORP practice groups, 72% reported a financial screening process and 50% had a cancer-specific financial navigator. Practice groups with more than 10% of new patients with cancer enrolled in Medicaid (adjOR = 2.81, P = 0.02) and with less than 30% racial/ethnic minority cancer patient composition (adjOR = 3.91, P < 0.01) were more likely to screen for financial concerns. Practice groups with less than 30% racial/ethnic minority cancer patient composition (adjOR = 2.37, P < 0.01) were more likely to have a dedicated financial navigator or counselor for patients with cancer. CONCLUSIONS Most NCORP practice groups screen for financial concerns and half have a cancer-specific financial navigator. Practices serving more racial or ethnic minority patients are less likely to screen and have a designated financial navigator. IMPACT The effectiveness of financial screening and navigation for mitigating financial hardship could be tested within NCORP, along with specific interventions to address cancer care inequities.See related commentary by Yabroff et al., p. 593.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, University of Kentucky, Markey Cancer Center, Center for Health Equity Transformation, Lexington, Kentucky.
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Emily V Dressler
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna C Snavely
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Matthew F Hudson
- NCORP of the Carolinas, Prisma Health, Greenville, South Carolina
| | - Joseph M Unger
- Department of Public Health Sciences, Fred Hutchinson Cancer Research Center, SWOG Statistics and Data Management Center, Seattle, Washington
| | - Anne E Kazak
- Centers for Healthcare Delivery Service, Nemours Children's Health System, Wilmington, Delaware
| | - Simon J Craddock Lee
- Department of Population and Data Sciences, University of Texas-Southwestern Medical Center, Dallas, Texas
| | - Jean Edward
- College of Nursing, University of Kentucky, Markey Cancer Center, UK Healthcare, Lexington, Kentucky
| | - Ruth Carlos
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Heather B Neuman
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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12
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Kaluzny AD, O'Brien DM. How vision and leadership shaped the U.S. National Cancer Institute's 50-year journey to advance the evidence base of cancer control and cancer care delivery research. HEALTH POLICY OPEN 2020; 1:100015. [PMID: 33073235 PMCID: PMC7550860 DOI: 10.1016/j.hpopen.2020.100015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 12/22/2022] Open
Abstract
In 1971, Congress passed the National Cancer Act, landmark legislation that reorganized the National Institutes of Health's National Cancer Institute (NCI). The Act included a new focus on cancer control, including the requirement that the NCI award research grants and contracts, in collaboration with other public agencies and private industry, to conduct cancer control activities related to the diagnosis, prevention, and treatment of cancer. The requirement placed the NCI at the nexus of a rapidly changing science and a complex and dynamic healthcare delivery system and involved an evolutionary transformation to advance cancer control and cancer care delivery research along the cancer care continuum. Analysis is based on a qualitative ethnographic approach using historical records, oral histories, and targeted interviews. The multimethod approach provided the opportunity to describe the vision, leadership, and struggle to build an infrastructure, expand expertise, and forge collaboration with the NCI and a complex and changing healthcare system. As the 50th anniversary of the National Cancer Act approaches in 2021, the process and these achievements are at risk of being taken for granted or lost in the flow of history. Documenting the process, milestones, and key players provides insight and guidance for continuing to improve cancer care, advance research, and reduce cancer incidence and mortality. Cancer care is a microcosm of the larger healthcare system providing insight and lessons on the importance of developing and maintaining a research infrastructure and the role of multi-level collaboration and partnerships involving both the private and public sectors. Fifty years ago the U.S. National Cancer Act mandated Cancer Control activities. Vision and leadership at the NCI were critical to advance cancer control on a global scale. Cancer care is a microcosm of challenges facing health policy globally. Evidence based strategies and infrastructure are important building blocks. Public-private collaboration is essential for meeting future challenges.
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Affiliation(s)
- Arnold D Kaluzny
- Gillings School of Global Public Health, Cecil G. Sheps Center for Health Services Research, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Donna M O'Brien
- Strategic Visions in Healthcare LLC, New York, NY, United States of America.,International Cancer Expert Corps, Washington, DC, United States of America
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13
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Beck JT, Rammage M, Jackson GP, Preininger AM, Dankwa-Mullan I, Roebuck MC, Torres A, Holtzen H, Coverdill SE, Williamson MP, Chau Q, Rhee K, Vinegra M. Artificial Intelligence Tool for Optimizing Eligibility Screening for Clinical Trials in a Large Community Cancer Center. JCO Clin Cancer Inform 2020; 4:50-59. [DOI: 10.1200/cci.19.00079] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Less than 5% of patients with cancer enroll in clinical trials, and 1 in 5 trials are stopped for poor accrual. We evaluated an automated clinical trial matching system that uses natural language processing to extract patient and trial characteristics from unstructured sources and machine learning to match patients to clinical trials. PATIENTS AND METHODS Medical records from 997 patients with breast cancer were assessed for trial eligibility at Highlands Oncology Group between May and August 2016. System and manual attribute extraction and eligibility determinations were compared using the percentage of agreement for 239 patients and 4 trials. Sensitivity and specificity of system-generated eligibility determinations were measured, and the time required for manual review and system-assisted eligibility determinations were compared. RESULTS Agreement between system and manual attribute extraction ranged from 64.3% to 94.0%. Agreement between system and manual eligibility determinations was 81%-96%. System eligibility determinations demonstrated specificities between 76% and 99%, with sensitivities between 91% and 95% for 3 trials and 46.7% for the 4th. Manual eligibility screening of 90 patients for 3 trials took 110 minutes; system-assisted eligibility determinations of the same patients for the same trials required 24 minutes. CONCLUSION In this study, the clinical trial matching system displayed a promising performance in screening patients with breast cancer for trial eligibility. System-assisted trial eligibility determinations were substantially faster than manual review, and the system reliably excluded ineligible patients for all trials and identified eligible patients for most trials.
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Affiliation(s)
| | | | | | | | | | | | | | - Helen Holtzen
- Research Department, Highlands Oncology Group, Fayetteville, AR
| | | | - M. Paul Williamson
- US Oncology Medical, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Quincy Chau
- US Oncology Medical, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Kyu Rhee
- IBM Watson Health, IBM Corporation, Cambridge, MA
| | - Michael Vinegra
- US Oncology Medical, Novartis Pharmaceuticals Corporation, East Hanover, NJ
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14
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Melas M, Subbiah S, Saadat S, Rajurkar S, McDonnell KJ. The Community Oncology and Academic Medical Center Alliance in the Age of Precision Medicine: Cancer Genetics and Genomics Considerations. J Clin Med 2020; 9:E2125. [PMID: 32640668 PMCID: PMC7408957 DOI: 10.3390/jcm9072125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022] Open
Abstract
Recent public policy, governmental regulatory and economic trends have motivated the establishment and deepening of community health and academic medical center alliances. Accordingly, community oncology practices now deliver a significant portion of their oncology care in association with academic cancer centers. In the age of precision medicine, this alliance has acquired critical importance; novel advances in nucleic acid sequencing, the generation and analysis of immense data sets, the changing clinical landscape of hereditary cancer predisposition and ongoing discovery of novel, targeted therapies challenge community-based oncologists to deliver molecularly-informed health care. The active engagement of community oncology practices with academic partners helps with meeting these challenges; community/academic alliances result in improved cancer patient care and provider efficacy. Here, we review the community oncology and academic medical center alliance. We examine how practitioners may leverage academic center precision medicine-based cancer genetics and genomics programs to advance their patients' needs. We highlight a number of project initiatives at the City of Hope Comprehensive Cancer Center that seek to optimize community oncology and academic cancer center precision medicine interactions.
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Affiliation(s)
- Marilena Melas
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA;
| | - Shanmuga Subbiah
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Glendora, CA 91741, USA;
| | - Siamak Saadat
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Colton, CA 92324, USA;
| | - Swapnil Rajurkar
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Upland, CA 91786, USA;
| | - Kevin J. McDonnell
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA
- Center for Precision Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
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15
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Good M, Castro K, Denicoff A, Finnigan S, Parreco L, Germain DS. National Cancer Institute: Restructuring to Support the Clinical Trials of the Future. Semin Oncol Nurs 2020; 36:151003. [PMID: 32265163 DOI: 10.1016/j.soncn.2020.151003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To describe the evolution and structure of the National Cancer Institute clinical trials programs, their notable accomplishments, nurses' roles in these accomplishments, and the essential role of nursing today and in the future. DATA SOURCES Manuscripts, government publications, websites, and professional communications. CONCLUSION Change is inevitable and a constant factor in the world of advancing science and clinical research. Nurses' contribution to research and evidence-based practice will continue to grow and is vital as the scientific landscape evolves. IMPLICATIONS FOR NURSING PRACTICE As the understanding of cancer biology increases and clinical trials evolve, nurses will need to remain key team members and leaders in National Cancer Institute Community Oncology Research Program and National Cancer Trials Network trials and their associated infrastructure.
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Affiliation(s)
- Marjorie Good
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD.
| | - Kathleen Castro
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Andrea Denicoff
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD
| | - Shanda Finnigan
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD
| | - Linda Parreco
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD
| | - Diane St Germain
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD
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16
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Weipert CM, Ryan KA, Everett JN, Yashar BM, Chinnaiyan AM, Scott Roberts J, De Vries R, Zikmund-Fisher BJ, Raymond VM. Physician Experiences and Understanding of Genomic Sequencing in Oncology. J Genet Couns 2017; 27:187-196. [PMID: 28840409 DOI: 10.1007/s10897-017-0134-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 07/18/2017] [Indexed: 01/14/2023]
Abstract
The amount of information produced by genomic sequencing is vast, technically complicated, and can be difficult to interpret. Appropriately tailoring genomic information for non-geneticists is an essential next step in the clinical use of genomic sequencing. To initiate development of a framework for genomic results communication, we conducted eighteen qualitative interviews with oncologists who had referred adult cancer patients to a matched tumor-normal tissue genomic sequencing study. In our qualitative analysis, we found varied levels of clinician knowledge relating to sequencing technology, the scope of the tumor genomic sequencing study, and incidental germline findings. Clinicians expressed a perceived need for more genetics education. Additionally, they had a variety of suggestions for improving results reports and possible resources to aid in results interpretation. Most clinicians felt genetic counselors were needed when incidental germline findings were identified. Our research suggests that more consistent genetics education is imperative in ensuring the proper utilization of genomic sequencing in cancer care. Clinician suggestions for results interpretation resources and results report modifications could be used to improve communication. Clinicians' perceived need to involve genetic counselors when incidental germline findings were found suggests genetic specialists could play a critical role in ensuring patients receive appropriate follow-up.
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Affiliation(s)
- Caroline M Weipert
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Kerry A Ryan
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jessica N Everett
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109-5419, USA
| | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Arul M Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - J Scott Roberts
- Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Raymond De Vries
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Brian J Zikmund-Fisher
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Victoria M Raymond
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109-5419, USA.
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17
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Spain P, Teixeira-Poit S, Halpern MT, Castro K, Prabhu Das I, Adjei B, Lewis R, Clauser SB. The National Cancer Institute Community Cancer Centers Program (NCCCP): Sustaining Quality and Reducing Disparities in Guideline-Concordant Breast and Colon Cancer Care. Oncologist 2017; 22:910-917. [PMID: 28487466 PMCID: PMC5553955 DOI: 10.1634/theoncologist.2016-0252] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 03/09/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The National Cancer Institute Community Cancer Centers Program (NCCCP) pilot was designed to improve quality of cancer care and reduce disparities at community hospitals. The NCCCP's primary intervention was the implementation of the Commission on Cancer Rapid Quality Reporting System (RQRS). The RQRS is a hospital-based data collection and evaluation system allowing near real-time assessment of selected breast and colon cancer quality of care measures. Building on previous NCCCP analyses, this study examined whether improvements in quality cancer care within NCCCP hospitals early in the program were sustained and whether improvements were notable for minority or underserved populations. METHODS We compared changes in concordance with three breast and two colon cancer quality measures approved by the National Quality Forum for patients diagnosed at NCCCP hospitals from 2006 to 2007 (pre-RQRS), 2008 to 2010 (early-RQRS), and 2011 to 2013 (later-RQRS). Data were obtained from NCCCP sites participating in the Commission on Cancer Rapid Quality Reporting System. Logistic regression analyses were performed to identify predictors of concordance with breast and colon cancer quality measures. RESULTS The sample included 13,893 breast and 5,546 colon cancer patients. After RQRS initiation, all five quality measures improved significantly and improvements were sustained through 2013. Quality of care measures showed sustained improvements for both breast and colon cancer patients and for vulnerable patient subgroups including black, uninsured, and Medicaid-covered patients. CONCLUSIONS Quality improvements in NCCCP hospitals were sustained throughout the duration of the program, both overall and among minority and underserved patients. Because many individuals receive cancer treatment at community hospitals, facilitating high-quality care in these environments must be a priority. IMPLICATIONS FOR PRACTICE Quality improvement programs often improve practice, but the methods are not maintained over time. The implementation of a real-time quality reporting system and a network focused on improving quality of care sustained quality improvement at select community cancer centers. The NCCCP pilot increased numbers of patients receiving guideline-concordant care for breast and colon cancer in community settings, and initial improvements noted in earlier years of RQRS were sustained into later years, both overall and among minority and underserved patients. National initiatives that improve care for diverse patient groups are important for reducing and eliminating barriers to care.
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Affiliation(s)
- Pamela Spain
- RTI International, Research Triangle Park, North Carolina, USA
| | | | | | | | | | - Brenda Adjei
- National Cancer Institute, Rockville, Maryland, USA
| | | | - Steven B Clauser
- Improving Healthcare Systems Research Program, Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, USA
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18
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Birken SA, Bunger AC, Powell BJ, Turner K, Clary AS, Klaman SL, Yu Y, Whitaker DJ, Self SR, Rostad WL, Chatham JRS, Kirk MA, Shea CM, Haines E, Weiner BJ. Organizational theory for dissemination and implementation research. Implement Sci 2017; 12:62. [PMID: 28499408 PMCID: PMC5427584 DOI: 10.1186/s13012-017-0592-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/04/2017] [Indexed: 11/14/2022] Open
Abstract
Background Even under optimal internal organizational conditions, implementation can be undermined by changes in organizations’ external environments, such as fluctuations in funding, adjustments in contracting practices, new technology, new legislation, changes in clinical practice guidelines and recommendations, or other environmental shifts. Internal organizational conditions are increasingly reflected in implementation frameworks, but nuanced explanations of how organizations’ external environments influence implementation success are lacking in implementation research. Organizational theories offer implementation researchers a host of existing, highly relevant, and heretofore largely untapped explanations of the complex interaction between organizations and their environment. In this paper, we demonstrate the utility of organizational theories for implementation research. Discussion We applied four well-known organizational theories (institutional theory, transaction cost economics, contingency theories, and resource dependency theory) to published descriptions of efforts to implement SafeCare, an evidence-based practice for preventing child abuse and neglect. Transaction cost economics theory explained how frequent, uncertain processes for contracting for SafeCare may have generated inefficiencies and thus compromised implementation among private child welfare organizations. Institutional theory explained how child welfare systems may have been motivated to implement SafeCare because doing so aligned with expectations of key stakeholders within child welfare systems’ professional communities. Contingency theories explained how efforts such as interagency collaborative teams promoted SafeCare implementation by facilitating adaptation to child welfare agencies’ internal and external contexts. Resource dependency theory (RDT) explained how interagency relationships, supported by contracts, memoranda of understanding, and negotiations, facilitated SafeCare implementation by balancing autonomy and dependence on funding agencies and SafeCare developers. Summary In addition to the retrospective application of organizational theories demonstrated above, we advocate for the proactive use of organizational theories to design implementation research. For example, implementation strategies should be selected to minimize transaction costs, promote and maintain congruence between organizations’ dynamic internal and external contexts over time, and simultaneously attend to organizations’ financial needs while preserving their autonomy. We describe implications of applying organizational theory in implementation research for implementation strategies, the evaluation of implementation efforts, measurement, research design, theory, and practice. We also offer guidance to implementation researchers for applying organizational theory.
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Affiliation(s)
- Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
| | - Alicia C Bunger
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH, 43210, USA
| | - Byron J Powell
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1105C McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA
| | - Kea Turner
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1107C McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA
| | - Alecia S Clary
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1107C McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA
| | - Stacey L Klaman
- Department of Maternal and Child Health, The University of North Carolina at Chapel Hill, 401 Rosenau Hall, Campus Box 7445, Chapel Hill, NC, 27599-7445, USA
| | - Yan Yu
- Department of Family Medicine, University of Calgary, 8th Floor, Sheldon M. Chumir Health Centre, 1213 - 4 Street SW, Calgary, Alberta, T2R 0X7, Canada
| | - Daniel J Whitaker
- School of Public Health, Georgia State University, PO Box 3995, Atlanta, GA, 30302-3995, USA
| | - Shannon R Self
- School of Public Health, Georgia State University, PO Box 3995, Atlanta, GA, 30302-3995, USA
| | - Whitney L Rostad
- School of Public Health, Georgia State University, PO Box 3995, Atlanta, GA, 30302-3995, USA
| | - Jenelle R Shanley Chatham
- School of Public Health, Georgia State University, PO Box 3995, Atlanta, GA, 30302-3995, USA.,National SafeCare Training and Research Center, Mark Chaffin Center for Healthy Development, PO Box 3995, Atlanta, GA, 30302-3995, USA
| | - M Alexis Kirk
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1107C McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA
| | - Christopher M Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1104F McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA
| | - Emily Haines
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1107C McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Box 357965, Seattle, WA, 98195-7965, USA.,Department of Health Services, University of Washington, Box 357965, Seattle, WA, 98195-7965, USA
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Gao L, Joseph J, Santoro-Levy M, Multz AS, Gotlieb VK. Utilization of Pharmaceutical Patient and Prescription Assistance Programs via a Pharmacy Department Patient Assistance Program for Indigent Cancer Patients. Hosp Pharm 2016; 51:572-6. [PMID: 27559190 DOI: 10.1310/hpj5107-572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND With the advances in cancer treatments, mortality rates in the United States have been consistently falling but they are accompanied by substantial increases in the cost of cancer care. Patient and prescription assistance programs (PPAPs) are offered by pharmaceutical manufacturers to provide free medications to medically indigent patients. To assist the Cancer Care Center (CCC) at Nassau University Medical Center (NUMC) with drug costs for chemotherapies, the pharmacy department uses a patient assistance program (PAP) to obtain medications from the drug companies at no cost. PURPOSE This study evaluates the impact of the PAP at a public hospital from which indigent cancer patients obtain assistance for chemotherapy. METHODS We followed all patients requiring assistance with chemotherapy who enrolled in the PAP from January 1, 2011 through December 31, 2012. Medications included both oral and parenteral chemotherapy drugs and antiemetics used in the outpatient clinic setting. RESULTS The program served 347 patients in 2011 and 579 patients in 2012. The total number of visits in the clinic over 24 months was 9,405. The total cost savings of the medications was $1,066,000 in 2011 and $1,715,538 in 2012. CONCLUSIONS A pharmacy-based PAP to procure free medications from PPAPs for cancer patients has helped to defray the expense of providing care at NUMC, increased patients' compliance with chemo protocols, and allowed many patients to receive the treatment they otherwise would not be able to afford. The combination of PPAPs and PAP provides a safety net to ensure that indigent cancer patients receive needed prescription medications in the outpatient clinic setting.
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20
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Hirsch BR, Locke SC, Abernethy AP. Experience of the National Cancer Institute Community Cancer Centers Program on Community-Based Cancer Clinical Trials Activity. J Oncol Pract 2016; 12:e350-8. [PMID: 27026649 DOI: 10.1200/jop.2015.005090] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A goal of the National Cancer Institute Community Cancer Centers Program (NCCCP) was to improve cancer research capacity in community settings. We examined research capacity development during the pilot phase of the NCCCP within the context of national trends in clinical trial activity with respect to the number and phase of trials, total accrual, and accrual of underserved populations. MATERIALS AND METHODS We examined self-reported data from NCCCP sites during 2007 to 2010, supplemented with data from the National Cancer Institute Cancer Therapy Evaluation Program. RESULTS Trial availability and accrual improved more quickly at NCCCP sites compared with national trends. Phase III trial availability increased 8% nationally versus 16% across NCCCP sites, and accrual increased 30% nationally versus 133% across NCCCP sites. Accrual of racial and ethnic minorities rose 82%, from 83 to 151 patients, and accrual of patients age ≥ 65 years rose by 221%, from 200 to 641 patients. Change in trial portfolio and accrual differed by sophistication of the site and by prior experience in conducting clinical trials at the site. CONCLUSION Despite the short duration, the NCCCP pilot resulted in an increase in the number of open trials as well as patient accrual at a faster rate than that observed nationally. These results, coupled with insights into the relative success of sites with varying sophistication at the outset, provide promise that lessons learned can be applied more broadly to increase research participation.
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Affiliation(s)
- Bradford R Hirsch
- Duke Clinical Research Institute; and Duke Cancer Institute, Durham, NC
| | - Susan C Locke
- Duke Clinical Research Institute; and Duke Cancer Institute, Durham, NC
| | - Amy P Abernethy
- Duke Clinical Research Institute; and Duke Cancer Institute, Durham, NC
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21
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Onukwugha E, Petrelli NJ, Castro KM, Gardner JF, Jayasekera J, Goloubeva O, Tan MT, McNamara EJ, Zaren HA, Asfeldt T, Bearden JD, Salner AL, Krasna MJ, Das IP, Clauser SB, Onukwugha E, Petrelli NJ, Castro KM, Gardner JF, Jayasekera J, Goloubeva O, Tan MT, McNamara EJ, Zaren HA, Asfeldt T, Bearden JD, Salner AL, Krasna MJ, Prabhu Das I, Clauser SB. ReCAP: Impact of Multidisciplinary Care on Processes of Cancer Care: A Multi-Institutional Study. J Oncol Pract 2016; 12:155-6; e157-68. [PMID: 26464497 PMCID: PMC4960465 DOI: 10.1200/jop.2015.004200] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The role of multidisciplinary care (MDC) on cancer care processes is not fully understood. We investigated the impact of MDC on the processes of care at cancer centers within the National Cancer Institute Community Cancer Centers Program (NCCCP). METHODS The study used data from patients diagnosed with stage IIB to III rectal cancer, stage III colon cancer, and stage III non–small-cell lung cancer at 14 NCCCP cancer centers from 2007 to 2012. We used an MDC development assessment tool—with levels ranging from evolving MDC (low) to achieving excellence (high)—to measure the level of MDC implementation in seven MDC areas, such as case planning and physician engagement. Descriptive statistics and cluster-adjusted regression models quantified the association between MDC implementation and processes of care, including time from diagnosis to treatment receipt. RESULTS A total of 1,079 patients were examined. Compared with patients with colon cancer treated at cancer centers reporting low MDC scores, time to treatment receipt was shorter for patients with colon cancer treated at cancer centers reporting high or moderate MDC scores for physician engagement (hazard ratio [HR] for high physician engagement, 2.66; 95% CI, 1.70 to 4.17; HR for moderate physician engagement, 1.50; 95% CI, 1.19 to 1.89) and longer for patients with colon cancer treated at cancer centers reporting high 2MDC scores for case planning (HR, 0.65; 95% CI, 0.49 to 0.85). Results for patients with rectal cancer were qualitatively similar, and there was no statistically significant difference among patients with lung cancer. CONCLUSION MDC implementation level was associated with processes of care, and direction of association varied across MDC assessment areas.
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Affiliation(s)
- Eberechukwu Onukwugha
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Nicholas J Petrelli
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Kathleen M Castro
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - James F Gardner
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Jinani Jayasekera
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Olga Goloubeva
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Ming T Tan
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Erica J McNamara
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Howard A Zaren
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Thomas Asfeldt
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - James D Bearden
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Andrew L Salner
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Mark J Krasna
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Irene Prabhu Das
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Steve B Clauser
- University of Maryland, Baltimore, Helen F. Graham Cancer Center at Christiana Care, National Cancer Institute, American College of Surgeons, Nancy N. and J.C. Lewis Cancer and Research Pavilion, at St. Joseph's/Candler Hospital System and Georgia Regents University, Sanford Health, Spartanburg Regional Hospital, Hartford Hospital, Meridian Health, Inc., Patient Centered Outcomes Research Institute
| | - Eberechukwu Onukwugha
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Nicholas J Petrelli
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Kathleen M Castro
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - James F Gardner
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Jinani Jayasekera
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Olga Goloubeva
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Ming T Tan
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Erica J McNamara
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Howard A Zaren
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Thomas Asfeldt
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - James D Bearden
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Andrew L Salner
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Mark J Krasna
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Irene Prabhu Das
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
| | - Steve B Clauser
- University of Maryland School of Pharmacy; University of Maryland School of Medicine, Baltimore; National Cancer Institute, Rockville; Cancer Institute at St Joseph Medical Center, Towson, MD; Helen F. Graham Cancer Center, Christiana Care, Wilmington, DE; American College of Surgeons, Chicago, IL; Nancy N. and J.C. Lewis Cancer and Research Pavilion, St Joseph's/Candler Hospital System, Savannah, GA; Sanford Cancer Center, Sioux Falls, SD; Gibbs Cancer Center and Research Institute, Spartanburg, SC; and Helen and Harry Gray Cancer Center, Hartford Hospital, Hartford, CT
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22
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Zullig LL, Fortune-Britt AG, Rao S, Tyree SD, Godley PA, Carpenter WR. Enrollment and Racial Disparities in Cancer Treatment Clinical Trials in North Carolina. N C Med J 2016; 77:52-8. [PMID: 26763244 PMCID: PMC4714783 DOI: 10.18043/ncm.77.1.52] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Clinical trials provide access to innovative, high-quality cancer treatment. Simultaneously, broad access helps to ensure that trials include heterogeneous patient populations, which improves the generalizability of findings and the development of interventions that are effective for diverse populations. We provide updated data describing enrollment into cancer treatment trials in North Carolina. METHODS For the period 1996-2009, person-level data regarding cancer clinical trial enrollment and cancer incidence were obtained from the North Carolina Central Cancer Registry and the National Cancer Institute (NCI). Enrollment rates were estimated as the ratio of trial enrollment to cancer incidence for race, sex, and year for each county, Area Health Education Center region, and the state overall. Enrollment rates for common cancers are presented. RESULTS From 1996 to 2009, North Carolina NCI treatment trial enrollment rates were 2.4% and 2.2% for white patients and minority patients, respectively. From 2007 to 2009, rates were 3.8% for white women, 3.5% for minority women, 1.3% for white men, and 1.0% for minority men; there was greater enrollment among more urban populations (2.4%) than among the most rural populations (1.5%). LIMITATIONS This study is limited to NCI-sponsored treatment trials in North Carolina. Policies governing collection of original data necessitate a delay in data availability. CONCLUSIONS Effort is needed to ensure trial access and enrollment among all North Carolina populations. Specifically, we identified racial and sex disparities, particularly for certain cancers (eg, breast cancer). Programs in North Carolina and across the nation can use the methods we employed to assess their success in broadening clinical trial enrollment to include diverse populations.
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Affiliation(s)
- Leah L Zullig
- research health science specialist, Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; adjunct assistant professor, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; assistant professor, Department of Medicine and Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Alice G Fortune-Britt
- postdoctoral fellow, Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Shangbang Rao
- researcher, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Seth D Tyree
- applications specialist, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paul A Godley
- professor, Department of Medicine, University of North Carolina at Chapel Hill; member and principal investigator, UNC-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - William R Carpenter
- adjunct associate professor, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina; senior research mentor, UNC-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
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23
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Copur MS, Ramaekers R, Gönen M, Gulzow M, Hadenfeldt R, Fuller C, Scott J, Einspahr S, Benzel H, Mickey M, Norvell M, Clark D, Gauchan D, Kurbegov D, Copur MS, Ramaekers R, Gönen M, Gulzow M, Hadenfeldt R, Fuller C, Scott J, Einspahr S, Benzel H, Mickey M, Norvell M, Clark D, Gauchan D, Kurbegov D. Impact of the National Cancer Institute Community Cancer Centers Program on Clinical Trial and Related Activities at a Community Cancer Center in Rural Nebraska. J Oncol Pract 2016; 12:67-8, e44-51. [PMID: 26265173 PMCID: PMC4976454 DOI: 10.1200/jop.2015.005736] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Although 85% of patients with cancer are diagnosed and treated in the community setting, only 3% are enrolled onto clinical trials. Lack of adequate time, infrastructure, resources, incentives, and reimbursement adversely affect clinical trial participation. In July 2007, Saint Francis Cancer Treatment Center (SFCTC) in Grand Island, Nebraska, was selected as one of the initial 16 sites for the National Cancer Institute Community Cancer Centers Program (NCCCP). METHODS Clinical trial and related activities data at SFCTC 5 years before and 5 years during the NCCCP were gathered and compared. Data included information on patients in clinical trials, number and type of trials, ratio of underserved patients, staffing, collection and storage of tissue samples, availability of new cancer services, and organizational infrastructure and linkage to National Cancer Institute-designated cancer centers. RESULTS The number and percentage of patients enrolled onto clinical trials increased from 89 (3.2%) to 640 (23%; P<.001). All enrollees were rural Nebraskans, with 70%age > 65 years. Available treatment and nontreatment (eg, prevention, biospecimen,cancer control) trials increased from eight and three per year to 28 and 12 per year (P=.012), respectively. Staffing increased from 1.2 to 3.9 full-time equivalents (P=.012). A genetic counselor, smoking cessation counselor, and outreach project coordinator and two nurse navigators were hired. The number of tissue samples collected and/or stored increased from 26 (19%) to 320 (52%; P<.001). CONCLUSION NCCCP participation had a direct and positive impact on all activities, with enhanced access to expanded types of trials and cancer care services. Our data demonstrate the feasibility of successful implementation of an expanded spectrum of clinical trials and programs in a rural community.
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Affiliation(s)
- Mehmet Sitki Copur
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO,Corresponding author: Mehmet Sitki Copur, MD, Saint Francis Cancer Treatment Center, 2116 W. Faidley Ave, Grand Island, NE 68803; e-mail:
| | - Ryan Ramaekers
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Mithat Gönen
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Mary Gulzow
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Rebecca Hadenfeldt
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Courtney Fuller
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Jenifer Scott
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Sarah Einspahr
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Heather Benzel
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Mary Mickey
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Max Norvell
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Douglas Clark
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Dron Gauchan
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Dax Kurbegov
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Mehmet Sitki Copur
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Ryan Ramaekers
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Mithat Gönen
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Mary Gulzow
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Rebecca Hadenfeldt
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Courtney Fuller
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Jenifer Scott
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Sarah Einspahr
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Heather Benzel
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Mary Mickey
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Max Norvell
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Douglas Clark
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Dron Gauchan
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
| | - Dax Kurbegov
- Saint Francis Cancer Treatment Center, Grand Island, NE; Memorial Sloan Kettering Cancer Center, New York, NY; and Catholic Health Initiatives, Denver, CO
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24
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Holden DJ, Reiter K, O'Brien D, Dalton K. The strategic case for establishing public-private partnerships in cancer care. Health Res Policy Syst 2015; 13:44. [PMID: 26462913 PMCID: PMC4604611 DOI: 10.1186/s12961-015-0031-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/17/2015] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND In 2007, the National Cancer Institute (NCI) launched the NCI Community Cancer Centers Program (NCCCP) as a public-private partnership with community hospitals with a goal of advancing cancer care and research. In order to leverage federal dollars in a time of limited resources, matching funds from each participating hospital were required. The purpose of this paper is to examine hospitals' level of and rationale for co-investment in this partnership, and whether there is an association between hospitals' co-investment and achievement of strategic goals. METHODS Analysis using a comparative case study and micro-cost data was conducted as part of a comprehensive evaluation of the NCCCP pilot to determine the level of co-investment made in support of NCI's goals. In-person or telephone interviews with key informants were conducted at 10 participating hospital and system sites during the first and final years of implementation. Micro-cost data were collected annually from each site from 2007 to 2010. Self-reported data from each awardee are presented on patient volume and physician counts, while secondary data are used to examine the local Medicare market share. RESULTS The rationale expressed by interviewees for participation in a public-private partnership with NCI included expectations of increased market share, higher patient volumes, and enhanced opportunities for cancer physician recruitment as a result of affiliation with the NCI. On average, hospitals invested resources into the NCCCP at a level exceeding $3 for every $1 of federal funds. Six sites experienced a statistically significant change in their Medicare market share. Cancer patient volume increased by as much as one-third from Year 1 to Year 3 for eight of the sites. Nine sites reported an increase in key cancer physician recruitment. CONCLUSIONS Demonstrated investments in cancer care and research were associated with increases in cancer patient volume and perhaps in recruitment of key cancer physicians, but not in increased Medicare market share. Although the results reflect a small sample of hospitals, findings suggest that hospital executives believe there to be a strategic case for a public-private partnership as demonstrated through the NCCCP, which leveraged federal funds to support mutual goals for advancing cancer care and research.
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Affiliation(s)
- Debra J Holden
- RTI International, 3040 E Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709, USA.
| | - Kristin Reiter
- Department of Health Policy and Management, The University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Donna O'Brien
- Strategic Visions in Healthcare, LLC, New York, NY, USA.
| | - Kathleen Dalton
- RTI International, 3040 E Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709, USA.
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25
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Kent EE, Mitchell SA, Castro KM, DeWalt DA, Kaluzny AD, Hautala JA, Grad O, Ballard RM, McCaskill-Stevens WJ, Kramer BS, Clauser SB. Cancer Care Delivery Research: Building the Evidence Base to Support Practice Change in Community Oncology. J Clin Oncol 2015; 33:2705-11. [PMID: 26195715 PMCID: PMC4559611 DOI: 10.1200/jco.2014.60.6210] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Understanding how health care system structures, processes, and available resources facilitate and/or hinder the delivery of quality cancer care is imperative, especially given the rapidly changing health care landscape. The emerging field of cancer care delivery research (CCDR) focuses on how organizational structures and processes, care delivery models, financing and reimbursement, health technologies, and health care provider and patient knowledge, attitudes, and behaviors influence cancer care quality, cost, and access and ultimately the health outcomes and well-being of patients and survivors. In this article, we describe attributes of CCDR, present examples of studies that illustrate those attributes, and discuss the potential impact of CCDR in addressing disparities in care. We conclude by emphasizing the need for collaborative research that links academic and community-based settings and serves simultaneously to accelerate the translation of CCDR results into practice. The National Cancer Institute recently launched its Community Oncology Research Program, which includes a focus on this area of research.
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Affiliation(s)
- Erin E Kent
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Sandra A Mitchell
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA.
| | - Kathleen M Castro
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Darren A DeWalt
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Arnold D Kaluzny
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Judith A Hautala
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Oren Grad
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Rachel M Ballard
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Worta J McCaskill-Stevens
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Barnett S Kramer
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
| | - Steven B Clauser
- Erin E. Kent, Sandra A. Mitchell, Kathleen M. Castro, Worta J. McCaskill-Stevens, Barnett S. Kramer, and Steven B. Clauser, National Cancer Institute, National Institutes of Health (NIH); Rachel M. Ballard, NIH Office of Disease Prevention, Bethesda, MD; Darren A. DeWalt and Arnold D. Kaluzny, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Judith A. Hautala and Oren Grad, Institute for Defense Analyses Science and Technology Policy Institute, Alexandria, VA
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Cariou C, Gonzales M, Krebill H. Adapting and implementing an evidence-based sun-safety education program in rural Idaho, 2012. Prev Chronic Dis 2014; 11:E77. [PMID: 24809363 PMCID: PMC4015303 DOI: 10.5888/pcd11.130268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Melanoma incidence and mortality rates in Idaho are higher than national averages. The importance of increased awareness of skin cancer has been cited by state and local organizations. St. Luke's Mountain States Tumor Institute (MSTI) prioritized educational outreach efforts to focus on the implementation of a skin cancer prevention program in rural Idaho. COMMUNITY CONTEXT As a community cancer center, MSTI expanded cancer education services to include dedicated support to rural communities. Through this expansion, an MSTI educator sought to partner with a community organization to provide sun-safety education. MSTI selected, adapted, and implemented an evidence-based program, Pool Cool. METHODS The education program was implemented in 5 phases. In Phase I, we identified and recruited a community partner; in Phase 2, after thorough research, we selected a program, Pool Cool; in Phase 3, we planned the details of the program, including identification of desired short- and long-term outcomes and adaptation of existing program materials; in Phase 4, we implemented the program in summer 2012; in Phase 5, we assessed program sustainability and expansion. OUTCOME MSTI developed a sustainable partnership with Payette Municipal Pool, and in summer 2012, we implemented Pool Cool. Sun-safety education was provided to more than 700 young people aged 2 to 17 years, and educational signage and sunscreen benefitted hundreds of additional pool patrons. INTERPRETATION Community cancer centers are increasingly being asked to assess community needs and implement evidence-based prevention and screening programs. Clinical staff may become facilitators of evidence-based public health programs. Challenges of implementing evidence-based programs in the context of a community cancer centers are staffing, leveraging of resources, and ongoing training and support.
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Affiliation(s)
- Charlene Cariou
- Idaho Department of Health and Welfare, 450 W State St, Boise, ID 83720. E-mail:
| | | | - Hope Krebill
- Midwest Cancer Alliance, University of Kansas Medical Center, Kansas City, Kansas
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St Germain D, Denicoff AM, Dimond EP, Carrigan A, Enos RA, Gonzalez MM, Wilkinson K, Mathiason MA, Duggan B, Einolf S, McCaskill-Stevens W, Bryant DM, Thompson MA, Grubbs SS, Go RS. Use of the National Cancer Institute Community Cancer Centers Program screening and accrual log to address cancer clinical trial accrual. J Oncol Pract 2014; 10:e73-80. [PMID: 24424313 PMCID: PMC3948711 DOI: 10.1200/jop.2013.001194] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Screening logs have the potential to help oncology clinical trial programs at the site level, as well as trial leaders, address enrollment in real time. Such an approach could be especially helpful in improving representation of racial/ethnic minority and other underrepresented populations in clinical trials. METHODS The National Cancer Institute Community Cancer Centers Program (NCCCP) developed a screening log. Log data collected from March 2009 through May 2012 were analyzed for number of patients screened versus enrolled, including for demographic subgroups; screening methods; and enrollment barriers, including reasons for ineligibility and provider and patient reasons for declining to offer or participate in a trial. User feedback was obtained to better understand perceptions of log utility. RESULTS Of 4,483 patients screened, 18.4% enrolled onto NCCCP log trials. Reasons for nonenrollment were ineligibility (51.6%), patient declined (25.8%), physician declined (15.6%), urgent need for treatment (6.6%), and trial suspension (0.4%). Major reasons for patients declining were no desire to participate in trials (43.2%) and preference for standard of care (39%). Major reasons for physicians declining to offer trials were preference for standard of care (53%) and concerns about tolerability (29.3%). Enrollment rates onto log trials did not differ between white and black (P = .15) or between Hispanic and non-Hispanic patients (P = .73). Other races had lower enrollment rates than whites and blacks. Sites valued the ready access to log data on enrollment barriers, with some sites changing practices to address those barriers. CONCLUSION Use of screening logs to document enrollment barriers at the local level can facilitate development of strategies to enhance clinical trial accrual.
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Affiliation(s)
- Diane St Germain
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
| | - Andrea M. Denicoff
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
| | - Eileen P. Dimond
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
| | - Angela Carrigan
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
| | - Rebecca A. Enos
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
| | - Maria M. Gonzalez
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
| | - Kathy Wilkinson
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
| | - Michelle A. Mathiason
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
| | - Brenda Duggan
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
| | - Shaun Einolf
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
| | - Worta McCaskill-Stevens
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
| | - Donna M. Bryant
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
| | - Michael A. Thompson
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
| | - Stephen S. Grubbs
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
| | - Ronald S. Go
- National Cancer Institute, Bethesda; SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick; The EMMES Corporation, Rockville, MD; St Joseph Hospital of Orange, Orange, CA; Billings Clinic Cancer Center, Billings, MT; Gundersen Health System, La Crosse; Waukesha Memorial Hospital (ProHealth Care), Waukesha, WI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE
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Halpern MT, Spain P, Holden DJ, Stewart A, McNamara EJ, Gay G, Das IP, Clauser S. Improving quality of cancer care at community hospitals: impact of the National Cancer Institute Community Cancer Centers Program pilot. J Oncol Pract 2013; 9:e298-304. [PMID: 23943902 DOI: 10.1200/jop.2013.000937] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with cancer treated at community hospitals may experience decreased quality of care compared with patients treated at higher-volume cancer hospitals. The National Cancer Institute Community Cancer Centers Program (NCCCP) pilot is designed to enhance research and improve cancer care at community hospitals. We assessed changes in quality of care among the 16 initial NCCCP sites versus 25 similar hospitals that did not participate in the NCCCP. METHODS We compared changes in concordance with five National Quality Forum-approved quality of care measures (three for breast cancer, two for colon cancer) for patients diagnosed from 2006 to 2007 (pre-NCCCP initiation) versus 2008 to 2010 (post-NCCCP initiation) at NCCCP and comparison-group hospitals. Data were collected using the Commission on Cancer Rapid Quality Reporting System. Analyses were performed using multivariate logistic regression. RESULTS Analyses included 18,608 patients with breast cancer and 7,031 patients with colon cancer. After NCCCP initiation, patient-level concordance rates for all five quality-of-care measures increased significantly among NCCCP and comparison-group hospitals. Increased quality of care among NCCCP sites was significantly greater than that among comparison-group hospitals for radiation therapy after breast-conserving surgery and hormonal therapy for women with hormone receptor-positive breast cancer. In multivariate regressions, increases in hormonal therapy among NCCCP-site patients were significantly greater than those among comparison-group hospitals. CONCLUSION Both NCCCP and comparison-group hospitals showed improved quality of care; however, NCCCP sites had significantly greater improvements for a subset of measures. This greater increase may reflect the multidisciplinary focus of the NCCCP. Because many individuals receive cancer treatment at community hospitals, facilitating high-quality care in these environments must be a priority.
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Affiliation(s)
- Michael T Halpern
- RTI International, Washington, DC, and Research Triangle Park, NC; American College of Surgeons, Chicago, IL; and National Cancer Institute, Bethesda, MD
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Zaren HA, Nair S, Go RS, Enos RA, Lanier KS, Thompson MA, Zhao J, Fleming DL, Leighton JC, Gribbin TE, Bryant DM, Carrigan A, Corpening JC, Csapo KA, Dimond EP, Ellison C, Gonzalez MM, Harr JL, Wilkinson K, Denicoff AM. Early-phase clinical trials in the community: results from the national cancer institute community cancer centers program early-phase working group baseline assessment. J Oncol Pract 2013; 9:e55-61. [PMID: 23814525 PMCID: PMC3595451 DOI: 10.1200/jop.2012.000695] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) formed an Early-Phase Working Group to facilitate site participation in early-phase (EP) trials. The Working Group conducted a baseline assessment (BA) to describe the sites' EP trial infrastructure and its association with accrual. METHODS EP accrual and infrastructure data for the sites were obtained for July 2010-June 2011 and 2010, respectively. Sites with EP accrual rates at or above the median were considered high-accruing sites. Analyses were performed to identify site characteristics associated with higher accrual onto EP trials. RESULTS Twenty-seven of the 30 NCCCP sites participated. The median number of EP trials open per site over the course of July 2010-June 2011 was 19. Median EP accrual per site was 14 patients in 1 year. Approximately half of the EP trials were Cooperative Group; most were phase II. Except for having a higher number of EP trials open (P = .04), high-accruing sites (n = 14) did not differ significantly from low-accruing sites (n = 13) in terms of any single site characteristic. High-accruing sites did have shorter institutional review board (IRB) turnaround time by 20 days, and were almost three times as likely to be a lead Community Clinical Oncology Program site (small sample size may have prevented statistical significance). Most sites had at least basic EP trial infrastructure. CONCLUSION Community cancer centers are capable of conducting EP trials. Infrastructure and collaborations are critical components of success. This assessment provides useful information for implementing EP trials in the community.
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Affiliation(s)
- Howard A. Zaren
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Suresh Nair
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Ronald S. Go
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Rebecca A. Enos
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Keith S. Lanier
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Michael A. Thompson
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Jinxiu Zhao
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Deborah L. Fleming
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - John C. Leighton
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Thomas E. Gribbin
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Donna M. Bryant
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Angela Carrigan
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Jennifer C. Corpening
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Kimberly A. Csapo
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Eileen P. Dimond
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Christie Ellison
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Maria M. Gonzalez
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Jodi L. Harr
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Kathy Wilkinson
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
| | - Andrea M. Denicoff
- Nancy N. and J.C. Lewis Cancer & Research Pavilion, St Joseph's/Candler Hospital, Savannah, GA; Lehigh Valley Health Network, Allentown; Albert Einstein Cancer Center, Philadelphia, PA; Gundersen Lutheran Health System, La Crosse; ProHealth Care Regional Cancer Center, Waukesha, WI; The EMMES Corporation, Rockville; SAIC-Frederick; Clinical Monitoring Research Program, National Cancer Institute at Frederick, Frederick; St Joseph Medical Center, Towson; National Cancer Institute, Bethesda, MD; Providence Cancer Center, Portland, OR; Lacks Cancer Center, Saint Mary's Health Care, Grand Rapids, MI; The Cancer Program of Our Lady of the Lake and Mary Bird Perkins Cancer Center, Baton Rouge, LA; Spartanburg Regional Healthcare System, Spartanburg, SC; Sanford Cancer Center, Sioux Falls, SD; St Joseph Hospital of Orange, Orange, CA; Penrose-St Francis Health Services, Colorado Springs, CO; and Billings Clinic Cancer Center, Billings, MT
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Forsythe LP, Rowland JH, Padgett L, Blaseg K, Siegel SD, Dingman CM, Gillis TA. The cancer psychosocial care matrix: a community-derived evaluative tool for designing quality psychosocial cancer care delivery. Psychooncology 2013; 22:1953-62. [DOI: 10.1002/pon.3254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 01/14/2013] [Accepted: 01/16/2013] [Indexed: 01/06/2023]
Affiliation(s)
- Laura P. Forsythe
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences; National Cancer Institute, NIH/DHHS; Rockville MD USA
- Cancer Prevention Fellowship Program, Center for Cancer Training; National Cancer Institute, NIH/DHHS; Rockville MD USA
- Patient-Centered Outcomes Research Institute; Washington DC USA
| | - Julia H. Rowland
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences; National Cancer Institute, NIH/DHHS; Rockville MD USA
| | - Lynne Padgett
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences; National Cancer Institute, NIH/DHHS; Rockville MD USA
| | | | - Scott D. Siegel
- Helen F. Graham Cancer Center; Christiana Care Health System; Newark USA
| | - Chad M. Dingman
- Gibbs Cancer Center; Spartanburg Regional Healthcare System; Spartanburg USA
| | - Theresa A. Gillis
- Helen F. Graham Cancer Center; Christiana Care Health System; Newark USA
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Clauser SB, Taplin SH, Foster MK, Fagan P, Kaluzny AD. Multilevel intervention research: lessons learned and pathways forward. J Natl Cancer Inst Monogr 2012; 2012:127-33. [PMID: 22623606 DOI: 10.1093/jncimonographs/lgs019] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This summary reflects on this monograph regarding multilevel intervention (MLI) research to 1) assess its added value; 2) discuss what has been learned to date about its challenges in cancer care delivery; and 3) identify specific ways to improve its scientific soundness, feasibility, policy relevance, and research agenda. The 12 submitted chapters, and discussion of them at the March 2011 multilevel meeting, were reviewed and discussed among the authors to elicit key findings and results addressing the questions raised at the outset of this effort. MLI research is underrepresented as an explicit focus in the cancer literature but may improve implementation of studies of cancer care delivery if they assess contextual, organizational, and environmental factors important to understanding behavioral and/or system-level interventions. The field lacks a single unifying theory, although several psychological or biological theories are useful, and an ecological model helps conceptualize and communicate interventions. MLI research designs are often complex, involving nonlinear and nonhierarchical relationships that may not be optimally studied in randomized designs. Simulation modeling and pilot studies may be necessary to evaluate MLI interventions. Measurement and evaluation of team and organizational interventions are especially needed in cancer care, as are attention to the context of health-care reform, eHealth technology, and genomics-based medicine. Future progress in MLI research requires greater attention to developing and supporting relevant metrics of level effects and interactions and evaluating MLI interventions. MLI research holds an unrealized promise for understanding how to improve cancer care delivery.
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Affiliation(s)
- Steven B Clauser
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Executive Plaza North, Rm 4086, Bethesda, MD 28092-7344, USA.
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Carpenter WR, Tyree S, Wu Y, Meyer AM, DiMartino L, Zullig L, Godley PA. A surveillance system for monitoring, public reporting, and improving minority access to cancer clinical trials. Clin Trials 2012; 9:426-35. [PMID: 22761398 PMCID: PMC3539770 DOI: 10.1177/1740774512449531] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Institute of Medicine (IOM) has recommended that each person with cancer should have access to clinical trials, which have been associated with improving care quality and disparities. With no effective enrollment monitoring system, patterns of trial enrollment remain unclear. PURPOSE We developed a population-based, statewide system designed to facilitate monitoring of cancer trial enrollment and targeting of future interventions to improve it. METHODS Person-level cancer incidence data from the North Carolina Central Cancer Registry (NCCCR), person-level treatment trial accrual data from the National Cancer Institute (NCI), and county-level Area Resource Files (ARF) measures for 12 years, 1996-2007, were studied. Deidentified person-level data necessitated county-level analysis. Enrollment rates were estimated as the ratio of trial enrollment to cancer incidence for each race, gender, year, and county combination. Multivariable analysis examined factors associated with trial accrual. Sensitivity analyses examined spurious fluctuations and temporal discordance of incidence and enrollment. RESULTS The NCI treatment trial enrollment rate was 2.39% for whites and 2.20% for minorities from 1996 to 2007, and 2.88% and 2.47%, respectively, from 2005 to 2007. Numerous counties had no minority enrollment. The 2005-2007 enrollment rates for white and minority females was 4.04% and 3.59%, respectively, and for white and minority males was 1.74% and 1.36%, respectively. Counties with a medical school or NCI Community Clinical Oncology Program (CCOP)-affiliated practice had higher trial enrollment. LIMITATIONS We examined NCI trial accrual only - industry-sponsored and investigator-initiated trials were excluded; however, studies comprise the majority of all clinical trial participants. Delays in data availability may hinder the immediacy of population-based analyses. CONCLUSIONS Model stability and consistency suggest that this system is effective for population-based enrollment surveillance. For North Carolina, it suggests a worsening disparity in minority trial enrollment, though our analyses elucidate targets for intervention. Regional enrollment variation suggests the importance of access to clinical research networks and infrastructure. Substantial gender differences merit further examination.
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Affiliation(s)
- William R Carpenter
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
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Teal R, Bergmire DM, Johnston M, Weiner BJ. Implementing community-based provider participation in research: an empirical study. Implement Sci 2012; 7:41. [PMID: 22568935 PMCID: PMC3482599 DOI: 10.1186/1748-5908-7-41] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 04/17/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since 2003, the United States National Institutes of Health (NIH) has sought to restructure the clinical research enterprise in the United States by promoting collaborative research partnerships between academically-based investigators and community-based physicians. By increasing community-based provider participation in research (CBPPR), the NIH seeks to advance the science of discovery by conducting research in clinical settings where most people get their care, and accelerate the translation of research results into everyday clinical practice. Although CBPPR is seen as a promising strategy for promoting the use of evidence-based clinical services in community practice settings, few empirical studies have examined the organizational factors that facilitate or hinder the implementation of CBPPR. The purpose of this study is to explore the organizational start-up and early implementation of CBPPR in community-based practice. METHODS We used longitudinal, case study research methods and an organizational model of innovation implementation to theoretically guide our study. Our sample consisted of three community practice settings that recently joined the National Cancer Institute's (NCI) Community Clinical Oncology Program (CCOP) in the United States. Data were gathered through site visits, telephone interviews, and archival documents from January 2008 to May 2011. RESULTS The organizational model for innovation implementation was useful in identifying and investigating the organizational factors influencing start-up and early implementation of CBPPR in CCOP organizations. In general, the three CCOP organizations varied in the extent to which they achieved consistency in CBPPR over time and across physicians. All three CCOP organizations demonstrated mixed levels of organizational readiness for change. Hospital management support and resource availability were limited across CCOP organizations early on, although they improved in one CCOP organization. As a result of weak IPPs, all three CCOPs created a weak implementation climate. Patient accrual became concentrated over time among those groups of physicians for whom CBPPR exhibited a strong innovation-values fit. Several external factors influenced innovation use, complicating and enriching our intra-organizational model of innovation implementation. CONCLUSION Our results contribute to the limited body of research on the implementation of CBPPR. They inform policy discussions about increasing and sustaining community clinician involvement in clinical research and expand on theory about organizational determinants of implementation effectiveness.
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Affiliation(s)
- Randall Teal
- Cecil G, Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA.
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Albert JM, Das P. Quality assessment in oncology. Int J Radiat Oncol Biol Phys 2012; 83:773-81. [PMID: 22445001 DOI: 10.1016/j.ijrobp.2011.12.079] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 12/23/2011] [Indexed: 01/05/2023]
Abstract
The movement to improve healthcare quality has led to a need for carefully designed quality indicators that accurately reflect the quality of care. Many different measures have been proposed and continue to be developed by governmental agencies and accrediting bodies. However, given the inherent differences in the delivery of care among medical specialties, the same indicators will not be valid across all of them. Specifically, oncology is a field in which it can be difficult to develop quality indicators, because the effectiveness of an oncologic intervention is often not immediately apparent, and the multidisciplinary nature of the field necessarily involves many different specialties. Existing and emerging comparative effectiveness data are helping to guide evidence-based practice, and the increasing availability of these data provides the opportunity to identify key structure and process measures that predict for quality outcomes. The increasing emphasis on quality and efficiency will continue to compel the medical profession to identify appropriate quality measures to facilitate quality improvement efforts and to guide accreditation, credentialing, and reimbursement. Given the wide-reaching implications of quality metrics, it is essential that they be developed and implemented with scientific rigor. The aims of the present report were to review the current state of quality assessment in oncology, identify existing indicators with the best evidence to support their implementation, and propose a framework for identifying and refining measures most indicative of true quality in oncologic care.
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Affiliation(s)
- Jeffrey M Albert
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Griggs JJ. Role of nonclinical factors in the receipt of high-quality systemic adjuvant breast cancer treatment. J Clin Oncol 2011; 30:121-4. [PMID: 22147739 DOI: 10.1200/jco.2011.39.4270] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Klabunde CN, Keating NL, Potosky AL, Ambs A, He Y, Hornbrook MC, Ganz PA. A population-based assessment of specialty physician involvement in cancer clinical trials. J Natl Cancer Inst 2011; 103:384-97. [PMID: 21317382 PMCID: PMC3107589 DOI: 10.1093/jnci/djq549] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 11/19/2010] [Accepted: 12/07/2010] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Clinical trials are critical for evaluating new cancer therapies, but few adult patients participate in them. Physicians have an important role in facilitating patient participation in clinical trials. We examined the characteristics of specialty physicians who participate in clinical trials by enrolling or referring patients, the types of trials in which they participate, and factors associated with physicians who report greater involvement in clinical trials. METHODS We analyzed data from the Cancer Care Outcomes Research and Surveillance Consortium. The study included 1533 specialty physicians who cared for colorectal and lung cancer patients (496 medical oncologists, 228 radiation oncologists, and 809 surgeons) and completed a survey conducted during 2005-2006 (response rate = 61.0%). Descriptive statistics were used to characterize physicians' personal and practice characteristics, and regression models were used to examine associations between these characteristics and physician participation in clinical trials. All statistical tests were two-sided. RESULTS A total of 87.8% of medical oncologists, 66.1% of radiation oncologists, and 35.0% of surgeons reported referring or enrolling one or more patients in clinical trials during the previous 12 months. The mean number of patients referred or enrolled by these physicians was 17.2 (95% confidence interval [CI] = 15.5 to 18.9) for medical oncologists, 9.5 (95% CI = 7.7 to 11.3) for radiation oncologists, and 12.2 (95% CI = 9.8 to 14.6) for surgeons (P < .001). Specialty type, involvement in teaching, and affiliation with a Community Clinical Oncology Program (CCOP) and/or a National Cancer Institute-designated cancer center were associated with physician trial participation and enrolling more patients (all Ps < .05). Two-thirds of physicians with a CCOP or National Cancer Institute-designated cancer center affiliation reported participating in trials. CONCLUSIONS Features of specialty physicians' practice environments are associated with their trial participation, but many physicians at CCOPs and cancer centers do not participate.
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Affiliation(s)
- Carrie N Klabunde
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-7344, USA.
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Minasian LM, Carpenter WR, Weiner BJ, Anderson DE, McCaskill-Stevens W, Nelson S, Whitman C, Kelaghan J, O'Mara AM, Kaluzny AD. Translating research into evidence-based practice: the National Cancer Institute Community Clinical Oncology Program. Cancer 2010; 116:4440-9. [PMID: 20572032 PMCID: PMC2945622 DOI: 10.1002/cncr.25248] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The recent rapid acceleration of basic science is reshaping both our clinical research system and our healthcare delivery system. The pace and growing volume of medical discoveries are yielding exciting new opportunities, yet we continue to face old challenges to maintain research progress and effectively translate research into practice. The National Institutes of Health and individual government programs increasingly are emphasizing research agendas that involve evidence development, comparative-effectiveness research among heterogeneous populations, translational research, and accelerating the translation of research into evidence-based practice as well as building successful research networks to support these efforts. For more than 25 years, the National Cancer Institute Community Clinical Oncology Program has successfully extended research into the community and facilitated the translation of research into evidence-based practice. By describing its keys to success, this article provides practical guidance to cancer-focused, provider-based research networks as well as those in other disciplines.
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Affiliation(s)
- Lori M. Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - William R. Carpenter
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, UNC, Chapel Hill, NC, USA
- UNC-Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- North Carolina Comprehensive Cancer Program, Raleigh, NC, USA
| | - Bryan J. Weiner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, UNC, Chapel Hill, NC, USA
- UNC-Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | | | | | - Cynthia Whitman
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Joseph Kelaghan
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Ann M. O'Mara
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Arnold D. Kaluzny
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, UNC, Chapel Hill, NC, USA
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Bradley CJ, Penberthy L, Devers KJ, Holden DJ. Health services research and data linkages: issues, methods, and directions for the future. Health Serv Res 2010; 45:1468-88. [PMID: 21054367 DOI: 10.1111/j.1475-6773.2010.01142.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Research on pressing health services and policy issues requires access to complete, accurate, and timely patient and organizational data. AIM This paper describes how administrative and health records (including electronic medical records) can be linked for comparative effectiveness and health services research. MATERIALS AND METHODS We categorize the major agents (i.e., who owns and controls data and who carries out the data linkage) into three areas: (1) individual investigators; (2) government sponsored linked data bases; and (3) public-private partnerships that facilitate linkage of data owned by private organizations. We describe challenges that may be encountered in the linkage process, and the benefits of combining secondary databases with primary qualitative and quantitative sources. We use cancer care research to illustrate our points. RESULTS To fill the gaps in the existing data infrastructure, additional steps are required to foster collaboration among institutions, researchers, and public and private components of the health care sector. Without such effort, independent researchers, governmental agencies, and nonprofit organizations are likely to continue building upon a fragmented and costly system with limited access. Discussion. Without the development and support for emerging information technologies across multiple health care settings, the potential for data collected for clinical and transactional purposes to benefit the research community and, ultimately, the patient population may go unrealized. CONCLUSION The current environment is characterized by budget and technical challenges, but investments in data infrastructure are arguably cost-effective given the need to reform our health care system and to monitor the impact of health reform initiatives.
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Affiliation(s)
- Cathy J Bradley
- Department of Healthcare Policy and Research, School of Medicine, Cancer Prevention and Control, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298-0203, USA.
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