Providing cessation treatment to every oncology patient who smokes: An essential component of cancer care

Cancer ◽  
2021 ◽  
Author(s):  
Michael C. Fiore ◽  
Timothy B. Baker ◽  
Margaret B. Nolan ◽  
Hamid Emamekhoo
Keyword(s):  
Cancer Care ◽  
Oncology Patient ◽  
Essential Component ◽  
Cessation Treatment

A Qualitative Analysis of Oncology Patient Awareness of Medication Shortages and Their Preferences for How Shortages Should Be Managed

2020 ◽  
pp. JOP.19.00608
Author(s):  
Andrew Hantel ◽  
Fay J. Hlubocky ◽  
Mark Siegler ◽  
Christopher K. Daugherty
Keyword(s):  
Cancer Care ◽  
Management Practices ◽  
Care Center ◽  
Tertiary Care ◽  
Weighted Average ◽  
Structured Interview ◽  
Decision Makers ◽  
Oncology Patient ◽  
Cross Sectional ◽  
Multiple Decision Makers

PURPOSE: Medication shortages in US hospitals are ongoing, widespread, and frequently involve antineoplastic and supportive medications used in cancer care. The ways shortages are managed and the ways provider-patient communication takes place are heterogeneous, but the related preferences of oncology patients are undefined. This study sought to qualitatively evaluate patient preferences. METHODS: A cross-sectional, semi-structured interview study was conducted from January to June 2019. Participants were adult oncology inpatients who received primary cancer care at the University of Chicago, had undergone treatment within 2 years, and had 1 or more previous hospitalizations during that period. Participants (n = 54) were selected consecutively from alternating hematology and oncology services. The primary outcome was thematic saturation across the domains of awareness of medication shortages, principle preferences regarding decision makers, preferences regarding allocation of therapy drugs, and allocation-related communication. RESULTS: Thematic saturation was reached after 39 participants completed the study procedures (mean age, 59.6 years [standard deviation, 14.5 years]; men made up 61.5% of the study population [mean age, 24 years]; response rate, 72.0%). In all, 18% of participants were aware of institutional medication shortages. Patients preferred having multiple decision makers for allocating medications in the event of a shortage. A majority of patients named oncologists (100%), ethicists (92%), non-oncology physicians (77%), and pharmacists (64%) as their preferred decision makers. Participants favored allocation of drugs based on their efficacy (normalized weighted average, 1.3), and they also favored prioritizing people who were already receiving treatment (1.8), younger patients (2.0), sicker patients (3.1), and those presenting first for treatment (5.3). Most participants preferred preferred disclosure of supportive care medication shortages (74%) and antineoplastic medication shortages (79%) for equivalent substitutions. CONCLUSION: In a tertiary-care center with medication shortages, few oncologic inpatients were aware of shortages. Participants preferred having multiple decision makers involved in principle-driven allocation of scarce medications. Disclosure was preferred when their usual medications needed to be substituted with equivalent alternatives. These preliminary data suggest that preferences do not align with current management practices for medication shortages.

Comprehensive Geriatric Assessment for Older Patients With Cancer

2007 ◽  
Vol 25 (14) ◽  
pp. 1824-1831 ◽  
Author(s):  
Martine Extermann ◽  
Arti Hurria
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Cancer Care ◽  
Older Patients ◽  
Morbidity And Mortality ◽  
Psychological State ◽  
Future Research ◽  
Oncology Patient ◽  
Patients With Cancer

Purpose During the last decade, oncologists and geriatricians have begun to work together to integrate the principles of geriatrics into oncology care. The increasing use of a comprehensive geriatric assessment (CGA) is one example of this effort. A CGA includes an evaluation of an older individual's functional status, comorbid medical conditions, cognition, nutritional status, psychological state, and social support; and a review of the patient's medications. This article discusses recent advances on the use of a CGA in older patients with cancer. Methods In this article, we provide an update on the studies that address the domains of a geriatric assessment applied to the oncology patient, review the results of the first studies evaluating the use of a CGA in developing interventions to improve the care of older adults with cancer, and discuss future research directions. Results The evidence from recent studies demonstrates that a CGA can predict morbidity and mortality in older patients with cancer. Accumulating data show the benefits of incorporating a CGA in the evaluation of older patients with cancer. Prospective trials evaluating the utility of a CGA to guide interventions to improve the quality of cancer care in older adults are justified. Conclusion Growing evidence demonstrates that the variables examined in a CGA can predict morbidity and mortality in older patients with cancer, and uncover problems relevant to cancer care that would otherwise go unrecognized.

Introduction to Special Issue on Advanced Cancer Care and Palliative Care Integration

2021 ◽  
Vol 36 (2) ◽  
pp. 71-72
Author(s):  
Bethany C. Calkins ◽  
Keith M. Swetz
Keyword(s):  
Palliative Care ◽  
Advance Directives ◽  
Cancer Care ◽  
Unmet Needs ◽  
Interdisciplinary Care ◽  
Special Issue ◽  
Oncology Patient ◽  
Care Integration ◽  
Patients At Risk ◽  
Community Supports

Palliative care is uniquely positioned to optimize the care of the oncology patient through exploring unmet needs and utilizing interdisciplinary care. The studies presented here highlight some of the ways this can be done which includes: identifying patients at risk or in need; providing solutions to those requiring community supports; addressing psychological and existential concerns; managing symptoms over the course of a disease; communicating prognosis effectively and with compassion; exploring goals of care and advance directives; and facilitating conversations regarding goals, preferences, and values.

Understanding the patient experience of cancer treatment in Ontario, Canada: A qualitative study.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 225-225
Author(s):  
Erica Bridge ◽  
Lesley Gotlib Conn ◽  
Suman Dhanju ◽  
Simron Singh ◽  
Lesley Moody
Keyword(s):  
Qualitative Study ◽  
Cancer Treatment ◽  
Patient Experience ◽  
Care Provider ◽  
Cancer Care ◽  
Information Needs ◽  
Qualitative Content Analysis ◽  
Oncology Patient ◽  
Patient Centred Care ◽  
Ambulatory Oncology

225 Background: In cancer care, patient experience is most often measured quantitatively. However, this approach has limitations in understanding the entire patient experience. Qualitative methods provide an opportunity to understand self reported and more complex issues most important to patients and their family members. This qualitative study explores the patient experience of outpatient cancer treatment throughout Ontario, Canada. Methods: Qualitative content analysis was done by two researchers using data from the annual Ambulatory Oncology Patient Satisfaction Survey (AOPSS) from 2013-15. The AOPSS is a retrospective, paper-based, mailed survey, designed to capture the experiences of patients who are currently receiving cancer treatment or who have received cancer treatment within the previous six months. Patients surveyed were asked “Is there anything else you would like to tell us about your cancer care services?” The National Research Corporation of Canada’s eight dimensions of patient-centred care was used to guide the analysis. Results: 5,391 patients responded to the open-ended question. Demographic information includes: gender, age, education level and disease site. 7,328 coded responses were generated, of which 3,658 (49.9%) were related to eight dimensions of patient-centred care with accompanying sub-dimensions: patients’ preferences (23.5%): dignity and respect; preferences and decision-making; care provider behaviours; emotional support (21.5%): caring, compassion and comfort; anxiety and stress; resources; and sensitive diagnosis; coordination of care (15.8%): care provider and treatment coordination; wait times; information and education (15.7%): patient-care provider communication; information needs; care provider knowledge and skills; access (9.4%): centre location; transportation and accommodation; system; parking; continuity and transition (8.1%): centre personnel; continuity between departments; continuity in the community; discharge; physical comfort (5.1%): environment; pain management and family and friends (0.8%). Conclusions: Qualitative analysis is an effective tool to capture patient experience on a population level.

scholarly journals Integration of Tobacco Treatment Services into Cancer Care at Stanford

2020 ◽  
Vol 17 (6) ◽  
pp. 2101 ◽  
Author(s):  
Kathleen Gali ◽  
Brittany Pike ◽  
Matthew S. Kendra ◽  
Cindy Tran ◽  
Priya Fielding-Singh ◽  
...  
Keyword(s):  
Cancer Care ◽  
Tobacco Cessation ◽  
Cancer Center ◽  
Treatment Services ◽  
Tobacco Treatment ◽  
Cessation Treatment ◽  
Opt Out ◽  
Patient Reported ◽  
Delivery Options ◽  
One Year

As part of a National Cancer Institute Moonshot P30 Supplement, the Stanford Cancer Center piloted and integrated tobacco treatment into cancer care. This quality improvement (QI) project reports on the process from initial pilot to adoption within 14 clinics. The Head and Neck Oncology Clinic was engaged first in January 2019 as a pilot site given staff receptivity, elevated smoking prevalence, and a high tobacco screening rate (95%) yet low levels of tobacco cessation treatment referrals (<10%) and patient engagement (<1% of smokers treated). To improve referrals and engagement, system changes included an automated “opt-out” referral process and provision of tobacco cessation treatment as a covered benefit with flexible delivery options that included phone and telemedicine. Screening rates increased to 99%, referrals to 100%, 74% of patients were reached by counselors, and 33% of those reached engaged in treatment. Patient-reported abstinence from all tobacco products at 6-month follow-up is 20%. In July 2019, two additional oncology clinics were added. In December 2019, less than one year from initiating the QI pilot, with demonstrated feasibility, acceptability, and efficacy, the tobacco treatment services were integrated into 14 clinics at Stanford Cancer Center.

scholarly journals Effective Cessation Treatment for Patients With Cancer Who Smoke—The Fourth Pillar of Cancer Care

2019 ◽  
Vol 2 (9) ◽  
pp. e1912264 ◽  
Author(s):  
Michael C. Fiore ◽  
Heather D’Angelo ◽  
Timothy Baker
Keyword(s):  
Cancer Care ◽  
Patients With Cancer ◽  
Cessation Treatment

scholarly journals Telehealth Delivery of Tobacco Cessation Treatment in Cancer Care: An Ongoing Innovation Accelerated by the COVID-19 Pandemic

2021 ◽  
Vol 19 (Suppl_1) ◽  
pp. S21-S24
Author(s):  
_ _
Keyword(s):  
Low Income ◽  
Rural Areas ◽  
Cancer Care ◽  
Tobacco Cessation ◽  
Healthcare Delivery ◽  
Retention In Care ◽  
Evidence Base ◽  
Cancer Center ◽  
Cessation Treatment ◽  
Video And Audio

The COVID-19 pandemic precipitated a rapid transformation in healthcare delivery. Ambulatory care abruptly shifted from in-person to telehealth visits with providers using digital video and audio tools to reach patients at home. Advantages to telehealth care include enhanced patient convenience and provider efficiencies, but financial, geographic, privacy, and access barriers to telehealth also exist. These are disproportionately greater for older adults and for those in rural areas, low-income communities, and communities of color, threatening to worsen preexisting disparities in tobacco use and health. Pandemic-associated regulatory changes regarding privacy and billing allowed many Cancer Center Cessation Initiative (C3I) programs in NCI-designated Cancer Centers to start or expand video-based telehealth care. Using 3 C3I programs as examples, we describe the methods used to shift to telehealth delivery. Although telephone-delivered treatment was already a core tobacco treatment modality with a robust evidence base, little research has yet compared the effectiveness of tobacco cessation treatment delivery by video versus phone or in-person modalities. Video-delivery has shown greater medication adherence, higher patient satisfaction, and better retention in care than phone-based delivery, and may improve cessation outcomes. We outline key questions for further investigation to advance telehealth for tobacco cessation treatment in cancer care.

Demographic, socioeconomic, and clinical factors associated with oncology patient experience in the Ontario cancer system.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 160-160
Author(s):  
Mary Mahler ◽  
Brett Nicholls ◽  
Catherine Chan ◽  
Narges Nazeri-Rad ◽  
Kelvin K. Chan ◽  
...  
Keyword(s):  
Patient Experience ◽  
Cancer Care ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Oncology Patient ◽  
Negative Experience ◽  
Care Experience ◽  
Cancer Services ◽  
Patient Reported ◽  
Disease Site

160 Background: Your Voice Matters (YVM) is an electronic real time Patient Reported Experience Measure (PREM) collected on all adult patients accessing cancer services in Ontario by Cancer Care Ontario/Ontario Health. To our knowledge, this is the largest oncology PREM dataset worldwide. A total of 25 Items are assessed including care coordination, wait times, access to care and satisfaction with healthcare providers. We attempted to identify demographic, socioeconomic and disease factors that predict for a positive patient experience. Methods: Responses were collated from 18 individual cancer centers between Jan 2017 and Dec 2019. Each item was dichotomized into positive/negative experiences. Multivariable logistic regression was constructed for each of the 25 items. Results: Demographics are described in table. Males (OR=1.11, p=0.0032), genitourinary patients (OR=1.30, p=0.0031) and those receiving radiation (OR=1.39, p=<0.0001) were more likely to have a positive experience. Patients aged 18-39 (OR=0.74, p=<0.0001), receiving chemotherapy (OR=0.76, p=0.0002), and with central nervous system or lung cancer (OR= 0.56, p=<0.001; OR=0.79 p=0.0059, respectively) were more likely to have a negative experience. Lowest income patients were more likely to have a negative experience with healthcare providers (OR=0.83, p=0.0119) and patients from the highest immigration areas had a worse quality experience (OR=0.82, p=0.0029). Conclusions: Age, sex, disease site, visit type, income and immigration status significantly influence patients cancer care experience. This information helps promote equity and the use of PREM data to improve cancer care delivery. [Table: see text]

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