The prevalence and pattern of chemotherapy-induced peripheral neuropathy among women with breast cancer receiving care in a large community oncology practice

58 Background: Emergency department (ED) utilization among oncology patients is a source of patient distress as well as a financial burden to the health care system. Effective outpatient symptom management can potentially reduce ED utilization. In this analysis, we review ED utilization prior to and post the institution of a nurse practitioner staffed symptom management clinic in a large community oncology practice. Methods: In April 2014 a symptom management clinic staffed by a nurse practitioner five days a week was established at our outpatient cancer institute to increase patient access to acute symptom management. ED utilization 6 months prior to and post starting this clinic was measured. Only patients who received chemotherapy within 30 days of an ED visit were included in this analysis. Results: Between October 2013 and September 2014, a total of 420 visits to the ED were documented. A total of 196 visits occurred in the 6 months prior to establishing the clinic. There was an increase in visits to 224 after instituting the clinic. The median number of monthly visits was 34.5 (range 24-38) prior to the clinic and increased to 38 (range 30-43) after establishing the clinic. Conclusions: In our practice, a nurse practitioner led symptom management clinic did not reduce ED utilization in patients receiving chemotherapy. Based on published studies, other factors may need to be incorporated into our cancer institute to effectively reduce ED utilization. These include standardizing symptom assessment and management, patient and caregiver education on how to effectively manage symptoms at home, and improved coordination with supportive services.

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The prevalence and pattern of chemotherapy-induced peripheral neuropathy (CIPN) among women with breast cancer receiving care in a large community oncology practice.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.28_suppl.80 ◽

2015 ◽

Vol 33 (28_suppl) ◽

pp. 80-80

Author(s):

Natalie Brooke Simon ◽

Michael A. Danso ◽

Thomas Alberico ◽

Ethan M. Basch ◽

Antonia Vickery Bennett

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

African American ◽

Health Status ◽

Global Health ◽

Symptom Severity ◽

Community Oncology ◽

The Mean ◽

Oncology Practice

80 Background: CIPN is a common side effect of taxane-based chemotherapy agents. This study examined the prevalence, severity, and risk factors of CIPN and its impact on quality of life (QOL) among women treated for breast cancer in a large U.S. community oncology practice. Methods: In this cross-sectional survey study, women previously treated with taxane-based chemotherapy for early stage breast cancer completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), breast cancer module (QLQ-BR23) and CIPN module (QLQ-CIPN20). Each subscale is scored 0-100 where higher scores indicate better function or greater symptom severity. Clinical data were abstracted from the medical record. Bivariate analyses were conducted to test pre- specified hypotheses. Results: 126 women with mean age 56.7 years (SD = 11.8) were stage I-II (79.4%) or stage III (20.6%) at the time of the survey; 65.1% were White and 27.8% were Black or African American. 73.0% of women reported they had CIPN. The mean time since last taxane chemotherapy cycle was 144.9 weeks (SD = 112.9). The mean (SD) score of QLQ-C30 global health status/QOL was 77.0 (20.3) and physical function was 85.7 (17.1). QLQ-CIPN20 mean scores for the sensory, motor, and autonomic subscales were 18.9 (23.1), 18.6 (18.7), and 17.1 (21.8), respectively. Presence of CIPN was associated with patient referral and visitation to a neurologist or pain specialist (p < 0.05). CIPN symptom severity was negatively correlated with global health status/QOL and physical and role functioning (range of r= -0.46 to -0.72). Further, it was not associated with age, body mass index, diabetes, or cumulative taxane dosage, but was greater for Black or African American patients versus White patients (e.g., sensory: 28.6 vs 14.5, p < 0.002). CIPN sensory impairment was marginally greater for patients treated with paclitaxel compared to docetaxel (23.3 vs 15.6, p < 0.06). Conclusions: CIPN was prevalent in this community oncology practice and significantly impacts function and QOL. These data highlight the importance of developing methods to mitigate CIPN.

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Lessons learned from the investigation of a sustained increase in paclitaxel hypersensitivity reactions (P-HSR) at a large community oncology practice: A mystery not fully solved.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.233 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 233-233

Author(s):

Katherine Enright ◽

Heather Bussey ◽

Maritza Carvalho ◽

Mary Yousef ◽

Allan Mills ◽

...

Keyword(s):

Reaction Rates ◽

Lessons Learned ◽

Quality Review ◽

Large Community ◽

Community Oncology ◽

Methodical Approach ◽

Tracking Process ◽

Slow Infusion ◽

Single Intervention ◽

Oncology Practice

233 Background: Trillium Health Partners (THP) is a large community oncology practice that has a culture of quality and safety. An investigation was triggered by a perceived increase in the rate of P-HSR during a weekly quality huddle in the chemotherapy suite. At the time THP had no formal hypersensitivity reaction tracking process. A retrospective review of P-HSR over the preceding 18 months identified an increase in reaction rates from a baseline of 1% to 4.5% that started 3 months prior to the raised concern. Methods: A systematic quality review was undertaken to identify triggers for the change and to identify steps to decrease P-HSR to baseline. There was no identified change in premedication, administration or compounding practice and no association with drug or lot number was identified. The increase in P-HSR was coincident with a change in the intravenous (IV) pumps and tubing system across the hospital. The change in IV pumps introduced several potential triggers including: a change in the options for priming the IV tubing which introduced a potential for variable concentrations of drug reaching the patient at the outset of the infusion, an interaction between drug and IV tubing, and a doubling of the IV tubing length which could result in incomplete delivery of the premedication. Results: Sequential practice changes were introduced to address each potential driver including i) a slow infusion protocol for first 2 cycles, ii) alternative tubing sets, iii) practice alert regarding potential for under-delivery of premedication. Over time P-HSR trended down towards the historic baseline, no single intervention had a sustained impact, although the practice alert regarding the administration of premedication seemed to induce the most change. A step wise withdrawal of interventions that were felt to be non impactful is underway. Conclusions: Although no clear cause for the increase in P-HSR was identified the systematic quality review resulted in improved standardization of nursing practice for chemotherapy delivery and the methodical approach also lead to the establishment of a more comprehensive hypersensitivity reporting system at THP.

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Utilization of liquid biopsy in a large community oncology practice.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19150 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19150-e19150

Author(s):

Dipen Patel ◽

Thuy Le ◽

Harry Staszewski

Keyword(s):

Solid Tumors ◽

Liquid Biopsy ◽

Molecular Testing ◽

Minimal Risk ◽

Liquid Biopsies ◽

Treatment Regimens ◽

Large Community ◽

Commercial Laboratory ◽

Community Oncology ◽

Oncology Practice

e19150 Background: Analysis of tumor cell free DNA, or liquid biopsy, is emerging as a useful adjunct to tissue biopsies in advanced solid tumors. These tests may reduce the need for repeating invasive biopsies, and may be performed serially with minimal risk to patients.The purpose of our study is to document how liquid biopsies are being used in a large, diverse community based practice in Long Island, NY and how often the results lead to changes in treatment. The aim is to derive guidelines within the practice for appropriate use of liquid biopsies going forward. Methods: The practice electronic medical record (EMR) was retrospectively examined for the first 100 patients with solid tumors who had a specimen sent to a commercial laboratory for a liquid biopsy. The EMR was also reviewed to establish the treatment regimens each patient was receiving prior to the liquid biopsy, as well as any changes to the regimen based on liquid biopsy results. Results: This analysis was based on 100 patients: 11 out of 100 patients (11%) were excluded due to loss of follow up and 89 out of 100 (89%) patients were included, 59% female and 41% male. 11 out of 100 patients (11%) were not found to have any tumor alterations on liquid biopsy. The most prevalent cancers were lung (40.4%), ovarian (17.0%), breast (6.4%), colon (5.3%) and prostate (5.3%). Treatment was changed 43% of the time after liquid biopsy results were obtained and there was no change in 57% of the time see Table. This change was irrespective of type of cancer, gender, or types of current regimen. Conclusions: Liquid biopsy has proven to be a useful adjunct to molecular testing of tumor tissue in a large community oncology practice, but ongoing examination of our results should better define its optimal use. [Table: see text]

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