Secondary Hematologic Neoplasms After Childhood Solid Cancer Treatment in a Single Reference Cancer Center

e24029 Background: Continued cigarette smoking among patients with cancer leads to numerous adverse health outcomes, even among patients with non-tobacco-related cancers such as breast, colon, and prostate cancer. Continued smoking is associated with poorer response to cancer treatment, increased risk for treatment-related toxicities, and shorter overall survival. While some patients with a smoking-related cancer make efforts to quit smoking at the time of diagnosis, patients with other forms of cancer might not understand the negative effects of continued smoking. In this study, we assessed patient knowledge of the harms of continued smoking, previous cessation attempts, and cessation support. Methods: We surveyed 102 adults with breast, colon, and prostate cancer at three locations: an NCI-designated cancer center, an urban safety-net medical center, and a rural cancer center. Patients were asked about current smoking behaviors, beliefs about the harms of continued smoking, quit attempts and resources used, and cessation support. We also surveyed seven oncologists to assess beliefs about harms of continued smoking, cessation support provided to patients, training and confidence in cessation counseling, and barriers to providing cessation support. Results: Most patients (82%) agreed or strongly agreed that continued smoking may shorten life expectancy, and 70% agreed or strongly agreed that continued smoking increased the risk of getting a different type of cancer. Only 41% of patients agreed or strongly agreed that continued smoking may cause more side effects from cancer treatment, and only 40% agreed or strongly agreed that ongoing smoking may affect treatment response. The majority of patients (86%) had tried to quit smoking for good, with an average 4.1 quit attempts per patient. Patients reported that physicians advised them to quit the majority of the time (92%), prescribed medication 33% of the time, and followed up on cessation attempts 43% of the time. Overall, oncologists had higher knowledge of the harms of continued smoking on treatment outcomes and survival. Those in practice for 20 years or more had higher confidence in cessation counseling than those in practice less than 4 years. Oncologists described lack of time and lack of confidence in cessation counseling as barriers to providing more cessation support. Conclusions: Among 102 patients with breast, colon, and prostate cancer who currently smoke, there was incomplete knowledge of the harms of continued smoking. Oncologists believe that tobacco cessation is important and frequently advise patients to quit, however they less frequently prescribe medication or follow up on cessation efforts. Interventions are needed to educate patients with cancer about the harms of continued smoking and to provide further cessation support.

Download Full-text

The impact of COVID 19 pandemic on pattern of cancer mortality in Najran, Saudi Arabia: a single-cancer center experience

10.21203/rs.3.rs-305960/v1 ◽

2021 ◽

Author(s):

Ahmed M Badheeb ◽

Mohamed A Badheeb ◽

Hamdi A Alhakimi

Keyword(s):

Hepatocellular Carcinoma ◽

Saudi Arabia ◽

Cancer Treatment ◽

Cancer Patients ◽

Cancer Mortality ◽

Cancer Center ◽

Anti Cancer ◽

Before And After ◽

The Difference ◽

The Impact

Abstract Background: The aim of this paper is to compare the patterns and determinants of cancer mortality in Najran region before and after the COVID-19 epidemics. The association between cancer mortality and each of age, sex, site of cancer, stage, and the 30-days survival rate after the last dose of chemotherapy were assessed.Materials & Methods: Adult cancer patients who died of cancer in King Khalid Hospital in Najran Saudi Arabia, were included in this retrospective observational study. We compared mortality patterns in a period of 6 months in 2020 (March to August) with the corresponding period of 2019.Results: 50 dead adult cancer patients were included, 24 in 2019 and 26 in 2020. Among them, 21% vs 42% were younger than 65 years of age; 61% vs 62% were males, for the years 2019 & 2020 respectively. The top three killers in 2019 were colorectal, gastro-esophageal cancers, and hepatocellular carcinoma, while in 2020 were colorectal, hepatocellular carcinoma, and lymphomas. About 16.7% of patients died within 30 days of receiving anti-cancer treatment in 2019 in comparison with 7.7% in 2020. The difference in the 30-days mortality after receiving anti-cancer treatment was not statistically significant between 2019 and 2020 (p = 0.329).Conclusion: The Year 2020, the time of the COVID-19pandemic, was not associated with a significant increase in short-term mortality among patients with malignancy in Najran, Saudi Arabia. Our results generally reflect the crucial role of strict preventive national measures in saving lives and warrants further exploration.

Download Full-text

Older Age and Increased Neutrophil-to-Lymphocyte Ratio (NLR) Are Predictors of Mortality in a Multiethnic Urban Cohort of Hematologic Neoplasms and COVID-19 Patients

Blood ◽

10.1182/blood-2020-138842 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 34-35

Author(s):

Angelica D'Aiello ◽

Sumaira Zareef ◽

Kith Pradhan ◽

Amanda Lombardo ◽

Fariha Khatun ◽

...

Keyword(s):

Cancer Treatment ◽

Board Of Directors ◽

Median Time ◽

Lymphocyte Count ◽

Research Funding ◽

Hematologic Neoplasms ◽

Private Company ◽

Advisory Committees ◽

Treatment Status ◽

Race Ethnicity

Introduction: We sought to compare outcomes among patients with hematologic neoplasms diagnosed with COVID-19 infection in a multiethnic urban academic medical center. Methods: A retrospective analysis of patients with hematologic neoplasms diagnosed with COVID-19 from March 17th to June 8th2020 was conducted. Subjects included were censored at last point of contact. Variables collected included age, gender, race/ethnicity, hematologic diagnosis, cancer treatment status, baseline and follow-up COVID-19 testing, neutrophil count, and lymphocyte count at time of diagnosis. Associations between hematologic diagnosis, cancer treatment status, age, gender, race/ethnicity, neutrophil-to-lymphocyte ratio (NLR), and overall survival (OS) were assessed using the Kaplan-Meier method with logrank test. Results: A total of 102 subjects with hematologic neoplasms and COVID-19 infection treated in Montefiore Health system were identified (Table 1). Thirty-nine (38%) subjects were undergoing active treatment, including 17 (16%) receiving conventional chemotherapy agents, 12 (12%) targeted therapy, and 10 (10%) combination therapy. Of those subjects, twenty (50%) experienced delay or discontinuation of treatment due to COVID-19 infection. Four subjects (4%) showed persistent infection by PCR at median duration of 25.1 days after initial diagnosis. Ten subjects (9.8%) showed clearance of the virus by PCR with median time-to-clearance of 51.8 days. Of 9 subjects with serologic testing, 8 tested positive for COVID-19 IgG antibody at median time of 62 days after initial COVID-19 diagnosis. Forty-seven (47%) subjects expired as a result of COVID-19 disease at the time of analysis. Disease type, treatment status, race/ethnicity, age, and gender showed no significant association with mortality. Patients older than 70 had worse outcomes than the younger population (p = 0.0082). Median neutrophil and lymphocyte count at time of diagnosis was 4500 and 900, respectively. NLR greater than 9 was associated with worse survival when compared to NLR less than 9 (p=0.0067). Conclusions: COVID-19 infection has adverse effects on patients with hematological neoplasms. Subjects older than 70 years had a significantly worse prognosis. Notably, subjects actively being treated with chemotherapy did not have worse outcomes than those not being treated in our cohort, supporting the notion than active COVID-19 infection per se should not result in treatment delays. In addition, high NLR correlates with worsened survival, suggesting that this could be a potential prognostic factor for COVID-19 mortality in the hematologic neoplasms population. Disclosures Steidl: Stelexis Therapeutics: Consultancy, Current equity holder in private company, Membership on an entity's Board of Directors or advisory committees; Bayer Healthcare: Research Funding; Pieris Pharmaceuticals: Consultancy; Aileron Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Verma:stelexis: Current equity holder in private company; BMS: Consultancy, Research Funding; Medpacto: Research Funding; Janssen: Research Funding; acceleron: Consultancy, Honoraria.

Download Full-text

A study for the development of oral functional management and community medical cooperation on cancer treatment in Aichi Cancer Center Hospital

Toukeibu Gan ◽

10.5981/jjhnc.45.286 ◽

2019 ◽

Vol 45 (3) ◽

pp. 286-293

Author(s):

Sumitaka Hagiwara ◽

Nobuhiro Hanai ◽

Hiroki Furue ◽

Chiharu Itou ◽

Yasuhisa Hasegawa

Keyword(s):

Cancer Treatment ◽

Cancer Center ◽

Center Hospital ◽

Functional Management

Download Full-text

Long-term cancer survivorship care: On the radar screen?

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20567 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20567-e20567

Author(s):

Rutika Mehta ◽

Rohit Jain ◽

Lori Rhodes ◽

Joseph Abraham ◽

Kenneth David Miller

Keyword(s):

Cancer Survivors ◽

Cancer Treatment ◽

Breast Cancer Survivors ◽

Demographic Data ◽

Cancer Center ◽

Specific Information ◽

Survivorship Care ◽

Coordination Of Care ◽

Long Term Effects

e20567 Background: Long-term cancer survivors require comprehensive care. The purpose of this study was to describe how survivorship care fits into oncologists’ clinical time, and characterize long-term cancer survivors’ problems and oncology follow-up care. Methods: We abstracted 18,882 medical records of unique cancer patient visits during 2010 at a major NCI-designated cancer center and then evaluated survivor care for one week in April, 2010 to characterize how oncologists spend their clinical time. Finally, we selected three subgroups from the survivor population (n≈100 each) of survivors at 1-5 years, 6-10 years, and >10 years after diagnosis. We collected demographic data, purpose of visit, cancer-specific information, late and long-term effects, and type of care delivered, including surveillance for recurrence, intervention, prevention, and coordination of care. Results: In the larger group of 18,882, only 14% of survivors were more than 10 years post-diagnosis. Approximately two-thirds of the survivors were women. Breast cancer survivors comprised 38%, and survivors of hematologic malignancies accounted for 21% of the population. During the one week studied, the majority of oncologists' patients (74%) were actively receiving treatment; only 5% of their patients were 5 or more years post-diagnosis. Second or secondary malignancies were noted in 8% of patients. Late and long-term effects were uncommon. Approximately 25% of survivors beyond five years were observed to have late effects due to cancer treatment, most common being fatigue, neurological endocrine, and cardiac. Of the 300 selected survivors, sixty-two percent received only surveillance care during their visit. Only 3% of these patients received an entire array of survivorship care that included surveillance, intervention, co-ordination and prevention. Conclusions: A small proportion of oncologists’ visits were with long-term cancer survivors (5-14%) of whom only 25% had late or long-term effects of cancer treatment so overall very few of office visits were with long-term survivors who had late and long-term complications. All visits involved surveillance for cancer recurrence but there was little focus on prevention, intervention, and coordination of care for cancer survivors.

Download Full-text

Pastoral care of cancer patients: Defining utilization of services at a comprehensive cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e24171 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e24171-e24171

Author(s):

Elizabeth Palmer ◽

Anghela Paredes ◽

Madison Hyer ◽

Timothy M. Pawlik

Keyword(s):

Pastoral Care ◽

Cancer Treatment ◽

Cancer Patients ◽

Spiritual Care ◽

Cancer Care ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Spiritual Needs ◽

Active Listening ◽

Patients With Cancer

e24171 Background: Addressing the religious/spiritual needs of patients is an important component of comprehensive cancer care. Patients often report that providers infrequently engage them about their needs during treatment. In addition, providers cite inadequate training as a significant barrier to providing spiritual care. While patients may benefit from the presence of a spiritual care specialist during cancer treatment, the utilization and content of these services are not well defined. We sought to characterize utilization of pastoral care (PC) services, as well as delineate differences in PC utilization among patients with cancer. Methods: Data on patients being treated for cancer at a Comprehensive Cancer Center between 2015-2018 were obtained from the electronic medical record. Overall utilization, type of PC services utilized, as well as factors associated with use of PC were assessed. Analyses included descriptive statistics and logistic regression. Results: Among 14,322 cancer patients, roughly one-third (n = 5166, 36.1%) had at least one PC encounter during their cancer treatment. Interventions most frequently provided by PC included supportive presence (93.5%) and active listening (86.6%), while the most frequently explored topics were treatment expectations (59.8%), issues with faith/beliefs (42.9%), and available coping mechanisms (35.4%). Patients diagnosed with colorectal (OR:1.42, 95%CI:1.07-1.89), liver (OR:2.41, 95%CI:1.80-3.24), or pancreatic cancer (OR:1.43, 95%CI:1.02-2.00) were more likely to utilize PC services compared with other cancers. Patients that identified as Catholic (OR:1.47, 95%CI:1.17-1.84) or Christian (OR:1.73, 95%CI:1.39-2.15) were more likely to request PC services (both p < 0.001) than individuals who had no religious preference/affiliation. Among surgical patients (n = 1,174), the majority of encounters with PC services were in the postoperative setting (n = 801, 70.6%). Patients most often reported that PC helped with verbalization of their feelings (93.6%) and helped reduce stress (76.9%). Conclusions: Over one-third of patients with cancer interacted with PC and received services that often addressed both psychosocial and spiritual concerns. Overall PC utilization and types of PC services rendered varied relative to demographic and religious factors. Providers should be aware of varying patient religious/spiritual needs so as to optimize the entire cancer care experience for patients.

Download Full-text

Challenge to Solid Cancer Treatment Using Bifidobacterium

Japanese Journal of Lactic Acid Bacteria ◽

10.4109/jslab.25.18 ◽

2014 ◽

Vol 25 (1) ◽

pp. 18-23

Author(s):

Shun'ichiro Taniguchi

Keyword(s):

Cancer Treatment ◽

Solid Cancer

Download Full-text

Evaluating Nutrition Services in Outpatient Cancer Centers in New Mexico – A Pilot Study Protocol

Current Developments in Nutrition ◽

10.1093/cdn/nzab057_007 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 1277-1277

Author(s):

Dolores Guest ◽

Joseph Rodman ◽

Karen Quezada ◽

Alexandra Haigh ◽

Michelle Thomas ◽

...

Keyword(s):

New Mexico ◽

Cancer Treatment ◽

Cancer Patients ◽

Financial Burden ◽

Organizational Level ◽

Cancer Center ◽

Environmental Scan ◽

Nutrition Care ◽

Ambulatory Oncology ◽

Improve Access

Abstract Objectives Nationally, 50% of all cancer patients experience malnutrition upon diagnosis or during the course of treatment. When registered dietitian nutritionists (RDNs) are involved in oncology treatment, outcomes improve, with a reduction in financial burden for the patient and health delivery system. Despite the high prevalence of outpatient treatment utilization (up to 90% of cancer patients), RDN understaffing is common in outpatient cancer treatment settings. The goal of this pilot project is to characterize and understand factors at the organizational level (e.g., policies and practices) and provider level (e.g., knowledge, attitudes, practices and needs) that affect implementation of nutrition standards of practice at outpatient oncology clinics in New Mexico (NM). Characterizing current nutrition resources in distinct regions across the state is crucial to the development of effective interventions to improve access to RDN nutrition care across NM. Methods We will conduct a comprehensive, 7-domain, nutrition-focused environmental scan of ∼15 treatment centers and surrounding areas. Data collected will include clinic catchment area information; patient and area census demographics; clinic screening and referral policies; clinic technical, financial, and personnel resources; and community nutrition resources. We will then conduct ∼50 semi-structured interviews of stakeholders, including administrators and medical and RDN providers, at ∼10 of these treatment facilities to contextualize the results of the environmental scan. Qualitative interviews will explore facilitators and barriers to provision of guideline concordant nutrition care. We will perform a case study analysis (both within-case and cross-case) of sites and examine the identified resources and gaps to care in each region and will note differences across settings (e.g., urban vs. rural centers). Results N/A. Conclusions This innovative, mixed-methods study will provide a context-driven inventory of nutrition processes, services, and resources at outpatient cancer treatment clinics in NM. These data will inform a tailored intervention to improve access to nutrition care for ambulatory oncology patients throughout NM. Funding Sources American Cancer Society Institutional Research Grant; NCI Cancer Center Support Grant.

Download Full-text

Improving Cancer Outcomes Through International Collaboration in Developing Countries: King Hussein Cancer Center As a Unique Experience

Journal of Global Oncology ◽

10.1200/jgo.18.43300 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 161s-161s

Author(s):

J. Khader

Keyword(s):

Developing Countries ◽

Clinical Research ◽

Cancer Treatment ◽

International Collaboration ◽

Cancer Care ◽

Research Work ◽

Cancer Center ◽

Cancer Centers ◽

Regional Collaboration ◽

Tumor Boards

Background and context: The need for international and regional collaboration in cancer care has grown stronger as we have made progress in both cancer treatment and screening. We sought to share our unique and successful experience at King Hussein Cancer Center (KHCC) in Jordan and to identify those efforts already underway, which facilitate such collaboration and lead to raise up the cancer care in Jordan to highest levels. Aim: To strengthen cancer care in Jordan. Strategy/Tactics: Over 15 years, KHCC succeeded in binding with well reputed international cancer centers, like MD Anderson Cancer Center, Princess Margret Hospital, St June Cancer Center, Sick Hospital Cancer Center and Moffit Cancer Center, through twinning programs and collaborative agreements to improve capacity building, holding joint scientific activities like joint telemedicine tumor boards, symposia, workshops, and clinical research. Outcomes: Through such international collaboration, KHCC could reach a highest level of cancer care and considered as a hub in the region for cancer treatment, training and research. This great achievement was not possible without this effective collaboration with these international cancer centers. Many clinical programs have been initiated at KHCC because of this collaboration, which lead to joint clinical research work and publication. What was learned: International collaboration between cancer centers in developing countries and developed countries is very beneficial and can reduce the gap in cancer care. The successful experience of KHCC in this regard should admire cancer centers in developing countries to consider it and adopt it.

Download Full-text

Implementation of Tanzania’s National Cancer Treatment Guidelines: A Qualitative Approach to Clinical Systems

JCO Global Oncology ◽

10.1200/go.20.34000 ◽

2020 ◽

Vol 6 (Supplement_1) ◽

pp. 38-38

Author(s):

Rohan Luhar ◽

Sarah K. Nyagabona ◽

Edith Tarimo ◽

Mwamvita Said ◽

Msiba Selekwa ◽

...

Keyword(s):

Cancer Treatment ◽

Health Care Providers ◽

Implementation Strategy ◽

Treatment Guidelines ◽

Guideline Implementation ◽

Cancer Center ◽

Care Providers ◽

Care Community ◽

Internal Barriers ◽

Clinical Systems

PURPOSE In response to the increasing burden of cancer in Tanzania, the Tanzanian Ministry of Health Community Development, Gender, Elderly, and Children plans to launch their first National Cancer Treatment Guidelines. These guidelines will provide an opportunity to improve and standardize care at Ocean Road Cancer Institute (ORCI), the national cancer center, where previous data suggest that patients do not consistently receive standard treatment. A theory-informed implementation strategy will be conducted to facilitate the routine use of guidelines among health care providers at ORCI. As part of the needs assessment for this effort, this study explored the barriers to and facilitators of guideline-concordant care at ORCI. METHODS We conducted three focus groups with participants stratified by profession, which included oncologists, radiotherapists, oncology residents, and nurses. A discussion guide was used to generate discussion about multiple aspects of current clinical processes at ORCI. Audio recordings were transcribed and translated to English, and data were analyzed using the framework method. RESULTS A total of 21 participants helped identify institutional and systemic factors that were internal and external to the clinical systems at ORCI that may affect guideline-concordant care. These can be categorized into the following: strengths and facilitators, barriers, and suggestions for improvement. Internal facilitators include multidisciplinary patient management, government-sponsored free cancer care, community engagement, and providers’ motivation for continuous learning and improvement. Internal barriers include interdepartmental and interinstitutional communication gaps, resource limitations for specialized services, high patient volumes, and patient misconceptions and nonadherence. Participants offered many practical suggestions for improving clinical systems at ORCI. CONCLUSION Our results highlight several barriers and facilitators within and outside of the clinical systems at ORCI that may affect the uptake of the National Cancer Treatment Guidelines. Findings have been used to recommend quality improvement and environmental restructuring measures at ORCI that will inform the broader guideline implementation strategy.

Download Full-text