The Impact of Dynamic Changes to a Bone Metastases Pathway in a Large Integrated National Cancer Institute Designated Comprehensive Cancer Center Network

Background: Patients with advanced cancer who have dependent children are an important population with a life-limiting illness and high levels of psychological distress. Few studies have addressed the experience of being a parent with advanced cancer and their potential palliative needs. Aim: To describe the experience of living with advanced cancer as a parent, including illness experience, parental concerns, and treatment decision making and to explore whether these experiences differ by their functional status. Design: We conducted a cross-sectional, qualitative study using in-depth, semi-structured interviews. Data were analyzed using thematic content analysis. Setting and participants: A total of 42 participants with metastatic cancer and with at least one child under the age of 18 years were recruited from a comprehensive cancer center. 25 participants were rated as having high functional status (the Eastern Cooperative Oncology Group (ECOG) Performance Status Scale = 0–1) and 17 with low functional status (ECOG=2–4). Results: We identified four themes regarding the experience of being a parent with advanced cancer: (1) parental concerns about the impact of their illness and death on their children, (2) “missing out” and losses of parental role and responsibilities, (3) maintaining parental responsibilities despite life-limiting illness, and (4) parental identity influencing decision making about treatment. Parental functional status influenced not only physical responsibilities but also intensified parenting psychological concerns. Conclusion: Parents with metastatic cancer may have unique palliative care needs as they experience parenting concerns while managing the psychological and physical demands of advanced cancer.

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Development of a Rapid Response Team in an Outpatient Free-Standing National Cancer Institute–Designated Comprehensive Cancer Center

Journal of the Advanced Practitioner in Oncology ◽

10.6004/jadpro.2010.1.2.15 ◽

2010 ◽

Vol 1 (2) ◽

Cited By ~ 1

Author(s):

Kim Blumenfeld, RN, BS, CCRN ◽

Iris Delfakis, RN, BSN, OCN® ◽

Sandra E. Kurtin, RN, MS, AOCN®, ANP-C ◽

Patricia Stumbo, RN, OCN®, MBA ◽

Kirsten Jonasson, RN ◽

...

Keyword(s):

National Cancer Institute ◽

Rapid Response Team ◽

Rapid Response ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Free Standing ◽

Response Team

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Impact of Safety Concerns of Erythropoiesis-Stimulating Agents (ESAs) and Regulatory Changes on the Use of ESAs and Red Blood Cell (RBC) Transfusions at a Comprehensive Cancer Center

Blood ◽

10.1182/blood.v112.11.1300.1300 ◽

2008 ◽

Vol 112 (11) ◽

pp. 1300-1300

Author(s):

Saroj Vadhan-Raj ◽

Victoria E. Hawkins ◽

Xiao Zhou ◽

Kurt Sizer ◽

Lincy S. Lal ◽

...

Keyword(s):

Hematological Malignancies ◽

Black Box ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Safety Concerns ◽

Regulatory Changes ◽

Time Period ◽

Number Of Patients ◽

Oncology Clinical Trials ◽

The Impact

Abstract Safety signals raised in the recent oncology clinical trials have led to various regulatory restrictions including FDA black-box warning, National Coverage Determination (NCD), and updated ASCO/ASH guidelines in 2007. The purpose of this study was to determine the impact of these changes on the utilization of ESAs and on transfusion (Tx) of RBCs in 2006 (prior to changes) and 2007. We identified the total number of unique patients that received any treatment including chemotherapy, radiation, transfusions, or any treatment in the out-patient and in-patient settings during this 2 year time period. All the data on the ESA doses dispensed by the hospital pharmacy and all the RBC transfusions dispensed by the Blood bank were also analyzed. The ESA units were calculated by converting 40,000 units of epoetin alfa or 100 mcg of darbepoetin alfa to one unit of ESA. When comparing 2007 to 2006, the number of patients that received ESAs decreased by 26% and the total ESA units decreased by 30%. The overall usage of ESAs decreased by 55%, from 2398 units in 1/2006 to 1080 units in 12/2007. However, the number of pts that received RBC transfusions increased only by 6% and the total number of RBC units transfused by 2% (from 38,218 units in 2006 to 38,948 units in 2007). The median Hgb on the day of transfusion was same for each year (Hgb 8.2 g/dL for both 2006 and 2007), suggesting that the lack of impact on RBC Tx may not be due to a change in Tx threshold. The total number of unique patients referred and treated at MDACC during 2007 (24,356) increased by 13% from 2006 (21,619), not accounting for a lack of impact on transfusions. We therefore examined Hgb at the initiation of ESAs in a subset of pts (n=212) that had not received ESA for at least 3 months. The median Hgb/HCT values at the initiation of ESAs were 9.5 g/dL/27.4. The most frequent utilization of ESAs and transfusions was in patients with hematological malignancies. Conclusion: These findings indicate that the recent ESA safety concerns and related regulatory changes have significantly affected the ESA utilization. The lack of significant impact of reduced ESA usage on RBC transfusions may be related to a lower Hgb threshold used at initiation of ESAs and/or the targeted patient population (less likely to respond) treated with ESAs. Further research is needed to establish the factors contributing to the lack of correlation and to optimize the use of ESAs.

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The impact of a palliative care service on overall hospital mortality in a comprehensive cancer center

Journal of Clinical Oncology ◽

10.1200/jco.2004.22.90140.8034 ◽

2004 ◽

Vol 22 (14_suppl) ◽

pp. 8034-8034

Author(s):

A. F. Elsayem ◽

R. Jenkins ◽

L. Parmley ◽

M. L. Smith ◽

J. L. Palmer ◽

...

Keyword(s):

Palliative Care ◽

Hospital Mortality ◽

Care Service ◽

Palliative Care Service ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

The Impact

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Health care worker attitudes about clinical trials at a comprehensive cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20633 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20633-e20633

Author(s):

Erica Leigh Campagnaro ◽

Seunghee Margevicius ◽

Barbara J. Daly ◽

Jennifer Rachel Eads ◽

Tyler G. Kinzy ◽

...

Keyword(s):

Health Care ◽

Clinical Trials ◽

Self Efficacy ◽

Small Sample Size ◽

Educational Interventions ◽

Small Sample ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Normative Beliefs ◽

The Impact

e20633 Background: Cancer patient (pt) participation in clinical trials (CT) is low. Little is known about the beliefs and attitudes of health care workers (HCW) and how they impact intention to discuss CT with pts. The overall goal of this project was to develop a conceptual model to guide future interventions to enhance communication about CT between HCW and cancer pts. Methods: Two email surveys of non-physician HCW at an NCI-designated comprehensive cancer center were conducted. The first was sent to a random sample of 150 HCW. The second was sent to 80 who completed the first survey. Based on our prior work (Eads et al. ASCO 2011) and Ajzen’s Theory of Planned Behavior, domains of the first included CT knowledge (19 items, agree/disagree) and attitudes (27 items, 5-point Likert); the second included normative beliefs about institutional attitudes toward CT (6 items, 5-point Likert), self-efficacy about engaging in discussion about CT (14 items, 5-point Likert), and intention to discuss CT with pts (4 items, 7-point Likert). Results: 41 HCW completed both anonymous surveys; 27 could be matched by demographics. Median age of matched respondents was 44.3 yrs (range 24-63), 26 female, 22 caucasian, 9 nurses. Overall, CT knowledge was high (median 17/19 items correct). There were strong associations between attitudes and self-efficacy (Spearman r=-0.425, p=0.03), as well as perceived normative beliefs and self-efficacy (r=0.651, p=0.0002). These associations were strong amongst nurses (r=-0.818, p=0.007 and r=0.656, p=0.05, respectively), with a particularly strong correlation between self-efficacy and intention to discuss clinical trials with pts (r=0.891, p=0.001). Conclusions: In spite of a small sample size, these pilot data strongly support a behavioral framework to understand and address the impact of HCW attitudes and beliefs about CT on discussions of CT with pts. Insofar as HCW (especially nurses) have substantial pt contact, and serve as a resource for pts regarding treatment decisions, educational interventions to address HCW barriers to discussing CT with pts (i.e. attitudes, beliefs, and self-efficacy) could positively impact pt attitudes and improve decision making.

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Patient attitudes toward oncofertility care in male cancer patients receiving targeted and immune therapies.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e21593 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e21593-e21593

Author(s):

Katy K. Tsai ◽

Puneet Kamal ◽

Joris Ramstein ◽

Alain Patrick Algazi ◽

Adil Daud ◽

...

Keyword(s):

Cancer Patients ◽

Checkpoint Inhibitors ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Patient Attitudes ◽

Durable Response ◽

Care Plans ◽

Future Fertility ◽

Long Term Treatment ◽

The Impact

e21593 Background: Tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) have resulted in durable response for many cancer patients. The impact of these agents on future fertility are not well described, and patients are often committed to long-term treatment without adequate oncofertility counseling. We sought to better characterize patient attitudes toward oncofertility and challenges faced by male cancer patients undergoing treatment with TKI or ICI. Methods: Men receiving TKI/ICI at the UCSF Helen Diller Family Comprehensive Cancer Center were retrospectively identified. Eligible men had received at least one dose of TKI/ICI. Detailed questionnaires addressing cancer history, possible effects of treatment on fertility, and obstacles to fertility preservation were completed. Results: Between January 2013 to September 2016, 51 men with a mean age of 46 years (SD 12, range 21-72), 65% white, completed questionnaires. Most (61%) were CML patients, with 12% RCC, 10% GIST, 6% melanoma, and NET, oligodendroglioma, and HCC comprising remaining histologies. 96% were treated with TKI, and 4% with ICI. At the time of diagnosis, 35% of patients indicated a desire to father future children, and 53% believed that cancer treatment might affect their fertility. Despite this, 45% were not asked whether having children was important to them, and 47% did not receive information from any provider on their oncology care team about the possible risks of TKI/ICI to future fertility. The majority of patients felt there was inadequate discussion of how treatment might affect testosterone levels (73%) and their ability to father a child (53%), yet only 14% recalled adequate referrals to a fertility specialist. Conclusions: These data demonstrate that male cancer patients perceive treatment-related infertility risks as important, yet have few opportunities to discuss these concerns with providers. Care plans to address oncofertility needs, especially as TKI/ICI are increasingly used in multiple cancer types, are needed as part of the diagnosis, treatment, and follow up of these patients. Larger retrospective and prospective studies are ongoing to further characterize this patient cohort.

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