274 THE IMPACT OF A PROSTATE MULTIDISCIPLINARY CLINIC PROGRAM ON PATIENT TREATMENT DECISIONS & ON ADHERENCE TO NCCN GUIDELINES

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
Howard Korman ◽  
David Wenzler ◽  
Thomas Lanni ◽  
Chirag Shah ◽  
Jan Parslow ◽  
...  
Keyword(s):  
Treatment Decisions ◽  
Patient Treatment ◽  
Nccn Guidelines ◽  
Multidisciplinary Clinic ◽  
The Impact ◽  
Clinic Program

Impact of a Prostate Multidisciplinary Clinic Program on Patient Treatment Decisions and on Adherence to NCCN Guidelines

2013 ◽  
Vol 36 (2) ◽  
pp. 121-125 ◽  
Author(s):  
Howard Korman ◽  
Thomas Lanni ◽  
Chirag Shah ◽  
Jan Parslow ◽  
Joyce Tull ◽  
...  
Keyword(s):  
Treatment Decisions ◽  
Patient Treatment ◽  
Nccn Guidelines ◽  
Multidisciplinary Clinic ◽  
Clinic Program

Impacts of toxicity on patient treatment choices for metastatic breast cancer.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 18-18 ◽  
Author(s):  
Carol B. White ◽  
Mary Lou Smith ◽  
Oyewale O. Abidoye ◽  
Deepa Lalla
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Online Survey ◽  
Metastatic Breast ◽  
Treatment Decisions ◽  
Subsequent Treatment ◽  
Patient Treatment ◽  
Treatment Choices ◽  
Almost All ◽  
The Impact

18 Background: Most patients with metastatic breast cancer (MBC) are treated with chemotherapy and/or targeted therapy with varying toxicity profiles. Experience with adverse events (AE) may vary and factor into subsequent treatment decisions. As newer agents and combinations become available, it becomes increasingly important to understand which AEs impact treatment decisions. Methods: The objective was to assess patient experience with AEs and preferences for future treatments. Following focus groups and pretests, an online survey was released by breast cancer organizations to recruit patients with MBC. The survey assessed the impact of experiences on future treatment choices and measured preferences via conjoint analysis (CA). Results: A total of 551 respondents completed the online survey. Among the AEs studied to assess their impact on either treatment stops or breaks, neutropenia topped the list, particularly for a required break. Fatigue, hand and foot syndrome, diarrhea, joint pain and peripheral neuropathy (PN) were high for chosen stops. Five AEs (fatigue, alopecia, diarrhea, PN, neutropenia) were studied extensively. Almost all respondents report experiencing fatigue, ~80% experienced alopecia, and ~66% each of the other 3 AEs. For each AE, the majority of respondents reported their prior experience would not impact a future decision involving the same AE; about 1/3 report they’d be more likely to take a treatment with the same AE; 8% to 18% would be less likely to take a treatment with the same AE. CA was also used to assess influence of the 5 AEs on future decisions. Within the tested ranges of likelihood, severity and duration, alopecia had the highest impact; PN, diarrhea, and neutropenia were in the middle; and fatigue was lowest. Further analysis is ongoing and final results will include differences in patient subgroups. Conclusions: This information informs priorities for development of new therapies allowing additional attention on AEs that matter most to patients. In addition, these results may generate discussion and consideration of patient preferences in conversations about care and treatment selection.

Impact of leucovorin shortage on patient treatment.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17566-e17566
Author(s):  
Mina Samir Erian Hanna ◽  
Peter Kozuch ◽  
Molly Thorn ◽  
Janna Roitman ◽  
Michael L. Grossbard ◽  
...  
Keyword(s):  
New York ◽  
Low Dose ◽  
Economic Effect ◽  
Patient Characteristics ◽  
Patient Treatment ◽  
Additional Patient ◽  
Drug Shortage ◽  
Chi Square ◽  
Nccn Guidelines ◽  
The Impact

e17566 Background: Shortages of intravenous leucovorin were initially reported in late 2008, and availability plummeted nationally and at Continuum Cancer Centers of New York (CCCNY) in late 2011. NCCN guidelines recommend either the use of levoleucovorin or low dose leucovorin during the shortage. The impact of the leucovorin shortage on patient therapy remains unknown. Methods: We reviewed patient charts for all outpatients treated with leucovorin at CCCNY between April and September of 2010, 2011, and 2012. We recorded patient characteristics, and leucovorin use (dose, number of treatments); and calculated descriptive statistics. We classified each dose as either low (20-40 mg/m2) or high (200-500mg/m2) and compared leucovorin use between years with Chi Square and ANOVA tests. We also reviewed pharmacy purchasing data to evaluate the economic effect of the leucovorin shortage. Results: We identified 55 patients treated with 313 doses of leucovorin in 2010, 99 patients treated with 582 doses in 2011 and 118 patients treated with 742 doses in 2012. No patients received levoleucovorin. Patient characteristics, disease and stage were similar between years with colorectal cancer accounting for 78%, 69%, and 70% of patients in 2010, 2011, and 2012 (p=0.87). Low dose leucovorin was used in 30.0% of doses in 2010, 30.4% in 2011, and 99.1% in 2012 (p<0.0001). The mean dose/treatment (SD) was 459 mg (296), 499 mg (328), and 47 mg (89), in 2010, 2011, 2012, respectively (p<0.0001). Among patients treated for colon cancer we found no association between stage (III vs. IV) and use of low dose leucovorin in 2010 or 2011. Quantity of leucovorin purchased at one hospital decreased by 63% from 171.75 g in 2010 and 157.50g in 2011 to 63.00 g in 2012. The price of leucovorin was similar at 0.017 $/mg in 2011 and 0.013 $/mg in 2012. Conclusions: Worsening leucovorin drug shortage was associated with a profound change in leucovorin use at CCCNY between 2011 and 2012. In accordance with NCCN guidelines, physicians used more low dose leucovorin. The price of leucovorin remained constant despite limited supply. Additional patient follow up is warranted to evaluate the outcomes of patients treated during the shortage.

Impact of CCP test on personalizing treatment decisions: Results from a prospective registry of newly diagnosed prostate cancer patients.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 63-63
Author(s):  
Neal D. Shore ◽  
Judd Boczko ◽  
Naveen Kella ◽  
Brian Joseph Moran ◽  
E. David Crawford ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Patient Treatment ◽  
Treatment Recommendation ◽  
Interventional Treatment ◽  
Newly Diagnosed ◽  
Actual Treatment ◽  
Therapy Recommendation ◽  
The Impact

63 Background: The cell cycle progression (CCP) test is a validated molecular assay that assesses risk of prostate cancer−specific disease progression and mortality when combined with standard clinicopathologic parameters. PROCEDE−1000 is the largest prospective registry to evaluate CCP test impact on personalizing prostate cancer treatment. Results of an interim analysis are presented. Methods: Untreated patients with newly diagnosed (≤6 months), clinically localized prostate adenocarcinoma were enrolled (n=816). The physician’s initial therapy recommendation (pre−CCP) was recorded on the first questionnaire. The CCP test was then conducted on prostate biopsy tissue. Three post−CCP questionnaires recorded the physician’s revised treatment recommendation, physician/patient treatment decision, and actual treatment administered. Changes in treatments between the pre-CCP and post−CCP questionnaires demonstrated the impact of CCP testing on treatment decisions at each stage. Results: Visual analog scale measurements indicated a significant increase (p=0.0125) in the physician’s likelihood of recommending non−interventional treatment post−CCP test; there was an increase in active surveillance from the initial interventional therapy recommendation. From pre−CCP therapy recommendation, the CCP score caused a change in actual treatment administered in 44% of patients; 72% of changes were reductions in treatment. Reductions occurred in radical prostatectomy (27%), radiation therapy (44% primary; 56% adjuvant), brachytherapy (46% interstitial; 66% HDR) and hormonal therapy (33% neoadjuvant; 68% concurrent) treatments. While 35.9% of patients were recommended for conservative management pre−CCP testing, there was a 6.5% increase in non−interventional treatments during actual follow−up. Overall, there was a significant reduction in the number of treatment options at each successive evaluation (p<0.0001). Conclusions: The CCP risk assessment score has a significant impact in helping physicians and patients reach consensus on an appropriate personalized treatment decision, often with major reductions in interventional treatment burden. Clinical trial information: NCT01954004.

scholarly journals The Impact of Tumor Heterogeneity on Patient Treatment Decisions

2013 ◽  
Vol 59 (1) ◽  
pp. 38-40 ◽  
Author(s):  
Carol J Farhangfar ◽  
Funda Meric-Bernstam ◽  
John Mendelsohn ◽  
Gordon B Mills ◽  
Agda Karina Lucio-Eterovic
Keyword(s):  
Tumor Heterogeneity ◽  
Treatment Decisions ◽  
Patient Treatment ◽  
The Impact

scholarly journals The impact of a multidisciplinary small renal mass clinic on patient treatment decisions

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Danielle Earis ◽  
Chris Wall ◽  
Nicolette Sinclair ◽  
Trustin Domes ◽  
Kunal Jana
Keyword(s):  
Decision Making ◽  
Watchful Waiting ◽  
Irreversible Electroporation ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Patient Treatment ◽  
Control Group ◽  
Treatment Decision Making ◽  
The Impact ◽  
Historic Cohort

Introduction: Small renal masses (SRMs) are managed with active surveillance (AS), thermal ablation (TA), irreversible electroporation (IRE), or surgery, depending on patient and tumor factors. A novel SRM multidisciplinary clinic (SRMC), involving urologists and interventional radiologists, was established to provide patients with information on treatments options. The objective of this study was to evaluate the impact of the SRMC on treatment decision-making Methods: Demographics, tumor characteristics, and treatment decisions were prospectively collected on patients (n=216) attending the SRMC between 2016 and 2019. A retrospective historic cohort (n=238) seen by urologists was used as a control group. Key variables were analyzed and compared. Patient satisfaction (n=27) was surveyed and responses were summarized and explored. Results: Mean age, tumor size, and pathology was similar between groups; however, the SRMC cohort had more male patients (65.7% vs. 53.8%, p=0.009). Chosen treatment modality differed significantly between cohorts (p<0.0001). Patients in the historic cohort were treated by AS (41.5%), surgery (37.9%), TA (11.9%), watchful waiting (7.9%), and IRE (0.8%). SRMC patients were treated by TA (42.2%), AS (26.7%), surgery (21.3%), IRE (7.6%), and watchful waiting (2.2%). Post-hoc analysis revealed statistically significant differences in proportions of AS, TA, IRE, and surgery between cohorts. Patients reported high satisfaction with the collaborative approach. Conclusions: A multidisciplinary approach may have an impact on patient treatment decision-making for SRMs. Consultations involving a urologist and an interventional radiologist resulted in more TA and IRE and less AS and surgery. Future studies should evaluate if these findings occur in other centers.

scholarly journals CanAssist Breast Impacting Clinical Treatment Decisions in Early-Stage HR+ Breast Cancer Patients: Indian Scenario

2019 ◽  
Author(s):  
Satish Sankaran ◽  
Jyoti Bajpai Dikshit ◽  
Chandra Prakash SV ◽  
SE Mallikarjuna ◽  
SP Somashekhar ◽  
...  
Keyword(s):  
High Risk ◽  
Early Stage ◽  
Risk Groups ◽  
Treatment Decisions ◽  
Low Risk ◽  
Not Given ◽  
Breast Cancer Patients ◽  
Number Of Patients ◽  
Risk Of Cancer ◽  
The Impact

AbstractCanAssist Breast (CAB) has thus far been validated on a retrospective cohort of 1123 patients who are mostly Indians. Distant metastasis–free survival (DMFS) of more than 95% was observed with significant separation (P < 0.0001) between low-risk and high-risk groups. In this study, we demonstrate the usefulness of CAB in guiding physicians to assess risk of cancer recurrence and to make informed treatment decisions for patients. Of more than 500 patients who have undergone CAB test, detailed analysis of 455 patients who were treated based on CAB-based risk predictions by more than 140 doctors across India is presented here. Majority of patients tested had node negative, T2, and grade 2 disease. Age and luminal subtypes did not affect the performance of CAB. On comparison with Adjuvant! Online (AOL), CAB categorized twice the number of patients into low risk indicating potential of overtreatment by AOL-based risk categorization. We assessed the impact of CAB testing on treatment decisions for 254 patients and observed that 92% low-risk patients were not given chemotherapy. Overall, we observed that 88% patients were either given or not given chemotherapy based on whether they were stratified as high risk or low risk for distant recurrence respectively. Based on these results, we conclude that CAB has been accepted by physicians to make treatment planning and provides a cost-effective alternative to other similar multigene prognostic tests currently available.

scholarly journals When Cells Suffocate: Autophagy in Cancer and Immune Cells under Low Oxygen

2011 ◽  
Vol 2011 ◽  
pp. 1-13 ◽  
Author(s):  
Katrin Schlie ◽  
Jaeline E. Spowart ◽  
Luke R. K. Hughson ◽  
Katelin N. Townsend ◽  
Julian J. Lum
Keyword(s):  
Tumor Microenvironment ◽  
Cancer Cells ◽  
Immune Cells ◽  
Immune Cell ◽  
Treatment Strategies ◽  
Patient Treatment ◽  
Low Oxygen ◽  
Tumor Environment ◽  
And Function ◽  
The Impact

Hypoxia is a signature feature of growing tumors. This cellular state creates an inhospitable condition that impedes the growth and function of all cells within the immediate and surrounding tumor microenvironment. To adapt to hypoxia, cells activate autophagy and undergo a metabolic shift increasing the cellular dependency on anaerobic metabolism. Autophagy upregulation in cancer cells liberates nutrients, decreases the buildup of reactive oxygen species, and aids in the clearance of misfolded proteins. Together, these features impart a survival advantage for cancer cells in the tumor microenvironment. This observation has led to intense research efforts focused on developing autophagy-modulating drugs for cancer patient treatment. However, other cells that infiltrate the tumor environment such as immune cells also encounter hypoxia likely resulting in hypoxia-induced autophagy. In light of the fact that autophagy is crucial for immune cell proliferation as well as their effector functions such as antigen presentation and T cell-mediated killing of tumor cells, anticancer treatment strategies based on autophagy modulation will need to consider the impact of autophagy on the immune system.

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