525 THE IMPACT OF RACE ON PANCREATIC CANCER TREATMENT AND SURVIVAL IN THE NATIONWIDE VETERANS AFFAIRS HEALTHCARE SYSTEM

The aim: Cancer is the second most common cause of death in Polish society. The healthcare system, already overwhelmed in many countries, has been further burdened by the outbreak of the SARS-CoV-2 pandemic. The healthcare system has become inefficient, especially in the oncology care sector. Surgeries, scheduled treatments, and follow-up appointments in some hospitals have been canceled or rescheduled to the “next available date after the end of the pandemic”. This research aims to analyze the impact of the COVID-19 pandemic on the availability of medical care among oncological patients and compare them with the results of studies on the effects of postponement of oncology treatment. Materials and methods: The study included a group of 544 respondents from all over Poland. The research tool was a self-administered survey questionnaire. Results: 37%, of those undergoing systemic treatment, experienced postponement of their treatment, and in the case of radiotherapy, it was 35%. Visits to the clinical oncologist/radiotherapist specialist were postponed in 51% of respondents. Imaging studies were delayed in 41.7% of respondents. Conclusions: The course of the COVID-19 pandemic has significantly impacted the health care system and, therefore, also on the availability of medical care among oncologicalpatients. The results signal an emerging problem. These visit shifts may negatively affect the outcome of cancer treatment. The potential risk of COVID-19 infection should beindividually balanced against cancer treatment delay in each patient. The ongoing pandemic, therefore, prompts a careful analysis of the effects of deferring cancer therapy.

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Impact of pancreatic cancer treatment on hospice utilization.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.52 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 52-52

Author(s):

Lauren M Wancata ◽

Huiying Yin ◽

Sandra L. Wong

Keyword(s):

Pancreatic Cancer ◽

Cancer Treatment ◽

Cancer Patients ◽

Poor Prognosis ◽

Primary Treatment ◽

Medicare Data ◽

Hospice Use ◽

Short Time ◽

Incident Cases ◽

The Impact

52 Background: There is an increasing incidence of pancreatic cancer over time, a cancer with a 5-year survival rate of only 7.2%.For patients with poor prognosis cancers, hospice is an important resource, but it is often not utilized or underutilized. Factors influencing hospice use are difficult to determine. We sought to evaluate the impact of pancreatic cancer treatment on hospice utilization. Methods: National Surveillance Epidemiology and End Results (SEER)-Medicare data was utilized to identify all incident cases of pancreatic cancer patients who died (2005-09, with follow up to 2011). Patients were stratified by primary treatment strategy: surgery, chemotherapy, or no treatment. Hospice utilization in the last 6 months of life, including average and median days enrolled in hospice and average time from diagnosis to hospice was evaluated. Results: 17,031 patients were identified, with 68.5% enrolling in hospice in the last 6 months of life. Patients undergoing surgery were less likely to enroll in hospice compared to patients not undergoing surgery (58.7% vs 69.4%, p < 0.0001). Interestingly, surgical patients spent on average 31.2 days in hospice (median 15.0 days) which was comparable to the non-surgical cohort (average 32.7 days, median 16.0 days; p = 0.32). Patients who received any chemotherapy spent an average of 29.2 days in hospice (median 15 days) compared to those who did not undergo chemotherapy, who spent an average of 34.5 days in hospice (median 16 days); p < 0.0001. While total hospice enrollment was equivalent between the chemotherapy and no chemotherapy cohorts (67.5% vs 69.1%), the time spent in hospice was significantly different (p < 0.0001). Patients not receiving any cancer-directed treatment enrolled in hospice at an average of 78.6 days (median 32 days) from diagnosis. Conclusions: Pancreatic cancer patients undergoing surgery enrolled in hospice to a much lesser extent than patients who did not have surgery. Patients not receiving cancer-directed treatment spend a relatively short time in hospice. Overall, hospice appears to be underutilized, and the majority of patients with this poor prognosis cancer are not realizing the full benefits of hospice.

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The Impact of Healthcare-Associated Methicillin-Resistant Staphylococcus aureus Infections Among United States Veterans on Post-Discharge Healthcare Cost and Utilization Outside the Department of Veterans Affairs Healthcare System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.157 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Richard E. Nelson ◽

Thomas Reese ◽

Makoto Jones ◽

Vanessa W. Stevens ◽

Chuan-Fen Liu ◽

...

Keyword(s):

United States ◽

Staphylococcus Aureus ◽

Healthcare System ◽

Healthcare Cost ◽

Methicillin Resistant Staphylococcus Aureus ◽

Veterans Affairs ◽

Department Of Veterans Affairs ◽

Post Discharge ◽

Healthcare Associated ◽

The Impact

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Enhancing Clinical Pharmacy Specialist Involvement in Transitions of Care Focusing on Ambulatory Care Sensitive Conditions within a Veterans Affairs Healthcare System

Pharmacy ◽

10.3390/pharmacy8010047 ◽

2020 ◽

Vol 8 (1) ◽

pp. 47

Author(s):

Morgan Fisher ◽

Amber Cardoza ◽

Autumn Gordon ◽

Molly Howard ◽

Lynsey Neighbors ◽

...

Keyword(s):

Healthcare System ◽

Clinical Pharmacy ◽

Medication Management ◽

Veterans Affairs ◽

Transitions Of Care ◽

Secondary Diagnosis ◽

Post Discharge ◽

Readmission Rates ◽

Improvement Project ◽

The Impact

The purpose of this quality improvement project was to evaluate the impact of clinical pharmacy specialist (CPS) involvement in the post-discharge period on 30-day readmission rates within a Veterans Affairs Healthcare System. Patients eligible for inclusion were discharged from a Veterans Affairs (VA) acute care facility with a principle or secondary diagnosis of heart failure (HF), chronic obstructive pulmonary disease (COPD), or both HF and COPD from 15 October 2018 through 14 January 2019. CPSs functioning as a mid-level provider with a scope of practice conducted telephone and in-clinic medication management appointments within 7 and 21 days post-discharge for qualifying patients discharged with a principle or secondary diagnosis of HF or COPD. CPS appointments focused on medication reconciliation, ensuring continuity of care, disease state counseling, and medication management. By enhancing the role of the CPS in the post-discharge period, there was an observed decrease in 30-day COPD index (p = 0.35), HF index (p = 0.23), and all-cause (p = 0.62) readmission rates from pre- to post-intervention. The results of this intervention show that CPS intervention in the post-discharge period may reduce index and all-cause readmission rates for patients discharged with a principle or secondary discharge diagnosis of COPD or HF.

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Sa092 ACCURACY OF ICD-9/10-CM CODES FOR IDENTIFYING PANCREATIC CANCER CASES IN THE NATIONWIDE VETERANS AFFAIRS HEALTHCARE SYSTEM

Gastroenterology ◽

10.1016/s0016-5085(21)01705-4 ◽

2021 ◽

Vol 160 (6) ◽

pp. S-418

Author(s):

Taher Jamali ◽

Kati Choi ◽

Ann Xu ◽

Daniela Abrams ◽

Hardeep Singh ◽

...

Keyword(s):

Pancreatic Cancer ◽

Healthcare System ◽

Veterans Affairs

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Regionalization of pancreatic cancer treatment within an integrated healthcare system

HPB ◽

10.1016/j.hpb.2021.06.021 ◽

2021 ◽

Vol 23 ◽

pp. S455

Author(s):

D. Hsu ◽

N. Kumar ◽

S. Le ◽

A. Chang ◽

E. Cho ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cancer Treatment ◽

Healthcare System ◽

Integrated Healthcare

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Racial Parity in Pancreatic Cancer Treatment and Outcomes within an Integrated Healthcare System

10.36959/829/400 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Hsu Diana S ◽

Le Sidney T ◽

Chang Alex ◽

Spitzer Austin L ◽

Kazantsev George ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cancer Treatment ◽

Healthcare System ◽

Integrated Healthcare

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Evaluating the Impact of ESPAC-1 on Shifting the Paradigm of Pancreatic Cancer Treatment

Journal of Surgical Research ◽

10.1016/j.jss.2020.09.009 ◽

2020 ◽

Author(s):

Leah K. Winer ◽

Alexander R. Cortez ◽

Syed A. Ahmad ◽

Koffi Wima ◽

Olubenga Olowokure ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cancer Treatment ◽

The Impact

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Risk factors for SARS-CoV-2 infection and course of COVID-19 disease in patients with IBD in the Veterans Affair Healthcare System

Gut ◽

10.1136/gutjnl-2021-324356 ◽

2021 ◽

pp. gutjnl-2021-324356

Author(s):

Nabeel Khan ◽

Nadim Mahmud ◽

Chinmay Trivedi ◽

Walter Reinisch ◽

James D Lewis

Keyword(s):

Healthcare System ◽

Veterans Affairs ◽

Secondary Outcome ◽

Disease Course ◽

Increased Risk ◽

National Cohort ◽

Inflammatory Bowel ◽

The Impact ◽

Related Mortality

ObjectiveOur aim was to explore the risk of infection with all classes of inflammatory bowel disease (IBD) medications and the impact of these medications on the disease course in a nationwide cohort of patients with IBD.DesignThis was a retrospective national cohort study of patients with IBD in the Veterans Affairs Healthcare System. We categorised IBD medication use immediately prior to the COVID-19 pandemic and used survival analysis methods to study associations with SARS-CoV-2 infection, as well as a combined secondary outcome of COVID-19 hospitalisation or COVID-19-related mortality.ResultsThe analytical cohort of 30 911 patients was primarily male (90.9%), white (78.6%) and with ulcerative colitis (58.8%). Over a median follow-up of 10.7 months, 649 patients (2.1%) were diagnosed with SARS-CoV-2 infection and 149 (0.5%) met the combined secondary outcome. In adjusted models, vedolizumab (VDZ) use was significantly associated with infection relative to mesalazine alone (HR 1.70, 95% CI 1.16 to 2.48, p=0.006). Patients on no IBD medications had increased risk of the combined secondary outcome relative to mesalazine alone (sub-HR 1.64, 95% CI 1.12 to 2.42, p=0.01), however, no other IBD medication categories were significantly associated with this outcome, relative to mesalazine alone (each p>0.05). Corticosteroid use was independently associated with both SARS-CoV-2 infection (HR 1.60, 95% CI 1.23 to 2.09, p=0.001) and the combined secondary outcome (sub-HR 1.90, 95% CI 1.14 to 3.17, p=0.01).ConclusionVDZ and corticosteroid were associated with an increased risk of SARS-CoV-2 infection. Except for corticosteroids no medications including mesalazine were associated with an increased risk of severe COVID-19.

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