scholarly journals Caregivers Clinic at Memorial Sloan Kettering Cancer Center

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 306-307
Author(s):  
Allison Applebaum
Keyword(s):  
Medical Records ◽  
Average Length ◽  
Medication Management ◽  
Psychosocial Care ◽  
Cancer Center ◽  
Psychosocial Services ◽  
To Receive

Abstract The mission of the Caregivers Clinic at Memorial Sloan Kettering Cancer Center (MSK) is to assure that no caregiver of an MSK patient experiencing significant distress as a result of their caregiving responsibilities goes unidentified and deprived of necessary psychosocial services. This presentation will cover the steps taken and barriers faced in the development of the Clinic, including advocating for caregivers to receive their own unique medical records. Data regarding the number of caregivers seen for psychotherapy and for medication management will be presented, as will data regarding presenting complaints and average length of care. Also included is a discussion of the challenges faced in expanding and maintaining the capacity of the Clinic, especially in the setting of the pandemic during which caregivers' use of psychosocial care at MSK is notably higher than in years past. Several current adjunct approaches to address capacity needs currently being piloted will be discussed.

Palliative Chemotherapy Near the End of Life in Oncology Patients

2018 ◽  
Vol 35 (9) ◽  
pp. 1215-1220 ◽  
Author(s):  
Zhe Zhang ◽  
Meng-Lei Chen ◽  
Xiao-Li Gu ◽  
Ming-Hui Liu ◽  
Wei-Wei Zhao ◽  
...  
Keyword(s):  
End Of Life ◽  
Medical Records ◽  
Palliative Chemotherapy ◽  
Metastatic Cancer ◽  
Performance Status ◽  
Age Groups ◽  
Treatment Strategies ◽  
Cancer Center ◽  
Eol Care ◽  
To Receive

Background: Although palliative chemotherapy during end-of-life (EOL) care is used to relieve symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive EOL care. We evaluated the use of and variables associated with chemotherapy at EOL. Methods: This study included data from patients who died from advanced cancer and underwent palliative chemotherapy between April 2007 and May 2017 at the Department of Palliative Care of Fudan University, Shanghai Cancer Center. Data were collected from hospital medical records. Univariate and multivariate analyses were conducted to identify the variables that independently predicted the use of palliative chemotherapy. Results: Among the 542 patients in the study, 85 (15.7%) underwent palliative chemotherapy during the last month and 28 (5.2%) underwent it during the last 2 weeks of life. Age <59 years (odds ratio [OR] = 1.82, 95% confidence interval [CI]: 1.51-2.61), performance status <3 (OR = 3.73, 95% CI: 1.46-4.67), and cardiopulmonary resuscitation (OR = 3.88, 95% CI: 3.01-5.34) were independently associated with the use of chemotherapy. The use of palliative chemotherapy during the last year of life differed significantly by patient age ( P < .001). Conclusion: The observed chemotherapy rates of 15.7% during the last month of life and 5.2% during the last 2 weeks of life are in line with international recommendations. This study showed that palliative chemotherapy is associated with more aggressive EOL care and indicates that younger patients and those with lower performance status are more likely to receive palliative chemotherapy. Significant variations in EOL treatment strategies among different age groups during the last year of life were also identified.

scholarly journals E-health ecosystem with integrated and stepped psychosocial services for breast cancer survivors: study protocol of a multicentre randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041548
Author(s):  
Cristian Ochoa-Arnedo ◽  
Joan Carles Medina ◽  
Aida Flix-Valle ◽  
Dimitra Anastasiadou
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Randomised Controlled Trial ◽  
Emotional Distress ◽  
Controlled Trial ◽  
Psychosocial Care ◽  
Cost Utility ◽  
Psychosocial Services ◽  
Randomised Controlled

IntroductionPsychosocial interventions for patients with breast cancer (BC) have demonstrated their effectiveness at reducing emotional distress and improving quality of life. The current digitisation of screening, monitoring and psychosocial treatment presents the opportunity for a revolution that could improve the quality of care and reduce its economic burden. The objectives of this study are, first, to assess the effectiveness of an e-health platform with integrated and stepped psychosocial services compared with usual psychosocial care, and second, to examine its cost–utility.Methods and analysisThis study is a multicentre randomised controlled trial with two parallel groups: E-health intervention with integrated and stepped psychosocial services vs usual psychosocial care. An estimated sample of 338 patients with BC in the acute survival phase will be recruited from three university hospitals in Catalonia (Spain) and will be randomly assigned to one of two groups. All participants will be evaluated at the beginning of the study (T1: recruitment), 3 months from T1 (T2), 6 months from T1 (T3) and 12 months from T1 (T4). Primary outcome measures will include number of clinical cases detected, waiting time from detection to psychosocial intervention and proportion of cases successfully treated in the different steps of the intervention, as well as outcomes related to emotional distress, quality of life, post-traumatic stress and growth, treatment adherence and therapeutic alliance. Secondary outcomes will include the acceptability of the platform, patients’ satisfaction and usability. For the cost–utility analysis, we will assess quality-adjusted life years and costs related to healthcare utilisation, medication use and adherence, work absenteeism and infrastructure-related and transport-related costs.Ethics and disseminationThis study was approved by the Ethics committee of the Institut Català d’Oncologia network in Hospitalet, Spain. Findings will be disseminated through peer-reviewed journals, reports to the funding body, conferences among the scientific community, workshops with patients and media press releases.Trial registration numberOnline Psychosocial Cancer Screening, Monitoring and Stepped Treatment in Cancer Survivors (ICOnnectat-B),NCT04372459.

Impact of a hospital specialty pharmacy in partnership with a free-standing care coordination organization on time to delivery and receipt of oral anticancer drugs.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 43-43
Author(s):  
Melissa Parsons Beauchemin ◽  
Morgan RL Lichtenstein ◽  
Rohit R. Raghunathan ◽  
Sahil D Doshi ◽  
Cynthia Law ◽  
...  
Keyword(s):  
Care Coordination ◽  
Multivariable Analysis ◽  
Cancer Center ◽  
Free Standing ◽  
Delivery Date ◽  
Anti Cancer ◽  
Before And After ◽  
Specialty Pharmacy ◽  
Insurance Data ◽  
To Receive

43 Background: Most oral anti-cancer drugs (OACD) prescriptions require extensive coordination between providers and payers, which can delay drug receipt. Specialty pharmacies are intended to facilitate communication between multiple entities to deliver OACDs with increased efficiency. In 2018, our cancer center partnered with Shields Health Solutions (SHS), a freestanding organization providing care coordination to implement a hospital-based specialty pharmacy. We evaluated the rate of failed drug receipt (FR) and time to drug receipt (TTR) before and after specialty pharmacy implementation. Methods: We prospectively collected data on all new OACD prescriptions for adult oncology patients at a large, urban cancer center from 1/1/2018 to 12/31/2019. In fall 2018, a specialty pharmacy was opened to facilitate drug procurement for patients. We collected patient demographic, clinical, and insurance data, OACD name, date prescribed, delivery date, and interactions with payers and financial assistance groups. For prescriptions received, TTR was the number of days from OACD prescription to patient receipt of the drug. FR was defined as failure to receive a prescribed OACD. We excluded OACD prescriptions for a washout period of two months during pharmacy initiation. We used multivariable logistic regression to examine factors associated with TTR > 7 days and FR before and after specialty pharmacy implementation. Results: In total, 883 patients were prescribed 1145 new OACDs. The majority of prescribed drugs were targeted treatment (56%, N = 646) and 72% (N = 819) required prior authorization (PA). Of all prescriptions, 86% (N = 999) were successfully received with an overall median TTR of 7 days. Adjusted analyses showed that patients were more likely to receive their drugs in less than 7 days after specialty pharmacy implementation (OR: 1.4 95% CI 1.04 – 1.81), p = 0.03). In an unadjusted analysis, patients were more likely to receive their initial medications after specialty pharmacy implementation, compared to before specialty pharmacy implementation (89% vs. 84%, p = 0.04). Multivariable analysis showed a trend toward more patients receiving drugs after specialty pharmacy implementation (OR: 1.42, 95% CI 0.98 – 2.03, p = 0.06). Conclusions: The implementation of a hospital-based specialty pharmacy in partnership with SHS decreased TTR. This difference is in part attributable to improved care coordination and communication. A centralized approach may improve overall efficiency due to fewer clinical practice disruptions.

scholarly journals End-Of-Life Discussions Reduce The Utilization of Life-Sustaining Treatments During The Last Three Months of Life in Cancer Patients : A Nationwide Population-Based Cohort Study

2021 ◽  
Author(s):  
Shang-Yih Chan ◽  
Yun-Ju Lai ◽  
Yu-Yen Hsin Chen ◽  
Shuo-Ju Chiang ◽  
Yi-Fan Tsai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiopulmonary Resuscitation ◽  
End Of Life ◽  
Cancer Patients ◽  
Medical Records ◽  
Population Based ◽  
Lower Likelihood ◽  
The Mean ◽  
The Impact ◽  
To Receive

Abstract Purpose Studies to examine the impact of end-of-life (EOL) discussions on the utilization of life-sustaining treatments near death were limited and had inconsistent findings. This nationwide population-based cohort study determined the impact of EOL discussions on the utilization of life-sustaining treatments in the last three months of life in Taiwanese cancer patients. Methods This cohort study included adult cancer patients from 2012–2018, which were confirmed by pathohistological reports. Life-sustaining treatments during the last three months of life included cardiopulmonary resuscitation, intubation, and defibrillation. EOL discussions in cancer patients were confirmed by their medical records. Association of EOL discussions with utilization of life-sustaining treatments were assessed using multiple logistic regression. Results Of 381,207 patients, the mean age was 70.5 years and 19.4% of the subjects utilized life-sustaining treatments during the last three months of life. After adjusting for other covariates, those who underwent EOL discussions were less likely to receive life-sustaining treatments during the last three months of life compared to those who did not (Adjusted odds ratio [AOR]: 0.82; 95% confidence interval [CI]: 0.80–0.84). Considering the type of treatments, EOL discussions correlated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.43, 95% CI: 0.41–0.45), endotracheal intubation (AOR = 0.87, 95%CI: 0.85–0.89), and defibrillation (AOR = 0.52, 95%CI: 0.48–0.57). Conclusion EOL discussions correlated with a lower utilization of life-sustaining treatments during the last three months of life among cancer patients. Our study supports the importance of providing these discussions to cancer patients to better align care with preferences during the EOL treatment.

scholarly journals ACUTE LYMPHOBLASTIC LEUKEMIA EXPERIENCE: EPIDEMIOLOGY AND OUTCOME OF TWO DIFFERENT REGIMENS

2013 ◽  
Vol 5 (1) ◽  
pp. e2013024 ◽  
Author(s):  
Salah Abbasi ◽  
Faten Maleha ◽  
Muhannad Shobaki
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Medical Records ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Complete Response ◽  
Cancer Center ◽  
Poor Prognostic Factor ◽  
Minimal Residual Disease Monitoring ◽  
Adult Acute Lymphoblastic Leukemia

Objectives. Accurate data about adult acute lymphoblastic leukemia (ALL) are lacking. We aim to assess demographics, prognostic factors, and outcome of ALL therapy at King Hussein Cancer Center (KHCC) in Jordan, and to compare the efficacy of two protocols.Methods. We reviewed medical records of adults diagnosed and treated for ALL at KHCC from January, 2006 to December, 2010.Results. Over a 5-year period, 108 patients with ALL were treated (66 with the Hyper-CVAD regimen, and 42 with the CALGB 8811 regimen). Median age at diagnosis was 33 years, with 63% males. The most common immunophenotype was CD10-positive common ALL, and 16% have BCR-ABL translocation. Complete response (CR) rate was 88%. After a median follow-up of 32 months (range, 10-72 months), the median survival (MS) was 30 months, and CR duration (CRD) was 28 months. In the multivariate analysis, the presence of BCR-ABL translocation was the only poor prognostic factor with lower MS of 23 months (p<0.01). There was no difference in MS or CRD between the two used regimens.Conclusion. International protocols for adult ALL were successfully applied to our patients. There is no difference in efficacy between Hyper-CVAD and CALGB 8811 regimens. Future protocols for adult ALL should incorporate new targeted agents and minimal residual disease monitoring to improve outcome.

Patterns and predictors of treatment in muscle-invasive bladder cancer (MIBC): A real-world study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16531-e16531
Author(s):  
Zengqi Lu ◽  
Jessica M. Clement ◽  
Qi Pan ◽  
Helen Swede ◽  
Rajni Mehta ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Real World ◽  
Alternative Treatment ◽  
Standard Care ◽  
Strong Predictor ◽  
Treatment Patterns ◽  
Cancer Center ◽  
Data Set ◽  
Adoption Rate ◽  
To Receive

e16531 Background: Among the approaches to curative-intent therapy for MIBC, neoadjuvant cisplatin-based chemotherapy (NAC) is recognized as the gold standard. The combined modality approach of concurrent chemo-radiation is also considered a standard of care. Despite guidelines recommending multidisciplinary care, studies have shown a low adoption rate of multidisciplinary approaches for MIBC. This study aimed to describe the treatment patterns for MIBC pts using real world data. Methods: Following the appropriate IRB approvals, investigators followed a common protocol under the auspices of the Rapid Case Ascertainment at the Yale Cancer Center. Manual chart review was performed on MIBC pts diagnosed in Connecticut from 2004 –2015 and treated at investigator-affiliated hospitals. Information on medical history, comorbidity, and treatment types were recorded. This data set was linked to the Surveillance, Epidemiology, and End Results (SEER) database for demographic information. The descriptive and logistic regression were used to analyze treatment patterns and predicators in each treatment lines: surgery alone, chemotherapy alone, radiation alone and standard care (NAC followed by surgery; surgery followed by adjuvant chemotherapy and concurrent chemo-radiation). Results: The number of adult MIBC pts in the cohort was 1,198. Among them, 290 (24.2%) received surgery as the only treatment; 117 (9.8%) received chemotherapy only; 100 (8.3%) received concurrent chemo-radiation; 96 (8.0%) received NAC followed by surgery. Besides age ( OR: 0.546, 95% CI: 0.289-0.986), when comparing female to male patients on the likelihood of receiving NAC to the alternative treatment types (radiation or surgery), female pts were less likely to receive NAC than males (OR: 0.421, 95% CI: 0.184-0.930). Conclusions: Regardless of demographics, the overall adoption rate of standard care was low, consisting of 236 pts (19.7%) of the population. From the logistic regression results, age was consistently shown as a predictor for receiving NAC over the alternative treatment types, and sex was identified as another strong predictor. Older and female patients were less likely to receive NAC than younger males.[Table: see text]

Electronic Medical Records, HIPAA, and Patient Privacy

2011 ◽  
pp. 1795-1804
Author(s):  
Jingquan Li ◽  
Michael J. Shaw
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Cancer Center ◽  
Privacy Policy ◽  
Patient Privacy ◽  
Healthcare Organizations ◽  
Privacy And Security ◽  
University Of Texas ◽  
Healthcare It ◽  
The University

The continued growth of healthcare information systems (HCIS) promises to improve quality of care, lower costs, and streamline the entire healthcare system. But the resulting dependence on electronic medical records (EMRs) has also kindled patient concern about who has access to sensitive medical records. Healthcare organizations are obliged to protect patient records under HIPAA. The purpose of this study is to develop a formal privacy policy to protect the privacy and security of EMRs. This article describes the impact of EMRs and HIPAA on patient privacy in healthcare. It proposes access control and audit log policies to safeguard patient privacy. To illustrate the best practices in the healthcare industry, this article presents the case of the University of Texas M. D. Anderson Cancer Center. The case demonstrates that it is critical for a healthcare organization to have a privacy policy.

Meaning-Centered Psychotherapy

2021 ◽  
pp. 489-494
Author(s):  
Melissa Masterson Duva ◽  
Wendy G. Lichtenthal ◽  
Allison J. Applebaum ◽  
William S. Breitbart
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
Psychosocial Care ◽  
Well Being ◽  
Cancer Center ◽  
Existential Psychology ◽  
Patients With Cancer ◽  
Spiritual Well Being ◽  
The Face

Existential concerns carry significant distress, particularly among patients with advanced cancer. For patients who are facing death, a sense of meaning—and the preservation of that meaning—is not only clinically and existentially important but also central to providing holistic, high-quality end-of-life care. Nearly two decades ago, the authors’ research group at Memorial Sloan Kettering Cancer Center began to understand that a meaning-centered approach to psychosocial care was imperative to alleviate the existential distress that plagued many patients with advanced cancer. Based on Viktor Frankl’s work on the importance of meaning and principles of existential psychology and philosophy, they developed Meaning-Centered Psychotherapy (MCP) to help patients with advanced cancer sustain or enhance a sense of meaning, peace, and purpose in their lives in the face of terminal cancer. This chapter provides an overview of MCP in working with patients with cancer. It summarizes the ever-growing body of research that has demonstrated the effectiveness of MCP in improving meaning, spiritual well-being, and quality of life and in reducing psychological distress and despair at end of life. Adaptations of MCP for other purposes and populations, such as cancer survivors, caregivers, and bereavement, are mentioned but are elaborated on in other specific chapters related to these issues in this textbook.

scholarly journals CMET-34. IMPROVEMENT OF LEPTOMENINGEAL DISEASE FOLLOWING INFECTIOUS MENINGITIS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi59-vi59 ◽  
Author(s):  
Nicholas Metrus ◽  
Carolos Kamiya ◽  
Shiao-Pei Weathers ◽  
Christa Seligman ◽  
Barbara O’Brien
Keyword(s):  
Median Survival ◽  
Post Infection ◽  
Systemic Disease ◽  
Cancer Center ◽  
Cns Infection ◽  
Leptomeningeal Disease ◽  
History Of ◽  
Md Anderson ◽  
To Receive ◽  
Systemic Therapies

Abstract INTRODUCTION The incidence of leptomeningeal disease (LMD) is increasing, due to better imaging, earlier diagnosis and improved systemic disease control. However, many of the systemic therapies do not cross the blood brain barrier (BBB) and, despite treatment with radiation and/or intrathecal (IT) chemotherapy, median survival is approximately 4-6months in solid tumors complicated by LMD. Repeated IT injections increase the risk of CNS infection. Preclinical models have shown that infectious meningitis transiently modifies the BBB. METHODS Our series consisted of 6 LMD patients (5 breast cancer primary, 1 lung cancer primary) treated on IT chemotherapy at MD Anderson Cancer Center between 2013 and 2018, who subsequently developed infectious meningitis. Three patients had history of parenchymal metastases in addition to LMD and four had history of radiation to brain and/or spine. LMD was confirmed by cytology and/or imaging. All were treated with IT topotecan. RESULTS CSF cultures were positive for Proprionobacterium acnes in three patients, Pseudomonas aeruginosa in two, and Raoultella ornithinolytica in one, who died shortly thereafter. Antibiotic regimens were variable. Three patients went on to receive IT chemotherapy post-infection (two never discontinued IT chemotherapy throughout infection). Those that had IT chemotherapy post-infection cleared CSF and imaging findings of LMD or maintained stability of radiographic LMD burden until death. No patients died directly from LMD. One patient, who developed infection after Ommaya placement and was never initiated on IT chemotherapy, still cleared his CSF of malignant cells. Excluding the patient who died shortly after meningitis diagnosis, the average time from meningitis diagnosis to death was 8.8 months and the average median survival from LMD diagnosis to death was 14 months. CONCLUSION Our findings support further evaluating the safety and timing of IT chemotherapy with active infectious meningitis and the potential synergistic benefit of increased immunogenicity and chemotherapy in LMD.

scholarly journals The general practitioner as the first contacted health professional by patients with psychosocial problems: a European study

1999 ◽  
Vol 29 (3) ◽  
pp. 689-696 ◽  
Author(s):  
WIENKE G. W. BOERMA ◽  
PETER F. M. VERHAAK
Keyword(s):  
Health Care ◽  
Social Workers ◽  
Medical Records ◽  
Psychosocial Care ◽  
Psychosocial Problems ◽  
The Self ◽  
Referral System ◽  
European Study ◽  
Practice Organization ◽  
Perceived Involvement

Background. There are considerable differences between and within countries in the involvement of general practitioners (GPs) in psychosocial care. This study aimed to describe the self-perceived role of GPs in 30 European countries as the first contacted professional for patients with psychosocial problems, and to examine the relationship with characteristics of the health care system, practice organization and doctors.Methods. Data collected in the European Study of GP Task Profiles were analysed in relation to the self-perceived involvement of GPs in psychosocial care. In 30 countries 7233 GPs answered standardized questionnaires in their own languages about seven brief case scenarios. The questions focused on care given as the first health care professional contacted, and were answered in a scored scale (1–4) ranging from ‘never’ to ‘almost always’. Independent variables examined were both on a national level and on an individual level, including: listed practice population, referral system, employment status of GPs, workload, measures of practice organization, contacts with social workers and urbanization of practice area. Data were analysed using multi-level techniques.Results. Self-perceived involvement in psychosocial care was much higher in Western than in Eastern Europe and also in countries with a referral system. Cooperation with social workers, rural practice, keeping medical records, presence of an appointment system and high workload were positively associated with this perceived involvement.Conclusions. In countries with self-employed doctors and a referral system, GPs are in a better position to provide psychosocial care. GPs should be encouraged to cooperate with social workers and to keep medical records of their patient contacts routinely.

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