Screening and Assessment in Pediatric Psycho-Oncology

2021 ◽  
pp. 687-695
Author(s):  
Darcy E. Burgers ◽  
Sarah J. Tarquini ◽  
Anne E. Kazak ◽  
Anna C. Muriel
Keyword(s):  
Pediatric Oncology ◽  
Standards Of Care ◽  
Psychosocial Needs ◽  
Systematic Screening ◽  
Current Implementation ◽  
Oncology Care ◽  
Different Cultures ◽  
The Impact ◽  
Brief Screening

This chapter provides an overview of current and recommended practices regarding systematic screening and assessment of psychosocial needs in pediatric oncology. The chapter reviews published recommendations from the Psychosocial Standards of Care Project for Childhood Cancer and provides information about validated instruments for brief screening of children and their families. It also describes guidelines for using follow-up symptom-based measures and in-person clinical assessment. It includes a summary of what is known about the current implementation of screening nationally, and possible steps to enhance implementation. There is also special consideration of screening and assessment of unique medical populations within pediatric oncology, children with developmental concerns, and families from different cultures. Future directions include using implementation science to develop models for routine screening and demonstrating the impact of screening on psychosocial outcomes for patients and families and on the system of pediatric oncology care.

scholarly journals IMPACT OF THE COVID-19 PANDEMIC ON THE AVAILABILITY OF MEDICAL CARE AMONG ONCOLOGICAL PATIENTS

2021 ◽  
Vol 74 (7) ◽  
pp. 1542-1551
Author(s):  
Klaudia Ewa Kościelecka ◽  
Aleksandra Joanna Kuć ◽  
Daria Małgorzata Kubik ◽  
Tomasz Męcik-Kronenberg ◽  
Dariusz Ceglarz
Keyword(s):  
Cancer Treatment ◽  
Medical Care ◽  
Healthcare System ◽  
Careful Analysis ◽  
Oncological Patients ◽  
Polish Society ◽  
Oncology Treatment ◽  
Oncology Care ◽  
The Impact

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.

scholarly journals OP17 Impact of phenotypic and genetic factors on Crohn’s Disease evolution in a cohort of 13,926 patients

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S016-S017
Author(s):  
Q Zhang ◽  
L Fachal ◽  
R Shawky ◽  
M Parkes ◽  
C Anderson ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Progression ◽  
Management Strategies ◽  
Standards Of Care ◽  
Disease Evolution ◽  
The Impact ◽  
Disease Location ◽  
Over Time

Abstract Background Patients with Crohn’s disease (CD) can develop complications including stricturing and penetrating disease [1, 2]. Although reliable baseline predictors of disease progression are urgently needed to inform management strategies, few studies have comprehensively explored the phenotypic and genetic determinants of disease progression in a sufficiently powered cohort. Methods We used data from 13,926 patients with CD in the UK IBD BioResource to investigate the effects of clinical phenotypes and genetics on CD progression. Median follow-up was 10.6 years and total follow-up was 193,033 patient-years. We applied the Montreal classification system to define disease as B1 (inflammatory), B2 (stricturing) and B3 (penetrating). Patients with B2 or B3 disease (N = 5,185) were compared to patients with B1 disease (N = 8,471) in a multivariate model fitted with both phenotype data and a polygenic score that we developed. Associations with q-values (false discovery rate adjusted p-values) less than 0.05 were defined as statistically significant. Results CD progression occurred over time from diagnosis (Figure 1). Consistent with previous findings, we confirmed factors including smoking, disease location and perianal disease were associated with disease progression [3] (Table 1). The impact of a genetic influence on disease progression was confirmed and shown to be independent of genetic effects on disease location [4]. Early prescription of medications showed a protective effect on disease progression: Infliximab, adalimumab and thiopurines significantly reduced the chance of B2/B3 progression when prescribed within two years of diagnosis. Additionally, we observed a decreased progression to B2/B3 disease in patients diagnosed recently (between 2012–2020) compared to those diagnosed before 2012. This finding persisted after conditioning on exposure to biologics and correcting for follow-up time and interval to first thiopurine prescription, and thus may be indicative of other improvements in standards of care in recent years. Conclusion Using a large, well-characterised cohort we confirm the importance of disease location, smoking status and genetics on disease progression. We highlight the positive impact of early medication prescription on disease progression and discover an independent signal relating to potential improvements in the standard of care in CD over time. These results create the framework for reliable predictors of CD progression that may better guide future CD management strategies. References

Community oncologists' perceptions three years after the Oncology Care Model.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 113-113
Author(s):  
Jonathan Karl Kish ◽  
Ting-Chun Yeh ◽  
Ajeet Gajra ◽  
Yolaine Smith ◽  
Bruce A. Feinberg
Keyword(s):  
Patient Care ◽  
Survey Methodology ◽  
Care Plan ◽  
Psychosocial Needs ◽  
Care Model ◽  
Patient Navigators ◽  
Chemotherapy Administration ◽  
Episodes Of Care ◽  
Oncology Care ◽  
The Impact

113 Background: The Oncology Care Model (OCM) is a Medicare-sponsored delivery and payment innovation pilot under the broader concept of value-based care (VBC). OCM aims to provide better quality and coordinated cancer care at reduced cost. The OCM participants, 176 practices and 10 payers who provide care to nearly half of Medicare beneficiaries, entered into payment arrangements based on financial and performance accountability for episodes of care surrounding chemotherapy administration. We sought to understand the impact of OCM adoption on community physicians 3 years into the pilot. Methods: A live meeting in April 2019 convened a sample of US-based community oncologists to discuss “The OCM Experience”. Audience response survey methodology addressed: participation in OCM and/or related commercial programs, implementation, operation and perceptions of outcomes to patient care and practice. Results: Regarding VBC initiatives at the practices (n = 48) of 57 providers: 61% identified their practice participated in OCM, 31% in other commercial payer pathway program, and 17% in other commercial payer VBC reimbursement (not mutually exclusive). Regarding impact of OCM on improving access to care: 60% indicated having same-day appointments, 45% 24/7 HCP access, 22% weekend hours and 18% evening clinic hours. Regarding changes to patient care: 58% stated OCM driven initiatives reduced ER visits, 48% reduced hospitalizations, 62% increased palliative care referrals, and 54% increased hospice referrals. Regarding impact on practice: 41% felt an increased administrative burden with 50% hiring administrative staff, advanced practice providers, and patient navigators, but only 11% hiring physicians. The 13-component oncology care plan was reported by 53% as “not easy” to devise. The “most challenging” components included estimating total out of pocket expenses (61%) and creating a plan to address psychosocial needs (16%). 49% respondents found their practices’ OCM transformation meaningful and 46% found it not very/not at all meaningful. Conclusions: The impact of OCM/VBC transformation upon community oncologists and their practices appear to be quite profound, while the precise impact on their patients remains to be determined.

scholarly journals Canadian Resources, Programs, and Models of Care to Support Cancer Survivors’ Transition beyond Treatment: A Scoping Review

2021 ◽  
Vol 28 (3) ◽  
pp. 2134-2145
Author(s):  
Claudia Romkey-Sinasac ◽  
Stephanie Saunders ◽  
Jacqueline Galica
Keyword(s):  
Supportive Care ◽  
Cancer Survivors ◽  
Models Of Care ◽  
Practice Recommendations ◽  
Canadian Association ◽  
Care Models ◽  
Oncology Care ◽  
The Impact ◽  
Broad Overview

(1) Background: One in two Canadians will be diagnosed with cancer in their lifetime, but as a result of the progress in diagnosis and treatment, more individuals are surviving cancer than ever before. However, the impact of cancer does not end with treatment. The objectives of this review are to (1) provide a broad overview of the supportive care interventions and models of care that have been researched to support Canadian post-treatment cancer survivors; and (2) analyze how these supportive care interventions and/or care models align with the practice recommendations put forth by Cancer Care Ontario (CCO) and the Canadian Association of Psychosocial Oncology/Canadian Partnership Against Cancer (CAPO/CPAC). (2) Methods: An electronic search was completed in MEDLINE, Embase, PsycINFO, and CINAHL in January 2021. Included studies described supportive care interventions or models of care utilized by adult Canadian cancer survivors. (3) Results: Forty-two articles were included. Survivors utilized a multitude of supportive care interventions, with peer support and physical activity programs being most frequently cited. Four models of follow-up care were identified: primary care, oncology care, shared-care, and transition clinics. The supportive care interventions and models of care variably aligned with the recommendations set by CCO and CAPO/CPAC. The most commonly followed recommendation was the promotion of self-management and quality resources for patients. (4) Conclusions: Results indicate an inconsistency in access to supportive care interventions and the delivery of survivorship care for cancer survivors across Canada. Current efforts are being made to implement the recommendations by CCO and CAPO/CPAC; however, provision of these guidelines remains varied.

scholarly journals Psychological Response to the Diagnosis of Advanced Cancer: A Systematic Review

2021 ◽  
Author(s):  
Mei Bai
Keyword(s):  
Systematic Review ◽  
Advanced Cancer ◽  
Effect Size ◽  
Interquartile Range ◽  
Psychosocial Needs ◽  
Distress Symptoms ◽  
Oncology Care ◽  
Quality Rating

Abstract Background Despite major efforts to address psychological distress and quality of life (QOL) in people with cancer, only none to small intervention effect has been observed. There is reason to question whether psychosocial needs of patients have already been met under the usual oncology care. Purpose The purpose of this systematic review was to examine changes in depression, anxiety and QOL during the existential plight in advanced cancer. Methods A literature search was performed in the PubMed and APA PsycINFO databases from year 1976 up to May 31, 2021. Longitudinal observational or experimental research targeting depression, anxiety or QOL in advanced cancer (stage III or IV), with baseline time since cancer diagnosis within 100 days, follow-up within 16 weeks post-baseline were eligible. Quality rating was based on the GRADE guidelines. Results Overall QOL did not reveal clinically relevant changes for the majority of studies as evaluated by effect size and raw score changes (median effect size 0.01, interquartile range −0.10–0.15). Nonetheless, modest to moderate improvement was found for depression (median effect size 0.28, interquartile range 0.03–0.38) and anxiety (median effect size 0.57, interquartile range 0.32–0.79). Conclusion Transient distress symptoms and temporarily reduced functioning in the oncology setting may be considered normal, whereas impaired overall QOL needs to be addressed. Developing innovative interventions that enhance QOL for patients newly diagnosed with advanced cancer without interfering with patients’ natural adaptation process is imperative.

The impact of C1/D1 treatment follow-up calls on emergency room visits for chemotherapy patients.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 289-289
Author(s):  
Kimberly Davidson
Keyword(s):  
High Risk ◽  
Emergency Room ◽  
Hospital Readmissions ◽  
Care Coordinator ◽  
Risk Patients ◽  
Oncology Care ◽  
New Treatment ◽  
Chemotherapy Patients ◽  
The Impact

289 Background: One of the more challenging aspects of managing patients receiving chemotherapy is to reduce Emergency Room (ER) visits and ultimately hospital readmissions. Patients may not understand who or when to call with issues and may be concerned about reaching their physician or receiving a call back in a reasonable amount of time. Methods: C1/D1 calls were initiated with the Medical Oncology Care Coordinator (CC) staff in August 2017. All patients receiving a C1/D1 dose of a new treatment and change in regimen were called by the CC. During this call, the patient is asked several questions including how they are currently feeling, if they are having any issues as well as reviewing contact information and direction regarding if they have a fever. Re-education was provided to the staff in January 2018 regarding the importance of the calls. Also at this time, the CC were asked to do Nadir calls (repeat call 7-10 days after D1) for those patients who were determined to be high risk (percentage calculated using a toxicity formula). Results: Initially the % of ER visits were reduced after the C1/D1 calls were initiated but then began trending upward again. After re-education and the initiation of the Nadir calls, ER visits again trended down. Conclusions: Increased touch points with patients, including C1/D1 follow up calls, Nadir calls and toxicity checks for high risk patients contributed to a downward trend of treatment patients visiting the ER.[Table: see text]

The impact of COVID-19 pandemic on oncology workload: The experience of an Italian Reference Cancer Center.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13520-e13520
Author(s):  
Carla Corvaja ◽  
Giada Targato ◽  
Silvio Ken Garattini ◽  
Cristina Barazzutti ◽  
Alessandra Bin ◽  
...  
Keyword(s):  
Substantial Reduction ◽  
Cancer Center ◽  
Cancer Treatments ◽  
Peak Period ◽  
Accountability System ◽  
New Therapy ◽  
Global Pandemic ◽  
Oncology Care ◽  
The Impact

e13520 Background: Since its outbreak in January 2020, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic dramatically affected health systems worldwide and a prompt realignment of clinical activities had to be thought. International Oncology guidelines recommended that routine oncology care continued to be delivered, ensuring triage procedures to prevent COVID-19 diffusion alongside treatments prioritization. Aim of this study was to assess the variation of activity volumes due to COVID-19 pandemic in the Oncology Department of the Academic Reference Cancer Center of Udine, Italy. Methods: We extracted activity volumes from the electronic “Data Warehouse” accountability system and compared activity in 2020 with historical activity in 2019. We then narrowed the analysis to the peak of COVID-19 pandemic, comparing data of a four-months period (February-May 2020 vs 2019). In accordance with the Italian Association of Medical Oncology guidelines, the activities analyzed included: new patients referrals, first consultations, new therapy assignments, treatment prescriptions and therapy administrations, disease re-assessments, follow-up visits, tele-examinations, unplanned visits and ward discharges. Results: Overall, throughout COVID-19 pandemic a negligible reduction in the number of first consultations (-5%) and new patients referrals to our Oncology Department (-10%) was detected. Of note, a significant reduction in the number of unplanned oncologic visits was observed (-23%). The replacement of follow up visits with telephonic interviews with the interpretation of laboratory and radiologic examinations (tele-examinations) led to a substantial reduction in follow-up visits throughout 2020 (-25%). Conversely, treatment-related activities, including new therapy assignments (+1%), treatment prescriptions and therapy administrations (+2% and +3%, respectively), confirmed the increasing trend of the previous year. Interestingly, similar trends were observed in the four-months peak period with a substantially higher decrease in follow-up visits in 2020 vs 2019 (-51%), whereas treatment-related activities remained stable. Conclusions: In the context of COVID-19 pandemic, our Oncology Department maintained stable performances on critical oncology activities. Strict triage procedures, serial swabs for patients and healthcare professionals and strategic follow-up visits remodulation were crucial. Notwithstanding the significant decrease in cancer treatments observed in several published reports, our experience demonstrates that the reorganization of oncology departments during a global pandemic is feasible and it should be pursued to preserve patients’ safety without compromising the continuum of care.

Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance

2020 ◽  
pp. 1-16
Author(s):  
Julie L. Wambaugh ◽  
Lydia Kallhoff ◽  
Christina Nessler
Keyword(s):  
Retrospective Analysis ◽  
Sound Production ◽  
Apraxia Of Speech ◽  
Practice Schedule ◽  
Practice Schedules ◽  
Baseline Performance ◽  
The Mean ◽  
Number Of Treatment ◽  
The Impact

Purpose This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech. Method Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined. Results The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics. Conclusions Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12–14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance. Supplemental Material https://doi.org/10.23641/asha.12592190

Research Participation Experiences of Informants of Suicide and Control Cases

Crisis ◽  
2010 ◽  
Vol 31 (5) ◽  
pp. 238-246 ◽  
Author(s):  
Paul W. C. Wong ◽  
Wincy S. C. Chan ◽  
Philip S. L. Beh ◽  
Fiona W. S. Yau ◽  
Paul S. F. Yip ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Research Participation ◽  
Self Report ◽  
Initial Contact ◽  
Psychological Autopsy ◽  
Autopsy Study ◽  
The People ◽  
And Control ◽  
The Impact

Background: Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. Aims: (1) To investigate whether informants of suicide cases recruited by two approaches (coroners’ court and public mortuaries) respond differently to the initial contact by the research team. (2) To explore the reactions, reasons for participation, and comments of both the informants of suicide and control cases to psychological autopsy interviews. (3) To investigate the impact of the interviews on informants of suicide cases about a month after the interviews. Methods: A self-report questionnaire was used for the informants of both suicide and control cases. Telephone follow-up interviews were conducted with the informants of suicide cases. Results: The majority of the informants of suicide cases, regardless of the initial route of contact, as well as the control cases were positive about being approached to take part in the study. A minority of informants of suicide and control cases found the experience of talking about their family member to be more upsetting than expected. The telephone follow-up interviews showed that none of the informants of suicide cases reported being distressed by the psychological autopsy interviews. Limitations: The acceptance rate for our original psychological autopsy study was modest. Conclusions: The findings of this study are useful for future participants and researchers in measuring the potential benefits and risks of participating in similar sensitive research. Psychological autopsy interviews may be utilized as an active engagement approach to reach out to the people bereaved by suicide, especially in places where the postvention work is underdeveloped.

Coexistent Osteoarthritis and Parkinson’s Disease: Data from the Parkinson’s Foundation Outcomes Project

2020 ◽  
Vol 10 (4) ◽  
pp. 1601-1610
Author(s):  
Jaimie A. Roper ◽  
Abigail C. Schmitt ◽  
Hanzhi Gao ◽  
Ying He ◽  
Samuel Wu ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Study Data ◽  
Functional Mobility ◽  
Quality Improvement Initiative ◽  
Timed Up And Go ◽  
Mobility Performance ◽  
Risk Of Mortality ◽  
The Impact

Background: The impact of concurrent osteoarthritis on mobility and mortality in individuals with Parkinson’s disease is unknown. Objective: We sought to understand to what extent osteoarthritis severity influenced mobility across time and how osteoarthritis severity could affect mortality in individuals with Parkinson’s disease. Methods: In a retrospective observational longitudinal study, data from the Parkinson’s Foundation Quality Improvement Initiative was analyzed. We included 2,274 persons with Parkinson’s disease. The main outcomes were the effects of osteoarthritis severity on functional mobility and mortality. The Timed Up and Go test measured functional mobility performance. Mortality was measured as the osteoarthritis group effect on survival time in years. Results: More individuals with symptomatic osteoarthritis reported at least monthly falls compared to the other groups (14.5% vs. 7.2% without reported osteoarthritis and 8.4% asymptomatic/minimal osteoarthritis, p = 0.0004). The symptomatic group contained significantly more individuals with low functional mobility (TUG≥12 seconds) at baseline (51.5% vs. 29.0% and 36.1%, p < 0.0001). The odds of having low functional mobility for individuals with symptomatic osteoarthritis was 1.63 times compared to those without reported osteoarthritis (p < 0.0004); and was 1.57 times compared to those with asymptomatic/minimal osteoarthritis (p = 0.0026) after controlling pre-specified covariates. Similar results hold at the time of follow-up while changes in functional mobility were not significant across groups, suggesting that osteoarthritis likely does not accelerate the changes in functional mobility across time. Coexisting symptomatic osteoarthritis and Parkinson’s disease seem to additively increase the risk of mortality (p = 0.007). Conclusion: Our results highlight the impact and potential additive effects of symptomatic osteoarthritis in persons with Parkinson’s disease.

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