scholarly journals COVD-25. THE PARADOXICAL EFFECTS OF COVID-19 ON CANCER CARE IN THE NEURO-ONCOLOGY SETTING

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii26-ii26
Author(s):  
Nicole Cort ◽  
Alex Broom ◽  
Katherine Kenny ◽  
Alexander Page ◽  
Jennifer Durling ◽  
...  
Keyword(s):  
Cancer Care ◽  
Standard Of Care ◽  
Adult Brain ◽  
Evidence Based ◽  
Negative Consequences ◽  
Traditional Practice ◽  
Delivery Of Care ◽  
Paradoxical Effects ◽  
Oncology Care ◽  
The Impact

Abstract COVID-19 has caused ongoing interruptions to healthcare systems worldwide, shifting care to virtual platforms, and placing significant economic and logistical burdens on clinical practice. The pandemic has created uncertainty in delivering the standard of care, both in areas of cancer diagnosis and treatment, especially within neuro-oncology. Due to the pandemic, care and operational planning goals have shifted to infection prevention, modifying recommendations to decrease viral transmission and increasing telemedicine use, potentially creating a burden on implementing evidence-based medicine. These dynamics have since begun to redefine traditional practice and research regimens, impacting the comprehensive care that cancer patients can and should receive; and the enduring consequences for the delivery of healthcare. The impact of COVID-19 on oncology practice and trials might endure well beyond the short- to mid-term of the active pandemic. Therefore, these shifts must be accompanied by improved training and awareness, enhanced infrastructure, and evidence-based support to harness the positives and offset the potential negative consequences of the impacts of COVID-19 on cancer care. To address these paradoxical effects, we will conduct iterative, qualitative (face-to-face/video conference) interviews with neuro-oncology clinical and research professionals and adult brain tumor patients receiving care during the pandemic. We will capture unique aspects of oncology care: the lived, subjective, situated, and contingent accounts of patients and medical professionals, especially during a pandemic. We will also specifically compare the impact of telehealth during the pandemic on delivery of care to complex neuro-oncology patients. A summary of this in-depth, qualitative approach will result in a sophisticated understanding of neuro-oncology care on the frontline at a time of crisis, as experienced during a pandemic, to articulate best practices for future implementation.

scholarly journals Cost Savings Analysis of Individualized Exercise Oncology Programs

2019 ◽  
Vol 18 ◽  
pp. 153473541983946 ◽  
Author(s):  
Karen Y. Wonders ◽  
Rob Wise ◽  
Danielle Ondreka ◽  
Josh Gratsch
Keyword(s):  
Cancer Care ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Standard Of Care ◽  
National Standard ◽  
Cost Burden ◽  
Post Intervention ◽  
Before And After ◽  
The Impact ◽  
Exercise Oncology

Background: The physical and economic toll of cancer make it a high health priority. The rising cost of cancer care is now a primary focus for patients, payers, and providers. Escalating costs of clinical trials and national drug regulations have led the median monthly costs of cancer drugs to rise from less than $100 in 1965 to 1969, to more than $5000 in 2005 to 2009, stressing the importance of finding innovative ways to reduce cost burden. In the present study, we report the economic evaluation of an individualized exercise oncology program beginning early after diagnosis. Methods: An independent research group, ASCEND Innovations, retrospectively analyzed patient records to statistically demonstrate the impact of exercise oncology during cancer treatment. All patients completed 12 weeks of prescribed, individualized exercise that included cardiovascular, strength training, and flexibility components. The 3 primary hospital measures leveraged for statistical comparison before and after supportive care enrollment were number of encounters, number of readmissions, and average total charges, as well as emergency room visits and length of hospital stay ( P < .05). Results: The resulting dataset consisted of 1493 total hospital encounters for 147 unique patients. The results statistically demonstrate a positive effect of exercise oncology during cancer care, in terms of reductions in overall cost per patient pre- to post-intervention. Conclusions: Individualized exercise oncology programs should be employed as part of the national standard of care for individuals battling cancer, in order to improve patient outcome and reduce cost burden.

Reducing the Cost of Cancer Care: How to Bend the Curve Downward

2012 ◽  
pp. e46-e51 ◽  
Author(s):  
Thomas J. Smith ◽  
Bruce E. Hillner ◽  
Ronan J. Kelly
Keyword(s):  
Cancer Care ◽  
Clinical Pathways ◽  
Cost Curve ◽  
Evidence Based ◽  
Curative Therapy ◽  
Appropriate Care ◽  
Insurance Costs ◽  
Oncology Care ◽  
The Cost ◽  
Care Costs

Overview: Health care and cancer care costs are rising unsustainably such that insurance costs have doubled in 10 years. Oncologists find themselves both victims of high costs and the cause of high-cost care by what we do and what we do not do. We previously outlined five ways that oncologists could personally bend the cost curve downward and five societal attitudes that would require change to lower costs. Here, we present some practical ways to reduce costs while maintaining or improving quality, including: 1) evidence-based surveillance after curative therapy; 2) reduced use of white cell stimulating factors (filgrastim and pegfilgrastim); 3) better integration of palliative care into usual oncology care; and 4) use of evidence-based, cost-conscious clinical pathways that allow appropriate care and lead to equal or better outcomes at one-third lower cost.

Using a disease pathway management approach to improve the quality of breast cancer care in Ontario.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 109-109
Author(s):  
Andrea Eisen ◽  
Jasmin Soobrian ◽  
Ashley Tyrrell ◽  
Clement Li ◽  
Derek Muradali ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Quality Indicators ◽  
Cancer Care ◽  
Evidence Based ◽  
Breast Cancer Care ◽  
Patient Journey ◽  
The Impact

109 Background: Disease Pathway Management (DPM) is used by Cancer Care Ontario (CCO) to set priorities for cancer control, plan cancer services, and improve the quality of care in Ontario by promoting standardization. The DPM approach applies a framework to examine the performance of the entire system from prevention to end of life care, and to identify any gaps within the system. In 2014, DPM began its breast cancer pathway initiative by mapping the patient journey, depicting evidence-based best practice along the breast cancer care continuum, identifying where further guidance is needed for clinical decision making, and identifying gaps in quality of care and performance measurement indicators. Objective: To evaluate the impact of DPM on quality assessment of breast cancer care in Ontario. Methods: DPM convened a multidisciplinary breast cancer working group (WG) of 40 experts from across Ontario. The WG held 12 meetings and used guidelines developed by CCO’s Program in Evidence Based Care (or other sources as needed) to generate pathways for the prevention, screening and diagnosis, treatment, and follow-up care for breast cancer. The pathways were used as a framework to review the existing inventory of provincial breast cancer quality indicators, and to identify areas where evidence based guidance is needed. The pathways were subjected to an extensive review process before publication. Results: The expert WG identified 28 priority areas, including opportunities to develop guidance in areas where it is lacking (e.g. role of perioperative breast MRI; indications for contralateral prophylactic mastectomy) and system barriers that may hinder optimal care (e.g. biomarker assessment). The WG also used the pathways as a framework for evaluating performance measurement indicators by mapping 48 existing quality indicators for breast cancer to the pathway. Conclusions: The CCO DPM Breast Cancer pathways facilitated a province-wide, multidisciplinary process to promote quality standards, to identify gaps and overlaps in performance and quality measurement, and to recommend additional indicators more relevant to the quality of breast cancer care in Ontario.

Quality improvement and implementation science in cancer care: Identifying areas of synergy and opportunities for further integration.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 29-29
Author(s):  
Devon Check ◽  
Leah L. Zullig ◽  
Melinda Davis ◽  
Angela M. Stover ◽  
Louise Davies ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Implementation Science ◽  
Cancer Care ◽  
Performance Monitoring ◽  
Care Delivery ◽  
Evidence Based ◽  
Theoretical Frameworks ◽  
Randomized Design ◽  
Stakeholder Input ◽  
The Impact

29 Background: Efforts to improve cancer care delivery have been driven by two approaches: quality improvement (QI) and implementation science (IS). QI and IS have developed independently but have potential for synergy. To inform efforts to better align these fields, we examined 20 cancer-related QI and IS articles to identify differences and areas of commonality. Methods: We searched PubMed for cancer care studies that used IS or QI methods and were published in the past 5 years in one of 17 leading journals. Through consensus-based discussions, we categorized studies as QI if they evaluated efforts to improve the quality, value, or safety of care, or IS if they evaluated efforts to promote the adoption of evidence-based interventions into practice. We identified the 10 most frequently cited studies from each category (20 total studies), characterizing and comparing their objectives, methods – including use of theoretical frameworks involvement of stakeholders – and terminology. Results: All IS studies (10/10) and half (5/10) of QI studies addressed barriers to uptake of evidence-based practices. The remaining five QI studies sought to improve clinical outcomes, reduce costs, and/or address logistical issues. QI and IS studies employed common approaches to change provider and/or organizational practice (e.g., training, performance monitoring/feedback, decision support). However, the terminology used to describe these approaches was inconsistent within and between IS and QI studies. Fewer than half (8/20) of studies (4 from each category) used a theoretical or conceptual framework and only 4/20 (2 from each category) consulted key stakeholders in developing their approach. Most studies (10/10 IS and 6/10 QI) were multi-site, and most were observational, with only 4/20 studies (2 from each category) using a randomized design to evaluate their approach. Conclusions: Cancer-related QI and IS studies had overlapping objectives and used similar approaches but used inconsistent terminology. The impact of IS and QI on cancer care delivery could be enhanced by greater harmonization of language and by promoting rigor through the use of conceptual frameworks and stakeholder input.

Elevating the standard of care: Impact of a regimen-level prior authorization tool on provider adherence to clinical guidelines.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19235-e19235
Author(s):  
Rogelio Alberto Brito ◽  
Geri Kuklinski ◽  
Patricia Angelica ◽  
Anne Claussen ◽  
Diana Fischer ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Quality Care ◽  
Standard Of Care ◽  
Clinical Decision ◽  
Cost Of Care ◽  
Evidence Based ◽  
Prior Authorization ◽  
Total Cost ◽  
Nccn Guidelines ◽  
The Impact

e19235 Background: New developments in oncology therapy continue to grow in complexity, fueling a dramatically rising cost of care. Traditional care models present opportunities to streamline plan sponsor management efforts, expedite therapy, and improve health outcomes. Studies suggest adherence to evidence-based standards results in higher quality care. Current plan sponsor management platforms match medical policy to individual drugs, not to combination therapy regimens and lack real-time access to standard treatment guidelines. 70% of precertification requests are submitted via antiquated, cumbersome methods such as paper and fax. Methods: CVS Health/Aetna developed a comprehensive oncology solution featuring an enterprise web-based clinical decision support prior authorization tool (Novologix) at the regimen level to reduce administrative burden and support quality care. Novologix regimens were updated via collaboration with the National Comprehensive Cancer Network (NCCN) evidence-based guidelines. Groups also entered a value-based payment (VBP) model to help support quality of care by promoting adherence to NCCN guidelines when clinically appropriate and tool utilization. Eligible members were Commercial, fully-insured members newly diagnosed with breast, colorectal, or lung cancer. Providers were offered dedicated, individual training sessions to provide education on the Novologix tool. NCCN-aligned regimens requested through the platform were automatically certified. Any non-NCCN aligned regimens received accelerated medical review by a board-certified medical oncologist with the option for an external peer-to-peer review upon denial. Providers received ongoing quality and cost of care reporting. Results: Primary in progress. N of precertification requests submitted via Novologix ( 28 requests as of 1/23/2020) - (will include graph displaying N of requests by month). N of regimens submitted via Novologix that were automatically certified (46% as of 1/23). Avg turnaround times for modified regimen requests requiring clinical review (TBD). Avg % adherence to NCCN guidelines (100% as of 1/23/20) Secondary: Total cost of care (preliminary/other leading indicator). Conclusions: By engaging oncology practices through an enhanced payer-provider collaboration and implementing an automated regimen-level precertification process we can facilitate higher-quality oncology care. Future studies will be needed to measure the impact of this program on total cost of care.

The impact of COVID-19 pandemic on access to new patient cancer care as evaluated in the Integra Connect Database (ICD).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18792-e18792
Author(s):  
Mike Gart ◽  
Prateesh Varughese ◽  
Lucio N. Gordan ◽  
Trevor Heritage ◽  
Greg Brown ◽  
...  
Keyword(s):  
Cancer Care ◽  
Real World Data ◽  
Cancer Society ◽  
Disease States ◽  
Care Access ◽  
Diagnosis Codes ◽  
Oncology Care ◽  
Oncology Providers ◽  
Tumor Types ◽  
The Impact

e18792 Background: The Covid-19 pandemic has affected all aspects of life. Integra Connect sought to assess its impact on new visits for cancer care by querying its Electronic Medical Record and Claims database as a surrogate for understanding Covid’s impact on cancer care in the larger United States population. Methods: Using Real World Data (RWD) from over 1200 oncology providers in 14 large practice settings, comprising 250 plus care sites in the ICD, we measured new patient (Pt) and established Pt visits from 2018 through 2020. Centers for Medicare & Medicaid Services (CMS) codes for new and established Pt’s were applied to define cohorts. Disease states were defined using CMS Oncology Care Model (OCM) mapping to diagnosis codes. Because the ICD is heavily based in the Eastern US, we conducted a geographic analysis by segmenting providers by Northeast (NE) with 506 providers from NY, NJ, PA, and VA and Southeast (SE) with 578 providers from FL, GA, SC, and AL. We looked at visits across all tumor types and identified breast cancer (BC) and colorectal cancer (CC) as likely to be most affected by decreased screening, and multiple myeloma (MM) and advanced prostate cancer (APC) as likely to be vulnerable to delay in initiation of first treatment since treatment often trails diagnosis. Results: We found a decline in new patient volume (NPV) in ‘20 of -1% compared to ‘19; this compared to an anticipated increase of +7% based on growth in NPV in the ICD from ‘18 to ‘19. In the NE we saw NPV decrease in ‘20 by -7% vs. ‘19 but increase by +6% in the SE compared to ‘19. In comparing NPV ‘20 to ’19 and ’19 to ‘18, we saw a smaller increase for BC of +4% vs. +6% and for CC of +5% vs. +7%, respectively. Whereas in MM it was -7% vs. +3% and APC -6% vs. +8%. (See Table). Conclusions: Covid-19 has negatively impacted cancer care access. This RWD shows the number of both newly diagnosed Pts and those with initial oncologic intervention in established Pts, where symptoms traditionally have determined initiation of treatment, has declined year-over-year. The American Cancer Society projected new Pt cases to increase +2% in ‘20 to 1.806 million ( ACS, Cancer Facts and Figures 2020), whereas in the ICD, that figure was projected +7% but resulted in -1%. This suggests a major expected reduction of new Pt cases in the US at large. The drop in cases during Covid-19 in our data was greater in the NE compared to the SE. In addition, the drop in the NE in our data was earlier and more prolonged than SE. While recovery occurred in both regions, after an initial overshoot following lockdowns, volumes plateaued at levels lower than pre-pandemic.[Table: see text]

Perceptions of cancer patients and their caregivers regarding COVID-19 pandemic in Ethiopia.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24116-e24116
Author(s):  
Aynalem Abraha Woldemariam ◽  
Nataliya Berbyuk Lindström ◽  
Rune Andersson ◽  
Adamu Addissie
Keyword(s):  
Cancer Patients ◽  
Cancer Care ◽  
Information Needs ◽  
Addis Ababa ◽  
Cross Sectional Study ◽  
Ethical Review ◽  
Cross Sectional ◽  
Tikur Anbessa Specialized Hospital ◽  
Oncology Care ◽  
The Impact

e24116 Background: Limited research is available about COVID 19 pandemic in Ethiopia in general and in relation to cancer care in particular. Ethiopia reported the first COVID-19 in March, 2020. The number of cases is increasing, putting much pressure on oncology care. This study examines what the Ethiopian cancer patients and their caregivers knew about COVID 19 after the initial stages of the pandemic. It also assesses the information needs, psychological experiences as well as the impact of pandemic on oncologist-patient-caregiver communication and treatment process. Methods: A cross-sectional study was conducted among 200 participants (100 cancer patients and 100 caregivers) at the initial stage of pandemic (May 1 - June 30, 2020) at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Data was collected using a pre-tested, structured questionnaire to assess knowledge and perceptions on COVID-19. Ethics approval was obtained from the Ethical Review Board of TASH (04/14/2015) and the Ethical Review Board of Western Sweden (DNR 520-18). Results: The results indicate that though both cancer patients and their caregivers show a high awareness of and knowledge about COVID 19, they need more information about the risks specific to cancer patients. The respondents are also concerned about the risks of pandemic outbreak in Ethiopia and its impact on availability of cancer care treatments in the country. The respondents report experiencing psychological concerns in relation to the pandemic. The higher educated patients and caregivers report being more concerned than the lower educated respondents. Delays in appointments and therapy are the main concerns in relation to cancer care. Further, both patients and caregivers experience that the restrictions on the number of caregivers present during interactions with oncologists negatively influence communication, resulting in relatives being excluded and patients experiencing loneliness and lack of support. Conclusions: Getting a better insight into knowledge and awareness of COVID-19 among cancer patients and their caregivers is essential for managing the effects of pandemic in cancer care. To our knowledge, there was no similar study in Ethiopia. The results of the study contribute to insights into patient and caregiver awareness of COVID 19, essential for adoption of health care protective practices, providing information and managing oncologist-patient-caregiver communication.

Assessing the use of low value oncology care following the release of Choosing Wisely guidelines.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18861-e18861
Author(s):  
Alexander Gunn ◽  
Melissa Sarver ◽  
Samantha J Kaplan ◽  
Yousuf Zafar ◽  
Rachel Adams Greenup
Keyword(s):  
Cancer Screening ◽  
Guideline Adherence ◽  
Cancer Care ◽  
Systemic Treatment ◽  
The United States ◽  
Choosing Wisely ◽  
Surveillance Imaging ◽  
Patient Reported ◽  
Oncology Care ◽  
The Impact

e18861 Background: Low -value care contributes to the high costs of cancer treatment. Almost a decade has passed since the American Society of Clinical Oncology (ASCO) Choosing Wisely campaign identified costly diagnostic testing, radiographic imaging, and therapies that are routinely utilized in cancer care despite lacking evidence of benefit. We sought to evaluate the impact of ASCO Choosing Wisely guidelines and to identify barriers to and facilitators of guideline adherence. Methods: A systematic review of published literature from 2012-2021 was performed in accordance with PRISMA guidelines on the trend in use of low value oncology care. All ten of ASCO Choosing Wisely Guidelines were selected for inclusion; these included recommendations focused on cancer screening, staging and surveillance imaging, and systemic treatment and support. The following databases were searched for original research based in the United States: PubMed, CINAHL, Embase, Web of Science, Scopus, and ASCO Meeting abstracts. Eligible studies were examined for information on design, population, and study outcomes, which included guideline adherence and facilitators and barriers to implementation. All citations were independently dual-screened in a blinded fashion by authors (AG, MS). Results: 35 independent studies were identified from 3,590 unique citations and included n = 1,130,216 patients. Data sources captured large claims database analyses (13 studies, n = 1,069,289), institutional studies (14 studies, n = 53,358), patient-reported surveys (2 studies, n = 915), and interventional studies (6 studies, n = 6654). Adherence to ASCO Choosing Wisely guidelines ranged from 13% to 100% overall. Use of low value oncology care varied depending on the area of recommendation, such as cancer screening (44% to 77%), staging and surveillance imaging (30% to 100%), and systemic treatment and support (13% to 100%). Adherence was facilitated by: (a) physician awareness of and education around the recommendations; (b) patient engagement; (c) embedded EHR best practice alerts; (d) guideline alignment with insurance payer requirements; and (e) integrated healthcare systems. Barriers to guideline incorporation included perceived patient anxiety and concerns about patient satisfaction; illness-specific practices; and time needed for patient-provider conversations regarding low value care. Conclusions: Adherence to the ASCO Choosing Wisely guidelines is variable across the cancer care continuum. Health system and policy-level interventions are needed to further reduce the overuse of low value care in oncology.

scholarly journals Characteristics of sleep-conducive music: A narrative evidence review

2020 ◽  
Vol 7 (3) ◽  
pp. 430-437
Author(s):  
Yuluan Wang ◽  
Annette Rivard ◽  
Christine Guptill ◽  
Carol Boliek ◽  
Cary Brown
Keyword(s):  
Sleep Disturbances ◽  
Meta Analysis ◽  
Sleep Onset ◽  
Well Being ◽  
Future Research ◽  
Evidence Based ◽  
Negative Consequences ◽  
Evidence Review ◽  
Evidence Based Guidelines ◽  
The Impact

Objectives: Sleep deficiency (SD) is a prevalent problem and has serious negative consequences for physical, cognitive, and psychological well-being. The use of music as a non-pharmacological sleep intervention has been proposed in several studies. A 2014 meta-analysis of 10 randomized trials evaluating the impact of music on sleep concluded that it can decrease sleep onset delay (latency) and sleep disturbances, increases sleep duration, and improves daytime dysfunction.  It appears that, to-date, evidence-based guidelines for the selection and/or production of sleep-promoting music do not exist.  This review addresses that gap and synthesizes available literature towards the goal of developing guidelines grounded in the evidence-based characteristics of sleep conducive music. Design and Results: A narrative review of research papers relevant to the topic identified evidence-based characteristics of sleep-conducive music related to tempo, rhythm, pitch, volume, and duration. Conclusion: This identification and compilation of evidence-based characteristics of sleep-conducive music can underpin future research that targets development and testing of specific music to promote sleep.  

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