Advances in Medical Oncology, Research, and Education

e20711 Background: Recent advances in medical oncology research and new possibilities of care create a growing number of treatment-related complications. Due to these clinical relevant toxicities a significative number of patients have to admit to our hospital emergency rooms in the recent years. Data from different institutions in Italy suggest that an integrated model of supportive care dedicated to symptoms management and not only, is more effective for cancer patient’s care. Methods: In the last seven months of 2012 we started the “supportive care-team” activity giving a dedicated-room inside the day hospital offering to the patients a direct and early management of chemotherapy toxicities (mucositis, febrile neutropenia, etc.) and “new drugs” induced toxicities (cutaneous, hypertension/cardiovascular, infective, etc.). The medical and nurse team does receive the patient without appointment, based on the severity of clinical problems and give a mobile phone consult all days in the morning. Patients receive symptomatic therapy, i.v. fluid infusions, collecting of blood samples, corrections of medical therapies (e.g. pain therapy), venous accesses management for one-day or more until resolution and physicians are able to organize further specialists evaluations. Moreover, there are strictly linked specialists such as anesthesiology involved in all cases of severe drugs adverse reactions. Other two ancillary support activities the for patients are offered by the psychologist and chaplain daily inside the day hospital. Results: During all 2012 we have delivered 13.365 courses of anticancer therapies in 1,358 patients. All these were outpatients. During the last 7 months of 2012 we have made 761 unplanned visits (median number/day 6, range 0-13) and the team did respond to 1,138 phone calls (median number/day 9, range 2-24). Conclusions: These analysis does attempt to answer to the main question of reducing hospitalizations and their related costs. Our new organizative model prompt to maintain much more the management of oncologic patients inside the oncologic department and to increase the feasibility of patient’s continuos care, improving symptoms control and patient’s quality of life.

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Clinical trials networks and enrollment of historically underrepresented populations in medical oncology trials

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e20598 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e20598-e20598

Author(s):

J. L. Berkowitz ◽

A. Fernandez ◽

R. A. Dichmann ◽

K. A. Kennedy ◽

B. DiCarlo

Keyword(s):

Clinical Trials ◽

Medical Oncology ◽

Cancer Center ◽

Underrepresented Populations ◽

Oncology Research ◽

Academic Center ◽

Clinical Investigations ◽

Number Of Patients ◽

Bony Metastases ◽

Two Populations

e20598 Background: Oncology research is limited by the very low number of patients accrued into clinical trials. Clinical trials networks may help to overcome this limitation by allowing investigations designed through academic centers to be available to patients seen in community practices that are far from these centers. This allows for increased accrual and access for these patients while potentially increasing the pace of progress in clinical oncology research. Methods: In this study, we attempted to determine the effect that clinical trials networks can have on the accrual of cancer patients into clinical investigations. We retrospectively analyzed the records from 2002–2008 of a private practice located over 150 miles from an academic center for accrual into trials. This practice is a member of a clinical trials network affiliated with a major academic cancer center. Accrued patients were divided into subgroups based upon type of malignancy, ethnicity and whether or not they were elderly. In addition, from 2007–2008, the percentage of patients accrued into trials relative to the total number treated onsite was calculated and compared to national averages. Results: In this period, a total of 139 patients at this practice were accrued into clinical trials. By malignancy, they were as follows: breast 36%, colorectal 22%, lung 13%, prostate 8.4%, gastric and lymphoma each 3.0%, pancreatic 1.8%, melanoma 1.2% and ovarian 0.6%. The other 18 patients were in trials for either chemotherapy related anemia 7.8% or bony metastases 3.0%. Of the 139 patients, 45% were elderly and 16% were Hispanic, both markedly higher than national averages. For 2007–2008, 12% of patients that received on site treatment were accrued on to trials. For lung, colorectal, and breast cancer, the number of patients on trial as a percentage of all treated onsite were also higher than the national averages. Conclusions: Clinical trial networks allow a higher percentage of total patients to be accrued than the national average and greatly enhance the potential for both minority and elderly enrollment, two populations that have been historically underrepresented in major clinical trials. It may also help to accelerate the progress of medical oncology research towards better treatments for all patients. No significant financial relationships to disclose.

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