Abstract P36: Virtual cancer care in a tertiary care academic centre in Ireland during the COVID-19 pandemic - An analysis of physician and patient opinion

2021 ◽  
Author(s):  
Mary N. O'Reilly ◽  
Mark Doherty
Keyword(s):  
Cancer Care ◽  
Tertiary Care ◽  
Patient Opinion

scholarly journals Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Kirtika Patel ◽  
R. Matthew Strother ◽  
Francis Ndiangui ◽  
David Chumba ◽  
William Jacobson ◽  
...  
Keyword(s):  
Cancer Care ◽  
Cost Model ◽  
Tertiary Care ◽  
Care Hospital ◽  
Middle Income ◽  
Western Kenya ◽  
Middle Income Countries ◽  
Resource Limited ◽  
Limited Setting ◽  
Low And Middle Income

Background: Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service.Objectives, methods and outcomes: Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to are source-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme.Conclusion: Development of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment.

A Qualitative Analysis of Oncology Patient Awareness of Medication Shortages and Their Preferences for How Shortages Should Be Managed

2020 ◽  
pp. JOP.19.00608
Author(s):  
Andrew Hantel ◽  
Fay J. Hlubocky ◽  
Mark Siegler ◽  
Christopher K. Daugherty
Keyword(s):  
Cancer Care ◽  
Management Practices ◽  
Care Center ◽  
Tertiary Care ◽  
Weighted Average ◽  
Structured Interview ◽  
Decision Makers ◽  
Oncology Patient ◽  
Cross Sectional ◽  
Multiple Decision Makers

PURPOSE: Medication shortages in US hospitals are ongoing, widespread, and frequently involve antineoplastic and supportive medications used in cancer care. The ways shortages are managed and the ways provider-patient communication takes place are heterogeneous, but the related preferences of oncology patients are undefined. This study sought to qualitatively evaluate patient preferences. METHODS: A cross-sectional, semi-structured interview study was conducted from January to June 2019. Participants were adult oncology inpatients who received primary cancer care at the University of Chicago, had undergone treatment within 2 years, and had 1 or more previous hospitalizations during that period. Participants (n = 54) were selected consecutively from alternating hematology and oncology services. The primary outcome was thematic saturation across the domains of awareness of medication shortages, principle preferences regarding decision makers, preferences regarding allocation of therapy drugs, and allocation-related communication. RESULTS: Thematic saturation was reached after 39 participants completed the study procedures (mean age, 59.6 years [standard deviation, 14.5 years]; men made up 61.5% of the study population [mean age, 24 years]; response rate, 72.0%). In all, 18% of participants were aware of institutional medication shortages. Patients preferred having multiple decision makers for allocating medications in the event of a shortage. A majority of patients named oncologists (100%), ethicists (92%), non-oncology physicians (77%), and pharmacists (64%) as their preferred decision makers. Participants favored allocation of drugs based on their efficacy (normalized weighted average, 1.3), and they also favored prioritizing people who were already receiving treatment (1.8), younger patients (2.0), sicker patients (3.1), and those presenting first for treatment (5.3). Most participants preferred preferred disclosure of supportive care medication shortages (74%) and antineoplastic medication shortages (79%) for equivalent substitutions. CONCLUSION: In a tertiary-care center with medication shortages, few oncologic inpatients were aware of shortages. Participants preferred having multiple decision makers involved in principle-driven allocation of scarce medications. Disclosure was preferred when their usual medications needed to be substituted with equivalent alternatives. These preliminary data suggest that preferences do not align with current management practices for medication shortages.

scholarly journals Treatment of Pancreatic and Periampullary Cancers at a Community Hospital: Successful Application of Tertiary Care Treatment Standards

2011 ◽  
Vol 2011 ◽  
pp. 1-8
Author(s):  
Robert C. Moesinger ◽  
Jan W. Davis ◽  
Britani Hill ◽  
W. Cory Johnston ◽  
Carl Gray ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Care ◽  
Tertiary Care ◽  
National Standards ◽  
Trial Participation ◽  
Periampullary Cancer ◽  
Published Data ◽  
Cancer Centers ◽  
Periampullary Neoplasms ◽  
Low Volume

Background. The treatment of pancreatic cancer and other periampullary neoplasms is complex and challenging. Major high-volume cancer centers can provide excellent multidisciplinary care of these patients but almost two-thirds of pancreatic cancer patients are treated at low volume centers. There is very little published data from low volume community cancer programs in regards to the treatment of periampullary cancer. In this study, a review of comprehensive periampullary cancer care at two low volume hospitals with comparison to national standards is presented.Methods. This is a retrospective review of 70 consecutive patients with periampullary neoplasms who underwent surgery over a 5-year period (2006–2010) at two community hospitals.Results. There were 51 successful resections of 70 explorations (73%) including 34 Whipple procedures. Mortality rate was 2.9%. Comparison of these patients to national standards was made in terms of operative mortality, resectability rate, administration of adjuvant therapy, clinical trial participation and overall survival. The results in these patients were comparable to national standards.Conclusions. With adequate commitment of resources and experienced surgical and oncologic practitioners, community cancer centers can meet national tertiary care standards in terms of pancreatic and periampullary cancer care.

scholarly journals Impact of Covid-19 Pandemic on the Treatment of Cancer Patients Registered at a Tertiary Care Centre in Eastern India

2021 ◽  
Vol 6 (S1) ◽  
pp. 11-16
Author(s):  
Arnab Kumar Ghosh ◽  
Bappaditya Chhatui ◽  
Bhukya Swetha ◽  
Anis Bandyopadhyay ◽  
Niladri Roy ◽  
...  
Keyword(s):  
Disease Progression ◽  
Cancer Patients ◽  
Cancer Care ◽  
Family Income ◽  
Tertiary Care ◽  
Treatment Facility ◽  
Treatment Delays ◽  
Social Distress ◽  
Per Capita ◽  
Cost Of Transportation

Background: Cancer care has suffered during the covid-19 pandemic due to diversion of manpower to treat covid patients and introduction of lockdown measures. Delay in treatment is detrimental to cancer patients. During the national lockdown, many patients were not able to visit our treatment facility. We conducted this study to evaluate the detriment caused by the pandemic on cancer care in terms of disease progression and the socio economic factors associated with delay in presentation.Materials and Methods: Patients visiting our OPD who were being treated at our department and could not visit the facility during the lockdown were selected. Present status of the disease was assessed using clinical examination and radiological tests. Psycho social distress was assessed using PO BADO SF questionnaire. Disease progression, cause of delay was assessed against various factors like per capita family income, cost of transportation etc. Appropriate statistics was used to analyse and represent the data. Results: 50% patients had disease progression. “High cost of transportation” was the most common response given by patients for not visiting the treatment facility during the lockdown. Most patients being treated with radiotherapy (69%) had responded either “high cost of transportation” or “lack of proper accommodation” as cause of delay (p 0.065). Patients with treatment gap of 80 days or more had higher per capita family income, higher cost of transportation during the lockdown and larger distance between residence and treatment facility. 77.5% patients had psycho social distress according to assessment by PO BADO SF questionnaire.Conclusion: COVID 19 pandemic control measures have impacted cancer care in resulting in disease progression, treatment delays and psycho-social distress. A number of factors may have contributed to the treatment delays like high cost of transportation during the lockdown, longer distance between residence and hospital.

scholarly journals Effects of oncological care pathways in primary and secondary care on patient, professional and health systems outcomes: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Jolanda C. van Hoeve ◽  
Robin W.M. Vernooij ◽  
Michelle Fiander ◽  
Peter Nieboer ◽  
Sabine Siesling ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cancer Care ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Tertiary Care ◽  
Evidence Base ◽  
System Level ◽  
Care Pathways ◽  
Positive Effects ◽  
Oncological Care

Abstract Background: Pathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify, and synthesise existing literature on the effects of pathways in oncological care. Methods: All patients diagnosed with cancer in primary and secondary/tertiary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding patients, professionals and system level were extracted from each study. Results: Out of 13,847 search results, we selected 158 articles eligible for full text assessment. 150 studies were excluded and the remaining eight studies represented 4,786 patients. Most studies were conducted in secondary/tertiary care. Length of Stay (LOS) was the most common used indicator, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter LOS regarding gastric cancer (Weighted Mean Difference (WMD)): -2.75, CI: -4.67–-0.83) and gynaecological cancer (WMD: -1.58, CI: -2.10–-1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups. Conclusions: Despite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary/tertiary care regarding the positive effects of LOS in favour of cancer care pathways. Systematic review registration: PROSPERO CRD42017057592

Timing of adjuvant chemotherapy in stage III colon cancer as a measure of quality: Reasons for noncompliance.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 640-640
Author(s):  
Omar M. Rashid ◽  
Karen A. Coyne ◽  
Thomas W. Ross ◽  
David Shibata
Keyword(s):  
Colon Cancer ◽  
Cancer Care ◽  
Tertiary Care ◽  
Stage Iii ◽  
Cancer Center ◽  
Patient Centered ◽  
Stage Iii Colon Cancer ◽  
Lost To Follow Up

640 Background: The Institute of Medicine's report on improving cancer care, along with the evolution of ASCO's Quality Oncology Practice Initiative, has helped to develop process measures into critical quality of cancer care indicators. One such measure relates to "receipt of chemotherapy for stage III colon cancer (CC) within 120 days of diagnosis" and is now being incorporated into processes including hospital accreditation (American College of Surgeons; ACS), managed care contracts and Center for Medicare and Medicaid Services (CMS) quality monitoring. To better understand potential pitfalls related to the strict guidelines of this measure, we sought to evaluate institutional adherence at a tertiary care cancer center and to examine the reasons for non-compliance. Methods: A retrospective review was performed of all cases of stage III colon cancer reported at a single institution from 2008 – 2012. Coding for compliance was performed using standard ACS guidelines. Results: A total of 122 eligible cases were identified and consisted of 49 (40.2%) women and 73 (59.8%) men with a median age of 58 (range 32 - 77). Overall, 15 (12.3%) cases were non-compliant with 2 (1.6%) lost to follow up. Of the non-compliant cases, 14 (93.3%) cases did go on to receive chemotherapy while 1 (6.7%) never received adjuvant treatment. Of those receiving delayed treatment, 7 were due to patient-centered factors [e.g. patient timing preference (n=4), request for chemotherapy closer to home (n=2) and lost to follow up (n=1)]. Other reasons included delays at outside facilities (n=4), postoperative complications (n=1) and insurance approval (n=1). In 2 cases, designation of date of diagnosis based on suspicion rather than definitive biopsy contributed to non-compliant status. Conclusions: Our center averaged an annual compliance with the CC adjuvant therapy measure of approximately 90%. Larger scale studies are indicated to determine whether refinements in coding guides that account for patient preferences, clear diagnosis dates and cross-facility care could better reflect quality of care, and also promote improved patient-centered multidisciplinary management.

Incidence of asymptomatic COVID-19 positivity in cancer patients and effects on therapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13506-e13506
Author(s):  
Nicole Ross ◽  
Elizabeth A. Handorf ◽  
Caitlin R. Meeker ◽  
Giana Chen ◽  
Donald Baldwin ◽  
...  
Keyword(s):  
General Population ◽  
Cancer Care ◽  
Care Delivery ◽  
Conditional Logistic Regression ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Future Research ◽  
Co Morbidity ◽  
Procedure Type

e13506 Background: As the coronavirus disease 2019 (COVID-19) pandemic threatens the delivery of cancer care, challenges to providing safe and quality care persist. Screening measures including SARS-CoV-2 polymerase-chain reaction (CovPCR) testing prior to invasive procedures, therapy administration, were instituted to address risk of spread from asymptomatic (AS) pts. Studies have documented poor outcomes with COVID-19 in cancer pts with rate of AS COVID-19 ranging from 0.6%- 8%. (Liang et.al, 2020; Al-Shamsi, et.al, 2020, Shah et.al. 2020). In the general population, rates of AS cases was estimated to be 17% (Byambasuren, O., 2020). This study aimed to examine the incidence and characteristics of AS COVID -19 in cancer pts, and determine its effect on cancer care delivery at a tertiary care center. Methods: With IRB approval, a retrospective chart review was conducted on cancer pts undergoing CoVPCR screening. Pts were considered AS if they had no recent fever (≥100.5 °F), cough, headache, loss of taste/smell, shortness of breath, diarrhea, or high risk exposure. This analysis compared cases (positive CoVPCR) identified by screening of AS pts to control (negative CoVPCR) pts (matched by planned procedure type and month of screening). Each COVID case was matched to 2 negative controls on month and planned procedure type. Patient characteristics and outcomes were compared between cases and controls using conditional logistic regression or Mantel-Haenszel tests. Results: Between 03/2020 and 09/2020, 4143 AS pts underwent CovPCR testing and 75 were chosen for analysis (25 cases; 50 controls). The incidence of AS COVID-19 in cancer pts was 0.6% (25/4143). Median age was lower in the cases (64 vs 70y, p = 0.04). Gender, race, primary cancer diagnosis, and co-morbidity distribution was similar between cases and controls. Of the cases, 10 pts (40%) never underwent the planned oncologic intervention while 11 (44%) had a delay related to the positive CoVPCR (2 pts had no intervention planned). Only 1 pt (2%) in control arm didn’t undergo the planned procedure. The mean duration of delay was 18 days (range 0-49 days, SD 16.72) in cases versus Zero days in control. Four (16.7%) cases developed symptoms within 14 days of positive CoVPCR testing but the PCR value did not predict this conversion. Conclusions: Incidence of AS COVID in our cancer pts was significantly lower than general population. Active screening delayed oncologic care but with institution of safety measures like separate treatment rooms and scheduling procedures at the end of the day have ensured safe and prompt cancer care delivery during the pandemic. Future research needs will address incorporating vaccination status into the screening algorithm to limit widespread CoVPCR screening, thus improving care delivery and cost effectiveness.

What to do with screening for distress scores? Integrating descriptive data into clinical practice

2013 ◽  
Vol 12 (1) ◽  
pp. 25-38 ◽  
Author(s):  
Marie-Claude Blais ◽  
Alexandre St-Hilaire ◽  
Lise Fillion ◽  
Marie De Serres ◽  
Annie Tremblay
Keyword(s):  
Cancer Care ◽  
Tertiary Care ◽  
Well Being ◽  
Assessment System ◽  
Routine Screening ◽  
Cutoff Score ◽  
Care Hospital ◽  
Descriptive Data ◽  
Nurse Navigator ◽  
Screening For Distress

AbstractObjective:Implementation of routine Screening for Distress constitutes a major change in cancer care, with the aim of achieving person-centered care.Method:Using a cross-sectional descriptive design within a University Tertiary Care Hospital setting, 911 patients from all cancer sites were screened at the time of their first meeting with a nurse navigator who administered a paper questionnaire that included: the Distress Thermometer (DT), the Canadian Problem Checklist (CPC), and the Edmonton Symptom Assessment System (ESAS).Results:Results showed a mean score of 3.9 on the DT. Fears/worries, coping with the disease, and sleep were the most common problems reported on the CPC. Tiredness was the most prevalent symptom on the ESAS. A final regression model that included anxiety, the total number of problems on the CPC, well-being, and tiredness accounted for almost 50% of the variance of distress. A cutoff score of 5 on the DT together with a cutoff of 5 on the ESAS items represents the best combination of specificity and sensitivity to orient patients on the basis of their reported distress.Significance of results:These descriptive data will provide valuable feedback to answer practical questions for the purpose of effectively implementing and managing routine screening in cancer care.

scholarly journals Retrospective Analysis of Early Impact of COVID-19 on Systemic Cancer Treatment—A Pilot Study

2021 ◽  
Vol 42 (01) ◽  
pp. 015-020
Author(s):  
Anakha Pattiyeil ◽  
Febin Antony ◽  
Sunu L Cyriac ◽  
Anilkumar Jose ◽  
Jini M. P.
Keyword(s):  
Cancer Care ◽  
Medical Oncology ◽  
Care Center ◽  
Tertiary Care ◽  
Significant Drop ◽  
Relaxation Phase ◽  
Number Of Patients ◽  
Increased Risk ◽  
The Impact

Abstract Introduction Cancer care during the coronavirus disease 2019 (COVID-19) pandemic is challenging as the patients are at an increased risk of developing complications compared with the general population. Objectives This study was conducted to assess the impact of COVID-19 pandemic and nationwide lockdown on systemic cancer care. Materials and Methods This comparative descriptive study was conducted in the Department of Medical Oncology and Haematology in a tertiary care center in India. The study compared and analyzed the consecutive patient data of two different units in the Department of Medical Oncology in the pre-COVID phase (PCP) and post lockdown relaxation phase (PLRP). We represented the categorical data in frequency and percentage, and chi-squared test was used to analyze the variables. Results Patients were categorized based on demographic, disease-related, and hospital visit-related parameters and a significant drop noted in patients who utilized a prebooking facility (p = 0.0001), in the number of patients aged >50 years (p = 0.004), number of patients who presented with hematological malignancies (p = 0.006), and who came for follow-up (p = 0.0001). The other parameters remained statistically insignificant. Conclusions During PLRP, active systemic cancer care seems to have been less affected, whereas follow-up of patients and visits of elderly patients were significantly reduced. If the pandemic remains under control, cancer care may not get compromised. This shows the importance of flattening the curve for quality management of other diseases during a pandemic.

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