The Support, Education, and Advocacy (SEA) Program of Care for Women With Metastatic Breast Cancer: A Nurse-Led Palliative Care Demonstration Program

2019 ◽  
Vol 36 (10) ◽  
pp. 864-870 ◽  
Author(s):  
Victoria Reiser ◽  
Margaret Rosenzweig ◽  
Ann Welsh ◽  
Dianxu Ren ◽  
Barbara Usher
Keyword(s):  
Breast Cancer ◽  
Palliative Care ◽  
Social Service ◽  
Patient Reported Outcomes ◽  
Metastatic Breast ◽  
Well Being ◽  
Mean Difference ◽  
Generalized Anxiety ◽  
Supportive Services ◽  
Patient Reported

Background: Women with metastatic breast cancer (MBC) experience unique symptom management and psychosocial needs due to aggressive, yet palliative treatment with a progressive, chronic illness. Objective: This article describes the effect of a quality improvement project for coordination of supportive care in MBC. Program evaluations included referral rates for supportive services, patient-reported outcomes of symptom distress, generalized anxiety, and overall well-being. Design: An interdisciplinary Support, Education and Advocacy Program (MBC-SEA) was developed. The 1-hour, weekly, patient review included collaborative assessments to determine needs for social service, psychological counseling, and palliative care. A prospective pre- and postexperimental cohort design with convenience sampling was used. Analysis was conducted with paired t test analysis of pre- and postimplementation outcomes. Setting/Participants: Program outcomes of 118 women with MBC visiting an urban outpatient breast cancer clinic during September 2016 to November 2016 (pre) and January 2017 to March 2017 (post) were evaluated. Measurements: Referral rates to social work and palliative care, symptom, anxiety, and overall well-being scores. Results: Following program implementation, referrals to palliative care and social work supportive services increased significantly including patient-reported outcomes symptom distress scores mean difference 1.4 (95% confidence interval [CI]: 0.4306-2.6428), P = .004; generalized anxiety scores mean difference 1.5 (95% CI: 0.5406-2.5781), P = .003; and overall well-being mean difference of −0.7 (95% CI: −1.3498 to −0.0570), P = .03. Conclusions: Purposeful nurse-led assessment for social service and palliative care needs increases referrals with improvement in patient-reported outcomes.

The effect of a structured weekly patient meeting on patient reported outcomes (PRO) and resource utilization for patients with metastatic breast cancer (MBC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23116-e23116
Author(s):  
Margaret Q. Rosenzweig ◽  
Victoria Resier ◽  
Rachel Heckman ◽  
Ann Welch ◽  
Dianxu Ren
Keyword(s):  
Palliative Care ◽  
Emergency Room ◽  
Program Implementation ◽  
Patient Reported Outcomes ◽  
Hospital Admissions ◽  
Well Being ◽  
Care Utilization ◽  
Emergency Room Visits ◽  
Supportive Services ◽  
Patient Reported

e23116 Background: Women with MBC experience unmet unique symptom management and psychosocial needs due to chronic treatment for an eventually life ending illness. Methods: The MBC Program of Care is a 1 hour weekly, nurse led review of scheduled clinic patients by an interdisciplinary team incorporating structured needs appraisal and referral for supportive, palliative care resources. Outcomes included referral rates to supportive services, patient reported outcomes (PRO) of symptom distress, generalized anxiety and overall well-being. Health care utilization outcomes included clinic calls as well as inpatient and emergency room visits. A prospective, paired pre and post experimental design. One hundred and eighteen women with MBC who visited an urban outpatient breast cancer clinic from September 2016-November 2016 (pre) and from January 2017-March 2017 (post). Validated instruments of symptoms ( Adapted Memorial Symptom Assessment), anxiety (Generalized Anxiety Scale), and overall well-being scores (0-10 Likert) assessed PROs. Electronic chart review evaluated social work and palliative care referrals, hospital admissions, emergency room visits and phone calls to the outpatient clinic pre and post program implementation. T test and chi squared test for paired comparison of mean was performed. Results: Following program implementation, referrals to palliative care (p = .000) and social work (p = .001) increased significantly. PROs of symptoms (p = .001); anxiety (p = 0.002); and overall well-being (p = .002) improved significantly. Health care utilization including emergency department visits (p = .001) and patient calls (p = .005) decreased significantly post program implementation, although hospital admissions increased (p = .003). Cost of program was $750 weekly. Conclusions: Systematic review of patient needs and referral to existing supportive services improved MBC PROs and decreased emergency room visits and clinic calls. Post hospital admission increase may be attributed to MBC disease progression. This is a cost effective MBC model of palliative care implementation.

The Significance of Patient-Reported Outcomes for Metastatic Breast Cancer Patients

2022 ◽  
Author(s):  
Larissa Elisabeth Hillebrand ◽  
Ulrike Söling ◽  
Norbert Marschner
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Metastatic Breast Cancer ◽  
Cancer Treatment ◽  
Patient Reported Outcomes ◽  
Metastatic Breast ◽  
Treatment Decision ◽  
Breast Cancer Patients ◽  
Treatment Decision Making ◽  
Patient Reported

Background: Breast cancer is still the most common malignancy in women worldwide. Once metastasized, breast cancer treatment primarily aims at reducing symptom burden, thereby trying to maintain and improve a patient´s quality of life (QoL), delaying disease progression, and prolonging survival. Curing the disease is not possible in the palliative setting. To better understand metastatic breast cancer patients, their symptoms and wishes, which are important for treatment-decision making and outcome, patient-reported outcomes (PROs) are of great importance, giving an impression of what really matters to and concerns a patient. Summary: Many advances have been made to implicate PROs in clinical trials, non-interventional studies, registries, and clinical routine care of metastatic breast cancer. For example, large phase III trials like PALOMA-3 (NCT01942135), MONALEESA-7 (NCT02278120), HER2CLIMB (NCT02614794), and KEYNOTE-119 (NCT02555657) trials implemented PROs in their trial design to assess the QoL of their trial patients. Also, non-interventional studies on metastatic breast cancer, like e.g., the NABUCCO study (IOM-02240), and prospective non-interventional, multicenter registries e.g., the tumor registry breast cancer (NCT01351584) or the breast cancer registry platform OPAL (NCT03417115), have implemented PROs to assess QoL during the anti-cancer treatment periods of the patients. Key Message: Using PROs in metastatic breast cancer can support shared treatment-decision making and management of symptoms, eventually leading to an improvement in QoL. Progressively, regulatory authorities take PROs into consideration for the approval of new drugs. Hence, the implication of PROs in cancer treatment, and especially in MBC, is of significant value.

Prioritization of Patient-Reported Outcomes by Women With Metastatic Breast Cancer

2019 ◽  
pp. 1-3
Author(s):  
Sarah S. Mougalian ◽  
Jenerius A. Aminawung ◽  
Carolyn J. Presley ◽  
Maureen E. Canavan ◽  
Margaret L. Holland ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Patient Reported Outcomes ◽  
Metastatic Breast ◽  
Patient Reported

Next steps: Incorporating patient-reported outcomes into palliative care referral for people with advanced breast cancer.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 133-133
Author(s):  
Yun Rose Li ◽  
Celine Denise Marquez ◽  
Hope S. Rugo ◽  
Michael W. Rabow ◽  
Laura Esserman
Keyword(s):  
Breast Cancer ◽  
Palliative Care ◽  
Advanced Breast Cancer ◽  
Severity Score ◽  
Patient Reported Outcomes ◽  
Metastatic Cancer ◽  
Advanced Breast ◽  
Patient Specific ◽  
Patient Reported

133 Background: Specialty palliative care (SPC) has been shown to improve quality of life, reduce unnecessary health care utilization, reduce overall costs, and decrease mortality in some settings for patients with advanced or metastatic cancer, however only a small proportion are being promptly referred. As interventions that respond to patient reported outcomes (PROs) have been shown to improve symptoms and decrease mortality, we hypothesized that the rates of SPC referral would be increased by documenting, tracking, and presenting PROs for oncology visits to referring oncologists. Methods: Over a period of 2 months, 74 English-speaking established patients seen in an advanced breast cancer clinic with an embedded SPC service were approached and completed the study. All patients filled out the electronic, validated PROMIS and PRO-CTCAE PRO questionnaires in the waiting room using a touch screen tablet. Results were presented to the oncologist during the encounter if the CTCAE severity score exceeded 3 in at least 1 domain. Patient demographics, clinical features and PC referrals or appointments were assessed via chart review. Results: At baseline, 9 (12.2%) patients scored a minimum of “severe” (4/5 or 5/5) in at least 1 of the 3 anxiety domains; 17 (23.0%) had moderate-severe pain; and 27 (32.1%) reported fatigue. At study entry, 25 patients (33.8%) had been referred previously to the SPC service; 19 had actually been seen (76% of referred). Of the 63 (85.1%) patients with sufficient follow-up, 13 (20.6%) reported at least “severe” in >1 CTCAE domains, 6 (46.2%) of whom were previously referred to SPC. For the remaining 7 patients, median PROMIS T-score and PRO-CTCAE maximum severity score were 58.3 and 3.2, respectively; none were referred to SPC during the follow up period. Conclusions: The choice to refer (or not to refer) a patient to SPC is complex and tied to patient specific factors such as coordinating additional visits and fear of end of life conversations. To enable greater access to SPC, alternative referral mechanisms, such as group-based or personalized patient education, or automatic referrals triggered by evidence of need, may be required. #YRL/CDM contributed equally.

scholarly journals Intraoperative irradiation in breast cancer: preliminary results in 80 patients as partial breast irradiation or anticipated boost prior to hypo-fractionated whole breast irradiation

2021 ◽  
Author(s):  
X. Li ◽  
J. Sanz ◽  
N. Argudo ◽  
M. Vernet-Tomas ◽  
N. Rodríguez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Patient Reported Outcomes ◽  
Well Being ◽  
Partial Breast Irradiation ◽  
X Rays ◽  
Breast Irradiation ◽  
Intraoperative Irradiation ◽  
Patient Reported ◽  
First Results ◽  
Good Cosmesis

Abstract Purpose To present the first results of intraoperative irradiation (IORT) in breast cancer with a low-energy photon system used as partial breast irradiation (PBI) or as an anticipated boost before whole breast hypo-fractionated irradiation (IORT + WBI), concerning tolerance, side effects, quality of life, and patient-reported outcomes. Materials and methods Eighty patients treated with an Intrabeam® system of 50 kV X-rays received a 20 Gy dose intraoperatively were included. Moderate daily hypofractionation of 2.7 Gy in 15 fractions up to 40.5 Gy was administered if high-risk factors were present. Acute post-operative toxicity, surgery complications, chronic toxicity, patient-reported cosmesis and Breast-Q questionnaire were performed at follow-up visits. Results Thirty-one patients were treated as PBI and the remaining 49 as IORT + WBI. Only the IORT + WBI group presented acute toxicity, mainly mild acute dermatitis (11 patients) and one subacute mastitis. A total of 20 patients presented fibrosis (18 patients grade I, 2 patients grade II), 15 (30.5%) patients in the IORT + WBI group and 3 (9.6%) patients in the group of PBI. The cosmesis evaluation in 73 patients resulted poor, fair, good or excellent in 2, 7, 38 and 26 patients, respectively. In PBI group Breast-Q scored higher, especially in terms of their psychosocial well-being (78 vs 65) and satisfaction with radiation-induced toxicity (77 vs 72, respectively) compared to IORT + WBI group. Conclusion IORT is a well-tolerated procedure with low toxicity, good cosmesis and favorable patient-reported outcomes mainly when administered as PBI.

Patient-reported outcomes to assess symptoms in patients with metastatic breast cancer: Pilot implementation project.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 177-177
Author(s):  
Shruti Sinkar ◽  
Faith Too ◽  
Kelly Carr ◽  
Jessica Jelinek ◽  
Elizabeth Saylor ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Patient Reported Outcomes ◽  
Metastatic Breast ◽  
Routine Care ◽  
Project Team ◽  
Assessment System ◽  
Improvement Project ◽  
Phone Calls ◽  
Patient Reported

177 Background: Use of patient-reported outcomes (PRO) to evaluate symptoms improves clinical outcomes. Best practices for implementing PROs into routine care may vary according to clinical scenario, site-specific resources and programmatic goals. Patients with metastatic breast cancer (MBC) often experience a variety of symptoms. Methods: As a quality improvement project, we are pilot testing incorporation of a battery of PRO measures into routine care for patients with MBC at Johns Hopkins in order to gain experience that will guide future broader implementation of PROs across our program. Participants complete the PROs on paper at baseline (BL), 3, and 6 months (mo). Measures include NCCN Distress Thermometer (BL only), Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder-7 (GAD-7), PRO-CTCAE Insomnia questions and a modified version of the revised Edmonton Symptom Assessment System (r-ESAS) questionnaire with 3 extra symptom domains. Project team members alert clinicians by email of scores that exceed severity thresholds as follows – Distress: ≥4, PHQ-8: ≥8, GAD-7: ≥10, any item on r-ESAS: ≥4 and PRO-CTCAE Insomnia: severe/very severe or quite a bit/very much. Results: From May 29, 2020 and April 5, 2021, 67 patients were approached for participation, and 40 (59.7%) completed the BL PROs. Median age was 64 (range 36-85). Most participants were White (70%), non-Hispanic (90%) and had hormone receptor-positive (93%) MBC. At BL, 22 (55%) had visceral disease and most were receiving endocrine-based regimens [21 (53%)] or chemotherapy [16 (40%)]. 27 (68%) participants had ≥1 BL alert. The most common BL alerts were for symptoms on the r-ESAS [23 participants (58%)]. The most frequent items on the r-ESAS for which participants had BL alerts were pain, tiredness, well-being, tingling/numbness and rash. Other BL alerts were: Distress [9 participants (23%)], PRO-CTCAE Insomnia [5 participants (13%)], PHQ-8 [4 participants (10%)] and GAD-7 [2 participants (5%)]. To date, 24 of 35 (69%) and 15 of 28 (54%) participants who have reached the 3 and 6 mo time points have completed the respective follow-up (FU) PROs. Most common FU alerts to date are on the r-ESAS [3 mo: 14 participants (58%), 6 mo: 9 participants (60%)]. The project team has successfully notified providers of all alerts to date. Clinical actions (phone calls, provider visits and/or referrals) have been taken within 30 days of notification for > 75% of alerts. Conclusions: Implementation of a PRO battery for patients receiving routine care for MBC led to detection of a range of symptoms, the majority of which were clinically actionable. Restrictions on in-person interactions during the COVID-19 pandemic may have contributed to low rates of PRO completion in this pilot project. Prior to broader implementation, we will consider strategies such as an electronic platform and a shorter battery to enhance patient engagement.

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