scholarly journals Assessment of Venous Thromboembolism Risk Based on the Khorana Predictive Model and Compliance with Prophylactic Anticoagulation at a Regional Cancer Center- a Quality Improvement Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4951-4951
Author(s):  
Noman Ahmed Jang Khan ◽  
Hassaan Yasin ◽  
Kemnasom Nwanwene ◽  
Mahmoud Abdallah ◽  
Todd Gress ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Predictive Model ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Healthcare Providers ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Baseline Body Mass Index ◽  
The Mean ◽  
Prophylactic Anticoagulation

Abstract Background: Malignancy is an independent risk factor for venous thromboembolism. Factors like site of the primary cancer, associated comorbidities, obesity, and baseline cytopenias play an important role in predicting the risk in cancer patients. Several risk assessments models have been proposed in the literature, however, the Khorana risk predictive model is the most favored tool used in the literature. Patient characteristics like site of primary, baseline hemoglobin/platelets/WBC and BMI are the main components of this scoring system. Patients are classified into low (0), intermediate (1-2) and high (> 3) risk groups. Low dose prophylactic anticoagulation (Apixaban 2.5 mg BID or Rivaroxaban 10 mg daily) for up to 6 months is indicated in patients with score 2 or higher. Methods: 83 patients with a new cancer diagnosis in the years 2018 and 2019 who received chemotherapy and developed a venous thromboembolism (VTE) after the cancer diagnosis were identified from the cancer registry at Edwards Comprehensive Cancer Center. All the components of Khorana score including patient's baseline body mass index (BMI), white blood cell count (WBC), hemoglobin, platelet count and site of the primary were collected. Compliance with prophylactic anticoagulation (Khorana score =/>2) was evaluated. Results: Among 83 patients identified, 61 % and 39 % were female and males, respectively with a mean age of 59 years. The mean duration of onset of VTE was 18 months from the time of cancer diagnosis. The mean Khorana score was 1.1. 34 % of patients(n=28) were found to have a Khorana score of =/> 2 and prophylactic anticoagulation was indicated. Only 7 % of patients (n=2) received prophylactic anticoagulation. The reason for no prophylactic anticoagulation was not documented in all the cases. Conclusion: In patients with a higher risk of VTE, a very low compliance rates for prophylactic anticoagulation were found at our cancer center. Poor documentation and failure to address the risk of VTE are possible reasons for the low compliance rates. Necessary steps needed to improve the compliance rates are warranted including education of the healthcare providers about current available guidelines to decrease risk of VTE in cancer patients. Dedicated lectures and sessions will be organized and educational materials highlighting the importance of VTE risks and prophylactic anticoagulation will be provided to the healthcare providers at the cancer center. Disclosures No relevant conflicts of interest to declare.

scholarly journals Complementary and Alternative Medicine Use at a Comprehensive Cancer Center

2016 ◽  
Vol 16 (1) ◽  
pp. 104-109 ◽  
Author(s):  
Qianlai Luo ◽  
Gary N. Asher
Keyword(s):  
Alternative Medicine ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Medicine Use ◽  
Energy Medicine ◽  
Cam Use ◽  
After Cancer ◽  
Oncology Providers

Background. Complementary and alternative medicine (CAM) use is common among cancer patients, but the majority of CAM studies do not specify the time periods in relation to cancer diagnoses. We sought to define CAM use by cancer patients and investigate factors that might influence changes in CAM use in relation to cancer diagnoses. Methods. We conducted a cross-sectional survey of adults diagnosed with breast, prostate, lung, or colorectal cancer between 2010 and 2012 at the Lineberger Comprehensive Cancer Center. Questionnaires were sent to 1794 patients. Phone calls were made to nonrespondents. Log binomial/Poisson regressions were used to investigate the association between cancer-related changes in CAM use and conversations about CAM use with oncology providers. Results. We received 603 (33.6 %) completed questionnaires. The mean age (SD) was 64 (11) years; 62% were female; 79% were white; and 98% were non-Hispanic. Respondents reported the following cancer types: breast (47%), prostate (27%), colorectal (14%), lung (11%). Eighty-nine percent reported lifetime CAM use. Eighty-five percent reported CAM use during or after initial cancer treatment, with category-specific use as follows: mind-body medicine 39%, dietary supplements 73%, body-based therapies 30%, and energy medicine 49%. During treatment CAM use decreased for all categories except energy medicine. After treatment CAM use returned to pretreatment levels for most CAMs except chiropractic. Initiation of CAM use after cancer diagnosis was positively associated with a patient having a conversation about CAM use with their oncology provider, mainly driven by patient-initiated conversations. Conclusions. Consistent with previous studies, CAM use was common among our study population. Conversations about CAM use with oncology providers appeared to influence cessation of mind-body medicine use after cancer diagnosis.

Sexual activity and function in male cancer patients receiving targeted an immune therapies.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21594-e21594
Author(s):  
Katy K. Tsai ◽  
Puneet Kamal ◽  
Joris Ramstein ◽  
Alain Patrick Algazi ◽  
Adil Daud ◽  
...  
Keyword(s):  
Sexual Dysfunction ◽  
Sexual Function ◽  
Sexual Activity ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Care Providers ◽  
Long Term Treatment ◽  
And Function

e21594 Background: Survivorship concerns–including sexual function–move increasingly to the foreground in cancer patient care as systemic therapies improve response and survival. Patients are often committed to long-term treatment with tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) despite poor characterization of their effects on sexual function. We sought to assess sexual activity and function in patients receiving TKI or ICI. Methods: A cohort of men receiving TKI/ICI at the UCSF Helen Diller Family Comprehensive Cancer Center were retrospectively identified. Eligible men were on ongoing TKI/ICI therapy. Detailed questionnaires addressing cancer history, treatment history, and sexual activity/function while receiving therapy were completed. Results: Between January 2013 to September 2016, 51 men completed questionnaires. Mean age was 46 years (SD 12, range 21-72). Most (61%) were CML patients, with 12% RCC, 10% GIST, 6% melanoma, and NET, oligodendroglioma, and HCC comprising remaining histologies. 96% were treated with TKI, and 4% with ICI (pembrolizumab). 32% identified as being married or in a domestic partnership, and 18% identified as single. Only 14% reported no attempted sexual activity. Sexual desire was described as low or very low to none in 29%, average in 39%, and high or very high in 29%. Since cancer diagnosis, 21 (41%) of patients noted a reduced amount of semen upon ejaculation, and all but 5 of those patients noted this as at least somewhat bothersome. 35% of patients reported feeling at least somewhat distressed from sexual experiences since cancer diagnosis, including concern that their time to ejaculation may leave their partners feeling unfulfilled (45%), decreased sensation of orgasm (35%), difficulty maintaining erection until completion of intercourse (23%), and pain/discomfort upon ejaculation (12%). Conclusions: The majority of men on TKI or ICI remain sexually active, with a significant portion reporting sexual dysfunction. These findings highlight the need for oncology care providers to proactively manage sexual dysfunction to improve quality of life for cancer patients. Retrospective and prospective studies are ongoing to further characterize this cohort.

Molecular tumor profiling ordering trends in cancer patients.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 165-165
Author(s):  
Joseph D. Ma ◽  
Winnie S Wang ◽  
Warren Yau ◽  
Chelsea Hagmann ◽  
Carolyn Revta ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Primary Objective ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Palliative Care Consultation ◽  
The Difference ◽  
Diagnosis Date ◽  
Tumor Profiling

165 Background: Molecular tumor profiling may provide information as to whether to initiate or not initiate a targeted therapy. As to the timing of when the tumor profiling is ordered relative to date of diagnosis, date of death, and palliative care (PC) consultations are unknown. The primary objective of this study was to examine molecular tumor profiling ordering trends in the course of cancer illness. Methods: A preliminary, retrospective chart review was conducted in a cohort of patients with a confirmed diagnosis of cancer at an academic, NCI-designated comprehensive cancer center. Patients were identified from a tumor registry and then matched to a next generation sequencing molecular tumor profiling database. The date of palliative care consultation was collected from the electronic medical record. Differences in the date of when tumor profiling was ordered and date of diagnosis, date of PC consultation, and/or date of death were determined. Data were compiled into a single database and descriptive statistical analyses were performed. Results: A cohort of 397 (205 women) cancer patients was included. Metastatic disease was present in 108 (27.2%) patients, with mean±SD age of 58.7 ± 13.5 yrs. One-hundred and nine (27.6%) patients received a PC consultation (n=60 inpatient, n = 49 outpatient). As of February 2016, 119 (30%) patients died, with 58 (48.7%) out of 119 receiving a PC consultation. The difference between date of cancer diagnosis and date of tumor profiling ordered was 2467.4 ± 6865.7 days (n = 376), while the difference between date of tumor profiling ordered and date of death was 229.1 ± 185.7 days (n = 111). The difference between date of cancer diagnosis and date of death was 1507.5 ± 2002.1 days (n = 119). In patients were the tumor profiling was ordered before the PC consultation (n = 29), the difference between date of PC consultation and date tumor profiling ordered was 157.3 ± 258.1 days. In contrast, in patients were the tumor profiling was ordered after the PC consultation (n = 76), the difference was 194.6 ± 168 days. Conclusions: This analysis suggests that molecular tumor profiling is ordered at the end and not at the beginning of a cancer illness. PC consultations are not routinely performed in patients who participate in tumor profiling.

Venous Thromboembolism in Cancer Patients Following Major Surgery

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5253-5253
Author(s):  
Tierry Haim Toledano ◽  
Dimple Kondal ◽  
Susan R. Kahn ◽  
Vicky Tagalakis
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Hospital Discharge ◽  
Surgical Procedures ◽  
Cancer Diagnosis ◽  
Research Funding ◽  
Hospital Admissions ◽  
Major Surgery ◽  
The Mean

Abstract Abstract 5253 Background: Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is common in cancer patients and surgery is an important risk factor. The timing of post-operative VTE in cancer patients is uncertain. Objectives: We used the administrative health claims (RAMQ) and hospital discharge (MED ECHO) databases of Quebec, Canada to describe the occurrence of post-operative VTE in cancer patients and to explore anticoagulant use following hospital discharge. Methods: Using a previously defined cohort of individuals with a discharge diagnosis of VTE between January 1, 1994 and December 31, 2004 in MED ECHO which systematically records information on all hospital admissions in the province of Quebec, we identified patients with a cancer diagnosis in the 12 months preceding the VTE and who had major surgery in the 3 months prior to the VTE. Discharge diagnoses were defined according to the 9th edition International Classification of Diseases codes and surgical procedures according to the Canadian classification of diagnostic, therapeutic, and surgical procedures. Results: In all, 2706 patients with VTE had a cancer diagnosis and underwent major surgery in the 3 months preceding the VTE. The mean age was 65.9 years (SD=12.6) and 54% were female. The most common cancer was gastrointestinal (38%), and general surgery was the most frequent procedure (48%). The mean hospital stay was 29.8 days (SD=35.3). The mean time to VTE was 34.8 days (SD=68.3). In all, 34% of VTE events occurred after discharge. Among patients with post-discharge VTE (n=917), 4% had an out-patient anticoagulant prescription at discharge. Conclusions: Post-operative VTE in cancer patients often occurs after hospital discharge. This suggests that the risk of VTE extends beyond the immediate postoperative period. Prospective studies are needed to determine the effectiveness and safety of thromboprophylaxis beyond discharge in cancer patients undergoing surgery. Disclosures: Tagalakis: Sanofi Aventis: Research Funding; Pfizer: Research Funding.

scholarly journals Changes in fatigue, barriers, and predictors towards physical activity in advanced cancer patients over a period of 12 months—a comparative study

2021 ◽  
Author(s):  
J. Frikkel ◽  
M. Beckmann ◽  
N. De Lazzari ◽  
M. Götte ◽  
S. Kasper ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Physical Functioning ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Advanced Cancer Patients ◽  
Psychological Conditions ◽  
Patient Reported

Abstract Purpose Physical activity (PA) is recommended to improve advanced cancer patients’ (ACP) physical functioning, fatigue, and quality of life. Yet, little is known about ACPs’ attitude towards PA and its influence on fatigue and depressiveness over a longer period. This prospective, non-interventional cohort study examined ACPs’ fatigue, depression, motivation, and barriers towards PA before and after 12 months of treatment among ACP Methods Outpatients with incurable cancer receiving treatment at a German Comprehensive Cancer Center reporting moderate/severe weakness/tiredness during self-assessment via MIDOS II were enrolled. Fatigue (FACT-F), depression (PHQ-8), cancer-related parameters, self-assessed PA behavior, motivation for and barriers against PA were evaluated (T0). Follow-up data was acquired after 12 months (T1) using the same questionnaire. Results At follow-up, fatigue (p=0.017) and depressiveness (p=0.015) had increased in clinical relevant extent. Physically active ACP did not show significant progress of FACT-F (p=0.836) or PHQ-8 (p=0.799). Patient-reported barriers towards PA remained stable. Logistic regression analyses identified motivation as a positive predictor for PA at both time points (T0, β=2.152, p=0.017; T1, β =2.264, p=0.009). Clinically relevant depression was a negative predictor for PA at T0 and T1 (T0, β=−3.187, p=0.044; T1, β=−3.521, p=0.041). Conclusion Our findings emphasize the importance of psychological conditions in physical activity behavior of ACP. Since psychological conditions seem to worsen over time, early integration of treatment is necessary. By combining therapy approaches of cognitive behavioral therapy and exercise in interdisciplinary care programs, the two treatment options might reinforce each other and sustainably improve ACPs’ fatigue, physical functioning, and QoL. Trial registration German Register of Clinical Trials, DRKS00012514, registration date: 30.05.2017

Differences in transitions of care among cancer patients with and without venous thromboembolism (VTE) events.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18636-e18636
Author(s):  
Cinduja Nathan
Keyword(s):  
Venous Thromboembolism ◽  
Patient Care ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Medical Center ◽  
Survival Rates ◽  
Transitions Of Care ◽  
Office Visits ◽  
Oncology Patient ◽  
History Of

e18636 Background: Transitions of care are an important part of medical care, as they provide opportunities to address patient concerns, refine goals to match current needs and prevent unforeseen complications and comorbidities. One such common and prevalent comorbidity amongst cancer patients is venous thromboembolism (VTE) events. Common VTE events include the occurrence of pulmonary embolism (PE), deep vein thrombosis (DVT) or both at the time of diagnosis or any time thereafter. It is estimated that approximately 4–20% of cancer patients will experience a VTE. Cancer patients developing VTE is a serious concern as it can adversely affect the patients’ quality of life and reduce overall survival rates and prognosis. Methods: This study is designed as a case control study. The subject group consists of 87 cancer patients who had one or several VTE events after their cancer diagnosis. Patients were selected from the UVM Medical Center electronic health record database. The goal of this project was to quantify and compare the average number of transitions of care in cancer patients with and without venous thromboembolism (VTE) events. This was achieved by reviewing the patients charts three months following a VTE event and evaluating whether these patients had a greater number of transitions compared to the three months prior to their VTE event. Transitions of care in our study were defined as office visits, ED visits, and inpatient admissions related to their VTE. Results: Initial evaluation of the results showed that there were more transitions of care amongst cancer patients with a VTE than without. Preliminary data of the 87 patients shows that patients who developed a VTE event after their cancer diagnosis had on average 1.3 more transitions of care within the three months following their VTE event compared to cancer patients without a VTE event. A t test will be used to determine whether the difference between the means (number of transitions of care) of the two groups (cancer patients with VTE and those without VTE) is significant. Conclusions: The implications of having greater transitions of care amongst cancer patients with VTE events are profound. Having more transitions of care exemplifies better implementation, patient care and involvement of health care teams given a history of VTE. Furthermore, the results of this study will provide further insight on ways to improve clinical outcomes and oncology patient care given a history of VTE.

Routine HIV Screening in Cancer Patients in the Emergency Department

2018 ◽  
Vol 17 (2) ◽  
pp. 91-95
Author(s):  
Terry W Rice ◽  
◽  
Patricia A. Brock ◽  
Carmen Gonzalez ◽  
Kelly W Merriman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hiv Testing ◽  
Cancer Patients ◽  
Linkage To Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Hiv Screening ◽  
Immunodeficiency Virus ◽  
Routine Hiv Screening ◽  
Incident Cases

Treatment of human immunodeficiency virus(HIV) in cancer patients improves outcomes and reduces transmission of this oncogenic virus. HIV testing rates of cancer patients are similar to the general population (15-40%), despite the association with cancer. Our aim was to increase HIV screening in the Emergency Department(ED) of a comprehensive cancer center through a quality initiative. Testing increased significantly during the intervention (p<0.001; 0.15/day to 2.69/day). Seropositive HIV rate was 1.4% (12/852), with incidence of 0.3%. All patients were linked to care. Incident cases were between 36 and 55 years of age. Barriers encountered included confusion regarding the need for written consent for HIV testing, failure to consider ordering the test, and concerns regarding linkage to care.

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