scholarly journals Active Mycobacterium tuberculosis infection at a comprehensive cancer center, 2006–2014

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joumana Kmeid ◽  
Prathit A. Kulkarni ◽  
Marjorie V. Batista ◽  
Firas El Chaer ◽  
Amrita Prayag ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Cancer Patients ◽  
Hematopoietic Cell Transplantation ◽  
Average Rate ◽  
Hematologic Malignancies ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Mycobacterium Tuberculosis Infection ◽  
Patients With Cancer ◽  
Disseminated Disease

Abstract Background Morbidity and mortality from Mycobacterium tuberculosis (Mtb) infection remain significant in cancer patients. We evaluated clinical characteristics, management, and outcomes in patients with active Mtb infection at our institution who had cancer or suspicion of cancer. Methods We retrospectively examined medical records of all patients with laboratory-confirmed active Mtb infection diagnosed between 2006 and 2014. Results A total of 52 patients with laboratory-confirmed active Mtb infection were identified during the study period, resulting in an average rate of 6 new cases per year. Thirty-two (62%) patients had underlying cancer, while 20 (38%) patients did not have cancer but were referred to the institution because of suspicion of underlying malignancy. Among patients with cancer, 18 (56%) had solid tumors; 8 (25%) had active hematologic malignancies; and 6 (19%) had undergone hematopoietic-cell transplantation (HCT). Patients with and without cancer were overall similar with the exception of median age (61 years in cancer patients compared to 53 years in noncancer patients). Pulmonary disease was identified in 32 (62%) patients, extrapulmonary disease in 10 (19%) patients, and disseminated disease in 10 (19%) patients. Chemotherapy was delayed in 53% of patients who were to receive such treatment. Eleven patients (all of whom had cancer) died; 3 of these deaths were attributable to Mtb infection. Conclusions Although not common, tuberculosis remains an important infection in patients with cancer. Approximately one-third of patients were referred to our institution for suspicion of cancer but were ultimately diagnosed with active Mtb infection rather than malignancy.

scholarly journals Active Mycobacterium tuberculosis Infection at a Comprehensive Cancer Center, 2006–2014

2019 ◽  
Author(s):  
Joumana Kmeid ◽  
Prathit A. Kulkarni ◽  
Marjorie V. Batista ◽  
Firas El Chaer ◽  
Amrita Prayag ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Cancer Patients ◽  
Hematopoietic Cell Transplantation ◽  
Average Rate ◽  
Hematologic Malignancies ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Mycobacterium Tuberculosis Infection ◽  
Patients With Cancer ◽  
Disseminated Disease

Abstract Background: Morbidity and mortality from Mycobacterium tuberculosis (Mtb) infection remain significant in cancer patients. We evaluated clinical characteristics, management, and outcomes in patients with active Mtb infection at our institution who had cancer or suspicion of cancer. Methods: We retrospectively examined medical records of all patients with laboratory-confirmed active Mtb infection diagnosed between 2006 and 2014. Results: A total of 52 patients with laboratory-confirmed active Mtb infection were identified during the study period, resulting in an average rate of 6 new cases per year. Thirty-two (62%) patients had underlying cancer, while 20 (38%) patients did not have cancer but were referred to the institution because of suspicion of underlying malignancy. Among patients with cancer, 18 (56%) had solid tumors; 8 (25%) had active hematologic malignancies; and 6 (19%) had undergone hematopoietic-cell transplantation (HCT). Patients with and without cancer were overall similar with the exception of median age (61 years in cancer patients compared to 53 years in noncancer patients). Pulmonary disease was identified in 32 (62%) patients, extrapulmonary disease in 10 (19%) patients, and disseminated disease in 10 (19%) patients. Chemotherapy was delayed in 53% of patients who were to receive such treatment. Eleven patients (all of whom had cancer) died; 3 of these deaths were attributable to Mtb infection. Conclusions: Although not common, tuberculosis remains an important infection in patients with cancer. Approximately one-third of patients were referred to our institution for suspicion of cancer but were ultimately diagnosed with active Mtb infection rather than malignancy.

scholarly journals Active Mycobacterium tuberculosis Infection at a Comprehensive Cancer Center, 2006–2014

2019 ◽  
Author(s):  
Joumana Kmeid ◽  
Prathit A. Kulkarni ◽  
Marjorie V. Batista ◽  
Firas El Chaer ◽  
Amrita Prayag ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Cancer Patients ◽  
Hematopoietic Cell Transplantation ◽  
Average Rate ◽  
Hematologic Malignancies ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Mycobacterium Tuberculosis Infection ◽  
Patients With Cancer ◽  
Disseminated Disease

Abstract Background: Morbidity and mortality from Mycobacterium tuberculosis (Mtb) infection remain significant in cancer patients. We evaluated clinical characteristics, management, and outcomes in patients with active Mtb infection at our institution who had cancer or suspicion of cancer. Methods: We retrospectively examined medical records of all patients with laboratory-confirmed active Mtb infection diagnosed between 2006 and 2014. Results: A total of 52 patients with laboratory-confirmed active Mtb infection were identified during the study period, resulting in an average rate of 6 new cases per year. Thirty-two (62%) patients had underlying cancer, while 20 (38%) patients did not have cancer but were referred to the institution because of suspicion of underlying malignancy. Among patients with cancer, 18 (56%) had solid tumors; 8 (25%) had active hematologic malignancies; and 6 (19%) had undergone hematopoietic-cell transplantation (HCT). Patients with and without cancer were overall similar with the exception of median age (61 years in cancer patients compared to 53 years in noncancer patients). Pulmonary disease was identified in 32 (62%) patients, extrapulmonary disease in 10 (19%) patients, and disseminated disease in 10 (19%) patients. Chemotherapy was delayed in 53% of patients who were to receive such treatment. Eleven patients (all of whom had cancer) died; 3 of these deaths were attributable to Mtb infection. Conclusions: Although not common, tuberculosis remains an important infection in patients with cancer. Approximately one-third of patients were referred to our institution for suspicion of cancer but were ultimately diagnosed with active Mtb infection rather than malignancy.

scholarly journals Active Mycobacterium tuberculosis Infection at a Comprehensive Cancer Center, 2006–2014

2019 ◽  
Author(s):  
Joumana Kmeid ◽  
Prathit A. Kulkarni ◽  
Marjorie V. Batista ◽  
Firas El Chaer ◽  
Amrita Prayag ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Cancer Patients ◽  
Hematopoietic Cell Transplantation ◽  
Average Rate ◽  
Hematologic Malignancies ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Mycobacterium Tuberculosis Infection ◽  
Patients With Cancer ◽  
Disseminated Disease

Abstract Background: Morbidity and mortality from Mycobacterium tuberculosis (Mtb) infection remain significant in cancer patients. We evaluated clinical characteristics, management, and outcomes in patients with active Mtb infection at our institution who had cancer or suspicion of cancer. Methods: We retrospectively examined medical records of all patients with laboratory-confirmed active Mtb infection diagnosed between 2006 and 2014. Results: A total of 52 patients with laboratory-confirmed active Mtb infection were identified during the study period, resulting in an average rate of 6 new cases per year. Thirty-two (62%) patients had underlying cancer, while 20 (38%) patients did not have cancer but were referred to the institution because of suspicion of underlying malignancy. Among patients with cancer, 18 (56%) had solid tumors; 8 (25%) had active hematologic malignancies; and 6 (19%) had undergone hematopoietic-cell transplantation (HCT). Patients with and without cancer were overall similar with the exception of median age (61 years in cancer patients compared to 53 years in noncancer patients). Pulmonary disease was identified in 32 (62%) patients, extrapulmonary disease in 10 (19%) patients, and disseminated disease in 10 (19%) patients. Chemotherapy was delayed in 53% of patients who were to receive such treatment. Eleven patients (all of whom had cancer) died; 3 of these deaths were attributable to Mtb infection. Conclusions: Although not common, tuberculosis remains an important infection in patients with cancer. Approximately one-third of patients were referred to our institution for suspicion of cancer but were ultimately diagnosed with active Mtb infection rather than malignancy.

Access to palliative care before death among patients treated at a comprehensive cancer center.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 25-25
Author(s):  
David Hui ◽  
Sun Hyun Kim ◽  
Jung Hye Kwon ◽  
Kimberson Cochien Tanco ◽  
Tao Zhang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Disease Process ◽  
Hematologic Malignancies ◽  
Median Number ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Medical Team ◽  
Missed Opportunities

25 Background: Palliative care (PC) access is a critical component of quality cancer care. Previous studies on PC access have mostly examined the timing of PC referral. The proportion of patients who actually received PC is unclear. We determined the proportion of cancer patients who received PC at our comprehensive cancer center, and the predictors of PC referral. Methods: We reviewed the charts ofconsecutive patients with advanced cancer from the Houston region seen at MD Anderson Cancer Center and died between September 2009 and February 2010. We compared patients who received PC services with those who did not receive PC services before death using univariate and multivariate logistic regression. Results: A total of 366/816 (45%) decedents had a PC consultation. The median interval between PC consultation and death was 1.4 months (interquartile range (0.5-4.2) and the median number of medical team encounters before PC was 20 (6-45). In multivariate analysis, older age, being married, and specific cancer types (gynecology, lung and head and neck) were significantly associated with a PC referral (Table). Patients with hematologic malignancies had significantly fewer PC referrals (33%), the longest interval between advanced cancer diagnosis and PC consultation (median 16 months), the shortest interval between PC consultation and death (median 0.4 month), and one of the largest number of medical team encounters (median 38) before PC. Conclusions: We found that a majority of cancer patients at our cancer center did not access PC before they die. PC referral occurs late in the disease process with many missed opportunities for referral. Further effort is needed to improve quality of end-of-life care. [Table: see text]

Pastoral care of cancer patients: Defining utilization of services at a comprehensive cancer center.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24171-e24171
Author(s):  
Elizabeth Palmer ◽  
Anghela Paredes ◽  
Madison Hyer ◽  
Timothy M. Pawlik
Keyword(s):  
Pastoral Care ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Spiritual Care ◽  
Cancer Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Spiritual Needs ◽  
Active Listening ◽  
Patients With Cancer

e24171 Background: Addressing the religious/spiritual needs of patients is an important component of comprehensive cancer care. Patients often report that providers infrequently engage them about their needs during treatment. In addition, providers cite inadequate training as a significant barrier to providing spiritual care. While patients may benefit from the presence of a spiritual care specialist during cancer treatment, the utilization and content of these services are not well defined. We sought to characterize utilization of pastoral care (PC) services, as well as delineate differences in PC utilization among patients with cancer. Methods: Data on patients being treated for cancer at a Comprehensive Cancer Center between 2015-2018 were obtained from the electronic medical record. Overall utilization, type of PC services utilized, as well as factors associated with use of PC were assessed. Analyses included descriptive statistics and logistic regression. Results: Among 14,322 cancer patients, roughly one-third (n = 5166, 36.1%) had at least one PC encounter during their cancer treatment. Interventions most frequently provided by PC included supportive presence (93.5%) and active listening (86.6%), while the most frequently explored topics were treatment expectations (59.8%), issues with faith/beliefs (42.9%), and available coping mechanisms (35.4%). Patients diagnosed with colorectal (OR:1.42, 95%CI:1.07-1.89), liver (OR:2.41, 95%CI:1.80-3.24), or pancreatic cancer (OR:1.43, 95%CI:1.02-2.00) were more likely to utilize PC services compared with other cancers. Patients that identified as Catholic (OR:1.47, 95%CI:1.17-1.84) or Christian (OR:1.73, 95%CI:1.39-2.15) were more likely to request PC services (both p < 0.001) than individuals who had no religious preference/affiliation. Among surgical patients (n = 1,174), the majority of encounters with PC services were in the postoperative setting (n = 801, 70.6%). Patients most often reported that PC helped with verbalization of their feelings (93.6%) and helped reduce stress (76.9%). Conclusions: Over one-third of patients with cancer interacted with PC and received services that often addressed both psychosocial and spiritual concerns. Overall PC utilization and types of PC services rendered varied relative to demographic and religious factors. Providers should be aware of varying patient religious/spiritual needs so as to optimize the entire cancer care experience for patients.

In-hospital mortality of patients admitted through the emergency department of a comprehensive cancer center.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6125-6125 ◽  
Author(s):  
Ahmed F. Elsayem ◽  
Carmen E. Gonzalez ◽  
S. J. Yeung ◽  
Kelly W. Merriman ◽  
Knox H. Todd
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Solid Tumors ◽  
Solid Tumor ◽  
Hematologic Malignancies ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Intractable Pain ◽  
Tumor Patients

6125 Background: Cancer is a common presenting condition for emergency departments (EDs); however, there is limited information on outcomes of ED cancer patients subsequently admitted to the hospital. The purpose of this study is to describe outcomes of patients with hematologic malignancies versus those with solid tumors admitted through the ED of a comprehensive cancer center. Methods: We queried the ED database of The University of Texas MD Anderson Cancer Center for calendar year 2010 and linked it to our institutional data warehouse, including tumor registry data. We classified all leukemia and related disorders, lymphoma, multiple myeloma, and bone marrow transplant patients as hematologic malignancies, and remaining cancers as solid tumors. Descriptive statistics, including chi-square, and t-tests were used in two-sided comparisons. All statistical analyses were performed using SPSS version 15. Results: 20,732 total ED visits were made by 9,320 unique cancer patients. Of these, 5,364 (58%) were admitted to the hospital at least once (range 1-13 admits). ED admissions constituted 39% of total unique patients admitted (N=13,753). The main admission indications for solid tumor patients were infectious complications (particularly pneumonia), intractable pain, or dehydration. For hematologic malignancies, the main indication was neutropenic fever. 211/1656 (13%) of liquid tumor patients were admitted to the Intensive Care Unit (ICU) compared to 484/3708 (13%) of solid tumor patients (P=NS). Of all patients admitted through the ED, 587/5364 (10.9%) died during hospitalization. The hematologic hospital mortality rate was 225/1653 (13.6%) versus 362/3708 (9.8%) for solid tumors (P<0.001). Only 242/8389 (3%) of patients admitted directly from outpatient clinics died during the hospitalization (p<0.001). Conclusions: Patients admitted through the ED, particularly those with hematologic malignancies, have a high hospital mortality rate. ED-based palliative care interventions may be justified to improve quality of life and prevent unnecessary costly interventions and ICU admission. Further research should define predictors of poor outcomes in cancer patients admitted through the ED.

Assessment of Pain Caused by Invasive Procedures in Cancer Patients

2003 ◽  
Vol 1 (3) ◽  
pp. 435-439 ◽  
Author(s):  
Jana Portnow ◽  
Christine Lim ◽  
Stuart A. Grossman
Keyword(s):  
Cancer Patients ◽  
Severe Pain ◽  
Invasive Procedure ◽  
Comprehensive Cancer Center ◽  
Procedural Pain ◽  
Cancer Center ◽  
Invasive Procedures ◽  
Patients With Cancer ◽  
Pain Ratings ◽  
Average Pain

Invasive procedures are commonly required in the diagnosis and management of cancer in adults. However, little is known regarding the prevalence and severity of procedure-related pain in this patient population. This prospective study was conducted to determine the frequency and types of invasive procedures performed in a large comprehensive cancer center, the intensity of pain associated with these procedures, the types of periprocedural analgesics administered, and how these patients would like their procedural pain to be managed in the future. During a 6-week period, 102 cancer patients were interviewed immediately after undergoing an invasive procedure. They were asked to rate the pain they experienced before, during, and after their procedure using a verbal descriptor scale (VDS) ranging from 0 to 10. They also were asked if they would want more, less, or the same amount of pain medication if they were to undergo the same procedure again. The most frequently performed procedures were bone marrow aspirates and biopsies (68%), lumbar punctures (14%), and placements of central venous catheters (10%). The average pain rating during these procedures was 4.2 (standard deviation [SD], 3.0). However, 26% of patients experienced severe pain (VDS score [threesuperoir]7) during the procedures. Twenty-four percent of patients surveyed received conscious sedation for their procedure. There was no statistical relationship between patients' pain ratings and their satisfaction with the pain control they received during the procedures. This study represents the largest descriptive study of procedural pain in adult cancer patients. As more than 50% of these patients experienced moderate to severe pain during procedures, further studies are needed to improve the control of procedure-related pain in patients with cancer.

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

scholarly journals Fears, beliefs, and quality of life of patients with cancer vs the general population during the coronavirus disease 2019 (COVID-19) pandemic in Lombardy

2021 ◽  
pp. 030089162110228
Author(s):  
Carla Ida Ripamonti ◽  
Giacomo Massa ◽  
Daniela Insolvibile ◽  
Mauro Guglielmo ◽  
Guido Miccinesi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
General Population ◽  
Perceived Risk ◽  
Well Being ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Psychological Consequences ◽  
Patients With Cancer ◽  
Fear Of Cancer

Aim: To understand how patients with cancer reacted to the coronavirus disease 2019 (COVID-19) pandemic and whether their quality of life (QoL) was affected. Methods: In June 2020, 111 patients with cancer treated in the supportive care unit of a Comprehensive Cancer Center in Milan and 201 healthy controls from the general population were enrolled and assessed both quantitatively and qualitatively for fears and COVID-19–related beliefs as well as for QoL. Results: Fear of COVID-19 was significantly lower among patients (41% vs 57.6%; p = 0.007), as was fear of cancer (61.5% vs 85.6%; p < 0.001) and other diseases. The perceived risk of getting COVID-19 was lower among patients (25.2% vs 52.7%; p < 0.001), as was the belief of having been exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (18.1% vs 40.8%; p < 0.001). The physical component of QoL was better among the population (54.5 vs 43.8; p < 0.001); the reverse was true for patients’ psychological well-being (44.6 vs 39.6; p < 0.001). The qualitative data supported such results, showing a reduced psychological effect on the patients with cancer compared to the controls. Various reasons explain this result, including the awareness of being treated for cancer and nevertheless protected against getting infected in a cancer center of public health reorganized to continue treating patients by protecting them and personnel from the risk of infection. Conclusions: The experience of a cancer diagnosis, together with proper hospital reorganization, may act as protective factors from fears and psychological consequences of the COVID-19 outbreak.

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