Pilot Study of Vaginal Microbiome Using QIIME 2™ in Women With Gynecologic Cancer Before and After Radiation Therapy

Cancer Center ◽

Rrna Gene ◽

Vaginal Microbiome ◽

Bioinformatics Pipeline ◽

Before And After

Objectives: To characterize the vaginal microbiome using QIIME 2™ (Quantitative Insights Into Microbial Ecology 2) in women with gynecologic cancer. Sample & Setting: 19 women with gynecologic cancer before and after radiation therapy at a comprehensive cancer center in Atlanta, Georgia. Methods & Variables: This pilot study analyzed vaginal microbiome communities using a microbiome analysis pipeline, beginning with 16S rRNA gene sequencing and processing through use of a bioinformatics pipeline to downstream microbial statistical analysis. Results: The findings showed the methods to be robust, and most women with gynecologic cancer showed depletion of Lactobacillus. Compared to those pre–radiation therapy, women post–radiation therapy showed higher abundances of Mobiluncus, Atopobium, and Prevotella but lower abundances of Lactobacillus, Gardnerella, and Peptostreptococcus, which are associated with bacterial vaginosis. Implications for Nursing: This study presents the fundamentals of human microbiome data collection and analysis methods to inform nursing science. Assessing the vaginal microbiome provides a potential pathway to develop interventions to ameliorate dysbiosis of the vaginal microbiome.

Predictors of referral to outpatient specialty palliative care (SPC) in gynecologic cancer (GC) patients.

10.1200/jco.2015.33.29_suppl.159 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 159-159

Author(s):

Rachel Ruskin ◽

Michelle Renee Rowland ◽

Katherine N Moore ◽

Katrina Slaughter ◽

Adam Walter ◽

...

Keyword(s):

Palliative Care ◽

Sexual Dysfunction ◽

Gynecologic Oncology ◽

Gynecologic Cancer ◽

Routine Care ◽

Multivariate Model ◽

Cancer Center ◽

Future Research ◽

Cross Sectional

159 Background: Prior studies in GC patients have described predictors of inpatient palliative care (PC) consultation, but predictors of outpatient SPC consultation have not been elucidated. We sought to identify factors predictive of referral and associated care outcomes. Methods: We performed a cross-sectional study of GC patients seen in the gynecologic oncology clinic at a comprehensive cancer center over a three month period. As a part of routine care, patients completed a symptom questionnaire. Patients previously seen at the outpatient PC clinic were compared to those who had not with respect to demographics, disease characteristics, symptom scores, and provider factors using univariate statistics. A multivariate model was created to identify independent predictors of referral. Results: 913 patients completed the symptom survey. 76 patients (8%) had been seen in the outpatient PC clinic. Disease factors associated with referral included site (p < 0.01), stage (p < 0.01), evidence of disease (p < 0.01), active treatment (p < 0.01), and time point in the disease trajectory (p < 0.01). Women with moderate to severe pain (p < 0.01), sadness (p = 0.03), distress (p < 0.01), fatigue (p < 0.01), neuropathy (p = 0.03), and sexual dysfunction (p < 0.01) were more likely to have seen PC. Marital status, number of symptoms, and patient provider were also predictive of referral (all p < 0.01). In a multivariate model, site, stage, number of symptoms, moderate to severe sexual dysfunction, and provider were independently associated with referral. Compared to women who had not been referred, patients seen in the PC clinic were more likely to have a health care proxy documented in the electronic medical record (p < 0.01). Among patients with related symptoms, patients referred to PC more often had an opioid prescribed for pain (p < 0.01) and medications prescribed for depression (p < 0.01), anxiety (p = 0.04), insomnia (p < 0.01), and fatigue (p < 0.01). Conclusions: Women with depression, anxiety, insomnia, and fatigue were more likely to receive pharmacologic treatment for these symptoms from a SPC provider. Future research should identify referral triggers for those patients most likely to benefit from outpatient SPC consultation.

Impact of parenteral opioid shortage on opioid prescriptions among patients seen by the palliative care team of a comprehensive cancer center.

10.1200/jco.2018.36.34_suppl.201 ◽

2018 ◽

Vol 36 (34_suppl) ◽

pp. 201-201

Author(s):

Ali Haider ◽

Yu Qian ◽

Zhanni Lu ◽

Syed Mussadiq Ali Akbar Naqvi ◽

Amy Zhuang ◽

...

Keyword(s):

Palliative Care ◽

Pain Management ◽

Cancer Pain ◽

Cancer Center ◽

Cancer Type ◽

Cancer Pain Management ◽

Before And After ◽

The Impact

201 Background: Recent parenteral opioid shortage (POS) has the potential to impact cancer pain management in hospitalized patients. This study aims to compare changes in the opioid prescriptions by the inpatient palliative care (PC) team before and after the institution first reported the POS. Methods: We reviewed and compared the electronic health records of 386 consecutive eligible consultations seen by the inpatient PC team equally in one month before and after the announcement of POS on February 8, 2018. The eligibility criteria include (1) cancer diagnosis, (2) ≥18 years of age, (3) taking opioid medication at the time of consultation, and (4) having at least two consecutive visits with the PC team. Patient demographics, cancer type, opioid type, route, and dose defined as the morphine equivalent daily dose were assessed. Results: POS was associated with less use of parenteral opioids (patient controlled analgesia, and intravenous breakthrough) and more use of non-parenteral opioids (extended release, transdermal, and oral breakthrough) by the referring oncology teams, and PC team (P≤.001) (Table 1). At first PC follow-up, significantly less proportion of patients achieved better pain control after POS [119/193 (62%) versus 144/193 (75%) (P=.006)] However, at second PC follow-up, the proportion of pain improvement was similar in both cohorts. Conclusions: There is a significant change in opioid routes associated with POS. POS was associated with worse analgesia. More research is needed to better understand the impact of POS on cancer pain management.[Table: see text]

Outcomes after adjuvant radiation therapy for prostate cancer at a comprehensive cancer center

Journal of Radiation Oncology ◽

10.1007/s13566-016-0248-5 ◽

2016 ◽

Vol 5 (3) ◽

pp. 287-292

Author(s):

Emma B. Holliday ◽

Deborah A. Kuban ◽

Yasemin Bolukbasi ◽

Lawrence Levy ◽

Priya Master ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Cancer Center ◽

Adjuvant Radiation ◽

Adjuvant Radiation Therapy

Monitoring Twitter Conversations for Targeted Recruitment in Cancer Trials in LA County: Protocol for a Mixed-Methods Pilot Study (Preprint)

10.2196/preprints.9762 ◽

2018 ◽

Author(s):

Katja Reuter ◽

Praveen Angyan ◽

NamQuyen Le ◽

Alicia MacLennan ◽

Sarah Cole ◽

...

Keyword(s):

Clinical Trial ◽

Social Media ◽

Clinical Trials ◽

Pilot Study ◽

Cancer Center ◽

Translational Science ◽

The Social ◽

Media Intervention ◽

Twitter Users

BACKGROUND Insufficient recruitment of participants remains a critical roadblock to successful clinical research, in particular clinical trials. Social media (SM) provides new ways for connecting potential participants with research opportunities. Researchers suggested that the social network Twitter may serve as a rich avenue for exploring how patients communicate about their health issues and increasing enrollment in cancer clinical trials. However, there is a lack of evidence that Twitter offers practical utility and impact. OBJECTIVE The objective of this pilot study is to examine the feasibility and impact of using Twitter monitoring data (i.e., user activity and their conversations about cancer-related conditions and concerns expressed by Twitter users in LA County) as a tool for enhancing clinical trial recruitment at a comprehensive cancer center. METHODS We will conduct a mixed-methods interrupted time series study design with a before and after SM recruitment intervention. Based on a preliminary analysis of eligible trials, we plan to onboard at least 84 clinical trials across six disease categories: breast cancer, colon cancer, kidney cancer, lymphoma, non-small cell lung cancer, and prostate cancer that are open to accrual at the USC Norris Comprehensive Cancer Center (USC Norris). We will monitor messages about the six cancer conditions posted by Twitter users in LA County. Recruitment for the trials will occur through the Twitter account (@USCTrials). Primary study outcomes include, first, feasibility and acceptance of the social media intervention among targeted Twitter users and the study teams of the onboarded trials, which will be assessed using qualitative interviews and 4-point Likert scale, and calculating the proportion of targeted Twitter users who engaged with outreach messages. Second, impact of the social media intervention will be measured by calculating the proportion of people who enrolled in trials. The enrollment rate will be compared between the active intervention period and the prior 10 months as historical control for each disease trial group. RESULTS This study has been funded by the National Center for Advancing Translational Science (NCATS) through a Clinical and Translational Science Award (CTSA) award. Study approval was obtained from the Clinical Investigations Committee (CIC) at USC Norris and the Institutional Review Board (IRB) at USC. Recruitment on Twitter started in February 2018. Data collection will be completed in November 2018. CONCLUSIONS This pilot project will provide preliminary data and practical insight into the application of publicly available Twitter data to identify and recruit clinical trial participants center across six cancer disease types. We will shed light on the acceptance of the SM intervention among Twitter users and study team members of the onboarded trials. If successful, the findings will inform a multisite, randomized controlled trial to determine the efficacy of the social media intervention across different locations and populations.

Practical Considerations Arising from the Implementation of Lung Stereotactic Body Radiation Therapy (SBRT) at a Comprehensive Cancer Center

Journal of Thoracic Oncology ◽

10.1097/jto.0b013e31818b1771 ◽

2008 ◽

Vol 3 (11) ◽

pp. 1332-1341 ◽

Cited By ~ 26

Author(s):

Max Dahele ◽

Shannon Pearson ◽

Tom Purdie ◽

Jean-Pierre Bissonnette ◽

Kevin Franks ◽

...

Keyword(s):

Radiation Therapy ◽

Stereotactic Body Radiation Therapy ◽

Cancer Center ◽

Stereotactic Body Radiation

How do palliative care needs vary across the disease trajectory in patients with gynecologic cancer?

10.1200/jco.2015.33.29_suppl.106 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 106-106 ◽

Cited By ~ 1

Author(s):

Rachel Ruskin ◽

Michelle Renee Rowland ◽

Katherine N Moore ◽

Carolyn Lefkowits ◽

Adam Walter ◽

...

Keyword(s):

Palliative Care ◽

Gynecologic Cancer ◽

Social Needs ◽

Cancer Center ◽

Primary Therapy ◽

Care Needs ◽

Time Points ◽

Multiple Domains ◽

Time Point

106 Background: The WHO’s integrated model emphasizes that palliative care (PC) should be provided concurrently with curative and life-prolonging care, with disease-directed treatments decreasing and PC increasing over time. This study aimed to understand how accurately this theoretical model matches the PC needs of gynecologic cancer (GC) patients. Methods: GC patients at a comprehensive cancer center completed a symptom and needs assessment questionnaire as part of routine care. Needs were divided into physical, emotional, social, practical, and informational domains. Patients reporting at least one symptom score ≥ 4/10 made the physical need domain positive. For the remainder of the categories, patients endorsing at least one need in a given domain made that domain positive. Time points in the illness trajectory were categorized as diagnosis, primary treatment, remission, and progression/recurrence. Univariate analyses were utilized to assess differences in needs at various time points. Results: Questionnaires from 1348 patient visits over 3 months were included. Patients had ovarian (39%), uterine (36%), cervical (16%), and vulvar (5%) cancer. Visits occurred around the time of diagnosis (6%), during primary therapy (28%), during remission (42%), and during disease progression or recurrence (23%). Physical needs were most common at diagnosis and during progression/recurrence (p < 0.01). Emotional needs (p < 0.01), social needs (p < 0.01), and informational needs (p < 0.01) all varied throughout the course of disease and were highest at diagnosis. At each time point, at least 65% of patients had one or more PC needs. Having needs in multiple domains ( ≥ 3) was associated with time point, with patients around the time of diagnosis having the highest rate of need in multiple domains (p < 0.01). Conclusions: GC patients have a broad range of PC needs across the trajectory of their illness. The WHO schema fails to capture the full scope of these needs and under-appreciates their prevalence earlier in the course of the disease. These results underscore the importance of training gynecologic oncologists in primary PC as well as increasing referrals to specialist PC providers.

Benefits of satellite lab in the reduction of chemotherapy waiting time.

10.1200/jco.2017.35.15_suppl.e18218 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18218-e18218

Author(s):

Abdullah Ahmed Bany Hamdan ◽

Jesusa Christine Tamani ◽

Sheena Peethambaran ◽

Isamme Alfayyad ◽

Richard Erlandez ◽

...

Keyword(s):

Patient Care ◽

Waiting Time ◽

Positive Impact ◽

Turnaround Time ◽

Cancer Center ◽

Base Line ◽

Oncology Patients ◽

Mean Waiting Time ◽

Before And After

e18218 Background: Oncology patients need to receive their course of treatment in a timely manner. Increasing the efficiency of laboratory testing could potentially improve hospital operations and thus have a positive impact on patient care. One way of doing this is by initiating an installation of a satellite laboratory. The purpose of this study is to determine the advantages of having a satellite laboratory in an oncology unit. Moreover, it shall also try to determine whether the presence of satellite laboratory will help reduce the chemotherapy waiting time of oncology patients. Methods: This study utilized experimental study design in order to analyze and compare Laboratory Turnaround time (TAT) and the chemotherapy waiting time before and after establishment of satellite laboratory. The samples taken as base line data was 150 and compared to samples taken from 2013-2015. The population of this study included patients in Comprehensive Cancer Center of King Fahad Medical City diagnosed with cancer and received chemotherapy regardless of their age and sex. Results: Laboratory Mean TAT decrease significantly from 1 hour and 30 minutes in 2012 to 43 minutes, 43 minutes, and 37 minutes in 2013, 2014 and 2015 respectively. Also chemotherapy Mean waiting time decreased from 2012 base line of 252 to 164 minutes in 2013, 115 minutes in 2014 and 146 minutes in 2015. The chemotherapy waiting time shows a decreasing pattern as the laboratory time decrease from 2013 to 2015. This shows that there is a decrease in the chemotherapy time and turnaround time before and after the intervention. We also have identified that there is a direct relationship between the reduction of turnaround time and chemotherapy waiting time. Conclusions: The need to structure how we deliver patient care specifically to cancer patient is an important drive for quality improvement. Basing on the result of the project and with the increase in patient satisfaction rate, it can be concluded that it is possible to reduce patients’ mean chemotherapy waiting time by applying more efficient process, which is the installation of satellite laboratory.

Improving the quality of life of geriatric cancer patients with a structured multidisciplinary intervention: A randomized controlled trial

Palliative & Supportive Care ◽

10.1017/s1478951507070174 ◽

2007 ◽

Vol 5 (2) ◽

pp. 107-114 ◽

Cited By ~ 34

Author(s):

MARIA I. LAPID ◽

TERESA A. RUMMANS,. ◽

PAUL D. BROWN ◽

MARLENE H. FROST ◽

MARY E. JOHNSON ◽

...

Keyword(s):

Quality Of Life ◽

Radiation Therapy ◽

Advanced Cancer ◽

Tertiary Care ◽

Intervention Group ◽

Cancer Center ◽

Controlled Clinical Trial ◽

Elderly Age

Objective: To examine the potential impact of elderly age on response to participation in a structured, multidisciplinary quality-of-life (QOL) intervention for patients with advanced cancer undergoing radiation therapy.Methods: Study design was a randomized stratified, two group, controlled clinical trial in the setting of a tertiary care comprehensive cancer center. Subjects with newly diagnosed cancer and an estimated 5-year survival rate of 0%–50% who required radiation therapy were recruited and randomly assigned to either an intervention group or a standard care group. The intervention consisted of eight 90-min sessions designed to address the five QOL domains of cognitive, physical, emotional, spiritual, and social functioning. QOL was measured using Spitzer uniscale and linear analogue self-assessment (LASA) at baseline and weeks 4, 8, and 27.Results: Of the 103 study participants, 33 were geriatric (65 years or older), of which 16 (mean age 72.4 years) received the intervention and 17 (mean age 71.4 years) were assigned to the standard medical care. The geriatric participants who completed the intervention had higher QOL scores at baseline, at week 4 and at week 8, compared to the control participants.Significance of results: Our results demonstrate that geriatric patients with advanced cancer undergoing radiation therapy will benefit from participation in a structured multidisciplinary QOL intervention. Therefore, geriatric individuals should not be excluded from participating in a cancer QOL intervention, and, in fact, elderly age may be an indicator of strong response to a QOL intervention. Future research should further explore this finding.