Electronic prompt to improve outpatient code status documentation for advanced lung cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6048-6048
Author(s):  
Jennifer S. Temel ◽  
Joseph A. Greer ◽  
Emily R. Gallagher ◽  
Vicki A. Jackson ◽  
Inga Tolin Lennes ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Focus Groups ◽  
Chemotherapy Regimen ◽  
Academic Medical Center ◽  
Advanced Lung Cancer ◽  
Code Status ◽  
One Year ◽  
Study Participants ◽  
The Impact ◽  
Historical Controls

6048 Background: Rates of documentation of end-of-life care preferences in the medical record remain low, even among patients with incurable malignancies.  The goal of this study was to assess the impact of electronic prompts to encourage oncology clinicians to document code status in the outpatient electronic health record (EHR) of patients with advanced lung cancers. Methods: We conducted two clinician focus groups (n=15) at an affiliated academic medical center to determine the appropriate content and timing of the electronic reminders.  Based on the focus groups, we developed email reminders that were timed to the start of each new chemotherapy regimen.  Between 6/09 and 1/11, 102 eligible patients with advanced lung cancer were approached, and 100 (98%) agreed to participate in the prospective study.  Email reminders were sent to oncology clinicians at the patient's next outpatient visit and with each new chemotherapy regimen.  Using a pre-post design, we compared study participants to a retrospective cohort of 100 consecutive historical controls who began chemotherapy for advanced lung cancer at least one year prior to the start of this study.  The primary outcome measure was the documentation of code status in the EHR.   Results: Study participants were similar to historical controls, with no significant differences in age, gender, performance status, histology or initial cancer therapy received.  At one year follow-up, 33/98 (34%) of participants had a code status documented in the outpatient EHR compared with 12/83 (15%) of historical controls, p=0.003.  Mean time to code status documentation was significantly shorter in study participants (8.6 months [95% CI 7.6-9.5]) compared with controls (10.5 months [95% CI 9.8-11.3]), p=0.004. Conclusions: Email prompts triggered by changes in chemotherapy improved the rate and timing of code status documentation in the EHR.

Electronic Prompt to Improve Outpatient Code Status Documentation for Patients With Advanced Lung Cancer

2013 ◽  
Vol 31 (6) ◽  
pp. 710-715 ◽  
Author(s):  
Jennifer S. Temel ◽  
Joseph A. Greer ◽  
Emily R. Gallagher ◽  
Vicki A. Jackson ◽  
Inga T. Lennes ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Medical Center ◽  
Primary Outcome Measure ◽  
Advanced Lung Cancer ◽  
Two Phase ◽  
Lung Cancers ◽  
Code Status ◽  
Phase Study ◽  
E Mail ◽  
Historical Controls

Purpose Rates of documentation of end-of-life care preferences in the medical record remain low, even among patients with incurable malignancies. We therefore conducted a two-phase study to develop and assess the effect of electronic prompts to encourage oncology clinicians to document code status in the outpatient electronic health record (EHR) of patients with advanced lung cancers. Patients and Methods To determine the optimal delivery, content, and timing of the electronic prompt, we first facilitated focus groups with oncology clinicians at an affiliated medical center. Given this feedback, we developed e-mail reminders timed to the start of each new chemotherapy regimen. Between July 2009 and January 2011, 102 eligible patients with incurable lung cancer were approached, and 100 agreed to participate. We compared e-mail prompt participants (EPPs) with a cohort of 100 consecutive historical controls who began therapy for incurable lung cancer at least 1 year before the start of this study. The primary outcome measure was clinician documentation of code status in the EHR. Results EPPs were similar to historical controls, with no significant differences in demographic or clinical characteristics. At 1-year follow-up, 33.7% (n = 33/98) of EPPs had a code status documented in the outpatient EHR compared with 14.5% (n = 12/83) of historical controls (P = .003). Mean time to code status documentation was significantly shorter in EPPs (8.6 months [95% CI, 7.6 to 9.5]) compared with controls (10.5 months [95% CI, 9.8 to 11.3]; P = .004). Conclusion e-mail prompts may improve the rate and timing of code status documentation in the EHR and warrant further investigation.

scholarly journals P1.16-07 Real World Evidence of the Impact of Immunotherapy in Patients with Advanced Lung Cancer

2019 ◽  
Vol 14 (10) ◽  
pp. S588
Author(s):  
C. Pettengell ◽  
J. Law ◽  
L. Le ◽  
M. Sung ◽  
S. Lau ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Real World ◽  
Advanced Lung Cancer ◽  
Real World Evidence ◽  
The Impact

Treatment of Lung Cancer in Medically Compromised Patients

2016 ◽  
pp. e484-e491
Author(s):  
Jeffrey Crawford ◽  
Paul Wheatley-Price ◽  
Josephine Louella Feliciano
Keyword(s):  
Lung Cancer ◽  
Socioeconomic Status ◽  
Clinical Trials ◽  
Molecular Mechanisms ◽  
Early Stage ◽  
Care Delivery ◽  
Advanced Lung Cancer ◽  
Early Stage Disease ◽  
Major Barrier ◽  
The Impact

Outcomes for patients with lung cancer have been improved substantially through the integration of surgery, radiation, and systemic therapy for patients with early-stage disease. Meanwhile, advances in our understanding of molecular mechanisms have substantially advanced our treatment of patients with advanced lung cancer through the introduction of targeted therapies, immune approaches, improvements in chemotherapy, and better supportive care. However, the majority of these advances have occurred among patients with good functional status, normal organ function, and with the social and economic support systems to be able to benefit most from these treatments. The aim of this article is to bring greater attention to management of lung cancer in patients who are medically compromised, which remains a major barrier to care delivery. Impaired performance status is associated with poor outcomes and correlates with the high prevalence of cachexia among patients with advanced lung cancer. CT imaging is emerging as a research tool to quantify muscle loss in patients with cancer, and new therapeutics are on the horizon that may provide important adjunctive therapy in the future. The benefits of cancer therapy for patients with organ failure are poorly understood because of their exclusion from clinical trials. The availability of targeted therapy and immunotherapy may provide alternatives that may be easier to deliver in this population, but clinical trials of these new agents in this population are vital. Patients with lower socioeconomic status are disproportionately affected by lung cancer because of higher rates of tobacco addiction and the impact of socioeconomic status on delay in diagnosis, treatment, and outcomes. For all patients who are medically compromised with lung cancer, multidisciplinary approaches are particularly needed to evaluate these patients and to incorporate rapidly changing therapeutics to improve outcomes.

scholarly journals Evaluation of Omics-Based Strategies for the Management of Advanced Lung Cancer

2020 ◽  
pp. OP.20.00117
Author(s):  
Ravi Salgia ◽  
Isa Mambetsariev ◽  
Rebecca Pharaon ◽  
Jeremy Fricke ◽  
Angel Ray Baroz ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Targeted Therapy ◽  
Predictive Value ◽  
Advanced Nsclc ◽  
Therapeutic Options ◽  
Advanced Lung Cancer ◽  
Molecular Testing ◽  
Cox Regression Analysis ◽  
The Impact

PURPOSE: Omic-informed therapy is being used more frequently for patients with non–small-cell lung cancer (NSCLC) being treated on the basis of evidence-based decision-making. However, there is a lack of a standardized framework to evaluate those decisions and understand the association between omics-based management strategies and survival among patients. Therefore, we compared outcomes between patients with lung adenocarcinoma who received omics-driven targeted therapy versus patients who received standard therapeutic options. PATIENTS AND METHODS: This was a retrospective study of patients with advanced NSCLC adenocarcinoma (N = 798) at City of Hope who received genomic sequencing at the behest of their treating oncologists. A thoracic oncology registry was used as a clinicogenomic database to track patient outcomes. RESULTS: Of 798 individuals with advanced NSCLC (median age, 65 years [range, 22-99 years]; 60% white; 50% with a history of smoking), 662 patients (83%) had molecular testing and 439 (55%) received targeted therapy on the basis of the omic-data. A fast-and-frugal decision tree (FFT) model was developed to evaluate the impact of omics-based strategy on decision-making, progression-free survival (PFS), and overall survival (OS). We calculated that the overall positive predictive value of the entire FFT strategy for predicting decisions regarding the use of tyrosine kinase inhibitor–based targeted therapy was 88% and the negative predictive value was 96%. In an adjusted Cox regression analysis, there was a significant correlation with survival benefit with the FFT omics-driven therapeutic strategy for both PFS (hazard ratio [HR], 0.56; 95% CI, 0.42 to 0.74; P < .001) and OS (HR, 0.51; 95% CI, 0.36 to 0.71; P < .001) as compared with standard therapeutic options. CONCLUSION: Among patients with advanced NSCLC who received care in the academic oncology setting, omics-driven therapy decisions directly informed treatment in patients and was correlated with better OS and PFS.

Prescribers' perceptions on the impact of hydrocodone rescheduling on geriatric pain management: A qualitative study

2018 ◽  
Vol 14 (5) ◽  
pp. 317-326
Author(s):  
Julianna Fernandez, PharmD, BCPS, CGP ◽  
James Douglas Thornton, PhD, PharmD, BCPS ◽  
Sanika Rege, MS ◽  
Benjamin Lewing, MS ◽  
Shweta Bapat, BPharm ◽  
...  
Keyword(s):  
Pain Management ◽  
Focus Groups ◽  
Geriatric Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Monitoring Program ◽  
Prescribing Patterns ◽  
Cross Sectional ◽  
Term Care ◽  
The Impact

Objective: To qualitatively assess prescribers’ perceptions regarding the consequences associated with hydrocodone rescheduling among geriatric patients being discharged from inpatient settings.Design: This was a cross-sectional study.Setting: Two focus groups were conducted by a trained facilitator in a metropolitan academic medical center in January 2016.Participants: Prescribers who manage noncancer pain for geriatric patients were recruited. Focus groups were recorded, transcribed, and then analyzed using ATLAS.ti Qualitative Data Analysis software. Codes were derived from six primary research questions and results were summarized into key themes regarding the impact of rescheduling.Main outcome measures: Prescribers’ perceptions regarding hydrocodone rescheduling.Results: Prescribers mentioned that they review the prescription monitoring program (PMP) more often before prescribing opioids after rescheduling. They expressed concern regarding the required special serialized prescription forms needed to issue schedule II prescriptions. This led to substituting hydrocodone with potentially less effective pain medications, the inability to issue refills on hydrocodone prescriptions, and an ethical concern over prescribing hydrocodone to patients not under their direct care. Additionally, rescheduling has affected the coordination of care upon discharge, as patients moving to long-term care or skilled nursing facilities may not have adequate pain management when transferred.Conclusions: The majority of physicians felt rescheduling negatively impacted both practical and ethical aspects of patient care related to pain management after discharge. Rescheduling has changed physicians’ hydrocodone prescribing patterns, leading to more caution when prescribing hydrocodone and greater use of the PMP. Future studies should assess geriatric patients’ satisfaction and quality of life regarding pain management since hydrocodone was rescheduled.

Reliability of imaging biomarkers for response assessment in advanced lung cancer: Influence of expertise and automation.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e13547-e13547
Author(s):  
Hubert Beaumont ◽  
Estanislao Oubel ◽  
Antoine Iannessi ◽  
Dag Wormanns
Keyword(s):  
Lung Cancer ◽  
Response Assessment ◽  
Response To Therapy ◽  
Measuring System ◽  
Response To Treatment ◽  
Advanced Lung Cancer ◽  
Imaging Biomarkers ◽  
Axial Diameter ◽  
Manual Adjustment ◽  
The Impact

e13547 Background: Image-based biomarkers play an important role in the assessment of the response to therapy. The value of imaging biomarkers relies on their reproducibility, which depends on the reviewer and on the measuring system. This study aims at evaluating the impact of readers’ expertise and automation of measurements. Methods: A retrospective study was performed on 10 patients with at least one Non-Small Cell Lung Cancer (NSCLC) lesion, and followed over time (7 time points in average) with Computed Tomography (CT). 2 expert radiologists (ERs) and 5 imaging scientists (ISs) measured the Longest Axial Diameter (LAD) and the volume (VOL) of each lesion at each time point. ERs and ISs segmented the lesions by using a proprietary software providing semi-automatic segmentation processing with manual adjustment. ISs performed an additional session using manual segmentation tools only. From each segmentation, VOL and LAD were automatically computed. The variability of the measurements was calculated by using standard statistics. The response to treatment was assessed according to RECIST thresholds for LAD and with +/-30% thresholds for volume. The inter-reader agreement was measured trough the Kappa coefficient. Finally, the reviewing time with and without automation was analyzed. Results: The use of automated tools by ISs reduced the standard deviation of LAD difference from 10.7% to 8.4%. The inter-reader agreement improved Kappa from 0.57 to 0.68 for LAD, and from 0.52 to 0.69 for VOL. The automation reduced the reviewing time by a factor 4 with respect to the manual assessment. No significant differences in variability were found between ISs and the first ER, but significant differences were observed with respect to the second ER. Conclusions: In a RECIST context, automation improved significantly inter-reader agreement. When using volume as a biomarker, automation not only improved the inter-reader agreement, but also decreased notably the reviewing time. No evidence was found about the influence of the expertise on the volume measurement. The difference in the lesions interpretation by the experts is a relevant factor to account for.

Relationship between cholangitis, initial chemotherapy regimen, and overall survival in patients with unresectable pancreatic adenocarcinoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15788-e15788
Author(s):  
Melissa Lumish ◽  
Thomas Wang ◽  
Elijah Darnell ◽  
Yasmin Hernandez-Barco ◽  
Kumar Krishnan
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Adenocarcinoma ◽  
Chemotherapy Regimen ◽  
Response To Therapy ◽  
Categorical Variables ◽  
Metal Stents ◽  
P Value ◽  
Primary Therapy ◽  
One Year ◽  
The Impact

e15788 Background: Chemotherapy remains the primary therapy for patients with unresectable pancreatic adenocarcinoma, though response to therapy is variable. Patients with pancreatic adenocarcinoma frequently develop jaundice and cholangitis and require endoscopic biliary stenting. Here, we investigate the association between cholangitis, initial chemotherapy regimen, and one-year survival in patients with unresectable pancreatic adenocarcinoma. Methods: We conducted a retrospective chart review of all patients who received metal stents for biliary obstruction with pancreatic adenocarcinoma over a five-year period at the Massachusetts General Hospital. Only patients with unresectable cancer were included. We compared the association between survival and cholangitis within four subgroups: no chemotherapy, gemcitabine alone or in combination, FOLFOX combination and FOLFIRINOX. The statistical methods used were the chi-squared test for categorical variables, regular ANOVA for continuous variables, and log-rank (Mantel-Cox) test for survival analysis. Results: In total, we identified 74 patients who did not develop cholangitis and 52 patients who developed at least one episode of cholangitis. Among patients undergoing chemotherapy, cholangitis was associated with decreased survival within each subgroup (p-value = < 0.001). At one year from diagnosis, there was an association between cholangitis and decreased survival among patients receiving chemotherapy, independent of the number of episodes of cholangitis. Among those who were not receiving chemotherapy, cholangitis was not associated with survival outcome (p-value = 0.60). Conclusions: In conclusion, the development of cholangitis in patients receiving chemotherapy for metastatic pancreatic cancer is associated with decreased survival. This association is not affected by the number of episodes of cholangitis or by chemotherapy regimen. These data suggest that the development of cholangitis among patients receiving chemotherapy for pancreatic cancer may be a predictor of poor clinical outcomes. Further studies are needed to understand the impact of the local tumor microbial environment and to determine whether cholangitis is a surrogate for a more aggressive disease phenotype.

Costs of Extended Use of the Immune Check Point Inhibitors in 1st-line Non-Small Cell Lung Cancer

2021 ◽  
Author(s):  
Helmy M Guirgis
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Check Point ◽  
Small Cell Lung ◽  
Curative Intent ◽  
Check Point Inhibitors ◽  
One Year ◽  
The Impact

Aim: Cost-effectiveness in the health care system has been extensively investigated. Reports, however, on costs and the impact of extended use of the immune check point inhibitors (ICI) are rare. Pembrolizumab (Pembro) improved the 5-year overall survival in1st-line advanced/metastatic non-small cell lung cancer a/m-NSCLC. ICI are rather expensive, and costs are bound to increase with prolonged therapy. We purposed to focus on cost of extended ICI use beyond their indications in a/m-NSCLC. Methods: The 2020 annual posted drug costs were calculated in US$. Except for the one-year adjuvant Durv, used for curative intent, ICI costs were calculated for 2-years and beyond. Adverse events-treatment costs and generic chemo-drugs were not included. Results: ICI costs ranged from $103,400 to $168,948 with $148,431 mean. Adjuvant Durv one-year costs were $148,013. The 2-year Pembro costs in PD-L1 > 50% were $334,652, multiplying to >$836,630 after 5 years. Addition of 4 Peme cycles improved outcome regardless of PD-L1 at costs of $360,912. Costs of the 2-year Atezolizumab/Bevacizumab (Atezo/Bev) and one-year Peme were $722,977. Use of Biosimilar (Bio) saved $77,120. Atezo-Peme without Bev reduced costs to $422,725. Costs of Ipilimumab/Nivolumab (Ipi/Nivo) were $544,696. Adding 2 Peme cycles increased costs to $557,826. Extended for 6 months, the 2-year-costs of the 3 ICI combinations increased by 25% of the maintenance ICI. As compared with Pembro-Peme, the 2-year costs of Atezo/Bio-Bev-Peme were 2.00 higher, Atezo-Bio-Bev-Peme 1.79, Atezo-Pem 1.17, Ipi/Nivo 1.51 and Ipi/Nivo-Peme 1.55. The ratios would further separate with extended use beyond 2 years. Conclusions: ICI costs are determined by duration of therapy more than by the posted annual price. Costs of extended use call for guidance on therapy duration and emphasize the need for cost constraint-policies.

Psychosocial distress in patients with driver-mutant lung cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24125-e24125
Author(s):  
Lia Head ◽  
Nicole Yun ◽  
Sanjib Basu ◽  
Lauren Rynar ◽  
Jill Elizabeth Feldman ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Academic Medical Center ◽  
Well Being ◽  
Psychosocial Distress ◽  
Anxiety Symptoms ◽  
Depression Symptoms ◽  
Rapid Weight Loss ◽  
Depression And Anxiety ◽  
Prevalence Of Depression ◽  
The Impact

e24125 Background: Project PRIORITY, a collaborative research study between The EGFR Resisters and the LUNGevity Foundation, found that 29% of United States respondents had clinical depression. While tyrosine kinase inhibitors (TKI) prolong lives, the impact of an oncogene driven lung cancer diagnosis on emotional well-being is not well studied nor are resource utilization and potential contributing factors to psychosocial distress. Methods: Our primary objective was to study cancer related distress in patients (pts) with newly diagnosed oncogene driver lung cancer. The secondary objective was to correlate distress with neutrophil to lymphocyte ratio (NLR) and body mass index loss (BMI) as a surrogate for cancer cachexia/precachexia to gauge the relationship to psychosocial distress. We retrospectively reviewed pts treated with TKI between 1/1/2008 and 2/1/2021. Sample size was based on estimates of depression in this population. A diagnosis of depression or anxiety was defined by documentation in the visit problem list, and active symptoms were based on progress note documentation. Depression and anxiety were recorded at 6 time points from diagnosis to progression on TKI, and their associations with treatment toxicities, progression free survival (PFS) and overall survival (OS) were assessed. Association with serial BMI and NLR were assessed using longitudinal statistical models. Results: We studied 78 pts: 71.8% female, 62.8% Caucasian, 15.4% African American, 15.6% Hispanic/LatinX, and 11.5% Asian. 94.9% had an EGFR mutation, and 5.1% had an ALK mutation. Prevalence of depression at diagnosis and progression was 11.5% and 25%, with anxiety prevalence 28.2% and 40.6%, respectively. Of these pts, 22.2% had active depression symptoms and 54.5% had active anxiety symptoms at diagnosis, although symptoms were not addressed in 33.3% and 22.7%, respectively. At progression, 68.8% had active depression symptoms and 46.2% had active anxiety symptoms, but symptoms were not addressed in 6.3% and 26.9%, respectively. At diagnosis and progression, 24.4% and 35.9%, respectively, were on treatment for anxiety and/or depression. Social work and psychology evaluated 12.8% and 10.3% of all pts at diagnosis and 10.9% and 17.2% at progression. NLR > 3.5 and > 5 were not associated with depression or anxiety. A more rapid longitudinal decrease in BMI was associated with depression. Grade ≥3 toxicities were not associated with depression or anxiety. Shorter PFS and OS were associated with higher rates of depression, but not anxiety. Conclusions: In this retrospective study of an ethnically diverse patient group at an academic medical center, we found a prevalence of depression and anxiety consistent with the Project PRIORITY findings. We saw an association between depression and more rapid weight loss but did not see correlation with NLR. Prospective evaluation with accurate documentation is needed to better address these questions in future studies.

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