A pilot study of direct care nurse (DCN) education to improve adherence and knowledge of erlotinib in patients with non-small cell lung cancer.

e19637 Background: Adherence for oral anticancer agents is a major concern for patients in the ambulatory setting. Adherence rates for oral medication regimens are associated with proper knowledge and monitoring for adverse side effects including symptom management. To improve patient-reported adherence we studied feasibility of a DCN educational intervention to enhance participant knowledge and adherence to erlotinib while monitoring for side effects. Methods: A prospective, pilot study with 30 NSCLC patients was conducted. The study included a DCN structured education session utilizing an adapted educational tool (MOATT) from the Multinational Association of Supportive Care in Cancer (MASCC); followed within 72 hours by a DCN phone call to assess patient learning, adherence, and adverse side effects. Primary endpoints included participant-reported Knowledge Rating Scale (KRS) scores and adherence behaviors measured by the Morisky Medication Adherence Scale (MMAS-8). Adverse side effects and feasibility data were analyzed for each DCN/patient encounter. Results: MMAS-8 adherence scores indicated medium (n=11) to high (n=14) adherence rates and high KRS scores (mean 8.9, range of 7.5-10). Mean age of patients was 67 years (range 45-84 years), majority were female (81%), with race/ethnicity as Caucasian 80%, Asian 10%, and Black 10%. Mean number of erlotinib adverse events was 2.48 per patient and 22% reported 4 or more side effects. Patients contacted DCN 60 times between start and end of protocol. Feasibility included 90% (n=27/30) completing the protocol, mean time 30 minutes to administer educational session and 14 minutes for DCN 72-hour follow-up phone call. Documentation of visits indicated nurse education and follow-up, including monitoring side effects, provided valued supportive care. Conclusions: Data supports the need for and feasibilty of a nurse-led structured protocol to enhance adherence, knowledge, and symptom management. Further study of this education/monitoring intervention for patients initiating oral anticancer agents in the ambulatory setting is recommended.

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Oral anticancer agents: a prospective pilot study of a patient educational surgery run by a pharmacist and a nurse

European Journal of Hospital Pharmacy ◽

10.1136/ejhpharm-2012-000074.265 ◽

2012 ◽

Vol 19 (2) ◽

pp. 185.2-185

Author(s):

D. Conde-Estévez ◽

D. Gómez-Ulloa ◽

A. Vila Bundó ◽

J. Mateu-de Antonio ◽

M. Florit ◽

...

Keyword(s):

Pilot Study ◽

Anticancer Agents ◽

Prospective Pilot Study ◽

Oral Anticancer Agents

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Combined Unilateral Subthalamic Nucleus and Contralateral Globus Pallidus Interna Deep Brain Stimulation for Treatment of Parkinson Disease: A Pilot Study of Symptom-Tailored Stimulation

Neurosurgery ◽

10.1093/neuros/nyaa201 ◽

2020 ◽

Cited By ~ 2

Author(s):

Chencheng Zhang ◽

Linbin Wang ◽

Wei Hu ◽

Tao Wang ◽

Yijie Zhao ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Side Effects ◽

Parkinson Disease ◽

Globus Pallidus ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Bilateral Stimulation ◽

Adverse Side Effects ◽

Deep Brain

Abstract BACKGROUND Subthalamic nucleus (STN) and globus pallidus interna (GPi) are the most effective targets in deep brain stimulation (DBS) treatment for Parkinson disease (PD). However, the individualized selection of targets remains a clinical challenge. OBJECTIVE To combine unilateral STN and contralateral GPi stimulation (STN DBS in one brain hemisphere and GPi DBS in the other) to maximize the clinical advantages of each target while inducing fewer adverse side effects in selected patients with PD because each target has its own clinical effects and risk profiles. METHODS We reviewed the clinical outcomes of 8 patients with idiopathic PD treated with combined unilateral STN and contralateral GPi DBS. Clinical outcome assessments, focusing on motor and nonmotor symptoms, were performed at baseline and 6-mo and 12-mo follow-up. We performed the assessments under the following conditions: medication on and off (bilateral stimulation on and off and unilateral STN stimulation on). RESULTS Patients showed a significant improvement in motor symptoms, as assessed by the Unified Parkinson Disease Rating Scale III (UPDRS-III) and Timed Up-and-Go Test (TUG), in the off-medication/on-stimulation state at 6-mo and 12-mo follow-up. Also, patients reported a better quality of life, and their intake of levodopa was reduced at 12-mo follow-up. In the on-medication condition, bilateral stimulation was associated with an improvement in axial symptoms, with a 64% improvement in measures of gait and falls at 12-mo follow-up. No irreversible adverse side effects were observed. CONCLUSION Our findings suggest that combined unilateral STN and contralateral GPi DBS could offer an effective and well-tolerated DBS treatment for certain PD patients.

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Hypofractionated adjuvant radiation therapy of soft tissue sarcoma in elderly patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e21521 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e21521-e21521

Author(s):

Ofer Merimsky ◽

Viacheslav Soyfer ◽

Benjamin W. Corn ◽

Solomon Dadia ◽

Yehuda Kollender

Keyword(s):

Radiation Therapy ◽

Side Effects ◽

Acute Toxicity ◽

Elderly Patients ◽

Metastatic Disease ◽

Ambulatory Setting ◽

Adjuvant Radiation ◽

Adjuvant Radiation Therapy ◽

Local Recurrences

e21521 Background: Adjuvant radiation therapy is an essential part of combined limb sparing treatment of STS. The recommended dose of radiation lies in the range of 60 Gy in standard fractionation of 1.8-2 Gy. Elderly or medically unfit patients often have difficulty in completing 6-7w of daily treatment. A prolonged course of radiation may be interrupted by acute side effects, which sometimes demands further extension of the overall course or even discontinuation of treatment. We intended to evaluate the efficacy of a hypofractionated adjuvant approach with radiation therapy for STS in the elderly and debilitated patients. Methods: 21 elderly patients were treated with a short course of adjuvant RT (39 to 48 Gy, 3 Gy per fraction) for STS. The medical records of the patients were retrospectively reviewed for the local or distant recurrence and side effects of RT. Results: Overall, the hypofractionated irradiation regimen of 39-48 Gy in 13-16 fractions was well tolerated with only 3 patients developing Grade 2-3 acute toxicity (mainly dermatitis). Three patients suffered from delayed Grade 2-3 toxicity (chronic pain, skin atrophy, teleangiectasiae) scaled according to CTSC. The mean time from the surgery until the initiation of RT was 65 days (SD 21.6). Mean RT time was 18.4 (SD 3) days. No delay of treatment due to acute toxicity was registered. All patients except for one were able to receive RT in the ambulatory setting. With a mean follow-up of 532 days (SD: 325), three local recurrences (14%) were detected. Three of eight patients with distant metastases died of sarcoma (graph 1). One patient with metastatic disease in the lung received salvage stereo tactic radiation therapy and was still alive 6 month after completion of SBRT with no evidence of disease. At a mean 532 days of follow up three local recurrences (14%) were detected .Eight patients (38%) had lung metastases during the observed period. Three of them died from metastatic disease. The hypofractionated radiation was well tolerated with minimum long term side effects. Conclusions: Hypofractionated adjuvant radiation appears to be an effective treatment in terms of local control in elderly and debilitated patients.

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Pilot study on outcome and antitumor efficacy of an autologous cancer cell vaccine applied in patients with advanced solid tumors.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.3000 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 3000-3000 ◽

Cited By ~ 1

Author(s):

Eglys Gonzalez Marcano ◽

Leona Kröhle ◽

Joachim Ahlers ◽

Joachim Drevs

Keyword(s):

Pilot Study ◽

Side Effects ◽

Tumor Marker ◽

Solid Tumors ◽

Tumor Cells ◽

Cell Vaccine ◽

Advanced Solid Tumors ◽

Tumor Cell Death ◽

Informed Consent Form

3000 Background: In the last decade cancer immunotherapy has emerged as the most promising anti-tumor approach. The most commonly used immunotherapies are vaccines and checkpoint inhibitors. An autologous cell vaccine is made with the patient's own tumor cells processed in vitro, which may elicit a cytotoxic T-lymphocytic immune response against tumor cells antigens, resulting in tumor cell death. We performed a pilot study to evaluate the clinical relevance and general outcome of an autologous vaccine as a treatment in different types of cancer. Methods: A total of 31 patients (n=31) with advanced solid tumors and the lack of standard treatments were treated with an immunotherapy protocol consisting of 6 intradermal doses of the vaccine, given the first two doses at day 1 and 2, and the rest every two weeks. All patients signed an informed consent form. Response evaluation was assessed by PET/CT identified as metric (iRECIST) response and in some cases tumor markers where available. Results: Out of 31 patients treated, 2 patients suffered from pancreatic cancer, 2 from sarcoma, 1 from lung cancer, 13 from breast cancer, 2 from ovarian cancer, 1 from prostate cancer, 1 from cholangiocarcinoma, 4 from colorectal cancer, 1 from non-Hodgkin lymphoma, 1 from gastric cancer, 1 from laryngeal and hypopharyngeal cancer, 1 from fallopian tube cancer, 1 from peritoneal cancer. Side effects related to the therapy were rare including light redness in the area of injection and in one case inflammation of the tumor area. 26 patients were evaluated for metric response and 5 for tumor marker response assessment. For tumor marker follow up 9.6 % had a SD of > 3 month and 6.5 % a PD. For metric follow up 12.9 % had a CR, 6.5 % a PR, 25.8 % a SD of > 3 month and 38.7 % a PD. Conclusions: This study have confirmed an anti-tumor response in the majority of patients treated, with none to very low side effects and a good quality of life during the treatment. To obtain more detailed and significant data on the efficacy of this therapy, a further controlled clinical phase study should be performed.

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A Novel Digital Patient-Reported Outcome Platform for Head and Neck Oncology Patients–-A Pilot Study

Clinical Medicine Insights Ear Nose and Throat ◽

10.4137/cment.s40219 ◽

2016 ◽

Vol 9 ◽

pp. CMENT.S40219 ◽

Cited By ~ 9

Author(s):

Maria K. Peltola ◽

Joel S. Lehikoinen ◽

Lauri T. Sippola ◽

Kauko Saarilahti ◽

Antti A. Mäkitie

Keyword(s):

Quality Of Life ◽

Pilot Study ◽

Side Effects ◽

Head And Neck ◽

Cancer Patients ◽

Early Stage ◽

Patient Reported Outcome ◽

Patient Reported

Introduction The patient's role in toxicity reporting is increasingly acknowledged. There is also a need for developing modern communication methods between the patient and the medical personnel. Furthermore, the increasing number of head and neck cancer (HNC) patients is reflected in the volume of treatment follow-up visits, which remains a challenge for the health care. Electronic patient-reported outcome (ePRO) measures may provide a cost-efficient way to organize follow-up for cancer patients. Materials and Methods We tested a novel ePRO application called Kaiku®, which enables real-time, online collection of patient-reported outcomes, such as side effects caused by treatment and quality of life. We conducted a pilot study to assess the suitability of Kaiku® for HNC patients at the Department of Oncology, Helsinki University Hospital, Helsinki, Finland. Patients used Kaiku® during and one month after radiotherapy to report treatment-related side effects and quality of life. Two physicians and a nurse performed the practical electronic communication part of the study. Results Five of the nine patients agreed to participate in the study: three of them had local early-stage larynx cancer (T2N0, T1aN0, and T2N0) and the remaining two patients had early-stage base of tongue cancer (T2N0 and T1N2b). The degree of side effects reported by the patients via Kaiku® ranged from mild to life threatening. The number of outcome data points on patients' progress was significantly increased, which resulted in a better follow-up and improved communication between the patient and the care team. Conclusions Kaiku® seems to be a suitable tool to monitor side effects and quality of life during and after radiotherapy among HNC patients. Kaiku® and similar tools could be useful in organizing a cost-effective follow-up process for HNC patients. We recommend conducting a larger study to further assess the impact of an ePRO solution in routine clinical practice. • ePRO solutions may aid in the follow-up for cancer patients. • They seem suitable to monitor, for example, side effects and quality of life. • These systems ensure fast patient-driven reporting.

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Is There a Role for Acupuncture in the Symptom Management of Patients Receiving Palliative Care for Cancer? A Pilot Study of 20 Patients Comparing Acupuncture with Nurse-Led Supportive Care

Acupuncture in Medicine ◽

10.1136/aim.2011.004044 ◽

2011 ◽

Vol 29 (3) ◽

pp. 173-179 ◽

Cited By ~ 24

Author(s):

Jan T W Lim ◽

Erin T Wong ◽

Steven K H Aung

Keyword(s):

Palliative Care ◽

Pilot Study ◽

Supportive Care ◽

Symptom Management

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Psychoeducation Improves Compliance and Outcome in Schizophrenia Without an Increase of Adverse Side Effects: A 7-Year Follow-up of the Munich PIP-Study

Schizophrenia Bulletin ◽

10.1093/schbul/sbw008 ◽

2016 ◽

Vol 42 (suppl 1) ◽

pp. S62-S70 ◽

Cited By ~ 17

Author(s):

Josef Bäuml ◽

Gabriele Pitschel-Walz ◽

Anja Volz ◽

Sandra Lüscher ◽

Michael Rentrop ◽

...

Keyword(s):

Side Effects ◽

Adverse Side Effects

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75 Community Dnacpr Forms: Opening A Can of Worms

Age and Ageing ◽

10.1093/ageing/afab030.36 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

J Odone ◽

R Schiff

Keyword(s):

Pilot Study ◽

Phone Call ◽

Post Intervention ◽

Patient Understanding ◽

Cardio Pulmonary Resuscitation ◽

Pdsa Cycle ◽

National Guidance ◽

The Impact ◽

Improve Patient

Abstract Background There is no national guidance for the transfer of Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions between care settings. This issue has been highlighted within our Integrated Care Trust. We reviewed our local process, to improve the transfer of DNACPR decisions between care settings. Method A third PDSA cycle was completed to evaluate intervention. Intervention Frequently asked questions were added to the reverse side of the DNACPR form to improve patient understanding. All patients discharged home were given this updated form during a pilot study. The impact of the intervention was analysed with a follow-up phone call (n = 30) and discussed at a staff focus group. Results No improvement in patient understanding was shown post-intervention, however the intervention was overwhelmingly supported by staff. 60% of patients reported receiving a DNACPR form on discharge and 12% recalled being informed that they would be discharged home with a form. Conclusion Further work is required on the DNACPR pathway across primary and secondary care. The next cycle will involve ensuring that the community form is highlighted in hospital discussions regarding DNACPR decisions.

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