Impact of a multidisciplinary cancer care program and nurse navigation on pancreatic adenocarcinoma treatment.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 200-200
Author(s):  
Laurence E. McCahill ◽  
Mary May ◽  
Coralyn Martinez ◽  
Wendy K. Taylor ◽  
Alan T. Davis
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Stage I ◽  
First Year ◽  
Evidence Based ◽  
Newly Diagnosed ◽  
Physician Visits ◽  
Cancer Program ◽  
Gi Cancer ◽  
Nurse Navigator ◽  
The Impact

200 Background: Treatment of pancreatic adenocarcinoma (PanCa) is complex and requires input from multiple physicians. We developed a unique gastrointestinal (GI) cancer program utilizing a multidisciplinary conference, a multidisciplinary clinic (MDC), a GI nurse navigator (NN) and continuous quality assessment with a nurse clinical auditor. The impact of this program, which requires significant additional resources, on adherence to evidence based cancer treatment for newly diagnosed PanCa patients is unknown. Methods: The GI (NN) interviews patients, coordinates staging and biopsies, physician visits and subsequent adjuvant care in the first year of diagnosis. A clinical quality specialist abstracted all treatment received (surgical, radiation, chemotherapy, palliative), and data was entered into a GI Quality database. Treatment received by patients in first year of diagnosis was compared to NCCN guidelines. Results: From January 2010 to April 2012, 68 patients with newly diagnosed PanCA were evaluated/treated. Overall compliance with NCCN treatment guidelines was 83.4%. Compliance was highest for stage I (almost all underwent surgical resection) and stage IV (none underwent surgery). Utilization of adjuvant therapies was 80% (16/20) for patients with stageI/II disease. Eight patients with stage I/II disease did not undergo surgery, due to comorbidities or disease progression. Conclusions: A novel GI cancer program utilizing a multispecialty MDC and a dedicated GI NN demonstrates very high compliance with evidence based therapy for first line treatment for PanCa patients. Although resource intensive, this level of adherence to evidence-based medicine is encouraging and higher than prior reports for PanCa. The relative contribution of the GI MDC clinic format versus the NN warrants further study. [Table: see text]

An assessment of the impact of geographic variation on resection rates and survival for early-stage pancreatic adenocarcinoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15052-e15052
Author(s):  
Bradley D. McDowell ◽  
Brian J. Smith ◽  
Anna M Button ◽  
James R. Howe ◽  
Elizabeth A. Chrischilles ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Pancreatic Adenocarcinoma ◽  
Early Stage ◽  
Stage I ◽  
Stage Ii ◽  
Survival Times ◽  
Resection Rate ◽  
Selection Factors ◽  
The Impact

e15052 Background: Pancreatic resection is the only known curative option for pancreatic adenocarcinoma. Resection has been previously reported to be underutilized in patients with early stage disease. To develop a better understanding of this issue and control for treatment selection factors, we examined the relationship between geographic area resection rates and survival in patients with stage I/II pancreatic cancer. Methods: We queried Surveillance, Epidemiology, and End Results (SEER) data for patients with stage I/II cancer of the pancreatic head diagnosed from 2004-2009. We excluded patients with less than 3mo survival. Resection rates were calculated within Health Service Areas (HSAs) across all 18 SEER regions. Resection rate was defined as the number of patients who had an operation divided by the total number diagnosed with early stage pancreatic cancer. Multivariate Cox regression was used to estimate the overall survival effect of HSA rates while controlling for age, gender, marital status, poverty level, education, and AJCC stage. Results: 8,323 patients with stage I (n=1,454) and stage II (n=6,869) disease were analyzed. Pancreatectomy was performed in 476 patients (32.7%) with stage I disease and 3,846 (56.0%) with stage II disease. HSA resection rates were arranged into five groups (quintiles) which ranged from 42.7 to 65.7% (Table). Across the quintiles, median overall survival increased from 11 to 14 months, suggesting a positive association with resection rate. Multivariate analysis revealed that for every 10.00% increase in resection rate, the risk of overall death decreased by 5.26% (p<0.001). Conclusions: Patients with early stage pancreatic cancer who live in areas with higher resection rates have longer average survival times. Because geography should not influence treatment response, we conclude that efforts to raise resection rates should increase survival times in patients for whom there is uncertainty about the risk/benefits of resection. [Table: see text]

scholarly journals Effects of Early Integrated Palliative Care in Patients With Lung and GI Cancer: A Randomized Clinical Trial

2017 ◽  
Vol 35 (8) ◽  
pp. 834-841 ◽  
Author(s):  
Jennifer S. Temel ◽  
Joseph A. Greer ◽  
Areej El-Jawahri ◽  
William F. Pirl ◽  
Elyse R. Park ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Usual Care ◽  
Study Groups ◽  
Cancer Type ◽  
Newly Diagnosed ◽  
Gi Cancer ◽  
Patient Health ◽  
Oncology Care ◽  
The Impact

Purpose We evaluated the impact of early integrated palliative care (PC) in patients with newly diagnosed lung and GI cancer. Patients and Methods We randomly assigned patients with newly diagnosed incurable lung or noncolorectal GI cancer to receive either early integrated PC and oncology care (n = 175) or usual care (n = 175) between May 2011 and July 2015. Patients who were assigned to the intervention met with a PC clinician at least once per month until death, whereas those who received usual care consulted a PC clinician upon request. The primary end point was change in quality of life (QOL) from baseline to week 12, per scoring by the Functional Assessment of Cancer Therapy-General scale. Secondary end points included change in QOL from baseline to week 24, change in depression per the Patient Health Questionnaire-9, and differences in end-of-life communication. Results Intervention patients ( v usual care) reported greater improvement in QOL from baseline to week 24 (1.59 v −3.40; P = .010) but not week 12 (0.39 v −1.13; P = .339). Intervention patients also reported lower depression at week 24, controlling for baseline scores (adjusted mean difference, −1.17; 95% CI, −2.33 to −0.01; P = .048). Intervention effects varied by cancer type, such that intervention patients with lung cancer reported improvements in QOL and depression at 12 and 24 weeks, whereas usual care patients with lung cancer reported deterioration. Patients with GI cancers in both study groups reported improvements in QOL and mood by week 12. Intervention patients versus usual care patients were more likely to discuss their wishes with their oncologist if they were dying (30.2% v 14.5%; P = .004). Conclusion For patients with newly diagnosed incurable cancers, early integrated PC improved QOL and other salient outcomes, with differential effects by cancer type. Early integrated PC may be most effective if targeted to the specific needs of each patient population.

QIM119-120: Utilizing Technology to Identify Oncology Patients to Impact Patient Care

2019 ◽  
Vol 17 (3.5) ◽  
pp. QIM119-120
Author(s):  
Brook Blackmore ◽  
Nicole Centers ◽  
Troy Gifford
Keyword(s):  
Data Mining ◽  
Cancer Patients ◽  
Total Patient ◽  
Oncology Nurse ◽  
Gi Cancer ◽  
Patient Recall ◽  
Nurse Navigator ◽  
Pathology Reports ◽  
The Impact ◽  
Technology Solution

Background: Sarah Cannon has established a standardized nurse navigation program for breast, lung, and Gi cancer patients. Navigators play a significant role in addressing barriers that may adversely impact patient outcomes. Historically, nurse navigators were spending up to 65% of their time data mining to identify new patients for navigation. This lost time compromises a navigator’s ability to effectively support patients. Sarah Cannon implemented a technology solution to address this manual process. Methods: A patient identification software application (patient ID), utilizing natural language processing technology, was developed to identify positive pathology reports across the enterprise in real time. Patient ID instantly routes those reports to a tumor site-specific oncology nurse navigator. The impact of this technology was assessed in 3 Hospital Corporation of America (HCA) markets from December 2016–March 2017. Total patient recall, total volume of reports reviewed, navigated patient volumes, navigator time allocation, and time from diagnosis to first treatment were studied. Results: Patient ID reviewed 47,544 pathology reports during the 4-month pilot, identifying 7,224 potential cancer reports. 2,782 of those represented breast, lung, or Gi cancer patients and were routed to a nurse navigator. Patient ID performed with an overall total patient recall of 98%, respectively. Decreased time spent data mining was observed, and navigator caseload increased by 71%. Time from diagnosis to first treatment decreased by an average of 6 days. Time allocated to direct patient contact and physician interaction increased by 35%. Conclusions: Implementation of a technology solution to rapidly identify new cancer patients for navigation in a community health system is feasible and associated with multiple benefits. Increased navigator patient volumes and navigator productivity were observed. Navigator time spent with patients and physicians increased with a concurrent reduction in data mining time. Timeliness of care metrics improved, suggesting a favorable impact on quality. This technology is now being deployed across the HCA enterprise.

Disease Extent in Newly Diagnosed Hodgkin Lymphoma: A Comparison of CT and PET/CT Staged Patients

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1532-1532
Author(s):  
Tarec Christoffer El-Galaly ◽  
Karen Juul Mylam ◽  
Peter de Nully Brown ◽  
Anne Bukh ◽  
Hans Erik Johnsen ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Stage I ◽  
Categorical Variables ◽  
Prognostic Impact ◽  
Newly Diagnosed ◽  
Extranodal Involvement ◽  
Pet Ct ◽  
Ann Arbor ◽  
The Impact

Abstract Abstract 1532 Introduction [18]F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) has become the method of choice for staging of Hodgkin lymphoma (HL). Studies indicate that PET/CT has higher sensitivity for both nodal and extranodal disease compared to stand-alone CT, which leads to upstaging of some patients and could potentially change the treatment strategy. The aims of this study were to assess the impact of PET/CT on staging results in newly diagnosed HL and to reevaluate the prognostic impact of the Ann Arbor classification in the PET/CT era. Patients and Methods We performed a retrospective review of pre-therapy staging results obtained in newly diagnosed HL patients before and after the introduction of PET/CT for routine staging at four Danish University Hospitals. Patients with histology verified HL and age ≥15 years were eligible for inclusion. Clinical information and staging results were obtained from the Danish Lymphoma Registry (LYFO) and supplemented by review of medical records. The CT cohort consisted of patients undergoing diagnostic work-up before the implementation of PET/CT (1998–2005). The PET/CT cohort consisted of patients staged with PET/CT during the period of 2006–2011 (for Copenhagen University Hospital 2001–2011). Follow-up data were collected on all PET/CT staged patients. Differences in clinico-pathological features between CT and PET/CT staged patients were tested with Fisher's exact test for categorical variables and Wilcoxon rank-sum test for continuous variables. In the PET/CT cohort, the Ann Arbor stage-specific progression-free survival (PFS) was evaluated by the Kaplan-Meier method and compared using the log-rank test. Results A total of 417 patients were included in the CT cohort and 454 patients were included in the PET/CT cohort. The two cohorts were similar on male:female ratio, histological HL subtype distribution and frequency of B-symptoms. The CT cohort differed from the PET/CT cohort in terms of slightly higher median age (42 yrs vs. 39 yrs; p=0.04) and poorer (≥2) ECOG performance score (17.8% vs. 5.3%; p<0.001). Stage I disease was less frequent among PET/CT staged patients (24% for CT vs. 17% for PET/CT, p=0.005), whereas stage II and III disease occurred more often in PET/CT staged patients. There was no difference in the occurrence of stage IV disease (18% for both CT and PET/CT staged patients). The overall frequency of extranodal involvement was 23% in the CT cohort and 26% in the PET/CT cohort (p=0.39). Among patients with extranodal involvement, the number of affected organs in CT vs. PET/CT staged patients was 1 organ: 82% vs. 73%; 2 organs: 16% vs. 25%; and ≥3 organs: 3% vs. 2% (p=0.24). PET/CT staged patients were more likely to be diagnosed with bone/bone marrow involvement (19% for PET/CT vs. 10% for CT, p<0.001), whereas the occurrence of lung/pleura, liver, muscle/soft tissue and gastrointestinal involvement was similar. In PET/CT staged patients, the Ann Arbor stage was predictive of PFS (median follow-up 34 months, range 1–113), although the difference between stage I and II was not statistically significant (Figure 1). Conclusions The two main differences between CT and PET/CT staged patients found in the present analysis were a lower occurrence of stage I disease and a more frequent detection of skeletal lesions in PET/CT staged patients. Unexpectedly, the overall frequency of extranodal involvement was similar between the two staging modalities. However, this does not necessarily imply a similar extranodal tumor burden since accurate lesion counts in each organ and volume measurements were not performed. Although developed decades ago, the Ann Arbor staging system still provides useful prognostic information in the PET/CT era. Disclosures: Hutchings: Takeda/Millennium: Consultancy.

The natural history and effect of adjuvant therapy on resected AJCC stage I-II lymph node-negative pancreatic cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 264-264
Author(s):  
Shaun McKenzie ◽  
Bin Huang ◽  
Thomas Tucker ◽  
Patrick McGrath ◽  
Dennie V. Jones ◽  
...  
Keyword(s):  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Pancreatic Adenocarcinoma ◽  
Cox Regression ◽  
Early Stage ◽  
Stage I ◽  
Lymph Node Status ◽  
Node Negative ◽  
The Impact

264 Background: Previous investigation has suggested that early stage, lymph node negative pancreatic adenocarcinoma (PAC) has a relatively good prognosis and adjuvant therapy provides little benefit over surgery alone. The purpose of our trial was to evaluate patients with stage I-II PAC receiving surgical resection to determine their clinical characteristics, overall outcome, and the impact of adjuvant therapy on survival. Methods: Utilizing the population-based registry data from the Kentucky Cancer Registry (KCR) we identified patients with lymph node negative, AJCC I-II, PAC who underwent pancreatic resection during the years of 1995-2008. Patients were further stratified by receipt of surgery alone versus surgery with adjuvant chemotherapy or chemoradiation. Clinical and pathologic data included patient demographics, tumor characteristics, and lymph node status. Kaplan-Meier and Cox-regression survival analyses were performed. Results: During the study period, 203 patients meeting criteria were identified from the KCR. Median survival (MS) for the entire cohort was 21.7 months. The majority of patients were >70 years old, Caucasian, had well or moderately differentiated tumors and tumors <5cm. 46% (n=94) and 54% (n=109) of patients had stage I and II disease respectively. When stratified by surgery only (n=119, 59%) versus adjuvant therapy (n=84, 41%), only younger age predicted receipt of adjuvant therapy (p=0.002). Adjuvant therapy provided no benefit over surgery alone regardless of stage (stage I MS: 21.5 vs. 24.7 months, p=0.97 and stage II MS: 24.2 vs. 18.0, p=0.13, respectively). By multivariate analysis, only tumor size >5cm predicted worse survival (HR 2.32, CI 1.21-4.45, p=0.012). Age, stage, adjuvant therapy, differentiation, and lymph node retrieval had no impact on survival. Conclusions: Our data indicate that the survival for surgically resected early stage, lymph node negative pancreatic adenocarcinoma remains poor and is not improved by the addition of adjuvant chemotherapy. These findings should be considered when designing future adjuvant therapy trials for this deadly disease.

Effect of surgical resection on survival following neoadjuvant chemotherapy in patients with stage I-II pancreatic adenocarcinoma.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 255-255
Author(s):  
Ryan James Henrix ◽  
Eva Rouanet ◽  
Kurt Schultz ◽  
Tasneem Ali ◽  
Bradley Alan Switzer ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Pancreatic Adenocarcinoma ◽  
Survival Benefit ◽  
Large Scale ◽  
Medical Center ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Curative Surgery ◽  
The Impact

255 Background: Pancreatic adenocarcinoma (PDAC) is a lethal malignancy, representing the 4th leading cause of cancer deaths. Our 2011 institutional protocol guides that patients with Stage I/II PDAC receive neoadjuvant chemotherapy (FOLFIRINOX or gemcitabine- nab-paclitaxel); a similar protocol is followed with patients with Stage III disease. The aim of the study is to determine if potentially curative surgery provides added survival benefit, compared to neoadjuvant chemotherapy alone. Methods: Patients who received neoadjuvant chemotherapy and who were diagnosed with stage I-III PDAC from 2011-2017 at a tertiary medical center were included in this prospectively-collected, retrospective analysis. The primary endpoint was overall survival (OS). Kaplan-Meier curves are compared using Log-rank. Cox proportional hazards were used to adjust for confounders. Results: 105 patients met inclusion criteria: 38 (36%) had Stage I disease (n = 18 had neoadjuvant chemotherapy and surgery [N+S], n = 20 had neoadjuvant chemotherapy [N] alone), 44 (42%) had stage II (N+S n = 20, N n = 24), 23 (22%) had stage III (N+S n = 4, N n = 19). There was no difference in 5-year OS regardless of treatment regimen in patients with Stage I (median OS N+S 22.5 mo vs N 27.9 mo; p = 0.99, HR 1.00, 95%CI 0.74-1.35) or Stage II disease (median OS N+S 28.7 mo vs N 27.6 mo; p = 0.69; HR 1.06, 95%CI 0.79-1.41). There is a trend towards improved OS with N+S in those with Stage III disease (median OS N+S 46.0 mo vs N 14.5 mo, p = 0.08), but the number who underwent resection is low (17%), limiting this analysis. Conclusions: In patients with Stage I-II PDAC, potentially curative surgery may not provide additional survival benefit beyond that afforded by modern day neoadjuvant chemotherapy. Stage III outcomes are limited by small numbers, and the impact of surgery is unclear. It may be possible that the locally unresectable tumor that is rendered resectable with neoadjuvant chemotherapy may be associated with a more favorable biology, such that surgery offers added survival benefit. Additional large-scale trials are needed to confirm whether newer therapies may obviate the need for resection in select patients.

Assessing the Impact on Critical Reading and Critical Thinking

2021 ◽  
Vol 21 (2) ◽  
pp. 277-294
Author(s):  
Anna Maria Johnson ◽  
Nusrat Jahan
Keyword(s):  
First Year ◽  
Evidence Based ◽  
Critical Reading ◽  
Reading Practices ◽  
Google Docs ◽  
Commonplace Books ◽  
Institutional Review ◽  
Writing Course ◽  
History Of ◽  
The Impact

Abstract Although much has been written about the history of commonplacing, there is a lack of evidence-based research to show the extent to which this historical practice may still be valuable today as a pedagogy that educates citizens in critical reading for democracy. This article describes an institutional-review-board-approved, experimental study to answer this question. Three sections of the same first-year reading and writing course were compared: one section did not use commonplace books, a second section used commonplace books that included quotations only, and a third section used commonplace books with reflective writing. We expected to find that students who used commonplace books would perform better in end-of-study assessments than those who did not. Instead, we were surprised to find that many of the students who were not required to use commonplace books created their own note-taking methods that performed a similar function. In essence, they developed their own commonplace book culture and methodology using Google Docs and other social reading practices. Their performance was as strong as the students who used commonplace books.

Perinatal mental illness

2017 ◽  
Vol 10 (11) ◽  
pp. 653-658 ◽  
Author(s):  
Carrie Ladd ◽  
Nathalie A Rodriguez McCullough ◽  
Claudia Carmaciu
Keyword(s):  
Mental Illness ◽  
Medical Complication ◽  
First Year ◽  
Evidence Based ◽  
Depression And Anxiety ◽  
Fear Of Childbirth ◽  
Case Histories ◽  
Wide Range ◽  
The Impact ◽  
In Pregnancy

Mental illness is the most common medical complication of pregnancy. The impact and prevalence are often underestimated. Depression and anxiety can occur, as at other times of life, but conditions such as postnatal psychosis and tokophobia (fear of childbirth) are specific to mental health in pregnancy and the first year after birth. In this article, we discuss the wide range of perinatal mental illness, using case histories to illustrate different presentations and evidence-based management. We also discuss the wider impact of perinatal mental illness.

Factors Predicting Early Mortality in Patients with Newly Diagnosed Multiple Myeloma,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3981-3981 ◽  
Author(s):  
Vishal Rana ◽  
Geetika Srivastava ◽  
Suzanne R Hayman ◽  
Francis K Buadi ◽  
Morie A Gertz ◽  
...  
Keyword(s):  
Risk Score ◽  
Performance Status ◽  
Initial Therapy ◽  
Early Mortality ◽  
First Year ◽  
The Novel ◽  
Newly Diagnosed ◽  
The Impact ◽  
Novel Agent

Abstract Abstract 3981 Background: Patients with multiple myeloma (MM) can present with life threatening complications including lethal infections during the disease course. The mortality is high during the early period following diagnosis, mostly as a result of complications of the disease or treatment. It is not clear if we can identify patients at the highest risk of early death based on the presenting clinical and laboratory features. Methods: From among 1545 patients seen at our institution between Jan 1999 and Dec 2008, we identified 265 patients who died within 12 months of diagnosis. For each of these patients we identified two “controls” who had at least 12 months of follow up, were alive at the time of last follow up and were closest to the ‘case' patient in terms of time of diagnosis. We performed logistic regression using the clinical and laboratory features, to identify parameters that predict for 12-month mortality and to determine the best cutoffs. Results: This study included 265 patients as cases and 530 controls. The gender distribution was similar in the two groups. We examined the impact of age, performance status (PS), hemoglobin, platelets, serum creatinine, calcium, LDH, albumin, B2M, free light chain difference, plasma cell labeling index, ISS stage, risk category and exposure to novel agents upfront. Based on the results of univariate and then multivariate analysis – age> 72, ECOG PS>2, Calcium >11.3 and ISS stage 3 were found to be significant. We developed the risk score using 1 point for each adverse factor, Age> 72, PS > 2, ISS 3, and Calcium > 11.3. The odds ratio of patients dying in the first year was 2.7, 9.2 and 37 in the presence of one, two and three or more risk factors compared to none of the risk factors. We then looked at the impact of the initial therapy on outcome. 279 patients (35%) received one of the novel agents (thalidomide, lenalidomide or bortezomib) as initial therapy. The odds ratio for dying in the first year was 0.35 for patients receiving a novel agent compared to the rest. The impact of the novel agent was independent of the risk score, with the risk score predicting outcome in both groups. Conclusions: In newly diagnosed MM advanced age, poor performance status, ISS stage and high calcium were associated with early mortality. If eligible all patients should get the benefit of use of novel agent upfront. Identifying these patients at the time of diagnosis is important and should help develop better risk-adapted strategies. Disclosures: No relevant conflicts of interest to declare.

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