MD Anderson Cancer Center Ongoing Professional Practice Evaluation (OPPE): We can see clearly now.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 277-277
Author(s):  
Joyce Roquemore ◽  
Leslie Kian
Keyword(s):  
Clinical Practice ◽  
Performance Metrics ◽  
Cancer Center ◽  
New Faculty ◽  
Statistical Process ◽  
Faculty Role ◽  
Technological Support ◽  
Control Rules ◽  
Electronic Display ◽  
Md Anderson

277 Background: Reviewing clinical practice by provider has been an ongoing process for quite some time. The metrics reviewed and how the review was conducted were not clearly defined and, as a result, has varied widely between organizations. Recredentialing or some self-imposed process were the main drivers until The Joint Commission required a more regular review of the clinicians’ practice in a hospital and clinics setting. MD Anderson embraced the requirement as an opportunity to improve its clinical review process and create a more robust infrastructure. Methods: Organizational and technological support was critical for success. The OPPE effort is led by the V.P. for Medical Affairs. A new faculty role, Quality Officer (QO), was established in each clinical department. The Office of Performance Improvement (OPI) was enlisted for data support and provided educational resources to the QOs. The Information Services staff maintains the technology to support the project long term. The Medical Staff Office has administrative responsibility for the program. Results: Two bi-annual OPPE reviews for credentialed providers (physicians and mid-levels) have been completed under the new process. Electronic display and processing has eliminated volumes of paper needed to track OPPE for 1,000+ faculty. External audit requirements are easily supported. Early adopters of the new OPPE tools have been complimentary of the support provided by display of values in control chart versus table formats. The application of statistical process control rules help QOs understand variation in performance among faculty and aid in identifying statistically valid quality issues. Conclusions: MD Anderson leveraged the OPPE requirements to make organizational changes and create processes that enhance review of clinical practice with electronic tools that improve decision making and analytical capabilities. The implementation of clinical quality metrics has made it clearer to see how each practice is doing based on criteria they defined, as well as create a path towards developing oncology performance metrics that can be considered nationally.

Systems engineering in health care: Overview and examples from The University of Texas MD Anderson Cancer Center.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 140-140
Author(s):  
Victoria S. Jordan
Keyword(s):  
Inventory Management ◽  
Systems Engineering ◽  
Physician Satisfaction ◽  
Cancer Center ◽  
Application Process ◽  
Statistical Process ◽  
University Of Texas ◽  
Diagnostic Center ◽  
Md Anderson ◽  
The University

140 Background: The University of Texas has six health institutions and Industrial and Systems Engineering faculty throughout university locations across the state. These academic medical centers, including MD Anderson Cancer Center, and schools of engineering, business, and medicine are partnering to implement Systems Engineering in healthcare throughout the UT system. The “systems approach to implementing Systems Engineering” is an opportunity to serve as a world-class model for collaboration across academic institutions for engineering, business, medicine, and healthcare organizations to implement Systems Engineering and systems thinking in healthcare. The objective of the collaboration is not just to produce successful projects, but to achieve transformational change. Methods: This presentation will provide an overview of Systems Engineering and provide examples of the different tools and strategies from the discipline including lean, six sigma, mathematical simulation, optimization and operations research, human factors, facility design layout, statistical process control, design of experiments, scheduling, supply chain and inventory management, staffing models, etc. Funding, leadership, training, and communication efforts associated with the effort will be reviewed including the grant application process for transformational efforts. (The implementation follows the PDSA process.) Results: Currently nine grants have been awarded in the UT system for implementing Systems Engineering. Results will be shared (in terms of cost savings and/or avoidance and patient satisfaction) from specific projects such as a lean effort in the Diagnostic Center and simulation models to schedule nurses in the OR and to determine resource requirements in the ICU. Conclusions: Systems Engineering is a valuable discipline that is relatively new to healthcare. Practicing clinical oncologists can increase efficiency, patient flow, and patient and physician satisfaction by applying Systems Engineering tools and strategies.

scholarly journals Assessment of Luminal and Basal Phenotypes in Bladder Cancer

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Charles C. Guo ◽  
Jolanta Bondaruk ◽  
Hui Yao ◽  
Ziqiao Wang ◽  
Li Zhang ◽  
...  
Keyword(s):  
Primary Care ◽  
Bladder Cancer ◽  
Clinical Practice ◽  
Molecular Subtypes ◽  
Routine Clinical Practice ◽  
Cancer Center ◽  
Genomic Profiling ◽  
Protein Expressions ◽  
Cancer Tumor ◽  
Md Anderson

Abstract Genomic profiling studies have demonstrated that bladder cancer can be divided into two molecular subtypes referred to as luminal and basal with distinct clinical behaviors and sensitivities to frontline chemotherapy. We analyzed the mRNA expressions of signature luminal and basal genes in bladder cancer tumor samples from publicly available and MD Anderson Cancer Center cohorts. We developed a quantitative classifier referred to as basal to luminal transition (BLT) score which identified the molecular subtypes of bladder cancer with 80–94% sensitivity and 83–93% specificity. In order to facilitate molecular subtyping of bladder cancer in primary care centers, we analyzed the protein expressions of signature luminal (GATA3) and basal (KRT5/6) markers by immunohistochemistry, which identified molecular subtypes in over 80% of the cases. In conclusion, we provide a tool for assessment of molecular subtypes of bladder cancer in routine clinical practice.

657 Interleukin-6 receptor blockade for management of immune checkpoint inhibitor related adverse events in patients with melanoma

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A694-A694
Author(s):  
Chantal Saberian ◽  
Faisal Fa’ak ◽  
Jean Tayar ◽  
Maryam Buni ◽  
Sang Kim ◽  
...  
Keyword(s):  
Adverse Events ◽  
Disease Activity ◽  
Median Time ◽  
Interleukin 6 ◽  
Immune Checkpoint ◽  
Activity Index ◽  
Critical Role ◽  
Cancer Center ◽  
Interleukin 6 Receptor ◽  
Md Anderson

BackgroundManagement of certain immune mediated adverse events (irAEs) can be challenging and may require prolonged/chronic immune suppression with corticosteroids or other immunosuppressant which could compromise and even reverse the efficacy of immune checkpoint inhibitors (ICI). While the exact immunobiology of irAEs is not fully understood there is enough evidence that IL-6 induced Th-17 that may play critical role in the pathogenesis. Herein, we describe our clinical experience using interleukin-6 receptor (IL-6R) blockade in management of irAEs in melanoma patients.MethodsWe searched MD Anderson databases to identify cancer patients who had received ICIs between January 2004 and March 2020. Of 11,391 ICI-treated patients, 21 patients with melanoma who received IL-6R blockade after ICI infusion were identified and their medical records were reviewed.ResultsMedian age was 61 years (41–82), 52% were females, 90% received anti-programmed cell death-1 antibodies. Fourteen patients (67%) had de novo onset irAEs (11 had arthritis, and 1 each with polymyalgia rheumatica, oral mucositis, and CNS vasculitis), and 7 patients (33%) had flare of their pre-existing autoimmune diseases (5 had had rheumatoid arthritis, and 1 each with myasthenia gravis and Crohn’s disease). Median time from ICI initiation to irAEs was 91 days (range, 1–496) and to initiation of IL-6R blockade was 6.6 months (range, 0.6–24.3). Median number of IL-6R blockade was 12 (range, 1–35), and 16 patients (76%) were concomitantly receiving corticosteroids of median dose of 10 mg (range, 5–20 mg). Of the 21 patients, irAEs improved in 14 (67%) (95% CI: 46%-87%). Of 13 evaluable patients with arthritis, 11 (85%) achieved remission or minimal disease activity as defined by the clinical disease activity index. Median time from initiation of IL-6R blockade till improvement of irAEs was 2.9 months (range, 1.5–36.9). Nineteen patients tolerated well IL-6R blockade, while two patients stopped treatment due to abdominal pain and sinus tachycardia. The median CRP levels at irAEs was 84 mg/L (0.6–187) and decreased to 1.9 mg/L (0.56–12) at 10 weeks after initiation of IL-6R blockade (P=0.02). Of the 17 evaluable patients, the overall tumor response rate by RECIST-1.1 criteria was similar before and after IL-6R blockade initiation (41% vs. 53%).ConclusionsOur data demonstrated that IL-6R blockade could be an effective therapy for irAEs management without dampening the efficacy of ICIs. Prospective clinical trials with longitudinal blood, tumor, and inflamed tissue biopsies are planned to accurately validate these findings and better study the immunobiology of irAEs.Ethics ApprovalThe study was approved by The University of Texas MD Anderson Cancer Center intuition’s Ethics Board, approval number PA19-0089

scholarly journals 236 Predictors of ICI renal toxicity: a pathological approach

2021 ◽  
Vol 9 (Suppl 3) ◽  
pp. A252-A252
Author(s):  
Ala Abudayyeh ◽  
Liye Suo ◽  
Heather Lin ◽  
Omar Mamlouk ◽  
Cassian Yee ◽  
...  
Keyword(s):  
Overall Survival ◽  
Renal Toxicity ◽  
Checkpoint Inhibitors ◽  
Interstitial Fibrosis ◽  
Transplant Rejection ◽  
Categorical Variables ◽  
Rank Test ◽  
Cancer Center ◽  
Renal Response ◽  
Md Anderson

BackgroundInflammatory response in unintended tissues and organs associated with the use of immune checkpoint inhibitors also known as immune related adverse events (irAEs) is a management challenge, and renal irAEs are associated with increased patient morbidity and mortality. The most common renal toxicity is acute interstitial nephritis (AIN), characterized by infiltration of renal tissue with immune cells, and may be analogous to kidney transplant rejection. Using both clinical variables and tissue findings we evaluated a large cohort of ICI cases to determine predictors of renal response and overall survival.MethodsWe retrospectively reviewed all patients treated with ICI (August 2007 to August 2020) at MD Anderson Cancer Center. A total of 38 patients with biopsy confirmed AIN and available tissue were identified. All slides were reviewed by two board certified renal pathologists and the severity of inflammation and chronicity was graded using transplant rejection BANFF criteria. Patients were categorized as renal responders if creatinine improved or returned to baseline after treatment and non-responders if it did not. Fisher’s exact tests for categorical variables and t-test/ANOVA or the counterparts of the non-parametric approaches (Wilcoxon rank-sum or Kruskal-Wallis) for continuous variables were used to compare patient‘s characteristics between groups. The distribution of overall survival (OS) was estimated by the Kaplan-Meier method. Log-rank test was performed to test the difference in survival between groups.ResultsBased on the detailed pathological findings, patients with increased interstitial fibrosis were less likely to have renal response with treatment compared to patients with less fibrosis, (p < 0.05). Inflammation, tubulitis, number of eosinophils and neutrophils had no impact on renal response. Patients with response within 3 months of AKI treatment had a superior OS in comparison to patients who responded late (12-month OS rate: 77% vs 27%, p < 0.05). Notably, patients who received concurrent ICI and achieved renal response within 3 months had the best OS while those who did not receive concurrent ICI nor achieved renal response had worst OS (12-month OS rate: 100% (renal response and concurrent ICI) vs 72% ( renal response with no concurrent ICI), vs 27% ( no renal response and nonconcurrent ICI) (p < 0.05).ConclusionsThis is the first analysis of ICI induced nephritis where a detailed pathological and clinical evaluation was performed to predict renal response. Our findings highlight the importance of early diagnosis and treatment of ICI-AIN while continuing concurrent ICI therapy.Ethics ApprovalThis retrospective study was approved by the institutional review board at The University of Texas MD Anderson Cancer Center, and the procedures followed were in accordance with the principles of the Declaration of Helsinki.

scholarly journals Pituitary carcinoma: The University of Texas MD Anderson Cancer Center experience

2018 ◽  
Author(s):  
Fernando Santos-Pinheiro ◽  
Marta Penas-Prado ◽  
Carlos Kamiya-Matsuoka ◽  
Steven G Waguespack ◽  
Anita Mahajan ◽  
...  
Keyword(s):  
Survival Rate ◽  
Disease Control ◽  
Survival Rates ◽  
Pituitary Carcinoma ◽  
Cancer Center ◽  
Ki 67 ◽  
Entire Cohort ◽  
University Of Texas ◽  
Single Center Experience ◽  
Md Anderson

AbstractBackground: Pituitary carcinoma (PC) is an aggressive neuroendocrine tumor diagnosed when a pituitary adenoma (PA) becomes metastatic. PCs are typically resistant to therapy and frequently recur. Recently, treatment with temozolomide (TMZ) has shown promising results, although the lack of prospective trials limits accurate assessment. Methods: We describe a single-center experience in managing PC over a 22-year period and review previously published PC series. Results: 17 patients were identified. Median age at PC diagnosis was 44 years (range 16-82), and the median PA-to-PC conversion time was 5 years (range 1-29). Median follow-up was 28 months (range 8-158) with 7 deaths. Most PC were hormone-positive based on immunohistochemistry (n=12): ACTH (n=5), PRL (n=4), LH/FSH (n=2), GH (n=1). All patients underwent at least one resection and one course of radiation after PC diagnosis. Immunohistochemistry showed high Ki-67 labeling index (>3%) in 10/15 cases. Eight patients (47%) had metastases only to the CNS, and 6 (35%) had combined CNS and systemic metastases. The most commonly used chemotherapy was TMZ, and TMZ-based therapy was associated with the longest period of disease control in 12 (71%) cases, as well as the longest period from PC diagnosis to first progression in 8 (47%) cases. The 2, 3 and 5-year survival rate of the entire cohort was 71%, 59% and 35%, respectively. All patients surviving >5 years were treated with TMZ-based therapy. Conclusions: PC treatment requires a multidisciplinary approach and multimodality therapy including surgery, radiation and chemotherapy. TMZ-based therapy was associated with higher survival rates and longer disease control.PrecisWe describe 17 PC patients who were diagnosed and treated at MDACC over a 22-year period. We have found that TMZ-based therapy correlated with longer disease control and higher survival rate.

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