Identifying opportunities to improve quality of cancer care: An evaluation of the use of routine surveillance imaging scans in women with early breast cancer (EBC) treated in Ontario, Canada.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 115-115
Author(s):  
Katherine Enright ◽  
Mohammed Ghannam ◽  
Lingsong Yun ◽  
Nathan Taback ◽  
Christopher M. Booth ◽  
...  
Keyword(s):  
Cancer Care ◽  
Advanced Imaging ◽  
X Ray ◽  
Imaging Test ◽  
Routine Surveillance ◽  
Surveillance Imaging ◽  
Second Year ◽  
Bone Scans

115 Background: Over use of routine surveillance imaging to detect recurrence in women with EBC was recently identified as one of the top five opportunities to improve the quality of cancer care by the American Society of Clinical Oncology. We undertook a population level assessment of the current practice of surveillance imaging in EBC women treated in Ontario Canada. Methods: Incident EBC patients diagnosed 01/07 – 12/09 in Ontario, Canada were identified from the Ontario Cancer Registry. Patient records were linked deterministically to provincial health care databases to provide comprehensive medical follow-up. Basic (chest x-ray, abdominal x-ray and abdominal ultrasound) and advanced (computed tomography [CT] or bone scans) surveillance imaging scans completed during the first and second year of follow-up (starting 6 months after surgery or upon completion of chemotherapy) were identified. Logistic regression models were used to identify covariates associated with advanced surveillance imaging. Results: 16,981 EBC patients were included in the analysis of which 7,907(46.6%) received chemotherapy. In the first year of follow up care, 8,311 (48.9%) had at least 1 basic imaging test, while 4,916 (29.0%) had advanced imaging. This fell to 45.7% (basic) and 25.1% (advanced) in the second year of follow-up. Bone scans were the most common advanced imaging test (14.5%), followed by CT thorax (10.8%). On multivariable analysis age, stage, the use of chemotherapy and comorbidity were associated with increased use of advanced surveillance imaging (Table). Conclusions: Surveillance imaging was common in the first two years of follow-up for EBC patients. While appropriate for symptom driven investigation, the high rate of advanced imaging scans suggests an opportunity for improvement with the Ontario cancer system. [Table: see text]

The use of routine surveillance imaging scans in women with early breast cancer (EBC) treated in Ontario, Canada.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6628-6628
Author(s):  
Katherine Enright ◽  
Mohammed Ghannam ◽  
Lingsong Yun ◽  
Nathan Taback ◽  
Christopher M. Booth ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Advanced Imaging ◽  
X Ray ◽  
Routine Surveillance ◽  
Surveillance Imaging ◽  
Follow Up Care ◽  
Second Year ◽  
Bone Scans

6628 Background: Over use of routine surveillance imaging to detect recurrence in women with EBC was recently identified as one of the top five opportunities to improve the quality of cancer care by the American Society of Clinical Oncology. We undertook a population level assessment of the current practice of surveillance imaging in EBC women treated in Ontario Canada. Methods: Incident early breast cancer patients diagnosed 01/07 – 12/09 in Ontario, Canada were identified from the Ontario Cancer Registry. Patient records were linked deterministically to provincial health care databases to provide comprehensive medical follow-up. Basic (chest x-ray, abdominal x-ray and abdominal ultrasound) and advanced (computed tomography [CT] or bone scans) surveillance imaging scans completed during the first and second year of follow-up care (starting 6 months after surgery or upon completion of adjuvant chemotherapy) were identified. Logistic regression models were used to identify covariates associated with advanced surveillance imaging. Results: 16,981 EBC patients were included in the analysis of which 7,907(46.6%) received chemotherapy. In the first year of follow up care, 8,311 (48.9%) had at least 1 basic imaging test, while 4,916 (29.0%) had advanced imaging. This fell to 45.7% (basic) and 25.1% (advanced) in the second year of follow-up. Bone scans were the most common advanced imaging test (14.5%), followed by CT thorax (10.8%). On multivariable analysis age, stage, the use of chemotherapy and comorbidity were associated with increased use of advanced surveillance imaging (Table). Significant geographic variation was also demonstrated. Conclusions: Surveillance imaging was common in the first two years of follow-up for EBC patients. While appropriate for symptom driven investigation, attention should be paid to the routine use of surveillance imaging in EBC women during follow-up care. [Table: see text]

Post-operative roentgenological findings and changes after mastoid obliteration

1983 ◽  
Vol 97 (5) ◽  
pp. 393-398 ◽  
Author(s):  
Kauko Ojala ◽  
Reijo Lahti ◽  
Antti Palva ◽  
Martti Sorri
Keyword(s):  
Bone Formation ◽  
Frequent Occurrence ◽  
New Bone Formation ◽  
Mastoid Obliteration ◽  
X Ray ◽  
Radiological Features ◽  
Operative Complications ◽  
Post Operative Complications

AbstractThis study consisted of the evaluation of the plain X-ray findings of films taken at early follow-up (mean 1.5 months after surgery) and at late follow-up(4–14 years after the early films) of 211 ears which had been operated on radically and obliterated. Residual cells which were detected on the basis of the early films were associated with a more frequent occurrence of post-operative infection and were thus hallmarks of a poorer prognosis. Changes in the bone surrounding the surgical cavity and the radiological quality of the walls of the surgical cavity, the presence of new bone formation in the cavity and other radiological features did not yield useful information about post-operative complications. New bone formation was associated with a smaller amount of post-operative cavitation. Post-operative X-ray examination of the obliterated ear is a prognostically useful examination, but it does not significantly contribute further to the information available by clinical and otomicroscopic examination in regards to the complications of infection and cholesteatoma.

An assessment of the total cost of pancreatic cancer using real-world evidence.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 773-773
Author(s):  
Vincent J. Picozzi ◽  
Victoria G. Manax ◽  
Kelly Feehan ◽  
Zachary Wintrob ◽  
Michele Korfin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pancreatic Cancer ◽  
Prescription Drug ◽  
Cancer Care ◽  
Drug Costs ◽  
Medical Expenditure ◽  
Total Cost ◽  
Patient Level ◽  
Second Year

773 Background: The aggregate health economic implications of pancreatic cancer are poorly understood, especially from the patient perspective. As a preliminary effort, we sought to better understand changes in type and quantity of medical expenditures over time, along with quality of life related costs, from this perspective. This preliminary research is part of a larger effort to understand how the introduction of new treatments affect both the outcome and costs of pancreatic cancer associated with care, patients, survivors, their families, and their communities. Methods: We analyzed patient-level data from the Medical Expenditure Panel Survey (MEPS, 1996- 2017). All analyses were performed using R version 3.6.1 on Ubuntu 19.04. Averages were computed for the total health care costs, including prescription drug costs. Average individual annual cost estimates for the second year excluded individuals that were identified as having died prior to the first round of data collection in the second year. The individual patient level ratios of prescription drug cost to other medical expenses was also computed. All expenditures are adjusted for inflation using 2017 US dollars. Included subjects, N= 80 had a diagnosis of pancreatic cancer and available prescription data. Individual age and employment status were accounted for as covariates. Results: Between 1997 and 2017 inflation adjusted first and second year non-medication spending on pancreatic cancer care averaged $66,999.96 and $105,308.60 respectively. However, inflation-adjusted first and second year charges for hospitalizations and emergency visits fell between 2007-2017. Prescription drug as a proportion of total spending prescription drugs increased during the same time period. Lost work/school days declined between 2007 and 2017. Conclusions: Total inflation adjusted pancreatic cancer care expenses declined over the past decade even as drug costs increased. Quality of life costs declined as well. Further analysis is needed to evaluate the relationship between drug spending, total cost of care and quality of life.

scholarly journals A pilot study of using smartphone application versus routine follow up for patients' care in advanced non-small cell lung cancer (NSCLC).

2019 ◽  
Vol 5 (suppl) ◽  
pp. 9-9
Author(s):  
Naiyarat Prasongsook ◽  
Kasan Seetalarom ◽  
Siriwimon Saichaemchan ◽  
Kitipong Udomdamrongkul
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Cancer Care ◽  
Mobile Application ◽  
Advanced Nsclc ◽  
Patient Reported Outcome ◽  
P Value ◽  
Patient Reported

9 Background: Web-based patient reported outcome (PRO) improved quality of life (QoL), and overall survival (OS) in patients with advanced NSCLC who were treating with specific therapy. Lung Cancer Care application is a mobile application program that provides patients with individually tailored information on patient reported outcome. This study aims to invent a novel mobile application evaluating PRO for Thai NSCLC patients, and to evaluate the validity of mobile application. Methods: Our mobile application-based PRO was designed for monitoring quality of life. The validity of the application was tested following guidelines for translating, and validating a questionnaire. The quality of life score (FACT-L score). After the validated mobile application-based PRO, patients with advanced NSCLC were randomized to use mobile application-based PRO versus routine follow-up. The primary endpoint was quality of life (QoL). Secondary endpoint was OS. Results: Thirty-three patients with advanced NSCLC were enrolled. The mean of FACT-L score at baseline in mobile application-based PRO arm and routine follow up arm was similar (90.08 ± 5.66 vs 91.78 ± 5.26, p-value= 0.82). Patients with mobile application group had more FACT-L score at 3 months than patients with routine follow up arm (106 ± 5.97 vs 99.96 ± 5.74, p-value = 0.07). There was a trend towards increased in different mean of FACT-L score at baseline and 3 months in patients with mobile application compared to patients with routine follow up ( p-value = 0.05). The median follow-up time was 5.43 months, patients with mobile application had longer median OS than patients with routine follow up (4 months vs 2.9 months, p-value = 0.5). Conclusions: Lung Cancer Care application based on self-reported symptoms is a novel electronic device for real-time patient care monitoring. Our study results showed trend towards improved quality of life from using this novel mobile application. However, there was small samples for pilot testing, the relatively large sampling errors may reduce the statistical power needed to validate this tool.

Timing of adjuvant chemotherapy in stage III colon cancer as a measure of quality: Reasons for noncompliance.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 640-640
Author(s):  
Omar M. Rashid ◽  
Karen A. Coyne ◽  
Thomas W. Ross ◽  
David Shibata
Keyword(s):  
Colon Cancer ◽  
Cancer Care ◽  
Tertiary Care ◽  
Stage Iii ◽  
Cancer Center ◽  
Patient Centered ◽  
Stage Iii Colon Cancer ◽  
Lost To Follow Up

640 Background: The Institute of Medicine's report on improving cancer care, along with the evolution of ASCO's Quality Oncology Practice Initiative, has helped to develop process measures into critical quality of cancer care indicators. One such measure relates to "receipt of chemotherapy for stage III colon cancer (CC) within 120 days of diagnosis" and is now being incorporated into processes including hospital accreditation (American College of Surgeons; ACS), managed care contracts and Center for Medicare and Medicaid Services (CMS) quality monitoring. To better understand potential pitfalls related to the strict guidelines of this measure, we sought to evaluate institutional adherence at a tertiary care cancer center and to examine the reasons for non-compliance. Methods: A retrospective review was performed of all cases of stage III colon cancer reported at a single institution from 2008 – 2012. Coding for compliance was performed using standard ACS guidelines. Results: A total of 122 eligible cases were identified and consisted of 49 (40.2%) women and 73 (59.8%) men with a median age of 58 (range 32 - 77). Overall, 15 (12.3%) cases were non-compliant with 2 (1.6%) lost to follow up. Of the non-compliant cases, 14 (93.3%) cases did go on to receive chemotherapy while 1 (6.7%) never received adjuvant treatment. Of those receiving delayed treatment, 7 were due to patient-centered factors [e.g. patient timing preference (n=4), request for chemotherapy closer to home (n=2) and lost to follow up (n=1)]. Other reasons included delays at outside facilities (n=4), postoperative complications (n=1) and insurance approval (n=1). In 2 cases, designation of date of diagnosis based on suspicion rather than definitive biopsy contributed to non-compliant status. Conclusions: Our center averaged an annual compliance with the CC adjuvant therapy measure of approximately 90%. Larger scale studies are indicated to determine whether refinements in coding guides that account for patient preferences, clear diagnosis dates and cross-facility care could better reflect quality of care, and also promote improved patient-centered multidisciplinary management.

Mindfulness Integrated Cognitive Behavioural Intervention: Effects on Palliative Cancer Care Professionals

2021 ◽  
pp. bmjspcare-2021-003318
Author(s):  
Amanpreet Kaur ◽  
Mahendra P Sharma ◽  
Santosh K Chaturvedi
Keyword(s):  
Traumatic Stress ◽  
Secondary Traumatic Stress ◽  
Cancer Care ◽  
Well Being ◽  
Psychological Well Being ◽  
Mindfulness Skills ◽  
Professional Quality ◽  
Cognitive Behavioural

ObjectiveBeing a palliative cancer care professional is challenging and stressful. In recent decades, there has been more interest in mindfulness to improve overall well-being of healthcare professionals. Mindfulness integrated cognitive behavioural interventions (MICBI) are more practical, flexible and understandable than traditional psychological therapies alone. There is a dearth of studies in India with no psychological intervention in palliative cancer care professionals to date. The aim was to examine the effects of MICBI for professional care workers at palliative cancer care centres in Bengaluru city of Southern India.MethodsA single group study design was adopted with pre, post and 3-month follow-up assessment with a sample of 25 participants working full-time at a hospice. The MICBI programme was for six sessions, once a week for 2–2.5 hours. Outcome variables were professional quality of life measures (burnout, secondary traumatic stress and compassion satisfaction), psychological well-being score and mindfulness skills score (assessed using Professional Quality of Life Scale-V.5, Psychological Well-Being Scale and Five Facet Mindfulness Questionnaire). Wilcoxon signed rank test and Friedman test analysed differences between pre, post and follow-up data.ResultsThe MICBI could significantly reduce burnout and secondary traumatic stress; it improved compassion satisfaction, psychological well-being and mindfulness skills; treatment gains were maintained at 3 months follow-up.ConclusionsMICBI was feasible and effective for palliative cancer care professionals with implications for training, practice and future research.PROSPERO registration numberThe study was registered under the Clinical Trials Registry- India (CTRI) (number: CTRI/2018/03/019170).

scholarly journals Contact X-ray Brachytherapy for Older or Inoperable Rectal Cancer Patients: Short-Term Oncological and Functional Follow-Up

Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6333
Author(s):  
Petra A. Custers ◽  
Barbara M. Geubels ◽  
Inge L. Huibregtse ◽  
Femke P. Peters ◽  
Ellen G. Engelhardt ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Functional Outcome ◽  
Cancer Patients ◽  
Mesorectal Excision ◽  
X Ray ◽  
Depth Interviews

Total mesorectal excision for rectal cancer is a major operation associated with morbidity and mortality. For older or inoperable patients, alternatives are necessary. This prospective study evaluated the oncological and functional outcome and quality of life of older or inoperable rectal cancer patients treated with a contact X-ray brachytherapy boost to avoid major surgery. During follow-up, tumor response and toxicity on endoscopy were scored. Functional outcome and quality of life were assessed with self-administered questionnaires. Additionally, in-depth interviews regarding patients’ experiences were conducted. Nineteen patients were included with a median age of 80 years (range 72–91); nine patients achieved a clinical complete response and in another four local control of the tumor was established. The 12 month organ-preservation rate, progression-free survival, and overall survival were 88%, 78%, and 100%, respectively. A transient decrease in quality of life and bowel function was observed at 3 months, which was generally restored at 6 months. In-depth interviews revealed that patients’ experience was positive despite the side-effects shortly after treatment. In older or inoperable rectal cancer patients, contact X-ray brachytherapy can be considered an option to avoid total mesorectal excision. Contact X-ray brachytherapy is well-tolerated and can provide good tumor control.

How to Perform a Reliable Full Spine X-ray Examination in Juvenile and Adolescent Scoliosis Our Experience

2020 ◽  
Author(s):  
Sergio Palandri ◽  
Fabrizio Trucchi
Keyword(s):  
Gold Standard ◽  
Exposure Dose ◽  
Point Of View ◽  
X Ray ◽  
Specific Category ◽  
Before And After ◽  
Ionizing Radiations ◽  
Detailed Protocol

Abstract Background:Ionizing radiations, even at low doses, present side effects that are known as well as girls and toung women constitute the most sensible individuals from a radioprotectional point of view. On the other side full spine x-ray radiography is the gold standard in diagnose and follow-up of AIS, where individuals involved are typicaly girls and young women.For these reasons, a partuicular care permorming radiographics esamination in this scope, in mandatory.The aim of this work is to provide a simple and detailed protocol to perform full-spine X-ray examination in diagnosis and follow-up of AISThis paper is the result of our experience along 7y of work in application and study of the scoliosis in the first two decades of life, combining the orthopaedist’s requirements, the surgical requirements along with the care for the particularly significant relational feature, due to the specific category of most individuals undergoing this radiological examination.Methods:For the maximum usability and Clarity, we considered three main topics: a) single examination b) examination during orthotic treatment and c) pre-op control. For each one we explained number and type of X-ray view used and how we performed them with the assistance of detalide figures. Results:By comparing X-ray images before and after the application of our protocol, we saw a significant increase in the quality of the produced images as well as a positive feedback from patients and parents acceptance.Conclusions:An extended collaboration between the Orthopaedic Surgeons and the Radiographer, has led to a clear improvement in technical execution and in an exposure dose reduction. Furthermore a particular attention to the patient’s comfort, along with some technical stratagems, led to an improving effectiveness of the services supplied.

Lack Of Clinical Benefit For Routine Surveillance Imaging For Diffuse Large B-Cell Lymphoma In First Complete Remission

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4303-4303 ◽  
Author(s):  
Julie M Vose ◽  
Ravi Pingali ◽  
Nina Wagner-Johnson ◽  
Fausto R. Loberiza ◽  
Timothy S. Fenske ◽  
...  
Keyword(s):  
Complete Remission ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Patient Characteristics ◽  
Large B Cell Lymphoma ◽  
Routine Surveillance ◽  
Surveillance Imaging ◽  
Large B Cell ◽  
First Complete Remission

Abstract Background The use of routine surveillance imaging (RSI) for patients in first complete remission (CR1) following front-line rituximab (R) based anthracycline therapy remains controversial. We compared patients with diffuse large B-cell lymphoma (DLBCL) who received an R-CHOP or a similar regimen, obtained a CR and then were followed by either RSI or clinical surveillance (CS) in which scans were only performed for signs or symptoms. Methods Patients from three tertiary care center from 2001-2011, who achieved a CR1 with frontline R-CHOP or similar therapy for DLBCL, and had a minimum follow up of 1 year were analyzed. Patients with HIV-related lymphoma, transformed lymphoma, and post-transplant lymphoproliferative disorders were excluded. Patients with composite lymphoma were included only if the DLBCL component was >50%. Patients were stratified into two groups based on the surveillance strategy employed. Baseline patient characteristics, prognostic features, treatment type, and outcomes were compared. Results 391 patients with DLBCL treated with R-CHOP or similar regimens who obtained CR1 were analyzed. There were 129 patients in the CS group and 262 in the RSI group. Patient characteristics (age, gender, stage, and IPI) were similar in the two groups. The median follow up is 5 years (range 1 – 12). Relapse after CR1 was detected in 26 (20%) of patients in the CS group and 46 (18%) of the RSI group. The median number of images in the CS group was 0 (range 0-14) and 4 (range 1-27) in the RSI group, p<0.0001. The median average number of images per year of follow up in the CS group was 0 (range 0-6) and 1 (range 1-13) in the RSI group, p<0.0001. Relapses were detected through clinical manifestations in 100 % of CS cases versus 43% in RSI cases, p=0.01. The 5 year progression-free survival (PFS) was 76% in the CS group and 82 % in the RSI group (p = 0.31). The 5 year overall survival (OS) was 87% in the CS group and 92 % in the RSI group (p=0.15). The table shows an analysis of OS by IPI and type of surveillance. Conclusions The majority of relapses in patients with DLBCL after achieving CR1 to an R-CHOP or similar regimen occur when signs or symptoms of the disease lead to evaluation and are not detected by RSI. Although asymptomatic relapses are occasionally detected by RSI, in this large cohort of patients neither a PFS nor OS benefit could be demonstrated in favor of RSI. Given the additional cost, radiation exposure and risk of additional procedures, we conclude that the use of RSI in patients with DLBCL in CR1 has limited clinical utility. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Importance of Using Physical Tridimensional Models for the Management and Planning of Extended Osseous Odontogenic Lesions

2021 ◽  
Vol 9 (11) ◽  
pp. 134
Author(s):  
Domenico Guerra ◽  
Marco Severino ◽  
Sara Caruso ◽  
Sofia Rastelli ◽  
Roberto Gatto
Keyword(s):  
Surgical Planning ◽  
Healthcare Professionals ◽  
Surgical Intervention ◽  
Planning Stage ◽  
X Ray ◽  
Physical Representation ◽  
Stereolithographic Model ◽  
Bony Lesion

(1) Surgical intervention becomes crucial in situations in which lack of action would cause a decrease in quality of life for the patient. As healthcare professionals, our next objective is to reduce patient fear perception. This work’s aim is to illustrate how physical tridimensional models can serve not only as confidence boosters for the patient, but also as a valid tool to aid both the clinician and the fostering of a patient–doctor relationship. (2) An example case managed using a stereolithographic model in the pre-surgical planning stage is presented in which surgical planning was carried out by analysis of radiographic investigations combined with a tridimensional resin model derived from the patient’s x-ray exam. (3) Successful enucleation, surgical debridement, and stable follow-up shows the effectiveness of the applied surgical protocol, confirming that planification using a physical representation of the tridimensional exam aids in the correct surgical management of said lesions. (4) The effectiveness o101f the surgical act itself as well as the follow-up showing ossification of the bony lesion and absence of relapse of a highly recurrent lesion confirms the effectiveness of the tools used for this surgical intervention.

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