Reduced symptom burden after visiting an outpatient supportive oncology clinic.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 204-204
Author(s):  
Kathryn C. Wrammert ◽  
Gwendolynn Harrell ◽  
Michael O'Neill ◽  
Anjali Grandhige ◽  
Zachary O. Binney ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Comprehensive Cancer Center ◽  
Rank Test ◽  
Cancer Center ◽  
Small Scale ◽  
Cancer Symptoms ◽  
Supportive Oncology ◽  
The Impact

204 Background: Outpatient palliative care in supportive oncology clinics (SOC) is growing and has shown promise in controlling symptoms. We sought toinvestigate the impact on symptom burden of a SOC in a National Cancer Institute-designated Comprehensive Cancer Center. Methods: New and returning SOC patients referred from our health system’s oncologists from November 2011 through May 2014 completed the Condensed Memorial Symptom Assessment Scale plus a sexual dysfunction structured assessment. Visits include a structured symptom assessment and personalized treatment plan from the clinic’s part-time physician and/or nurse practitioner. Patients rated from 0-4 how bothersome 15 cancer symptoms were. Descriptive statistics were calculated. We used the Wilcoxon signed rank test to compare symptom scores at patients’ first and second visits. Results: 135 patients had multiple SOC visits. Mean age was 54.7 (SD 12.5) years. 55.3% were female. The most common cancers were breast, lung, and head and neck (18.1% each). Median time between visits was 29 days (mean: 52.8, range: 2-446). The most bothersome symptoms at baseline were pain (mean 3.1, SD 1.3), lack of energy (2.4, SD 1.3), and difficulty sleeping (2.1, SD 1.6). Least bothersome were dyspnea (0.8, SD 1.1), sexual problems (0.9, SD 1.4), and nausea (1.0, SD 1.3). Energy, pain, drowsiness, constipation, sleep, worrying, sadness, and nervousness were significantly improved at follow-up with reductions between 0.2 (drowsiness) and 0.5 (pain) points (all p<0.05). Weight loss trended toward improved (p=0.053). Conclusions: 8 of 15 symptoms significantly improved after the first visit to a small-scale SOC. These reductions may underestimate the SOC’s effect if disease was progressing or overestimate differences if disease was shrinking, but such data were unavailable. Larger multi-site trials with well-defined interventions and control groups are needed.

Impact of an initial supportive oncology clinic visit on hospitalizations and emergency department visits.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 150-150
Author(s):  
Kimberly A. Curseen ◽  
Debbie Gunter ◽  
Gwendolynn Harrell ◽  
Lindsay Penny Prizer ◽  
Danielle Moulia ◽  
...  
Keyword(s):  
Emergency Department ◽  
Treatment Plan ◽  
Cost Savings ◽  
Symptom Assessment ◽  
Emergency Department Visits ◽  
Rank Test ◽  
Small Scale ◽  
Supportive Oncology ◽  
Ed Visits ◽  
The Impact

150 Background: Hospitalizations and emergency department (ED) visits can be frequent, costly and discordant with stated goals-of-care for cancer patients. Little is known about the impact of outpatient palliative care and supportive oncology on hospitalizations and ED visits. Our aim was to investigate the impact of an initial visit at an outpatient supportive oncology clinic (SOC) on patient hospitalizations and ED visits. Methods: New patients were referred to a SOC from our health system’s oncologists from November 1, 2014 through January 31, 2015. Visits include a structured symptom assessment and personalized treatment plan from the clinic’s physician and/or nurse practitioner. Data were collected 90 days retrospectively and 90 days prospectively from 134 consecutive initial SOC visits. Descriptive statistics were calculated. We used the Wilcoxon signed rank test to compare the mean number of hospitalizations and ED visits in the 90 days prior and 90 days post a patient’s first SOC visit. Results: Mean patient age at first SOC visit was 55.6 (SD = 16.4). 51.2% of patients were female. The most common cancers were breast, lung, head and neck. Mean number of hospitalizations per patient was significantly (p < 0.05) decreased: 1.3 (SD = 1.6) in the 90 days prior to initial SOC visit vs. 0.7 (SD = 0.7) in the 90 days post initial SOC visit. There was a non-significant reduction in mean ED visits per patient: 0.9 (SD = 0.9) in the 90 days prior to initial SOC visit vs. 0.7 (SD = 0.7) in the 90 days post initial SOC visit. Conclusions: Hospitalizations were significantly decreased and ED visits were reduced after the first visit to a small-scale SOC. This provides evidence that outpatient supportive care including aggressive symptom management may reduce patient crises, preventing ED visits and hospitalizations, and will likely lead to cost savings and improve quality of life for patients during and after cancer therapy. The decrease in hospitalizations and ED visits may be underestimated if disease was progressing and overestimated if disease was shrinking, but this data was not available for this study.

The influence of a cachexia clinic on palliative care integration in oncology.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 124-124
Author(s):  
Diane Portman ◽  
Sarah Thirlwell ◽  
Kristine A. Donovan
Keyword(s):  
Palliative Care ◽  
Weight Loss ◽  
Advanced Cancer ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Cancer Center ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
The Impact

124 Background: Appetite and weight loss are common in patients with advanced cancer and specialized cachexia clinics have been established to address these symptoms. Given the association between anorexia/cachexia and other adverse symptoms, these patients may also benefit from specialty level palliative care (PC). However, referral to outpatient specialty level PC is often delayed or does not occur. We sought to examine the prevalence of other factors associated with appetite and weight loss in patients with advanced cancer and the impact of a specialized cachexia clinic on identification and treatment of other PC needs. Methods: The records of patients referred by their Oncologist to the cachexia clinic of a cancer center from August 2016 to June 2017 were reviewed retrospectively. Subjects who had been referred to PC by their Oncologist were excluded. Patients had been assessed for symptom burden using the Edmonton Symptom Assessment Scale (ESAS-r). Patients identified with PC needs had been referred to the PC clinic for follow-up within 30 days after cachexia clinic consultation. Results: Thirty subjects were evaluated in the cachexia clinic (average age 68 years; 63% female). The predominant diagnosis was lung cancer (70%). An average of 6 symptoms per patient were in the moderate to severe range on ESAS, excluding appetite. Depression, fatigue and pain were most common. The average cachexia clinic total ESAS score was 51.61. Only 17% of patients had completed advance directives. Ninety-three % of patients were referred to PC and 68% were seen. The average number of PC visits was 2.79. Within the PC clinic, advance directive completion increased to 37%, goals of care discussion occurred with 50% and 17% received hospice referrals. At the most recent follow-up in the PC clinic, the average total ESAS score had decreased by 11.44 (22%) and all ESAS item scores were improved on average. Conclusions: The cachexia clinic proved a useful means to identify other PC needs and achieve effective PC referrals. We suggest this is proof of concept that specialty clinics can be a meaningful way to achieve an earlier entry point to comprehensive PC in patients who were not previously referred by their Oncologists.

Effects of Tai Chi and Qi Gong group class participation on self-reported symptoms in cancer patients and caregivers: A preliminary report.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 100-100
Author(s):  
Gabriel Lopez ◽  
Santhosshi Narayanan ◽  
Amie J Christie ◽  
Catherine Powers-James ◽  
M. Kay Garcia ◽  
...  
Keyword(s):  
Tai Chi ◽  
Symptom Assessment ◽  
Well Being ◽  
Comprehensive Cancer Center ◽  
Rank Test ◽  
Cancer Center ◽  
Qi Gong ◽  
Class Participation ◽  
Edmonton Symptom Assessment Scale ◽  
Global Distress

100 Background: Tai chi and qi gong are movement-based, mind-body approaches offered as part of an integrative oncology program at a comprehensive cancer center. We explored the effects of tai chi and qi gong group class participation on cancer patient and caregiver self-reported symptoms. Methods: Patients and caregivers attending a tai chi and/or qi gong group class completed the Edmonton Symptom Assessment Scale (ESAS) immediately before and after participation. The ESAS assessed 10 symptoms (scale 0-10, 10 worst possible); ESAS subscales analyzed included global (GDS), physical (PHS), and psychosocial (PSS). Descriptive statistics; Chi-Squared test, Fisher’s exact test, Wilcoxon rank-sum test and Wilcoxon signed-rank test were used for data analysis. Results: 304 participants (Oct 2017-April 2019; 184 patients, 120 caregivers; 72% women, 60% white; mean age 58) were included in the analysis. For patients (symptom reduction by class type: tai chi -4.5 SD 7.6; qi gong -6.1 SD 7.9) and caregivers (tai chi -3.7 SD 6.3; qi gong -4.0 SD 7.8), both class types contributed to clinically and statistically significant improvement (ESAS GDS decrease ≥3; p’s ≤0.0001) in global distress. Patients (-2.07 SD 5.49) and caregivers (-2.34 SD 3.71) participating in tai chi experienced clinically and statistically significant improvement in physical distress (ESAS PHS decrease ≥2; p’s ≤0.0001). For the individual symptom of well-being, we observed clinically and statistically significant improvement for caregivers participating in qi gong (-1.2 SD 2) and patients participating in tai chi (-1.0 SD 1.8) (p’s ≤0.0001). For fatigue, patients (-1.4) and caregivers (-1.0) participating in qi gong experienced clinically and statistically significant improvement (p’s ≤0.0001). Conclusions: Patients and caregivers participating in both class types experienced significant improvement in physical and global distress. Additional research is warranted to learn more about how differences in class content (tai chi vs qi gong) and participants may contribute to observed differences in symptom change.

scholarly journals Self-Care Support for Patients with Gastrointestinal Cancer: iCancerHealth

2018 ◽  
Vol 09 (04) ◽  
pp. 833-840 ◽  
Author(s):  
Donna Berry ◽  
Traci Blonquist ◽  
Manan Nayak ◽  
Nina Grenon ◽  
Thaer Momani ◽  
...  
Keyword(s):  
Medication Management ◽  
Symptom Assessment ◽  
High Rate ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Patient Centered ◽  
Management Tools ◽  
Patient Acceptability ◽  
Gastrointestinal Malignancies ◽  
Cancer Symptoms

Background Patient-centered symptom assessment and management tools allow patients to perform self-assessments and engage in self-symptom management. Efficacious tools exist for reducing symptom distress; however, little is known about feature-specific use. Objectives This article evaluates the feasibility of the iCancerHealth app as an adjunct to usual patient education regarding cancer symptoms and medication management. Methods We conducted a single-arm, pilot study grounded in the health outcomes model. Our evaluation included (1) enrollment rates, (2) 2-month utilization rates, (3) patient acceptability, and (4) clinician satisfaction with the provider-side application. English-speaking, adult patients receiving care in the gastrointestinal oncology service of a comprehensive cancer center were invited to participate. Research coordinators enrolled consenting participants who had a personal, Internet-connected device; participants registered and used the platform to complete the baseline symptom assessment in clinic. Participants were reminded weekly to use the app and to perform a symptom report 4 to 6 weeks later. Results A total of 64 patients were approached, of which 57 (89%; 95% exact confidence interval [CI], 79–96%) enrolled. About half were ≥ 60 years old and 40% were women. Fifty-three patients (93%; 95% exact CI, 85–99%) accessed at least one app feature, at least once, from home. The most frequently used (86%) feature was Health Tracker in which participants monitored and reported symptoms; followed by My Inbox (63%) and My Medications features (60%). The mean acceptability score was 24.8 (standard deviation = 4.2), indicating good acceptability. Clinicians reported that the app was most acceptable with regard to facilitating in-person interactions that occurred after app use. Conclusion In a sample of adults with various stages of gastrointestinal malignancies, the iCancerHealth app was utilized at a high rate. Features that focused on symptoms and medication side effects plus communication with clinicians were used most frequently. This extends our understanding of preferences and specific feature use with patient-centered technologies.

Self report assessment and support for cancer symptoms: Impact on hospital admissions and emergency department visits.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20552-e20552 ◽  
Author(s):  
Donna Lynn Berry ◽  
Fangxin Hong ◽  
Traci Blonquist ◽  
Barbara Halpenny ◽  
Mary Lou Siefert ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Intervention Group ◽  
Emergency Department Visits ◽  
Self Report ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Unequal Variance ◽  
Cancer Symptoms ◽  
The Impact

e20552 Background: Attending to symptoms and side effects promotes safe and effective delivery of cancer therapies. Educated and supported patients (Pts) may be able to self-manage symptoms (Sx) and know when to contact the clinician, avoiding emergency department visits (EDV) or hospital admissions (HA). The web-based Electronic Self Report Assessment for Cancer (ESRA-C) is an easy-to-use, automated program for assessing and teaching about symptom and quality of life issues (SQI) and has been shown to improve communication and reduce symptom distress over the course of active therapy. The purpose of this secondary analysis was to explore the impact of the ESRA-C intervention on rates of EDV and HA. Methods: AdultPts with all cancer types and stages treated in medical and radiation oncology at a comprehensive cancer center used ESRA-C to self-report SQI during new anti-cancer therapy, with summary reports delivered to clinicians. Patients were randomized to assessment-only ESRA-C (control) or the ESRA-C intervention adding self-monitoring and education and coaching between clinic visits. We analyzed group differences on EDV and HA using descriptive statistics and a two group unequal variance t-test. Results: Among 663 Pts, 34 out of 327 control Pts made 47 EDV vs 30 out of 336 intervention Pts made 42 visits. Likewise, 36 control Pts had 59 HA vs 36 intervention Pts who had 41 HA during the study duration. The majority of EDV (87%) and HA (88%) were Sx-related. The frequency of Sx-related events (EDV or HA) was higher in the control (n=94) vs the intervention group (n=71). The mean number of unplanned events were 0.29 and 0.21 per patient in the control and intervention groups, respectively (p=0.24). Conclusions: Although the trial sample size was not planned to test differences in EDV or HA, the ESRA-C intervention, compared with assessment alone, may have reduced symptom-related EDV and HA in a large sample of patients during active cancer treatment. If we are able to reduce Sx-related unplanned visits and admissions from more than 1 of 4 patients to 1 of 5 patients with an automated, patient-centered system, we can anticipate substantial cost savings when scaled to the volume of most comprehensive cancer centers. Clinical trial information: NCT00852852.

Building a novel near real-time multisource database to assess and improve infusion wait time at a comprehensive cancer center.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 4-4
Author(s):  
Jing Jing Wang Yakowec ◽  
Mark Pettengill ◽  
Sadiqa Mahmood ◽  
Belen Fraile ◽  
Hakim Lakhani
Keyword(s):  
Real Time ◽  
Processing Time ◽  
Treatment Plan ◽  
Wait Time ◽  
Medication Administration ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Wait Times ◽  
Automatic Data ◽  
The Impact

4 Background: Evidence has shown that long infusion wait time is one of the main contributors to oncology patient dissatisfaction. To identify bottlenecks and inefficient processing, a comprehensive understanding of the infusion workflow at Dana-Farber Cancer Institute was explored. The goal of the project is to leverage existing data sources to quantify time to process completion and to serve as the database for multiple wait time improvement projects. Methods: Infusion workflow from patient check-in or appointment time to first infusion medication administration (wait time) was mapped. Data from Epic and Real-Time Locating System (RTLS) were pulled into a single integrated source in Tableau and SAS for analysis. Using a custom SQL query, the following tables including crucial timestamps were pulled and pooled: encounters, pharmacy processing and dispense, treatment plan and protocol, RTLS events related to infusion chair occupancy, and medication administration records. Further programming was written to flag categories such as investigational versus non-investigational drugs, linked versus un-linked to exam appointments, and inclusion and exclusion criteria regarding date range, infusion floor, and encounter type. Results: The final clean infusion database includes data from September 1, 2017 through the day before current day via automatic data pull. Processing and wait times were analyzed at multiple levels by drug, encounter, department, staff, and protocol. To date, four known wait time improvement projects that aim to shorten processing time, such as early signing of orders by providers, have leveraged this near real-time dataset to monitor and evaluate the impact of the projects. The automation of data to pre-built visualizations in Tableau comparing baseline processing time to post-pilot impact and overall wait time trends has been extremely well received by all improvement stakeholders at the institute. Conclusions: A novel database merging Epic and RTLS data was successfully built to explore and improve infusion patient wait time. This technique can be applied at other institutions interested in reducing wait times and improving patient satisfaction.

scholarly journals Enhancing Patient-Provider Communication With the Electronic Self-Report Assessment for Cancer: A Randomized Trial

2011 ◽  
Vol 29 (8) ◽  
pp. 1029-1035 ◽  
Author(s):  
Donna L. Berry ◽  
Brent A. Blumenstein ◽  
Barbara Halpenny ◽  
Seth Wolpin ◽  
Jesse R. Fann ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Clinic Visit ◽  
Self Report ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Control Group ◽  
Cancer Symptoms ◽  
Patient Reported ◽  
Life Issues ◽  
Clinic Visits

Purpose Although patient-reported cancer symptoms and quality-of-life issues (SQLIs) have been promoted as essential to a comprehensive assessment, efficient and efficacious methods have not been widely tested in clinical settings. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment–Cancer (ESRA-C) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits. Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians. Patients and Methods This randomized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center. Patient-reported SQLIs were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit (n = 327); in the control group, no summary was provided (n = 333). SQLIs were scored for level of severity or distress. One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI. We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians. Results The likelihood of SQLIs being discussed differed by randomized group and depended on whether an SQLI was first reported as problematic (P = .032). Clinic visits were similar with regard to duration between groups, and clinicians reported the summary as useful. Conclusion The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US randomized clinical trial.

Development of a dosimeter prototype with machine learning based 3-D dose reconstruction capabilities

2021 ◽  
Author(s):  
Grant Finneman ◽  
Owen Eichorn ◽  
Nathan Meskell ◽  
Timothy Caplice ◽  
Alexander Benson ◽  
...  
Keyword(s):  
Machine Learning ◽  
Treatment Plan ◽  
Active Material ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Need For Treatment ◽  
Machine Learning Approach ◽  
Delivery Verification ◽  
Radiation Hard ◽  
Prototype Detector

Abstract A 3-D dosimeter fills the need for treatment plan and delivery verification required by every modern radiation-therapy method used today. This report summarizes a proof-of-concept study to develop a water-equivalent solid 3-D dosimeter that is based on novel radiation-hard scintillating material. The active material of the prototype dosimeter is a blend of radiation-hard peroxide-cured polysiloxane plastic doped with scintillating agent P-Terphenyl and wavelength-shifter BisMSB. The prototype detector was tested with 6 MV and 10 MV X-ray beams at Ohio State University’s Comprehensive Cancer Center. A 3-D dose distribution was successfully reconstructed by a neural network specifically trained for this prototype. This report summarizes the material production procedure, the material’s water equivalency investigation, the design of the prototype dosimeter and its beam tests, as well as the details of the utilized machine learning approach and the reconstructed 3-D dose distributions.

Impact of Pharmacist-Led Patient Education in an Ambulatory Cancer Center: A Pilot Quality Improvement Project

2020 ◽  
pp. 089719002097077
Author(s):  
Daniel Park ◽  
Sweta Patel ◽  
Kendra Yum ◽  
Cardinale B. Smith ◽  
Che-Kai Tsao ◽  
...  
Keyword(s):  
Side Effects ◽  
Patient Education ◽  
Interdisciplinary Approach ◽  
Rank Test ◽  
Cancer Center ◽  
Median Score ◽  
Improvement Project ◽  
Gastrointestinal Malignancies ◽  
Ambulatory Oncology ◽  
The Impact

Introduction: Although pharmacist-driven patient education has been shown to increase adherence, reduce medication errors, and lower 30-day readmission rates, the data in the ambulatory oncology setting is limited. This pilot quality initiative study was conducted from June 1, 2018, to November 15, 2018, in the ambulatory cancer center affiliated with The Mount Sinai Hospital in New York, NY, to determine the impact of pharmacist counseling on chemotherapy regimens. Methods and Materials: English-speaking patients with gastrointestinal malignancies who were newly started on chemotherapy were selected for this study. They received a pharmacist-led education session regarding their medications, potential side effects, and how to manage them at home. After each session, they completed a 5-question survey on a 5-point Likert-scale about how they felt before and after speaking with a pharmacist. Survey results were analyzed by median scores and Wilcoxon signed-rank test. Results: Of the 96 patients who were counseled, 71 patients were included in this analysis. The median score increased from 3 to 5 for the understanding of their chemotherapy regimen and side effects (questions 1 and 2), 3 to 4.5 for knowledge about interactions with their oral chemotherapy (question 3), 4 to 5 for overall experience in the cancer center (question 5). The median score for anxiety level was unchanged at 3 (question 4). Conclusion: This survey-based study demonstrated the benefit of a pharmacist-led counseling session. An interdisciplinary approach involving the integration of oncology pharmacists in patient education can greatly impact the quality of care for oncology patients.

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