Palliative treatment directives for bone metastases: A quality-directed approach to guiding institutional practice.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 188-188 ◽  
Author(s):  
Lindsay Puckett ◽  
Lucille Lee ◽  
Petrina Zuvic ◽  
Isabella Bingchan Zhang ◽  
Louis Potters ◽  
...  
Keyword(s):  
Bone Metastasis ◽  
Bone Metastases ◽  
Radiation Treatment ◽  
Standard Of Care ◽  
Evidence Based ◽  
Chi Square ◽  
Evidence Based Treatment ◽  
Improve Compliance ◽  
Chi Square Test ◽  
New Treatment

188 Background: The efficacy of single fraction (fx) radiation treatment (RT) has proven to have equipoise for palliation of bone metastases when compared to courses of 10 fx or more. Despite these data, there has been a slow adoption of this practice in the US and worldwide. Examination of our multicenter practice from 2004 - 2016 showed that single fx RT utilization has remained at 17% and hypofractionationed (HFX) courses (1 or 5 fx) have remained at 71% since 2009. We hypothesized that evidence-based, treatment-guiding directives could improve HFX utilization in this population. Methods: Institutionally, palliative bone metastasis treatments are routinely tracked by a Quality Assurance committee. In 2/2016, two consensus-driven and evidence-based clinical directives were created within our electronic health system for use with either simple or complicated bone metastasis, irrespective of primary histology. The simple and complex directives had default prescriptions of 8 Gy/1fx or 20 Gy/5fx, respectively. The directives were reviewed with physician staff to improve compliance; directives were allowed to be edited at the physician’s discretion if an alternative fx was indicated. The chi-square test was used for analysis. Results: From 1/2009-5/2016, there were 1,781 treatment courses of palliative external beam RT. Following implementation in 2/2016, the new clinical directives were used for 96% of cases and were modified in 12 cases (n = 72). Single fx use increased from 17% to 36% among palliative bone metastasis treatments (p ≤ 0.001) and HFX (1 or 5 fx) utilization increased from 71% to 92% compared to other fractionation schemes (10 fx or other) (p = 0.001). Conclusions: The institution-wide adoption of evidence-based, treatment directives proved to be a straightforward and successful intervention which allowed for rapid adoption and increased utilization of the standard of care. Our early data suggests that this may be a useful approach in the setting of reticence to new treatment paradigms. Further examination of evidence based directives is warranted to address issues of overtreatment in palliation and in standardizing oncologic care.

Championing Change to Save Lives: A Call to Action to Implement Reforms to Increase Use of Medications to Treat Opioid Use Disorder in Correctional Settings

2020 ◽  
pp. 073401682098162
Author(s):  
Sonia L. Canzater ◽  
Regina M. LaBelle
Keyword(s):  
Standard Of Care ◽  
Opioid Use Disorder ◽  
Correctional Facilities ◽  
Evidence Based ◽  
Opioid Use ◽  
Call To Action ◽  
Evidence Based Treatment ◽  
High Prevalence ◽  
Correctional Settings ◽  
Overdose Deaths

The disproportional rates of opioid use disorder (OUD) in U.S. correctional facilities make them prime intervention points to treat OUD utilizing medication to treat opioid use disorder (MOUD), the evidence-based clinical standard of care. MOUD has been shown to be effective to support recovery and reduce recurrence of OUD, overdose deaths, and recidivism for justice-involved persons both while incarcerated and once they reenter their communities. Despite the high prevalence, most jails and prisons do not offer MOUD. Litigation has spurred expanded access in more facilities, but widespread MOUD access can only become a reality through a comprehensive effort of corrections officials, medical experts, advocates, legislators, and other champions to raise awareness and affect ideological and policy change. It is a legal and ethical imperative that the lives of justice-involved persons not be jeopardized by the lack of evidence-based treatment for OUD in correctional settings.

Renal insufficiency in bone metastasis cancer patients: Prevalence and implications on anticancer drugs management, subgroup analysis of the IRMA study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9121-9121 ◽  
Author(s):  
N. Janus ◽  
C. Le Tourneau ◽  
V. Launay-Vacher ◽  
J. Gligorov ◽  
O. Rixe ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Metastasis ◽  
Renal Insufficiency ◽  
Cancer Patients ◽  
Anticancer Drugs ◽  
Subgroup Analysis ◽  
Dosage Adjustment ◽  
Breast Cancer Patients ◽  
Chi Square ◽  
Chi Square Test

9121 Background: The IRMA study reported the high prevalence of renal insufficiency (RI) in 4684 solid tumour patients, with a glomerular filtration rate (GFR) <90 ml/min for 50–60%. Furthermore, 80.1% were receiving nephrotoxic anticancer drugs and 79.9% drugs necessitating dosage adjustment. We present the results for IRMA patients with bone metastasis (BM). Methods: Subgroup analysis of IRMA patients with BM. Data collected: sex, age, weight, serum creatinine (SCR), bone metastasis (BM) and anticancer drugs. The prevalence of SCR>110 μmol/L was assessed. GFR was estimated with Cockcroft-Gault (CG) and abbreviated MDRD (aMDRD) formulae. Drugs necessitating dosage adjustment and those potentially nephrotoxic were identified. Chi-square test was used to compare the prevalence of RI between patients with BM and patients without, for all patients and for breast cancer (BC) ones. Results: 1,000 patients (BC 577) with BM were included: median age 60, mean 59.8, weight 66 kg, 659 women. The prevalence of SCR>110 μmol/L was 8.3%. That of GFR<90 ml/min was 57.9% with CG and 54.7% with aMDRD. 83.4% of treated patients received at least one drug needing dosage adjustment (or no data) and 69% received at least one nephrotoxic drug. The prevalence of RI was not statistically different between patients with or without BM. However, the prevalence of RI was significantly higher in BC patients with BM as compared to BC patients without BM (62.1 versus 56.7 %, p=0.04). Conclusions: RI is highly frequent in cancer patients with BM. Appropriate evaluation of renal function necessitates CG or aMDRD calculation. In those patients, and especially in breast cancer patients with BM, anticancer drugs should be cautiously selected regarding their potential renal toxicity and need for dosage adjustment. [Table: see text] No significant financial relationships to disclose.

scholarly journals Incidence of Hyperglycemia/Secondary Diabetes in Women who have Undergone Curative Chemotherapy for Breast Cancer: First Study from India

2021 ◽  
Author(s):  
Suresh Rao ◽  
Krishna Prasad ◽  
Soniya Abraham ◽  
Thomas George ◽  
Supreeth Kakkaje Chandran ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Treatment ◽  
Previous History ◽  
World Health ◽  
Chi Square ◽  
Secondary Diabetes ◽  
Number Of Children ◽  
Glucose Levels ◽  
Chi Square Test ◽  
Health Organization

Abstract Purpose Development of cancer chemotherapy treatment-induced hyperglycemia/ diabetes (secondary diabetes) is a major problem and has never been reported from India. The present study was planned to ascertain this in women undergoing curative chemotherapy for their breast cancer. Materials and Methods This was a retrospective chart-based study and was conducted in a cancer specialty hospital. The information on women who were nondiabetic at the start of the treatment was collected from the files. Details on cancer diagnosis, domicile, body mass index (BMI), type of diet, marital status, number of children, and previous history of diabetes if any were considered. The blood glucose levels before surgery and after the completion of radiotherapy were considered. World Health Organization (WHO) guidelines for diabetes were considered. The data were subjected to frequency and percentage and analyzed using Chi-square test. Association between the demographic details and development of Hyperglycemia or secondary diabetes or prediabetes was done using the Pearson’s correlation analysis. p < 0.05 was considered as statistically significant. Results A total of 474 cases were included in accordance with the inclusion criteria. The results indicated that by the end of the radiation treatment, 24.89% were prediabetic, 10.97% were diabetic after being in prediabetic stage, 8.22% became diabetic without going through a prediabetic stage, and that 55.91% did not develop either prediabetic or diabetic condition. Analysis of development of secondary diabetes and prediabetes with BMI (p < 0.0001) and age (p < 0.024) showed a strong correlation and was significant. Conclusion To the best of the authors’ knowledge, this is the first study from India, and the results indicate that the development of secondary diabetes in women undergoing curative chemotherapy is high. Attempts are underway to ascertain the cause for the development and how it can be mitigated.

Japanese psychiatric nurses’ attitudes toward Evidence-Based Practice: association with needs for learning psychoeducation practices.

2016 ◽  
Vol 4 (2) ◽  
pp. 352
Author(s):  
Mitsunobu Matsuda ◽  
Ayumi Kono
Keyword(s):  
Evidence Based Practice ◽  
Symptom Control ◽  
Psychiatric Hospitals ◽  
Psychiatric Nurses ◽  
Evidence Based ◽  
Chi Square ◽  
Nursing Managers ◽  
Chi Square Test ◽  
Nursing Professionals

Rationale, aims and objectives: To support patients with mental disorders to address appropriate symptom control and preventive measures against relapse, evidence-based practice (EBP), such as psychoeducation, is an important intervention while performing psychiatric pharmacotherapy. However, the use of EBP is likely to have remained passive, as it has been reported being disseminated and implemented slowly. This study explored a classification of psychiatric nurses’ attitudes toward EBP and examined the association between a classification of attitudes toward EBP and needs for learning psychoeducation practices in nursing professionals involved with psychiatric services, with the aim of providing a basis for the dissemination of psychoeducation. Method: A mail questionnaire survey was conducted, involving a total of 194 nurses and assistant nurses working in 13 of the 42 psychiatric hospitals. Analysis was performed using the cluster analysis, chi-square test and one-way analysis of variance. Results: The psychiatric nurses’ attitudes toward EBP were classified into 3 types: experience-oriented challenging, amotivational and rejective and conservative and obedient. Nurses showing amotivational and rejective attitudes accounted for the majority, while those showing experience-oriented challenging attitudes were more aware of the usefulness of psychoeducation and their levels of need for learning related practices were higher on comparison with the others. Conclusions: In order to disseminate psychoeducation among psychiatric hospitals, it may be important to develop interest in psychoeducation, particularly that of nurses showing experience-oriented challenging or conservative and obedient attitudes, with co-operation from nursing managers.

A Web-Based Decision Support Platform to Reduce Non Evidence-Based Treatment of Hodgkin Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4267-4267
Author(s):  
Stephen Grund ◽  
Arlene Forastiere ◽  
William Flood ◽  
Whyler Elaine
Keyword(s):  
Decision Support ◽  
Hodgkin Lymphoma ◽  
Radiation Treatment ◽  
Hematologic Malignancy ◽  
Point Of Care ◽  
Standards Of Care ◽  
Evidence Based ◽  
Web Based ◽  
Evidence Based Treatment ◽  
Treatment Plans

Abstract Abstract 4267 Background: Published reports indicate 30–40% of oncology treatments deviate from evidence-based standards. Little is known about the extent of deviation from guidelines in Hodgkin Lymphoma, a highly curable cancer. Methods: eviti is a web-based decision support platform that incorporates all recognized guidelines (ASCO, NCI, NCCN, ASTRO and others) and supporting literature. An automated precertification code is issued if planned treatment is evidence based and meets payer language- Variances may be discussed in a peer to peer (P2P) with staff oncologists. We analyzed all treatment plans submitted for patients with stage I to IV Hodgkin's lymphoma (all pathology subtypes) between 1/1/2011 and 6/30/2012 to understand reasons for non-compliance with practice guidelines. There were six payers with a total of 605,412 covered lives encompassing 22 states. Results: 124 treatment plans were submitted, including 37 with radiation treatment as part of the plan or as primary treatment. 48 (39%) received an automatic code, and another 63 (51%) were given preauthorization codes after submission of medical records. 25 treatment plans (20%) required a P2P and 7 (6% of all cases) were changed to evidence-based treatments as a result. 5 plans were deemed evidence-based as a result of the P2P, while13 plans (10%) did not meet evidence-based standards and did not receive a code for pre-certification even after a P2P. 3 of these were resubmitted with evidence-based plans. The most common deviations were; 1.Use of supportive drugs not consistent with guidelines 6 cases (6%); 2. Non evidence-based therapeutic regimens 2% (2 cases); 3. Non evidence-based variation in dose and/or schedule of chemotherapy 2% (2 cases). 4. Use of IMRT with IGRT. Conclusions: Decision support for automated pre-certification reduced non- evidence-based treatment of Hodgkin lymphoma from 16% (20 cases) to 8% (10 cases). A Web-based, point of care decision-support platform connecting providers and payers can reduce unwarranted variability, improve quality and reduce payment for unwarranted care. It facilitates analysis of variations from accepted standards of care for any hematologic malignancy at a granular level. Any such tool should promote compliance with evidence-based cancer care but allow flexibility for medically justified variances. Disclosures: Grund: eviti: Employment. Forastiere:eviti: Employment. Flood:eviti: Employment. Elaine:eviti: Employment.

Does increasing number of core biopsies change the results of needle biospy in prostate cancer?

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 113-113
Author(s):  
M. H. Farhat ◽  
A. Dabaja ◽  
P. Agarwal
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Gleason Score ◽  
Core Biopsy ◽  
Perineural Invasion ◽  
Standard Of Care ◽  
Chi Square ◽  
Prostate Biopsies ◽  
Match Rate ◽  
Chi Square Test

113 Background: The superiority of extended sampling of the prostate compared to standard sextant biopsy in predicting the final Gleason score has been controversial. In the literature, sextant biopsies have a match rate between 28–68% and an upgrading rate of 25–57%. Consequently, multiple studies recommend that extended biopsies should be the standard of care. This study examines the effect of greater core biopsy number on upgrading GS and predicting surgical pathology. Methods: Prostate biopsies of 984 patients who underwent RP between 2001 and 2008 were retrospectively reviewed. The GS of the biopsies was compared to the pathological specimens using the Chi-square test. Further adjusted comparison was performed using logistic regression. A clinical significant upgrade was defined as increase of the total GS or the primary GS. Results: The majority of the upgrading occurred in biopsy Gleason 3+3 and 3+4 cases. Upgrading was seen in 35.1% of patients with 6 cores or less, 34.5% with 7–12 cores, and 45.5% with 13+ cores (p=0.061). Number of cores, BMI, or prostate size did not affect upgrading, while perineural invasion, cancer volume on a biopsy, and D'Amico risk criteria increased the likelihood of upgrading. Conclusions: The extended core biopsy does not seem to correlate with higher gleason score or to better predict the final pathologic gleason score compared to standard sextant biopsies in prostate cancer. D'Amico risk factors, perineural invasion, and cancer volume can be viewed as risk factors for upgrading especially in GS 3+3. No significant financial relationships to disclose.

scholarly journals Information Retrieval Sources and Skill, and Knowledge of Evidence-based Dentistry Among Iranian Dental Students

2021 ◽  
Author(s):  
Mohammad Mehdi Naghibi Sistani ◽  
Ali Kazemian ◽  
Jorma I Virtanen
Keyword(s):  
Information Retrieval ◽  
Information Sources ◽  
Information Source ◽  
Scientific Information ◽  
Knowledge Score ◽  
Dental Students ◽  
Evidence Based ◽  
Chi Square ◽  
Chi Square Test ◽  
Evidence Based Dentistry

Abstract Background: This study aimed to determine the common scientific information sources used, information retrieval skills, and knowledge of evidence-based dentistry (EBD) among graduating dental students in two dental schools in Iran.Methods: In total, 179 final-year dental students from Mashhad University (71%) and Babol University (29%) participated in this anonymous survey in 2019. A valid self-administered questionnaire has been translated using forward-backward method to assess students' use of information sources for the past six months, their information retrieval skills, and knowledge of EBD. We used chi-square test, t-test, and one way ANOVA for statistical analysis.Results: Most commonly used information sources by the students in the university and at home were: personal lecture notes, fellow dental students, and Compact Dentistry References (CDR) books. Proportion of students with good knowledge of EBD was 53.6%. Dental students who sensed to possess weaker information retrieval skills revealed lower EBD scores (p=0.01). Students who used at least one evidence-based information source (Cochrane, PubMed/Medline, scientific journals’ websites) more frequently sensed to possess better information retrieval skills (p=0.02).Conclusions: Commonly used information sources by the dental students were not evidence-based. Those students with better information retrieval skill showed higher EBD knowledge score and used evidence-based information sources more frequently. Therefore, more efforts should be put to basic skill of information retrieval and EBD in Iranian dental curricula.

Randomized trial of short-course versus long-course radiotherapy for palliation of painful vertebral bone metastases: A retrospective analysis of RTOG 97–14

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9521-9521
Author(s):  
D. D. Howell ◽  
J. L. James ◽  
W. F. Hartsell ◽  
M. Suntharalingam ◽  
M. Machtay ◽  
...  
Keyword(s):  
Pain Relief ◽  
Bone Metastases ◽  
Late Toxicity ◽  
Future Research ◽  
Recurrent Pain ◽  
Chi Square ◽  
Entire Study ◽  
Vertebral Bone ◽  
Significant Difference ◽  
Chi Square Test

9521 Background: RTOG 97–14 [Hartsell et al, breast/prostate cancer patients (pts) with painful bone metastases randomized to 8 Gy/1 fraction or 30 Gy/10 fractions], revealed no difference in pain relief or narcotic use 3 months post randomization. The 8 Gy regimen resulted in fewer acute toxicities, but higher rates of retreatment for recurrent pain. Single 8 Gy fractions for painful vertebral bone mets have not been well accepted, possibly due to provider concerns about efficacy and toxicity. The present study evaluates treatment differences in the subset of pts treated specifically for painful vertebral bone mets (PVBM). Methods: PVBM were treated to the cervical, thoracic, and/or lumbar spine. Chi-square test was used to evaluate population differences between PVBM and non-PVBM. Amongst PVBM, differences in retreatment rates (cumulative incidence method, Gray's test) and in pain relief/BPI worst pain score, narcotic use, and toxicity 3 months post randomization (chi-square test) were evaluated. Results: Of 909 eligible pts, 235 (26%) were PVBM. PVBM and non-PVBM pts differed in % of males [55% vs. 47%,p=0.03] and pts with multiple painful sites [57% vs. 38%,p<0.01]. Amongst PVBM, more 30 Gy pts had multiple sites treated [65% vs. 49%, p=0.02]. T [10% vs. 20%, p=0.01] here was no statistically significant difference (8 vs. 30 Gy) in pain relief [70% vs. 62%, p=0.59] or narcotic use [27% vs. 24%, p=0.76] at 3 months. There were significant differences in acute grade 2–4 toxicityand acute grade 2–4 GI toxicity [6% vs. 14%, p=0.01] at 3 months, lower toxicity seen in 8 Gy. Late toxicity was rare, with 1 grade 3 CNS event (8 Gy) and 1 grade 4 lung event (30 Gy). 8 Gy showed significantly higher 3-year retreatment rates [15% vs. 5%, p=0.01]. Conclusions: Although a clinically different pt population, the results for PVBM are comparable to those of the entire study population. Both 8 Gy/1 fraction and 30 Gy/10 fractions resulted in comparable pain relief and narcotic use at 3 months. Both were well tolerated with few adverse effects. 8 Gy had less acute toxicity, and a higher need for retreatment than 30 Gy. This may have implications for future research comparing single fraction conventional radiation therapy with stereotactic spine radiosurgery. No significant financial relationships to disclose.

Phase II trial combining atezolizumab concurrently with chemoradiation therapy in locally advanced non-small cell lung cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 8512-8512 ◽  
Author(s):  
Steven H. Lin ◽  
Yan Lin ◽  
Isabel Mok ◽  
Jenean A. Young ◽  
See Phan ◽  
...  
Keyword(s):  
Phase Ii ◽  
Phase Ii Trial ◽  
Locally Advanced ◽  
Cancer Recurrence ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Chi Square ◽  
Tumor Biopsy ◽  
Chi Square Test ◽  
Grade 3

8512 Background: Consolidation durvalumab after chemoradiation (CRT) is the new standard of care in locally advanced NSCLC (LA-NSCLC). We hypothesized that adding immunotherapy concurrently with CRT (cCRT) would increase efficacy without significant additive toxicity. To test this concept, we conducted a phase II trial called DETERRED combining atezolizumab (atezo) with cCRT followed by consolidation full dose carboplatin/paclitaxel (CP) with atezo (CP-atezo) for 2 cycles and then maintenance atezo for 1 year. The primary endpoint was safety/toxicity and feasibility. Methods: This study enrolled patients (pts) between February 2016 - April 2018 and was done in two parts: In part 1 (N=10), conventionally fractionated CRT (60-66 Gy in 30-33 fractions combined with weekly low dose CP) was followed by CP-atezo then maintenance atezo. Part 2 was cCRT (N=30) with atezo followed by CP-atezo then maintenance atezo. Atezo was given at 1200 mg IV Q3 weeks. Severe adverse events (SAEs) ≥ grade 3 were defined by CTCAE v5.0. Evaluable pts received at least one dose of atezo. PD-L1 staining utilizes the DAKO 22C3 platform. Kaplan Meier were analyzed for progression free survival (PFS) and overall survival (OS), and chi-square test for PD-L1 levels on any recurrence, with significance set at <0.05. Results: In Part 1, atezo related SAEs were seen in 4 pts (40%) (2 grade 3 arthralgia, 1 grade 3 dyspnea and 1 grade 5 TE fistula). Grade 2 radiation pneumonitis (RP) was seen in 1 pt. In Part 2, seven (23%) pts had atezo related SAEs (diarrhea, nephritis, dyspnea, fatigue and heart failure). RP was seen in 3 pts, 2 grade 2 and 1 grade 3, which led to atezo discontinuation. In Part 1, with an overall median follow up (f/u) time of 22.5 months and 27.4 months for survivors, the 1-year PFS is 50%, and OS is 79%. In part 2, with a median f/u time of 11.8 months and 13.7 months for survivors, the 1-year PFS was 57%, and OS is 79%. Baseline tumor biopsy PD-L1 status was evaluable for 34 pts. There were no significant differences in cancer recurrence for PD-L1 <1% (7/16=44%) vs ≥1% (6/18=33%), or for the PD-L1 cutoff of <50% (11/26=42%) vs ≥50% (2/8=25%). Conclusions: Concurrent atezo with CRT followed by CP-atezo and maintenance atezo is safe without increased toxicities compared to CRT alone followed by CP-atezo and maintenance atezo. Updated efficacy results from DETERRED will be presented. Ultimately, the clinical benefit of immunotherapy with cCRT followed by consolidation chemo-immunotherapy will need to be compared to the PACIFIC regimen in a larger randomized trial. Clinical trial information: NCT02525757.

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