Using the Risk Assessment Index (RAI) to predict 90-day mortality and hospital utilization in cancer patients at UPMC Hillman Cancer Center.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 243-243
Author(s):  
Christine Ann Garcia ◽  
Jeffrey Borrebach ◽  
Stefanie C Altieri Dunn ◽  
Johanna E Bellon ◽  
Ellen Ormond ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Hospital Utilization ◽  
Cancer Center ◽  
Mortality Data ◽  
Cancer Type ◽  
Assessment Index ◽  
Significant Difference ◽  
Ed Visits

243 Background: Patients with cancer vary considerably in health status and functional reserve. Identifying the most frail patients whom are at risk of treatment toxicity or death can be difficult. The Risk Assessment Index (RAI) is a validated tool used to assess frailty in patients prior to surgery. Thus, we aimed to investigate frailty assessment utilizing the RAI in cancer patients and its ability to predict hospital utilization and 90-day mortality. Methods: From 9/15/2017 to 1/31/2018, new patients with solid tumor malignancies at the UPMC Hillman Cancer Center completed the RAI. Age, cancer type and stage, and treatments were abstracted. ED visits, hospitalizations and mortality data were provided by the Wolff Center at UPMC. Mann-Whitney U and likelihood-ratio tests were performed comparing RAI, ED usage/hospitalizations, and mortality. Elective hospital admissions were excluded. Results: 273 patients completed the RAI. 58.6% of pts were male and average age was 62.7 (21-88), and the average RAI score was 39.9 (IQR 35-44). The most common cancer types were melanoma (22.7%), prostate (14.3%), and lung (11.4%). 43.6% of patients had stage IV cancer. Within 90 days after RAI, 51 patients (18.7%) experienced at least one unplanned ED visit or hospitalization, and 10 patients (3.7%) were deceased. Patients with an ED visit/hospitalization had an average RAI of 42 (IQR 37-46) compared to 39.4 (IQR 35-43) for patients without one: a 2.6-point difference (p = 0.008). 90-day mortalities had an average RAI score of 47.5 (IQR 42-53) compared to 39.6 (IQR 35-44) for non-mortalities: a 7.9-point difference (p = 0.003). Six of 242 (2.5%) patients without a hospitalization experienced mortality whereas 4 of 31 (12.9%) patients with a hospitalization experienced mortality (p = 0.017). Conclusions: This study shows that the RAI may be utilized to predict 90-day mortality in cancer patients. Patients at greatest risk of 90-day mortality were more likely to have unplanned hospitalizations. While there was a statistically significant difference in RAI scores between patients with and without unplanned ED visits/hospitalizations, this difference was too small to be clinically meaningful.

Analysis of reasons for emergency department (ED) visits and resulting hospital admissions in breast cancer patients: A retrospective study from rural cancer center in Maine.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18682-e18682
Author(s):  
Anannya Patwari ◽  
Vineel Bhatlapenumarthi ◽  
Courtnery Brann ◽  
Jackson Waldrip ◽  
Victoria Caruso ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Working Hours ◽  
Neutropenic Fever ◽  
Cancer Center ◽  
Breast Cancer Patients ◽  
Fall Injury ◽  
Treatment Type ◽  
Ed Visits

e18682 Background: Reducing ED visits in patients with cancer is cost saving and is particularly relevant during the COVID pandemic. Methods: We analyzed the number of ED visits occurred in our breast cancer population between July 1 2019 and August 31 2020 including demographics, stage distribution, treatment type within the month of ED visit, reason, time of the day, day of the week the visit occurred. Results: A total of 101 patients had 162 visits. 38 (38%) had more than 1 ED visit. Majority (36%) had stage 4 disease at the time of ED visit. The top 5 reasons for ED visits were fall and injury (N=30), GI (N=24), cardiac (N=17), respiratory symptoms (N=14) and cancer related pain (N=11). The median age in patients with ED visit due to fall injury/pain was 75 and non-fall injury/pain was 55 years. The most common reasons for chemotherapy induced ED visits were GI related (N=8) and Neutropenic fever (N=7). Cyclophosphamide/doxorubicin was the common regimen associated with neutropenic fever. A total of 72 (44%) visits resulted in hospital admissions. Most common symptom categories requiring hospital admissions were cardiac (82.3%), sepsis/cellulitis (81.8%), respiratory (64%), cancer related pain (54.5%) and GI (50%). Most were on endocrine therapy at the time of their visit (N= 59) and 31 were on no treatment at all. Falls were unrelated to disease or treatment and occurred in patients above age 70. Visits occurred during working hours from 6AM to 5PM, with peak incidence on Mondays and Fridays. Conclusions: Reducing ED visit in cancer patients is a worthwhile endeavor particularly in the context of the COVID pandemic. The main reason for ED visits were falls and injuries that were unrelated to disease or treatment in breast cancer patients. As a result, we are implementing systematic physical therapy assessment for our breast cancer population over age of 60 at our cancer center and call us first campaign, to get an opportunity to intervene prior to going to the ED as majority of the ED visits occurred during working hours.[Table: see text]

Impact of an Infusion Center on the Utilization of Hospital Based Care in Sickle Cell Disease

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 6-7
Author(s):  
Jonathan B Hurst ◽  
Richard Gentry Wilkerson
Keyword(s):  
Sickle Cell Disease ◽  
Acute Care ◽  
Hospital Admissions ◽  
Hospital Utilization ◽  
Cell Disease ◽  
High Utilizers ◽  
Significant Difference ◽  
Opioid Administration ◽  
Before And After ◽  
Ed Visits

Background: Sickle cell disease (SCD) consists of a group of hemoglobinopathies inherited in an autosomal recessive pattern whereby a single point mutation results in the formation of a hemoglobin protein with altered structure. Many of the complications of SCD and their end organ manifestations are the result of a vaso-occlusive process. These include acute chest syndrome, dactylitis, myocardial infarction, stroke, venous thromboemboli, avascular necrosis, and acute vaso-occlusive episodes (VOEs). VOEs are the most common reason for a patient with SCD to seek medical attention. This care is often provided at an emergency department (ED). It has been well documented that the management of VOEs are often delayed and fail to follow published guidelines. Numerous efforts have been undertaken to ensure appropriate and timely analgesic administration to patients with SCD who are experiencing a VOE. One such intervention is the creation of an infusion center (IC) that has the capability to administer parenteral opioids while avoiding the delays associated with an ED visit. Objectives: This study aims to evaluate the impact of a dedicated IC that was established for the treatment of SCD VOEs. The goal of the IC is to provide timely and appropriate pain management in an effort to reduce ED visits and hospital admissions related to treatment of VOEs in patients with SCD. The IC was available to adult patients with SCD who regularly sought care at our hospital and who did not have a care plan that excluded the administration of parenteral opioids. Methods: This is an observational, retrospective study comparing the rates of hospital utilization before and after the opening of a dedicated IC for patients treated for SCD VOE at a single, urban medical center that regularly provides care for approximately 150 adult patients with SCD. We compared the rates of ED visits, hospital admissions, and length of stay for six months prior and four months following the opening of the IC. Hospital utilization was standardized before and after the intervention using 30-day rates. Additionally, opioid usage, measured in Morphine Equivalent Dose (MED) was compared between the ED and the IC. Results: A total of 12 patients (Table 1) utilized the IC during the 4 months after its opening (6/20/19 - 10/16/19). During this time there were 92 total visits to the IC. Four patients were noted to be high utilizers accounting for 77 (83.7%) of the 92 visits (median = 20 visits, range 12 - 25). The other 8 patients were low utilizers and accounted for 15 (16.3%) of the visits (median = 2, range 1 - 4). Following implementation of the IC, there was found to be a statistically significant decrease in ED visits (pre- = 3.97/30d vs post- = 2.40/30d; p = 0.04) (Table 2, Fig. 1). No significant difference was found in hospital admissions (pre- = 1.47/30d vs post- = 1.17/30d; p = 0.18) or inpatient days (pre- = 6.47/30d vs post- = 5.47/30d; p = 0.23). The total number of acute care visits (sum of ED and IC visits) was found to increase after the opening of the IC, although the change was not statistically significant (pre- = 3.97/30d vs post- = 5.47/30d; p = 0.07). The change in acute care visits was largely driven by an increase in visits from the high utilizers (pre- = 2.00/30d vs post- = 3.53/30d; p = 0.05). In terms of parenteral opioid administration, there was a statistically significant decrease in amount of opioids given in the IC compared to the ED (ED = 251.64 MED vs IC = 177.17 MED; p = 0.04), although this was only seen in the low utilizer group (Table 3, Fig. 2). There was no significant difference in opioid doses received for the high utilizers (ED = 256.31 MED vs IC = 272.12 MED; p = 0.24) and for the group as a whole (ED = 253.34 MED vs IC = 208.84 MED; p = 0.10). Conclusion: The introduction of an IC for the management of SCD VOE led to a significant decrease ED visits but also led to an increase in overall acute care visits, although this was not statistically significant. This increase was largely driven by a subset of this population considered high utilizers. Additionally, the use of the IC was not associated with a decrease in the total amount of parenteral opioids that were administered. However, for the low utilizer group there was a decrease in parenteral opioid administration. The IC did not reduce admissions and duration of hospitalization in this population. Overall, the IC had variable success and further refinement of how it is used should be undertaken to ensure quality care for patients with SCD. Disclosures No relevant conflicts of interest to declare.

Effect of a supportive medicine program for cancer patients on patient connectivity to care and health care utilization.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2034-2034
Author(s):  
Brooke Worster ◽  
Gregory D. Garber ◽  
Rebecca Cammy ◽  
Liana Yocavitch ◽  
Ayako Shimada ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Cost Of Care ◽  
Emergency Department Visits ◽  
Comprehensive Cancer Center ◽  
Categorical Variables ◽  
Cancer Center ◽  
Ed Visits ◽  
The Impact

2034 Background: The benefits of supportive medicine (SM) for cancer patients include improved quality of life, increased patient satisfaction, improved symptom management, increased cost savings and improved survival rates. At one NCI-designated cancer center, all patients were screened for distress; those who screened positive or were directly referred by a provider were enrolled into our multi-disciplinary SM program. Here, we document the impact of the supportive medicine program on outcomes of emergency department (ED) visits, hospital readmission, and non-billable touchpoints associated with patient navigation and resource referrals. Methods: The program systematically screened for biopsychosocial distress utilizing the National Comprehensive Cancer Center Distress Thermometer (DT) and the Problem Checklist (PC) to identify practical, emotional, spiritual and physical issues. Patients were categorized into three types: screened and enrolled in the SM program, and screened and not enrolled in the SM program, or provider referral into the SM program. Data included patient’s age, number of hospital admissions, emergency department visits, and non-billable touchpoints at 90 and 180 days after the distress screening or referral. Descriptive data were analyzed with counts and percentages for categorical variables and summarized with mean and standard deviation for numerical variables. For investigation of the effects of time and patient type on the change in utilization rate, generalized estimation equations for Poisson regression were conducted for each outcome. Results: In all, 2,738 patients were included in the analysis. Patients who were referred from a provider tended to be younger (p < .01) and more likely to die within 90 days (p < .001). At 180 days, ED visits decreased 18% for patients referred to the SM program and 42% for patients screened into the SM program, compared to a 3% decrease in ED visits among those not enrolled in the SM program (p < .01). Similarly, hospital admissions decreased 34% for patients referred to and 39% screened into the SM program, compared to a 4% increase for patients not enrolled in the SM program (p < .01). Non-billable touchpoints increased among all types of patients. Conclusions: An SM program reduces hospital admissions and ED visits, therefore improving outcomes and potentially reducing the cost of care for cancer patients. Future research should link this data to claims data to definitely evaluate the impact of SM programs on cost.

Improving hematology/oncology clinical research recruitment via universal prescreening: The VA Connecticut (VACT) Cancer Center experience.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 79-79
Author(s):  
Jenny Jing Xiang ◽  
Alicia Roy ◽  
Christine Summers ◽  
Monica Delvy ◽  
Jessica Lee O'Donovan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Trials ◽  
Clinical Research ◽  
Cancer Patients ◽  
Cancer Center ◽  
Cancer Type ◽  
Eligibility Criteria ◽  
Research Recruitment ◽  
Lung Cancer Patients ◽  
Study Enrollment

79 Background: Patient-trial matching is a critical step in clinical research recruitment that requires extensive review of clinical data and trial requirements. Prescreening, defined as identifying potentially eligible patients using select eligibility criteria, may streamline the process and increase study enrollment. We describe the real-world experience of implementing a standardized, universal clinical research prescreening protocol within a VA cancer center and its impact on research enrollment. Methods: An IRB approved prescreening protocol was implemented at the VACT Cancer Center in March 2017. All patients with a suspected or confirmed diagnosis of cancer are identified through tumor boards, oncology consults, and clinic lists. Research coordinators perform chart review and manually enter patient demographics, cancer type and stage, and treatment history into a REDCap (Research Electronic Data Capture) database. All clinical trials and their eligibility criteria are also entered into REDCap and updated regularly. REDCap generates real time lists of potential research studies for each patient based on his/her recorded data. The primary oncologist is alerted to a patient’s potential eligibility prior to upcoming clinic visits and thus can plan to discuss clinical research enrollment as appropriate. Results: From March 2017 to December 2020, a total of 2548 unique patients were prescreened into REDCAP. The mean age was 71.5 years, 97.5% were male, and 15.5% were African American. 32.57 % patients had genitourinary cancer, 17.15% had lung cancer, and 46.15% were undergoing malignancy workup. 1412 patients were potentially eligible after prescreening and 556 patients were ultimately enrolled in studies. The number of patients enrolled on therapeutic clinical trials increased after the implementation of the prescreening protocol (35 in 2017, 64 in 2018, 78 in 2019, and 55 in 2020 despite the COVID19 pandemic). Biorepository study enrollment increased from 8 in 2019 to 15 in 2020. The prescreening protocol also enabled 200 patients to be enrolled onto a lung nodule liquid biopsy study from 2017 to 2019. Our prescreening process captured 98.57% of lung cancer patients entered into the cancer registry during the same time period. Conclusions: Universal prescreening streamlined research recruitment operations and was associated with yearly increases in clinical research enrollment at a VA cancer center. Our protocol identified most new lung cancer patients, suggesting that, at least for this malignancy, potential study patients were not missed. The protocol was integral in our program becoming the top accruing VA site for NCI’s National Clinical Trial Network (NCTN) studies since 2019.

Impact of cancer on the risk of unplanned 30-day readmissions.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6581-6581
Author(s):  
Alexander Qian ◽  
Edmund Qiao ◽  
Vinit Nalawade ◽  
Nikhil V. Kotha ◽  
Rohith S. Voora ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Hospital Admissions ◽  
Reference Group ◽  
Cancer Site ◽  
Cancer Type ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Initial Hospitalization ◽  
The Impact

6581 Background: Hospital readmission are associated with unfavorable patient outcomes and increased costs to the healthcare system. Devising interventions to reduce risks of readmission requires understanding patients at highest risk. Cancer patients represent a unique population with distinct risk factors. The purpose of this study was to define the impact of a cancer diagnosis on the risks of unplanned 30-day readmissions. Methods: We identified non-procedural hospital admissions between January through November 2017 from the National Readmission Database (NRD). We included patients with and without a cancer diagnosis who were admitted for non-procedural causes. We evaluated the impact of cancer on the risk of 30-day unplanned readmissions using multivariable mixed-effects logistic regression models. Results: Out of 18,996,625 weighted admissions, 1,685,099 (8.9%) had record of a cancer diagnosis. A cancer diagnosis was associated with an increased risk of readmission compared to non-cancer patients (23.5% vs. 13.6%, p < 0.001). However, among readmissions, cancer patients were less likely to have a preventable readmission (6.5% vs. 12.1%, p < 0.001). When considering the 10 most common causes of initial hospitalization, cancer was associated with an increased risk of readmission for each of these 10 causes (OR range 1.1-2.7, all p < 0.05) compared to non-cancer patients admitted for the same causes. Compared to patients aged 45-64, a younger age was associated with increased risk for cancer patients (OR 1.29, 95%CI [1.24-1.34]) but decreased risk for non-cancer patients (OR 0.65, 95%CI [0.64-0.66]). Among cancer patients, cancer site was the most robust individual predictor for readmission with liver (OR 1.47, 95%CI [1.39-1.55]), pancreas (OR 1.36, 95%CI [1.29-1.44]), and non-Hodgkin’s lymphoma (OR 1.35, 95%CI [1.29-1.42]) having the highest risk compared to the reference group of prostate cancer patients. Conclusions: Cancer patients have a higher risk of 30-day readmission, with increased risks among younger cancer patients, and with individual risks varying by cancer type. Future risk stratification approaches should consider cancer patients as an independent group with unique risks of readmission.

Acute kidney injury and major outcomes in cancer patients with no history of chronic kidney disease (CKD) with coronavirus 2019 (COVID-19) infection.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18816-e18816
Author(s):  
Cesar Simbaqueba ◽  
Omar Mamlouk ◽  
Kodwo Dickson ◽  
Josiah Halm ◽  
Sreedhar Mandayam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Hazard Model ◽  
Cancer Center ◽  
Icu Admission ◽  
Significant Difference ◽  
History Of

e18816 Background: Acute Kidney Injury (AKI) in patients with COVID-19 infection is associated with poor clinical outcomes. We examined outcomes (hemodialysis, mechanical ventilation, ICU admission and death) in cancer patients with normal estimated glomerular filtration rate (eGFR) treated in a tertiary referral center with COVID-19 infection, who developed AKI within 30 days of diagnosis. Methods: All patient data — demographics, labs, comorbidities and outcomes — were aggregated and analyzed in the Syntropy platform, Palantir Foundry (“Foundry”), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test; (2) baseline eGFR >60 ml/min/1.73m2most temporally proximal lab results within 30 days prior to the patient’s infection. AKI was defined by an absolute change of creatinine ≥0.3 within 30 days after the positive COVID-19 test. Kaplan-Meier analysis was used for survival estimates at specific time periods and multivariate Cox Proportional cause-specific Hazard model regression to determine hazard ratios with 95% confidence intervals for major outcomes. Results: 635 patients with Covid-19 infection had a baseline eGFR >60 ml/min/1.73m2. Of these patients, 124 (19.5%) developed AKI. Patients with AKI were older, mean age of 61+/-13.2 vs 56.9+/- 14.3 years (p=0.002) and more Hypertensive (69.4% vs 56.4%, p=0.011). AKI patients were more likely to have pneumonia (63.7% vs 37%, p<0.001), cardiac arrhythmias (39.5% vs 20.7%, p<0.001) and myocardial infarction (15.3% vs 8.8%, p=0.046). These patients had more hematologic malignancies (35.1% vs 19%, p=0.005), with no difference between non metastatic vs metastatic disease (p=0.284). There was no significant difference in other comorbidities including smoking, diabetes, hypothyroidism and liver disease. AKI patients were more likely to require dialysis (2.4% vs 0.2%, p=0.025), mechanical ventilation (16.1% vs 1.8%, p<0.001), ICU admission (43.5% vs 11.5%, p<0.001) within 30 days, and had a higher mortality at 90 days of admission (20.2% vs 3.7%, p<0.001). Multivariate Cox Proportional cause-specific Hazard model regression analysis identified history of Diabetes Mellitus (HR 10.8, CI 2.42 - 48.4, p=0.001) as an independent risk factor associated with worse outcomes. Mortality was higher in patients with COVID-19 infection that developed AKI compared with those who did not developed AKI (survival estimate 150 days vs 240 days, p=0.0076). Conclusions: In cancer patients treated at a tertiary cancer center with COVID-19 infection and no history of CKD, the presence of AKI is associated with worse outcomes including higher 90 day mortality, ICU stay and mechanical ventilation. Older age and hypertension are major risk factors, where being diabetic was associated with worse clinical outcomes.

Interdisciplinary care rounds in the community: Changing the paradigm of supportive service involvement in cancer care.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 83-83
Author(s):  
Robert D. Siegel ◽  
Hal E. Crosswell ◽  
Terra Dillard ◽  
Jennifer Bayne ◽  
Tina Redenz ◽  
...  
Keyword(s):  
Emergency Room ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Academic Community ◽  
Adolescent And Young Adult ◽  
Cancer Center ◽  
Interdisciplinary Care ◽  
Supportive Services ◽  
Short Term ◽  
Tumor Boards

83 Background: Although cancer centers have focused on optimizing seamless Multidisciplinary Care (MDC) at tumor boards and/or clinics, there has been little published on effective ways to involve supportive services into the management of cancer patients. Historically, supportive services have been initiated when there is an active need rather than in anticipation of that need. As an alternative to pursuing such "crisis management" in our patients, Bon Secours St. Francis Cancer Center (BSSF) initiated Interdisciplinary Care (IDC) Rounds in an effort to anticipate patient needs, enhance quality of life (QoL), and potentially limit avoidable emergency room and hospital admissions. Methods: We initiated IDC Rounds with participants from the following disciplines: medical oncology, navigation, clinic nursing, palliative medicine, financial counseling, psychology, nutrition, clinical research, adolescent and young adult, and oncology rehabilitation/survivorship (ORS). A database was created to track new patients with malignancies within three weeks of presentation and the subsequent recommendations made by the IDC team. Those recommendations are then forwarded to the primary medical oncologist who has the ability to agree to those recommendations in full or in part before they are actuated. Results: BSSF is a non-academic, community-based cancer program and receives over 1,300 referrals annually from a referral population of 1.32 million in 10 counties. Short term metrics demonstrate a 57% and 100% increase in referrals to ORS and palliative care, respectively. Successes and challenges including sustainability, cost and measurable impact will be discussed. Conclusions: We have shown that it is feasible in the community setting to create a process that will allow early integration of supportive services into the full service care of cancer patients. Results demonstrate an increase in short-term metrics such as referrals to supportive services. Our ultimate goal is that formalized IDC results not only in earlier involvement by needed services but enhanced QoL for our patients with fewer emergency room and hospital admissions. Those data will be compiled as the program matures.

Implementation of a distress/supportive care screening tool in lung and head and neck cancer clinic.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21646-e21646
Author(s):  
Mary Pasquinelli ◽  
Sandra Obilade ◽  
David Rosenberg ◽  
Zane Deliu ◽  
Aakash Shah ◽  
...  
Keyword(s):  
Supportive Care ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Screening Tool ◽  
Supportive Care Needs ◽  
Cancer Center ◽  
Head Neck Cancer ◽  
Cancer Type ◽  
Care Needs ◽  
Head Neck

e21646 Background: Identifying and addressing depression, anxiety, and supportive care needs in cancer patients is an emerging standard of care. The Coleman Foundation “Patient Screening Questions for Supportive Care” tool was used with demographic and diagnostic data to investigate the relationships between screening scores. Methods: Lung/head/neck cancer patients at the University of Illinois Cancer Center were screened using the Coleman Foundation tool. This screening tool identified needs in several categories including Patient Health Questionnaire 4 (PHQ-4) scores; practical, family/caregiver, nutritional, treatment, physical, and spiritual/faith/religious concerns; levels of pain, fatigue, physical activity to quantitatively assess patient distress/supportive care needs. Scores were compared with age, sex, race/ethnicity, insurance, cancer type, and cancer stage. Linear regression was used for statistical analysis. Results: We performed initial screening on 164 lung/head/neck patients ages 36-88 (mean 61), with stages IA to IVC (May 2016 to Jan. 2017). Our findings are summarized in below. We found a 1oeffect that racial/ethnic minority status was significantly correlated with higher scores. We found that lung cancer was correlated with higher screening scores than head & neck on initial screen. Medicare insurance was correlated with significantly lower screening scores. Conclusions: Patients with lung/head/neck cancer have significant needs and concerns that go beyond merely treating their cancer. Our findings show that certain demographic groups have especially high burdens in some specific dimensions and that these specific concerns may be predicted based on diagnostic and demographic information. Thus, these findings serve to inform providers as to where and how to focus supportive care for these patient populations. [Table: see text]

Prescribing patterns for FOLFIRINOX in the real world.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 463-463
Author(s):  
Chad Michael Guenther ◽  
Nizar Bhulani ◽  
Adam Korenke ◽  
Jenny Jing Li ◽  
Leticia Khosama ◽  
...  
Keyword(s):  
Real World ◽  
Prescribing Patterns ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Bivariate Analysis ◽  
Treatment Delays ◽  
The Real ◽  
Significant Difference ◽  
Ed Visits ◽  
Dose Modifications

463 Background: FOLFIRINOX therapy is associated with improved outcome in patients with gastrointestinal cancers. The regimen can be associated with significant toxicity and empiric dose modifications are often used. We analyzed 1) real-world prescribing patterns of FOLFIRINOX and 2) toxicity of therapy. Methods: Patients undergoing FOLFIRINOX chemotherapy at an academic, NCI-Designated Comprehensive Cancer Center were identified and electronic medical records reviewed. Patients who received at least one dose of FOLFIRINOX were included. Chemotherapy dose, growth factor use and toxicity data was abstracted for the first 8 weeks. ‘Standard FOLFIRNOX’ was defined as the regimen utilized by Conroy et al (NEJM 2011). Any empiric reduction/withholding of drug dose for cycle 1 was classified as ‘modified FOLFIRINOX’. Bivariate analysis was performed on the data. Results: There were 111 patients seen between 5/2011-3/2017 and 94% had pancreatic cancer. Age range was 29-87 years and 52% were female. 59% received ‘modified FOLFIRINOX’ and 20% received empiric growth factors. Line of therapy for standard vs modified respectively was 71.1% vs 45.5% for 1st, 17.8% vs 36.4% for 2nd, and 11.1% vs 18.2% for beyond 2nd (p = 0.03). Patients with ‘modified FOLFIRINOX’ were more likely to have metastatic disease (p = 0.01), have received second line or beyond, and higher ECOG score (p = 0.03). Patients with ‘modified FOLFIRINOX’ had a trend toward fewer treatment-related ED visits or hospitalization vs ‘standard FOLFIRINOX’ (27.2% vs 42.2% p = 0.10) and fewer treatment delays (25.8% vs 42.2% p = 0.07). Conclusions: In the real world setting, a majority of patients on FOLFIRINOX receive empiric dose modifications. Although modified dose did not translate to a significant difference in ED visits, hospitalizations or treatment delays, there was a trend toward fewer events.

Mortality within 30 days of immunotherapy (checkpoint inhibitors) in metastatic cancer patients treated at Australian tertiary cancer center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6600-6600
Author(s):  
Hiren A. Mandaliya ◽  
Sang Kim ◽  
Gaik Tin Quah ◽  
Sandy Tun Min ◽  
James Carlton ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Checkpoint Inhibitors ◽  
Metastatic Cancer ◽  
Univariate Analysis ◽  
Cell Cancer ◽  
Small Sample ◽  
Cancer Center ◽  
Published Data ◽  
Cancer Type

6600 Background: Cancer treatment has evolved rapidly since the advent of immunotherapy (checkpoint inhibitors). As compared to chemotherapy, immunotherapy is associated with a more favourable but distinct side effect profile. Mortality within 30 days of chemotherapy in cancer patients has been accepted as a clinical indicator of preventable harm and used as an auditing tool for clinical practice and improving quality of life. This should be investigated in the current era of immunotherapy, as it has been the standard treatment for advanced melanoma, lung cancer, renal cell cancer and others. Methods: We conducted a retrospective study on patients with advanced cancer treated with immunotherapy and died within 30 days of treatment. Clinical data on patients treated with immunotherapy at Calvary Mater Newcastle between 2006 and 2018 was collected. Data were compared with 30-day mortality statistics of chemotherapy. Results: A total of 601 metastatic cancer patients received immunotherapy agents (Pembrolizumab, Nivolumab, Ipilimumab, Atezolizumab, Tislelizumab and MSB0011359C) on 5022 occasions. Seventy-six (12.6%) patients died within 30 days of receiving immunotherapy. Median age was 68 years (35-90). Melanoma was the most prevalent cancer type (63%) followed by lung (20%). Forty-seven (47%) of patients received immunotherapy as first-line treatment and 39% as second-line. Patients died within 30 days received an average 2 (1-16) immunotherapy doses. A quarter of patients had ECOG 3 and ECOG 4 before last dose. Majority of deaths were related to disease (86%). Nearly 80% of patients died in hospital. One patient died due to treatment-related pneumonitis. In univariate analysis, there was no association between mortality and patients’ demographic variables such as age, sex, BMI, cancer type, ECOG performance status, immunotherapy agent and prior treatment. Conclusions: To our knowledge, this is the first ever real-world data on 30-day mortality after immunotherapy in advanced cancer. Thirty-day mortality rates were comparable to published data on patients treated with chemotherapy. Results emphasise significance of careful selection of advanced cancer patient for immunotherapy. Due to small sample size, the power to detect a significant association between patients demographics and survival is reduced.

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