Oral chemotherapy education sessions at an academic and community cancer center.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 254-254
Author(s):  
Daniel Aaron Roberts ◽  
Jim Doolin ◽  
Christina Cibotti ◽  
Rebekah A Hartwell ◽  
Mary Yenulevich ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Community Setting ◽  
Oral Chemotherapy ◽  
Cancer Center ◽  
P Value ◽  
Specific Information ◽  
Education Session ◽  
Academic Medical ◽  
Oral Agents

254 Background: Oral chemotherapy is becoming more widely utilized within oncology. Concerns regarding poor adherence and toxicity may be addressed by providing patient education. Methods: We developed and implemented a pharmacist-led initial education session for patients newly prescribed oral chemotherapy in both an academic medical center gastrointestinal oncology clinic and an affiliated community oncology cancer center. We provided an education packet including drug-specific information, clinic contact telephone numbers, and a drug schedule calendar. Standardized teaching and documentation templates were used. Patients completed each education session with the MOATT teaching tool for patients receiving Oral Agents for Cancer V1.2. Assessment of compliance with the ASCO/ONS Chemotherapy Administration Safety Standards on Oral Chemotherapy Education was assessed through use of Quality Oncology Practice Initiative (QOPI) quality measures where applicable and compared to historical QOPI data from the academic medical center from 2015-2017. Results: Thirty-one patients were newly prescribed oral chemotherapy and received the initial education session from November 2017 through May 2018. Based on a monthly report generated of new oral chemotherapy prescriptions, after a seven-month run-in, the rate reached 100% of patients at both sites for the most recent month. When comparing the intervention cohort to the historical QOPI cohort using a one-sided P value of 0.017 with bonferroni correction, there was improvement in safe handling/storage (pre: 19%, post 100%, P = 0.0001), drug-drug and food interactions (pre: 31%, post 100%, P = 0.0001), and plan for missed doses (pre: 37%, post: 97%, P = 0.0001). A trend toward improvement was found for schedule/start date discussion (pre: 87%, post: 100% P = 0.018) and side effect/toxicities (pre: 87%, post: 100% P = 0.018). Conclusions: Implementation of an oral chemotherapy education session in both an academic and community setting was feasible and improved adherence to QOPI measures of oral chemotherapy education and ASCO/ONS standards for oral chemotherapy. Further data regarding time to clinical outcomes is forthcoming.

Using an online portal and nurse navigators to improve access to cancer care between network hospitals.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 126-126
Author(s):  
Eleanor Miller ◽  
Margaret Rummel
Keyword(s):  
Cancer Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Community Setting ◽  
Cancer Center ◽  
Proton Radiation ◽  
Online Portal ◽  
Academic Medical ◽  
Nurse Navigator ◽  
Improve Access

126 Background: Nurse navigation-facilitated access to cancer care is an emerging trend in healthcare. One way to improve access to specialized cancer care is through nurse navigators in collaboration with affiliated network hospitals. The Abramson Cancer Center (ACC) has a network of 15 community hospitals in the tri-state area that provides patients access to an academic medical center for subspecialty care that is not always available the community cancer center. Methods: In 2010, a navigation referral process was developed using nurse navigators from the ACC and the network hospitals. Then in 2012, an online portal was developed to further streamline physician referrals to and from the ACC. Updates were made to the online portal in 2013 and 2014 for continued improvement. Results: Prior to the online portal, no central repository for network referrals existed to ensure that patients were scheduled with the correct provider(s). Now with the portal patients are referred, assessed, and scheduled with appropriate providers by the nurse navigator. This has increased accountability and streamlined the scheduling process. Now, patients can be seen by multiple providers during one visit to the ACC. It has also provided a network for the ACC nurse navigators to connect patients back to the community setting for ongoing care once consults or treatments at the ACC are completed. Since the navigation process was implemented, over 1200 patients have been referred (over 500 in the past year alone) for second opinions, clinical trials, proton radiation, bone marrow transplants, surgical options, and cutting- edge technology that may not have otherwise been available. Conclusions: Using nurse navigators at the core of the process ensures that patients are triaged and scheduled in a timely and medically-appropriate manner, thus enhancing their access to specialized cancer care.

scholarly journals Improving the Safety of Oral Chemotherapy at an Academic Medical Center

2016 ◽  
Vol 12 (1) ◽  
pp. e71-e76 ◽  
Author(s):  
Nirav N. Shah ◽  
Erica Casella ◽  
Donna Capozzi ◽  
Suzanne McGettigan ◽  
Tara C. Gangadhar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lean Six Sigma ◽  
Oral Chemotherapy ◽  
University Of Pennsylvania ◽  
Cancer Center ◽  
Improvement Project ◽  
Academic Medical ◽  
The University

Purpose: Over the last decade, the use of oral chemotherapy (OC) for the treatment of cancer has dramatically increased. Despite their route of administration, OCs pose many of the same risks as intravenous agents. In this quality improvement project, we sought to examine our current process for the prescription of OC at the Abramson Cancer Center of the University of Pennsylvania and to improve on its safety. Methods: A multidisciplinary team that included oncologists, advanced-practice providers, and pharmacists was formed to analyze the current state of our OC practice. Using Lean Six Sigma quality improvement tools, we identified a lack of pharmacist review of the OC prescription as an area for improvement. To address these deficiencies, we used our electronic medical system to route OC orders placed by treating providers to an oncology-specific outpatient pharmacist at the Abramson Cancer Center for review. Results: Over 7 months, 63 orders for OC were placed for 45 individual patients. Of the 63 orders, all were reviewed by pharmacists, and, as a result, 22 interventions were made (35%). Types of interventions included dosage adjustment (one of 22), identification of an interacting drug (nine of 22), and recommendations for additional drug monitoring (12 of 22). Conclusion: OC poses many of the same risks as intravenous chemotherapy and should be prescribed and reviewed with the same oversight. At our institution, involvement of an oncology-trained pharmacist in the review of OC led to meaningful interventions in one third of the orders.

Accelerating the clinical trial start-up process for early-phase cancer studies: A test of process change to support rapid activation in an academic medical center.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17507-e17507 ◽  
Author(s):  
Sheilah K Hurley ◽  
Therica M Miller ◽  
Rebecca Flores Stella ◽  
Keren Dunn ◽  
Ryan Schroeder ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cancer Center ◽  
Small Series ◽  
Academic Medical ◽  
One Year ◽  
Activation Times ◽  
High Level

e17507 Background: Clinical trial sponsors have strong scientific, financial, and regulatory interests in rapidly activating studies at participating sites. Academic medical centers have difficulty activating trials within a few weeks of sponsor agreement because, among other inefficiencies, they engage the necessary committee reviews, regulatory approvals, contracting, and budgeting in serial fashion. Incremental revisions in such workflows do not result in strong improvements. Methods: We redesigned our institutional workflow to complete clinical trial activation tasks within six weeks. Historical procedures were replaced rather than scrutinized. A high level leadership committee was required to change and integrate procedures across the medical center, and engage sponsors to improve their turnaround times. A web-based collaborative workflow tracking tool was created to help coordinate the necessary tasks and measure performance. Six clinical trials from the Cancer Center portfolio were used to test and improve the new workflow. Results: Clinical trial activation redesign took one year. For the six studies used as tests of change, the activation times were 49, 54, 78, 58, 62, and 32 days. Times in excess of 6 weeks were largely due to sponsor delays. Conclusions: Considerable effort is required to significantly alter a complex workflow like clinical trial activation. Appropriate priorities, leadership, staffing, and tools are required. Markedly shortened study activation for a small series of cancer trials taught our academic medical center lessons that will be useful for improving the process for all clinical trials, and will make us a better partner for pharmaceutical and academic sponsors as well as for investigator initiated research. [Table: see text]

Electronic monitoring of patient-reported adherence and symptoms on oral chemotherapy at an academic and a community site.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 283-283
Author(s):  
Jim Doolin ◽  
Daniel Aaron Roberts ◽  
Christina Cibotti ◽  
Scott M Devlin ◽  
Holly Dowling ◽  
...  
Keyword(s):  
Median Time ◽  
Medical Center ◽  
Academic Medical Center ◽  
Symptom Assessment ◽  
Oral Chemotherapy ◽  
Community Practice ◽  
Financial Toxicity ◽  
Online Tool ◽  
Academic Medical ◽  
Patient Reported

283 Background: Monitoring of toxicity and adherence is often lacking for patients recently started on oral chemotherapy. National guidelines recommend active outreach to patients within a week after treatment start. We developed an online tool to actively reach out to patients newly started on oral chemotherapy at one academic medical center and community practice. Methods: A multi-disciplinary team, including patients, developed an online oral chemotherapy adherence, symptom, and financial toxicity assessment tool within REDCap. We implemented this tool for new oral chemotherapy prescriptions in May 2018 in the gastrointestinal oncology group of an academic medical center and a general community practice. To quantify the impact of this tool on symptom management, we completed a retrospective analysis of patients receiving new oral chemotherapy prescriptions at these same sites, in the 13 months immediately preceding clinical implementation of the online tool, May 2017 to May 2018. Results: In the pre-intervention historical cohort (n = 58) the median time to first symptom assessment by a clinician was 7 days (range 1 – 41 days, SD 7 days), median time to identifying a new or worsening symptom was 10 days (range 1-55 days, SD 10 days), and median time to clinical action regarding a new or worsening symptom was 10 days (range 1-104, SD 20 days). Our first intervention patient used the online tool in May 2018 to report symptoms of “nausea and fatigue,” 4 days after starting oral chemotherapy. This resulted in an oncology clinical nurse calling the patient to review symptom management by phone. Conclusions: The median time to first symptom assessment in our historical control cohort is 7 days, with standard deviation of 7 days, suggesting potential room for improvement. Thus far, the online tool has been completed by one patient. Further data will be reported regarding the uptake of this tool, the tool’s impact on quality measures, and patient reported symptoms, adherence, and financial toxicity.

Telemedicine visits result in a significantly lower rate of cancellations compared to in-person visits for interventional oncology clinic patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13624-e13624
Author(s):  
Suken Shah ◽  
Stephen Barnett Solomon
Keyword(s):  
Interventional Oncology ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
P Value ◽  
Waiting Room ◽  
Academic Medical ◽  
Physician Time ◽  
Clinic Visits

e13624 Background: Telemedicine allows increased access to specialists, less time in a waiting room and on-demand options with little to no transportation costs. These changes have been accelerated by the COIVD-19 pandemic. The purpose of the study was to test the hypothesis that a virtual telemedicine clinic would significantly decrease no-show rates and cancellations compared to in-person visits for interventional oncology (IO) clinic patients. Methods: Telemedicine visits were performed by a physician or advanced practice provider (PA or NP) at a single institution, academic medical center including 5 regional sites to patients at home in multiple states. Total patients encounters and data from January 2020 to December 2020 were analyzed. Visit types included new visits and follow up visits. Phone only visits were excluded. Primary outcome measures were an analysis of total cancelled visits (both same day and rescheduled visits), completed visits, and total scheduled visits with calculation of the telemedicine and in-person cancellation rates. Results: There was a total of 9,044 IR clinic visits in 2020 from 6,348 unique patients across the MSK Main Campus and Regional Network. Of these clinic visits, 5586 were telemedicine visits and 3458 were in-person visits. There was a significant decrease in no show and cancellation rates for telemedicine patients (6.3%) compared to in-person visits (8.1%) (p-value <0.00001). Conclusions: Telemedicine visits resulted in a significantly lower rate of visit cancellation compared to in-person visits. This reduction in no-show and cancellation rates may yield significant cost savings by eliminating gaps in the interventional oncology clinic schedule to allow for more efficient use of physician time and resources.

Patients’ perspectives and outcomes on an oral chemotherapy education and electronic monitoring program.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18007-e18007
Author(s):  
Noah Xavier Tocci ◽  
Jim Doolin ◽  
Daniel Aaron Roberts ◽  
Christina Cibotti ◽  
Rebekah A Hartwell ◽  
...  
Keyword(s):  
Electronic Monitoring ◽  
Medical Center ◽  
Academic Medical Center ◽  
Monitoring Program ◽  
Management Program ◽  
Oral Chemotherapy ◽  
P Value ◽  
Online Tool ◽  
Significant Difference ◽  
Patient Reported

e18007 Background: Patients on oral chemotherapy (OC) often lack consistent education and monitoring, risking toxicity and poor adherence. We developed an OC management program including education and an online tool for active outreach. Methods: In November 2017, we initiated pharmacist-led education for patients newly prescribed OC at a community practice and in the gastrointestinal oncology group at an academic medical center (AMC). An online tool assessing adherence, symptoms, and financial toxicity was emailed to patients three days after starting OC. Non-responders were contacted for phone interviews. A random sample of 28 patients newly started on OC at both sites before the intervention in 2017 was analyzed at baseline. A retrospective chart analysis was done to collect time to symptom assessment, identification and action. A report generated date of first emergency department (ED) visit or hospitalization within the AMC. We conducted a Mann Whitney U-Test, using a one-sided p value of 0.025 with Bonferroni correction. Results: Sixty-nine of 106 eligible patients (66%) received education, of whom 36 (52.1%) received the online tool, and 13 (36.1%) responded. There was a significant difference between the intervention and baseline median times to first new/worsening symptoms (p = 0.0105) but otherwise there were no outcome improvements. Eight of 23 patients who did not respond to the electronic tool were interviewed and indicated that their illness impeded their ability to check email (n = 2), and that they never check email (n = 2). Conclusions: This OC management program improved time to detect new/worsening symptoms and could potentially improve outcomes after further patient accrual. Future investigation should examine ways to improve patient responsiveness to electronic patient-reported symptom tools. [Table: see text]

scholarly journals Evaluation of a Pharmacist Led Oral Chemotherapy Clinic: A Pilot Program in the Gastrointestinal Oncology Clinic at an Academic Medical Center

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 46 ◽  
Author(s):  
Julianne O. Darling ◽  
Farah Raheem ◽  
Katelyn C. Carter ◽  
Elizabeth Ledbetter ◽  
Jennifer F. Lowe ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Clinic Visit ◽  
Oral Chemotherapy ◽  
Satisfaction Survey ◽  
Pilot Program ◽  
Continuous Variables ◽  
Percentage Difference ◽  
Academic Medical ◽  
Strongly Agree

Oral chemotherapy represents a major patient-centric advancement in therapy convenience. However, ownership of safe and correct administration of these agents requires significant patient education. To address this challenge, an in-person pharmacist-led oral chemotherapy education clinic in gastrointestinal oncology patients within an academic medical center was created and assessed. In this pilot program, a medication-specific quiz was administered to patients before and after education performed by a pharmacist to assess patient understanding of their new oral chemotherapy. A five-question satisfaction survey was also administered at the conclusion of the pharmacist clinic visit. Primary outcome was the percentage difference between pre-and post-education quiz scores. Secondary outcomes included patient satisfaction, time to treatment initiation, and number of pharmacist interventions. Frequencies and medians were used to describe categorical and continuous variables, respectively. Of the 18 patients analyzed, 50% were male and median age was 59.5 years. Approximately 28% had colon cancer, and 61% were treated with capecitabine. The median post-education scores improved from a pre-education score of 75% to 100%. Overall, seventeen of the eighteen patients responded with “strongly agree” to all satisfaction survey statements. An in-person oncology pharmacist-led oral chemotherapy education session demonstrated an improvement in patients’ understanding of their new oral chemotherapy treatment.

scholarly journals The Community Oncology and Academic Medical Center Alliance in the Age of Precision Medicine: Cancer Genetics and Genomics Considerations

2020 ◽  
Vol 9 (7) ◽  
pp. 2125
Author(s):  
Marilena Melas ◽  
Shanmuga Subbiah ◽  
Siamak Saadat ◽  
Swapnil Rajurkar ◽  
Kevin J. McDonnell
Keyword(s):  
Precision Medicine ◽  
Cancer Genetics ◽  
Medical Center ◽  
Academic Medical Center ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Academic Center ◽  
Community Oncology ◽  
Academic Medical ◽  
Genetics And Genomics

Recent public policy, governmental regulatory and economic trends have motivated the establishment and deepening of community health and academic medical center alliances. Accordingly, community oncology practices now deliver a significant portion of their oncology care in association with academic cancer centers. In the age of precision medicine, this alliance has acquired critical importance; novel advances in nucleic acid sequencing, the generation and analysis of immense data sets, the changing clinical landscape of hereditary cancer predisposition and ongoing discovery of novel, targeted therapies challenge community-based oncologists to deliver molecularly-informed health care. The active engagement of community oncology practices with academic partners helps with meeting these challenges; community/academic alliances result in improved cancer patient care and provider efficacy. Here, we review the community oncology and academic medical center alliance. We examine how practitioners may leverage academic center precision medicine-based cancer genetics and genomics programs to advance their patients’ needs. We highlight a number of project initiatives at the City of Hope Comprehensive Cancer Center that seek to optimize community oncology and academic cancer center precision medicine interactions.

The City of Hope (COH) performance excellence program (PEP): A physician incentive program to improve health care performance (HCP) in an academic medical center.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17556-e17556
Author(s):  
Joseph C. Alvarnas ◽  
Tricia Kassab ◽  
Priscilla Avanessian ◽  
Michael Pierce ◽  
Alexandra M. Levine
Keyword(s):  
Adjuvant Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Performance Model ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Healthcare Associated Infection ◽  
Advanced Directives ◽  
Vte Prophylaxis ◽  
Academic Medical

e17556 Background: The Affordable Care Act (ACA) introduced a pay for performance model focused on: safety, timeliness, effectiveness, efficiency, patient-centered, equitable care. COH is an NCI sponsored Comprehensive Cancer Center, focused on cancer care. Methods: In 2011, a physician led team with representation from finance, QRRM, nursing and legal identified 13 quality measures (QM) where opportunities for improvement (OFI) existed. Selection criteria included measurability, importance, applicability to ACA, physician impact, return on investment and national importance. The QM include HCAHPS score, Healthcare Associated Infection rate (HAI), quantity of blood products internally produced (BP), coder response rate (RR), use of sepsis bundle orders, time to new patient appointments (NPA), OR 1st case on-time starts, timeliness of adjuvant therapy for breast/colon cancer patients, SCIP composite score and use of VTE prophylaxis orders. HCP for the first 4 QM was assessed based upon institutional performance; 6 QM were assessed upon departmental performance. There were 3 build measures (BM): creating a system to obtain advanced directives (AD) on all new patients, creating a system for effective communication with referring physicians and 4 departmental BM based on best practices. Results: PEP performance was assessed between 5/1/12-12/31/12. 174 physicians in 11 departments were eligible for a $2.05 million incentive pool. QM were evaluated using a tiered bonus structure. Significant improvements were seen in HAI, BP production, SCIP, OR starts and timely adjuvant therapy. There were improvements in the use of VTE orders, but aggregate performance fell below payment threshold. The build measure for AD was completed. Conclusions: (1) PEP is an effective tool for physician engagement in an academic medical center. (2) PEP enhanced alignment between the medical group, hospital, nursing and administration. (3) PEP was effective in improving HCP in less than one year from its inception. [Table: see text]

scholarly journals Assessment of adherence and relative dose intensity with oral chemotherapy in oncology clinical trials at an academic medical center

2017 ◽  
Vol 24 (5) ◽  
pp. 348-353 ◽  
Author(s):  
Jeff A Engle ◽  
Anne M Traynor ◽  
Toby C Campbell ◽  
Kari B Wisinski ◽  
Noelle LoConte ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Medical Center ◽  
Performance Status ◽  
Academic Medical Center ◽  
Dose Intensity ◽  
Oral Chemotherapy ◽  
Relative Dose Intensity ◽  
Cancer Center ◽  
Related Factors ◽  
Oncology Clinical Trials

Background/Aims Oral chemotherapy is increasingly utilized leaving the patient responsible for self-administering an often complex regimen where adverse effects are common. Non-adherence and reduced relative dose intensity are both associated with poorer outcomes in the community setting but are rarely reported in clinical trials. The purpose of this study is to quantify adherence and relative dose intensity in oncology clinical trials and to determine patient and study related factors that influence adherence and relative dose intensity. Methods Patients were identified from non-industry-funded clinical trials conducted between 1 January 2009 and 31 March 2013 at the University of Wisconsin Carbone Cancer Center. Data were extracted from primary research records. Descriptive statistics and linear regression modeling was performed using SAS 9.4. Results A total of 17 clinical trials and 266 subjects were included. Mean adherence was greater than 97% for the first eight cycles. Mean relative dose intensity was less than 90% for the first cycle and declined over time. Male gender, a performance status of 1 or 2, metastatic disease, and traveling more than 90 miles to reach the cancer center were associated with higher relative dose intensity. Conclusions Patients with cancer enrolled in clinical trials are highly adherent but unlikely to achieve protocol specified relative dose intensity. Given that determining the phase II dose is the primary endpoint of phase I trials, incorporating relative dose intensity into this determination should be considered.

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