Harnessing the electronic health record to optimize oral anticancer therapy monitoring and follow-up.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 305-305
Author(s):  
Kate Jeffers ◽  
Amy Walde
Keyword(s):  
Quality Improvement ◽  
Cancer Therapy ◽  
Gap Analysis ◽  
Patient Adherence ◽  
Therapy Monitoring ◽  
Discrete Data ◽  
Oral Chemotherapy ◽  
Cancer Therapies ◽  
Anti Cancer

305 Background: UCHealth pursued and became certified as a Quality Oncology Program from the Quality Oncology Practice Initiative (QOPI) through the American Society of Clinical Oncology (ASCO) in 2015. During our gap analysis to prepare for certification, we identified a deficit in our education, monitoring, and follow up relating to oral anti-cancer therapies. Although we used QOPI as a benchmark, we sought to improve patient care and safety in the realm of oral anti-cancer therapies. Methods: UCHealth has implemented policies surrounding oral chemotherapy to include patient education, consent, use of the EHR for ordering, and patient monitoring of adherence and toxicity through development of a flowsheet. This includes the use of Best Practice Alerts (BPA) to trigger staff to evaluate adherence and compliance, smart texts to pull data into progress notes, silent BPAs to remind staff to call patients within 10 days of starting oral chemotherapy, and weekly reporting of staff compliance with assessing patient adherence. Results: EHR changes were implemented in May, 2015 with reporting of staff compliance beginning in September. At that time, UCHealth was only monitoring adherence and toxicity in 24% of patients on an oral anti-cancer therapy. Through continued quality improvement projects, staff education, and optimization of clinical decision support tools, UCHealth consistently monitors adherence and toxicity in over 85% of patients on an oral anti-cancer therapy. Results have been monitored for over two years with continued improvements seen. Conclusions: Using the reporting data, we are able to identify quality improvement projects to include discrete data such as individual staff member compliance. Continuous refinements of the BPA and report have occurred as a result of discrete data analysis by a multi-disciplinary committee.

scholarly journals Epigenetic Research in Stem Cell Bioengineering—Anti-Cancer Therapy, Regenerative and Reconstructive Medicine in Human Clinical Trials

Cancers ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 1016 ◽  
Author(s):  
Claudia Dompe ◽  
Krzysztof Janowicz ◽  
Greg Hutchings ◽  
Lisa Moncrieff ◽  
Maurycy Jankowski ◽  
...  
Keyword(s):  
Gene Expression ◽  
Clinical Trials ◽  
Stem Cell ◽  
Cancer Therapy ◽  
Regulation Of Gene Expression ◽  
Epigenetic Modifications ◽  
Transcriptional Level ◽  
Cancer Therapies ◽  
Stem Cell Engineering ◽  
Anti Cancer

The epigenome denotes all the information related to gene expression that is not contained in the DNA sequence but rather results from chemical changes to histones and DNA. Epigenetic modifications act in a cooperative way towards the regulation of gene expression, working at the transcriptional or post-transcriptional level, and play a key role in the determination of phenotypic variations in cells containing the same genotype. Epigenetic modifications are important considerations in relation to anti-cancer therapy and regenerative/reconstructive medicine. Moreover, a range of clinical trials have been performed, exploiting the potential of epigenetics in stem cell engineering towards application in disease treatments and diagnostics. Epigenetic studies will most likely be the basis of future cancer therapies, as epigenetic modifications play major roles in tumour formation, malignancy and metastasis. In fact, a large number of currently designed or tested clinical approaches, based on compounds regulating epigenetic pathways in various types of tumours, employ these mechanisms in stem cell bioengineering.

scholarly journals Microbes as Medicines: Harnessing the Power of Bacteria in Advancing Cancer Treatment

2020 ◽  
Vol 21 (20) ◽  
pp. 7575 ◽  
Author(s):  
Shruti S. Sawant ◽  
Suyash M. Patil ◽  
Vivek Gupta ◽  
Nitesh K. Kunda
Keyword(s):  
Cancer Therapy ◽  
Cancer Treatment ◽  
Treatment Options ◽  
Current Treatment ◽  
Genetically Engineered ◽  
Cancer Therapies ◽  
Anti Cancer ◽  
Tumor Environment ◽  
Systemic Side Effects ◽  
Hypoxic Tumor

Conventional anti-cancer therapy involves the use of chemical chemotherapeutics and radiation and are often non-specific in action. The development of drug resistance and the inability of the drug to penetrate the tumor cells has been a major pitfall in current treatment. This has led to the investigation of alternative anti-tumor therapeutics possessing greater specificity and efficacy. There is a significant interest in exploring the use of microbes as potential anti-cancer medicines. The inherent tropism of the bacteria for hypoxic tumor environment and its ability to be genetically engineered as a vector for gene and drug therapy has led to the development of bacteria as a potential weapon against cancer. In this review, we will introduce bacterial anti-cancer therapy with an emphasis on the various mechanisms involved in tumor targeting and tumor suppression. The bacteriotherapy approaches in conjunction with the conventional cancer therapy can be effective in designing novel cancer therapies. We focus on the current progress achieved in bacterial cancer therapies that show potential in advancing existing cancer treatment options and help attain positive clinical outcomes with minimal systemic side-effects.

scholarly journals Targeting ERK-Hippo Interplay in Cancer Therapy

2020 ◽  
Vol 21 (9) ◽  
pp. 3236 ◽  
Author(s):  
Karel Vališ ◽  
Petr Novák
Keyword(s):  
Cancer Therapy ◽  
Signaling Pathways ◽  
Signaling Pathway ◽  
Cross Talk ◽  
Mapk Signaling ◽  
Mapk Signaling Pathway ◽  
Mitogen Activated Protein Kinase ◽  
Cancer Therapies ◽  
Anti Cancer ◽  
Targeted Inhibition

Extracellular signal-regulated kinase (ERK) is a part of the mitogen-activated protein kinase (MAPK) signaling pathway which allows the transduction of various cellular signals to final effectors and regulation of elementary cellular processes. Deregulation of the MAPK signaling occurs under many pathological conditions including neurodegenerative disorders, metabolic syndromes and cancers. Targeted inhibition of individual kinases of the MAPK signaling pathway using synthetic compounds represents a promising way to effective anti-cancer therapy. Cross-talk of the MAPK signaling pathway with other proteins and signaling pathways have a crucial impact on clinical outcomes of targeted therapies and plays important role during development of drug resistance in cancers. We discuss cross-talk of the MAPK/ERK signaling pathway with other signaling pathways, in particular interplay with the Hippo/MST pathway. We demonstrate the mechanism of cell death induction shared between MAPK/ERK and Hippo/MST signaling pathways and discuss the potential of combination targeting of these pathways in the development of more effective anti-cancer therapies.

QIM19-118: Oral Anti-Cancer Therapy Initiation: A Standardized Approach for Patient Care and Education

2019 ◽  
Vol 17 (3.5) ◽  
pp. QIM19-118
Author(s):  
Megan Corbett ◽  
Cynthia Arcieri ◽  
Emma Dann ◽  
Jeff Durney ◽  
Frances Fuller ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Education ◽  
Cancer Therapy ◽  
Patient Care ◽  
Treatment Plan ◽  
Care Team ◽  
Educational Materials ◽  
Extended Care ◽  
Anti Cancer ◽  
Adherence Monitoring

Background: The availability and popularity of oral anti-cancer therapy has recently increased. In this shift of delivery, control over downstream steps in the process moves to patients, families, and the extended care team. Unique challenges have been identified including effective patient education, adherence, and monitoring. The purpose of this quality improvement project was to standardize the approach to initiating oral anti-cancer patient care. Methods: A quality improvement team developed and implemented a standard approach for before, during, and after initiation of oral anti-cancer therapy. Key components included ensuring completion of informed consent, electronic orders within an evidence-based treatment plan, and adherence monitoring with a specific emphasis on patient education. Education prior to initiating therapy was standardized through both an education folder and one-on-one teaching sessions with an oncology nurse. A voluntary, anonymous 4-question paper survey (deemed clinical quality improvement by the IRB) solicited feedback from patients to assess both the educational materials and teaching session. Questions included perceived acceptability of the content and whether materials guided conversation, provoked questions, and complimented the teaching. An opportunity for comments was provided. Results: A 3-month collection period yielded overwhelmingly positive results. 100% of patients (n=18) felt the education materials provided were “just right” and provoked discussion with the care team. 94% of patients felt the educational materials and teaching session were complimentary. Conclusions: As oral anti-cancer therapy becomes more common, it is vital to form a collaborative partnership with the patient, family, and the extended care team to ensure overall success. Standardized educational content supports the transfer of expert knowledge to ensure adherence, management, and patient safety, ultimately improving patient outcomes. A standard approach that includes informed consent, orders within a treatment plan, adherence monitoring, and patient education prior to initiating oral anti-cancer therapy is one way to ensure quality, comprehensive patient care.

Health care practitioner prescribing patterns and perspectives on oral chemotherapy management: A survey of cancer centers in Toronto, Canada.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 48-48
Author(s):  
Mark Pasetka ◽  
Larissa Day ◽  
Maggie Ford ◽  
Angela Boudreau ◽  
Angie Giotis ◽  
...  
Keyword(s):  
Side Effects ◽  
Patient Education ◽  
Oral Cancer ◽  
Patient Adherence ◽  
Oral Chemotherapy ◽  
Cancer Therapies ◽  
Prescription Practices ◽  
Toxicity Monitoring ◽  
Improve Patient Adherence ◽  
Improve Patient

48 Background: With an increasing number of patients receiving oral cancer therapies, evaluation of safe prescription practices, effective patient education, and toxicity monitoring of these agents is imperative. Methods: Multi-disciplinary oncology practitioners at several cancer centres in Toronto, Canada were surveyed using a web-based platform, to evaluate their prescription practices, use of patient education and symptom management tools, as well as their views on patient adherence and toxicity reporting. Results: Of 170 respondents, 43% were nurses, 34% were pharmacists, and 23% were physicians. Seventy nine percent considered patient education, medication adherence (76%), and toxicity management (78%) as “very important” components of oral chemotherapy management. Prescription methods varied: 59% of respondents used written prescriptions, 39% computerized physician order entry (CPOE), and 0% pre-printed orders, ≥50% of the time. Clinicians felt that patients report side effects from oral agents only “some of the time” (53%), and the most problematic toxicities were nausea (61%) and diarrhea (61%). Practitioners perceived the most common reasons for patient underreporting of side effects to be “fear of treatment interruption” (62%), and that “toxicities are part of the treatment” (66%). Seventy three percent of those surveyed felt individual counseling, follow-up calls (69%), and updated medication information (57%) would improve patient adherence and safety. Conclusions: A diverse group of surveyed oncology professionals expressed the importance of utilizing educational and toxicity monitoring tools for patients on oral cancer therapies, particularly as patients are thought to under-report symptoms. Prescription practices are variable, and CPOE use should be improved. The results of this survey will also be compared to a patient survey, to help develop better tools and policies to standardize practice, and improve patient adherence and toxicity management on oral cancer agents.

Feasibility of pharmacist co-management for patients prescribed oral anticancer therapy for gastrointestinal cancers.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 77-77
Author(s):  
Cathy Cao ◽  
James M. Cleary ◽  
Anuj K. Patel ◽  
Matthew B. Yurgelun ◽  
Kimmie Ng ◽  
...  
Keyword(s):  
Drug Information ◽  
Cancer Center ◽  
Future Research ◽  
Cancer Therapies ◽  
Clinical Workflow ◽  
Drug Access ◽  
Anti Cancer ◽  
Gi Cancers ◽  
The Impact

77 Background: There is an increased use of oral anti-cancer therapies (OACTs) for treatment of gastrointestinal (GI) cancers. While OACTs provide convenience compared to IV agents, they carry similar risks for drug-drug interactions (DDI), toxicities, and unique challenges like adherence and drug access. Patients on OACTs have fewer touch-points with clinicians, requiring more patient ownership of treatment. Pharmacist co-management of pts has been shown to be successful in teaching and monitoring of IV therapy. We sought to assess feasibility of pharmacist co-management for pts prescribed OACTs for treatment of GI cancers. Methods: In 2019, the Dana-Farber GI Cancer Center (GCC) had an embedded pharmacist 8 hrs/week to help with co-management of pts on OACTs. The pharmacist provided (1) in-person and telephone teaching; (2) comprehensive medication reconciliation; (3) DDI review; and (4) supportive care recommendations. Patients were identified by reviewing provider schedules and through provider referrals. The initial teach visit was one-on-one with each patient before initiation, with joint visits with providers thereafter for monitoring and adherence checks. Data were collected to quantify the types of support/recommendation provided by pharmacist and the impact on clinical workflow. Results: After 4 months in the GCC clinic, the pharmacist has co-managed 26 new pts, 61% seen in-person. In initial visits, the pharmacist identified 3 DDI, updated 15 medication lists, and assisted 11 pts/or providers with drug access and drug information. The pharmacist saw 10 of 26 pts for follow up, totaling 21 encounters. The pharmacist assisted in 17 of the 21 encounters with drug access and drug information. Pharmacist spent 20 min/pt on teaching. For follow-up visits, the pharmacist did not additional incur clinic resources as patients were seen with providers. Conclusions: Pharmacist co-management of patients on OACTs is feasible and offers an added safety resource to pts and providers from initial teaching to monitoring. Future research will focus on the impacts of co-management on clinical outcomes, such as the use of emergency/hospital visits, the duration of therapy, and adherence.

scholarly journals MicroRNA-Based Combinatorial Cancer Therapy: Effects of MicroRNAs on the Efficacy of Anti-Cancer Therapies

Cells ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. 29 ◽  
Author(s):  
Hyun Ah Seo ◽  
Sokviseth Moeng ◽  
Seokmin Sim ◽  
Hyo Jeong Kuh ◽  
Soo Young Choi ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Combination Therapy ◽  
Cancer Cells ◽  
Extracellular Vesicles ◽  
Therapeutic Resistance ◽  
Cancer Therapies ◽  
Anti Cancer ◽  
Different Types ◽  
Therapeutic Responses

The susceptibility of cancer cells to different types of treatments can be restricted by intrinsic and acquired therapeutic resistance, leading to the failure of cancer regression and remission. To overcome this problem, a combination therapy has been proposed as a fundamental strategy to improve therapeutic responses; however, resistance is still unavoidable. MicroRNA (miRNAs) are associated with cancer therapeutic resistance. The modulation of dysregulated miRNA levels through miRNA-based therapy comprising a replacement or inhibition approach has been proposed to sensitize cancer cells to other anti-cancer therapies. The combination of miRNA-based therapy with other anti-cancer therapies (miRNA-based combinatorial cancer therapy) is attractive, due to the ability of miRNAs to target multiple genes associated with the signaling pathways controlling therapeutic resistance. In this article, we present an overview of recent findings on the role of therapeutic resistance-related miRNAs in different types of cancer. We review the feasibility of utilizing dysregulated miRNAs in cancer cells and extracellular vesicles as potential candidates for miRNA-based combinatorial cancer therapy. We also discuss innate properties of miRNAs that need to be considered for more effective combinatorial cancer therapy.

scholarly journals A Promising Biocompatible Platform: Lipid-Based and Bio-Inspired Smart Drug Delivery Systems for Cancer Therapy

2018 ◽  
Vol 19 (12) ◽  
pp. 3859 ◽  
Author(s):  
Min Kim ◽  
Seung-Hae Kwon ◽  
Jung Choi ◽  
Aeju Lee
Keyword(s):  
Drug Delivery ◽  
Cancer Therapy ◽  
Drug Delivery Systems ◽  
Controlled Drug Release ◽  
Research Area ◽  
Delivery Systems ◽  
Cancer Therapies ◽  
Smart Systems ◽  
Tumor Microenvironments ◽  
Anti Cancer

Designing new drug delivery systems (DDSs) for safer cancer therapy during pre-clinical and clinical applications still constitutes a considerable challenge, despite advances made in related fields. Lipid-based drug delivery systems (LBDDSs) have emerged as biocompatible candidates that overcome many biological obstacles. In particular, a combination of the merits of lipid carriers and functional polymers has maximized drug delivery efficiency. Functionalization of LBDDSs enables the accumulation of anti-cancer drugs at target destinations, which means they are more effective at controlled drug release in tumor microenvironments (TMEs). This review highlights the various types of ligands used to achieve tumor-specific delivery and discusses the strategies used to achieve the effective release of drugs in TMEs and not into healthy tissues. Moreover, innovative recent designs of LBDDSs are also described. These smart systems offer great potential for more advanced cancer therapies that address the challenges posed in this research area.

Feasibility of Repurposing Clioquinol for Cancer Therapy

2020 ◽  
Vol 15 (1) ◽  
pp. 14-31 ◽  
Author(s):  
Raheel Khan ◽  
Harras Khan ◽  
Yassen Abdullah ◽  
Q. Ping Dou
Keyword(s):  
Clinical Trial ◽  
Cancer Therapy ◽  
Database Search ◽  
Research Articles ◽  
Cancer Drug ◽  
Cancer Therapies ◽  
Pubmed Database ◽  
Anti Cancer ◽  
Prevalent Disease ◽  
Poor Outcomes

Background: Cancer is a prevalent disease in the world and is becoming more widespread as time goes on. Advanced and more effective chemotherapeutics need to be developed for the treatment of cancer to keep up with this prevalence. Repurposing drugs is an alternative to discover new chemotherapeutics. Clioquinol is currently being studied for reposition as an anti-cancer drug. Objective: This study aimed to summarize the anti-cancer effects of clioquinol and its derivatives through a detailed literature and patent review and to review their potential re-uses in cancer treatment. Methods: Research articles were collected through a PubMed database search using the keywords “Clioquinol” and “Cancer.” The keywords “Clioquinol Derivatives” and “Clioquinol Analogues” were also used on a PubMed database search to gather research articles on clioquinol derivatives. Patents were gathered through a Google Patents database search using the keywords “Clioquinol” and “Cancer.” Results: Clioquinol acts as a copper and zinc ionophore, a proteasome inhibitor, an anti-angiogenesis agent, and is an inhibitor of key signal transduction pathways responsible for its growth-inhibitory activity and cytotoxicity in cancer cells preclinically. A clinical trial conducted by Schimmer et al., resulted in poor outcomes that prompted studies on alternative clioquinol-based applications, such as new combinations, new delivery methods, or new clioquinol-derived analogues. In addition, numerous patents claim alternative uses of clioquinol for cancer therapy. Conclusion: Clioquinol exhibits anti-cancer activities in many cancer types, preclinically. Low therapeutic efficacy in a clinical trial has prompted new studies that aim to discover more effective clioquinol- based cancer therapies.

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