Improving timeliness of care for breast, GYN, and aerodigestive cancer patients with nurse navigators in a safety net hospital.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 183-183
Author(s):  
Christine Rehr ◽  
Teralyn Carter ◽  
Eric Flenaugh ◽  
Zhensheng Wang ◽  
Gail Ohaegbulam ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Cancer Survival ◽  
Stage Iv ◽  
Safety Net ◽  
Cancer Center ◽  
Inclusion Criteria ◽  
Safety Net Hospital ◽  
Aerodigestive Cancer ◽  
Timeliness Of Care

183 Background: The Georgia Cancer Center for Excellence (GCCE) at Grady received a 5-year MERCK Patient Centered Grant in 2017 that focuses on improving care to vulnerable cancer patients (pts) through the introduction of nurse (RN) navigators, a dietician and a part time exercise coach. A review of the literature shows improved patient outcomes and satisfaction with decreased time to treatment for breast and lung cancer pts. [1-2] RN navigation has been shown to expedite care and one of our goals for the MERCK grant was to study the effect of introducing RN navigation in a safety net hospital for three cancer sites. Methods: Three RN navigators were hired for the Breast, GYN and Aerodigestive cancer programs since 2017. RN navigators meet all newly diagnosed cancer pts during clinic and track their progression of care, often intervening for timeliness of work up and treatment. Each RN navigator keeps a record of pts navigated. An audit of this prospectively collected data measuring time from diagnosis to treatment for breast, GYN and aerodigestive cancer pts took place for 2018 and 2019. Inclusion criteria: diagnosed and treated at Grady, navigated by RN, and not Stage IV disease. Results: The total numbers of cancer pts navigated over the past two years were 244 breast, 131 GYN, and 265 aerodigestive pts. Using the inclusion criteria described in the methods section, the time from diagnosis to treatment decreased for these three cancer sites (see Table). Conclusions: Implementation of RN navigators within the cancer program trended towards decreases in time from diagnosis to treatment for our breast, GYN, and aerodigestive cancer patients. These measurable improvements over three cancer sites are largely attributed to RN navigation and suggest that cancer outcomes will improve over time for our patients treated in our safety net hospital. We plan to study patients who were retained in the system or were adherent to care to better understand the importance of RN navigation in our system. References: (1)Bleicher RJ, Ruth K, Sigurdson ER, et al. Time to Surgery and Breast Cancer Survival in the US. JAMA Oncol 2016;2(3):330–339. (2) Olsson JK, Schultz EM, Gould MK. Timeliness of care in patients with lung cancer. Thorax 2009;64:749-756. [Table: see text]

Reducing delays to lung cancer treatment through systematic consult scheduling: A multidisciplinary quality improvement initiative at a safety-net hospital.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18640-e18640
Author(s):  
Yue Lin ◽  
Muhammad M. Qureshi ◽  
Umit Tapan ◽  
Kei Suzuki ◽  
Ehab Billatos ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Median Time ◽  
Safety Net ◽  
Appointment Scheduling ◽  
Treatment Delays ◽  
Cause Analysis ◽  
Lung Cancer Patients ◽  
Root Cause ◽  
Safety Net Hospital

e18640 Background: Delays in diagnosis and treatment have been identified as practice gaps in lung cancer management. At our large safety-net hospital, 2016-2018 data provided by the Commission on Cancer (CoC) indicated that 58-66% of lung cancer patients began treatment > 30 days after their diagnosis, compared to a median of 30 days for CoC-accredited hospitals. A quality improvement (QI) project was performed to identify causes for treatment delays, and to implement changes to reduce the median time from diagnosis to treatment to < 30 days. Methods: Root cause analysis was performed on a cohort of lung cancer patients identified and abstracted by the CoC Registry with diagnosis in October 2018-September 2019, to provide more recent data on treatment delays and to identify actionable interventions. Subsequently, a multidisciplinary QI initiative through Thoracic Surgery, Hematology Oncology, and Radiation Oncology was implemented using the Plan-Do-Study-Act (PDSA) tool. The initiative was tracked for 6 months starting in August 2020, with time from referral to consult and time from diagnosis to treatment calculated via chart review. Results: For the root cause analysis, 36 patients were identified. Eleven cases were excluded as they did not receive treatment at our institution. For the remaining 25 patients, the median time from referral to consult across all three oncology specialties was 13 days. The most common barriers to initiating treatment were appointment scheduling delays (37.5%), patient factors including synchronous malignancies or insurance, geographic or cultural barriers (31.3%), and multiple factors including appointment scheduling delays (25%). Median time from diagnosis to treatment was 31 days, with 36% (N = 9) starting treatment in < 30 days. While appointment scheduling delays included both work-up (imaging, procedures) and consults as well as follow-ups, multidisciplinary discussions identified time from referral to consult as the most actionable QI initiative. With support from Patient Navigation, the three oncology specialties jointly implemented a system whereby suspected or confirmed new lung cancer patients were scheduled for consult ideally in < 7 days, and no more than 14 days from the referral date. Of 28 new lung cancer patients who started treatment after the QI intervention, median time from referral to consult decreased to 7 days. Median time from diagnosis to treatment decreased to 26.5 days, with 53.6% (N = 15) of patients starting treatment in < 30 days. Conclusions: By decreasing time from referral to consult, this multidisciplinary QI intervention facilitated earlier initiation of treatment for lung cancer patients. Similar actions to decrease other scheduling delays and mitigate the impact of social determinants of health could further promote improvements in timely patient care.

Costs and outcomes in stage IV non-small cell lung cancer at an urban safety net hospital.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 14-14
Author(s):  
Julian Lel ◽  
Edmund Folefac ◽  
Ken Scott Zaner ◽  
Kevan L. Hartshorn
Keyword(s):  
Lung Cancer ◽  
Antineoplastic Therapy ◽  
Racial Disparity ◽  
Combined Therapy ◽  
Stage Iv ◽  
Safety Net ◽  
Cytotoxic Chemotherapy ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
White Patients

14 Background: Stage IV NSCLC is an incurable illness with significant morbidity. Chemotherapy prolongs average survival from 6 to 10 months and targeted therapies further reduce morbidity and prolong survival. These advances pose financial challenges for safety net hospitals, which may also disproportionately feel the impact of racial disparity. Outcomes in advanced lung cancer may thus differ in the underserved population and resources may not be allocated optimally. Methods: A retrospective review was conducted on all patients diagnosed with Stage IV NSCLC between 2005 and 2011 at Boston Medical Center, an urban safety net hospital. Data were collected on survival from time of diagnosis, type and duration of treatment, utilization of healthcare resources, as well as detailed personal characteristics. We calculated costs of treatment for all patients. We assessed the effect of treatment and patient characteristics on survival. Results: Of 198 patients analyzed, 57% were white, 32% were black, 6% were Hispanic. 11% were homeless. 57% did not receive antineoplastic therapy, 24% received cytotoxic chemotherapy, 18% received combined cytotoxic and targeted therapy. Median survival was 5.0 months without therapy, 7.0 months with cytotoxic chemotherapy and 9.2 months with combined therapy. Any therapy was associated with 56% longer survival. Hazard of death in white patients was 0.68 relative to non-white patients. Median total and monthly costs for patients on no therapy were $70,000 and $14,000, on cytotoxic chemotherapy were $112,000 and $19,000 and on combined therapy were $247,000 and $26,000. Cost per month of survival was $12,000 less for white patients and $15,000 more for homeless patients. Conclusions: The majority of patients did not receive antineoplastic therapy, despite robust survival gains associated with its use. Untreated patients nevertheless incurred a high cost of care. White patients showed better survival at a lower cost. Further topics for study and intervention in this population include barriers to therapy, early involvement of palliative and home-based care in patients not suitable for treatment, strategies for cancer care in the homeless, as well as closer inquiry into drivers of racial disparity.

Impact of time to treatment initiation (TTI) on survival of patients with newly diagnosed non-small cell lung cancer (NSCLC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 9058-9058
Author(s):  
Abdel-Ghani Azzouqa ◽  
Ruqin Chen ◽  
Yanyan Lou ◽  
Sikander Ailawadhi ◽  
Rami Manochakian
Keyword(s):  
Lung Cancer ◽  
Cox Regression ◽  
Stage Iv ◽  
Primary Objective ◽  
Stage I ◽  
Rank Test ◽  
Cancer Center ◽  
P Value ◽  
Newly Diagnosed ◽  
Timeliness Of Care

9058 Background: Lung Cancer is the leading cause of cancer related deaths in the USA. NSCLC comprises about 85% of lung cancer cases. Although timeliness of care in patients with NSCLC is considered an important aspect of quality care, there are conflicting data about its impact on clinical outcomes. The primary objective of this study is to determine if there is an association between TTI and survival in patients with NSCLC. Methods: In this retrospective study, we reviewed data from our multi-site Mayo Clinic Cancer Center registry and identified patients with newly diagnosed NSCLC from 2000 to 2016. TTI was calculated from time of diagnosis to time of first treatment (surgery, radiation therapy or systemic therapy). Analyses were performed by SAS software 9.4. Log-Rank test was used to compare survival. Cox regression multivariate model was used to evaluate the prognostic value of variables to survival. Results: 10010 patients (53% males and 47%) were reviewed. Median age at diagnosis was 70. Median TTI was 12 days for stage I, and 20 days for stage II, III and IV. We compared outcomes of patients with TTI > 20 days to TTI ≤20 days. Outcomes were stratified based on age, gender, grade, and stage. Median Overall Survival (OS) was significantly better for patients with TTI ≤20 days compared to TTI > 20 days (39.1 vs 28.6 months P-value < 0.0001). Further stratification, based on stage, showed significantly better OS for stage I and II patients with TTI ≤20 days compared to TTI > 20 days (103.4 vs. 63.9 months P-value < 0.0001 and 72.3 vs. 46.8 months P-value 0.0014 respectively). OS for stage III patients with TTI ≤20 days was not significantly different from patients with TTI > 20 days (30.6 vs. 28.5 months P-value 0.118). Interestingly, stage IV patients had worse OS if TTI ≤20 days compared to TTI > 20 days (8.3 vs. 12.8 months P-value < 0.0001). Conclusions: Our study showed an association between TTI and survival of patients with NSCLC. Shorter TTI was associated with better survival in stage I and II patients and worse survival in stage IV patients. Our study further highlights the controversy surrounding the topic of impact of timeliness of care on survival in patients with cancer, specifically NSCLC across different stages.

scholarly journals Black Patients Experience Highest Rates of Specific Cancer-Associated Venous Thromboembolism: A Study Based at a Large Safety-Net Hospital in New England

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 496-496
Author(s):  
Nana Oduraa Addo-Tabiri ◽  
Rani Chudasama ◽  
Rhythm Vasudeva ◽  
Orly Leiva ◽  
Brenda Garcia ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Logistic Regression ◽  
Venous Thromboembolism ◽  
New England ◽  
Cancer Patients ◽  
Safety Net ◽  
Black And White ◽  
Black Patients ◽  
Safety Net Hospital ◽  
Specific Cancer

Abstract Background: Several studies have shown that cancer is associated with a 2 to 9-fold increased risk of venous thromboembolism (VTE) (Heit 2000; Hutton 2000; Hansson 2000; Prandoni 2002; Descourt 2006), with an absolute risk ranging from 1%-8% (Timp 2013). Importantly, the presence of VTE significantly reduces the 1-year survival rate from 36% in cancer patients without VTE to 12% in cancer patients with VTE (Sorensen 2000). Large cohort studies in the general population have suggested that Blacks compared to Whites are at higher risk of developing VTE (Zakai 2014). However, studies examining the influence of race on specific cancer-associated VTE have been scarce. To address racial disparities in cancer-associated VTE, we conducted a retrospective study in the largest safety-net hospital in New England, Boston Medical Center, with a large cancer cohort consisting of a substantial number of Black patients. This has provided a unique opportunity to directly compare the risk of specific cancer-associated VTE between Black and White cancer patients which could lead to future mechanisms-based studies. Methods: Summary statistics were performed and presented as mean, proportion and their respective standard deviation. Differences between blacks and whites for various variables were tested using Student's t-test, Pearson's Chi-square, and Fisher's exact test as appropriate using RStudio software (v1.0.153). Logistic regression was then used to estimate and compare odds of VTE occurrence in Lung cancer after adjusting for other confounders. Statistical significance was assessed at p <0.05. Results: We analyzed 16,498 cases with all types of solid organ and hematologic malignancies from 2004 to present (2018) with case mix characterized by Whites (53%) and Blacks (33%) and Others (11.7%). Our review of the electronic medical record revealed that 238 (1.4%) of 16,498 cancer patients had VTE, either at presentation or within one year following the cancer diagnosis. Since some VTE cases might have been undiagnosed prior to cancer development/manifestation, we used the term cancer-associated VTE to denote co-existence of these pathologies. The proportion of VTE cases were similar among male (55.5%) and female patients (44.1%). Of 238 cases of cancer presenting with VTE, Blacks predominated with 121 cases (51.3%) compared to 65 cases of Whites (27.5%). Interestingly, selected cancers were more associated with VTE in Blacks. As shown in Table 1, a significantly higher proportion of cancer-associated VTE was observed in Black patients with lung cancer, >breast cancer, >prostate cancer, >colorectal cancer and gastric/small bowel cancer; in descending order. VTE occurrence was observed predominantly in the pulmonary artery (36.9%) and femoral/iliac vein (16.1%). Sixteen percent of patients with cancer-associated VTE experienced recurrent VTE, however, no statistical difference in race was seen (p= 0.6). Given the high number of cases of lung cancer with VTE, we examined the influence of race with adjustment for confounders. Our logistic regression model showed that Black lung cancer patients have a significantly higher odds of developing cancer-associated VTE even after adjusting for cancer stage, age, and sex (OR- 2.39, CI = 1.26-4.60, p = 0.0079). Interestingly, the proportions of VTE in cancers such as pancreatic cancer, head and neck cancer and glioblastoma, were equally observed in Black and White patients, which can be ascribed to low event rates of VTE in these cancers in this series. Conclusions: This single-center study suggests that a higher proportion of Black cancer patients exhibited cancer-associated VTE compared to White cancer patients. Importantly, this significant difference was especially reflected in specific cancer subtypes. Race had an independent effect on cancer-associated VTE but showed no significant influence on recurrent VTE. Our current investigation motivates additional large-scale studies of cohorts with substantial representation of Blacks and ethnic minorities to further identify factors that contribute to racial disparities in the context of cancer-associated VTE, thus guiding necessary interventions to maximize outcome. Our study also lays the ground for mechanistic cause-and-effect inquiries related to intricate associations of specific cancers with VTE in a certain races. Disclosures Brophy: Novartis: Research Funding.

Time to treatment for lung cancer patients at an urban safety net institution.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 26-26
Author(s):  
Kalyani Narra ◽  
Yan Lu ◽  
Bassam Ghabach ◽  
Rohit P. Ojha
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Median Time ◽  
Stage Iv ◽  
Safety Net ◽  
Self Report ◽  
Optimal Time ◽  
Time To Treatment ◽  
Lung Cancer Patients ◽  
Urban Safety

26 Background: Lung cancers are rapidly fatal, but no guidelines currently exist in the US for the optimal time between symptomatic presentation and treatment. A recent study from multiple institutions estimated a median of 52 days from symptomatic presentation to treatment, but this estimate was based on patient self-report and the study under-represented settings that provide care to patients with socioeconomic barriers to care that could affect time to treatment. Therefore, we aimed to assess time to treatment for lung cancer patients at an urban safety-net institution. Methods: We used institutional registry data from the JPS Center for Cancer Care (Fort Worth, TX), an accredited Comprehensive Community Cancer Program. Eligible patients were aged ≥18 years and had a pathological diagnosis of lung cancer between January 1, 2018 and December 31, 2018. We estimated the median overall and stage-specific time from abnormal imaging (chest X-ray or CT scan) to initiation of treatment, which were documented in medical records. Results: Our study population comprised 75 lung cancer patients. The majority of patients who received treatment ( n=46) were aged 55–64 years (54%), female (52%), and racial/ethnic minorities (54%). The overall median time to treatment was 81 days (interquartile range [IQR]=48–111) which varied by stage: stage I=108 (IQR=92–140), stage II=123 (IQR=111–134), stage III=85 (IQR=45, 102), stage IV=59 (IQR=39–72). In particular, the median time from ordering chemotherapy to start was 22 days (IQR= 13–30). Conclusions: Time to treatment for lung cancer patients at our institution is substantially longer than reported in the literature, which may partially reflect the patient population but warrants interventions (e.g. enhanced care coordination) to reduce this interval. Nevertheless, without an optimal time to treatment that is associated with improved outcomes among lung cancer patients, we and other institutions lack a meaningful benchmark.

scholarly journals Epidemiologic and Histopathologic Feature of Lung Cancer in Central Iran (2012-2018)

2020 ◽  
Author(s):  
Mohammad Sadegh Khalilian ◽  
Sina Narrei ◽  
Mahdi Hadian ◽  
Mehrdad Zeinalian
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Stage Iv ◽  
Developed Countries ◽  
Cross Sectional Study ◽  
Central Iran ◽  
Cancer Center ◽  
Molecular Testing ◽  
Cross Sectional ◽  
Lung Cancer Patients

Background: Lung cancer is one of the common causes of death worldwide. Although the incidence rate of lung cancer in Western countries is decreasing, it presents a growing trend in developed countries. Since there is no accurate enough information about the epidemiological and Histopathologic features of lung cancer in central Iran, Isfahan, we were motivated to conduct this research. Materials and Methods: This was a descriptive, cross-sectional study carried out in central Iran, Isfahan. All demographic, histopathological and clinical data of the lung cancer patients registered in MACSA, a referral charity-based cancer center in central Iran, was analyzed within 2012-2018 using SPSS v.22 software. Results: Altogether 260 patients with lung cancer were included in this study from 6127 cancer patients registered within 2012-2018 (4.2%). Out of them, 66.2% were men, and 18.8 % of the patients were alive at the time of the study. The mean age of the patients at diagnosis was 61.56 (SD=14.11, range: 9-93). Altogether, 63.1% of patients had metastasis of whom 57.6% were in stage IV at diagnosis. The Frequency of different types of lung cancer was 36.9% adenocarcinomas, 14.2% squamous cell carcinoma, 9.6% bronchogenic carcinoma and 8.1% small cell lung cancer, respectively. Altogether, 128 cases were smokers with an average 35.45 &plusmn; 14 pack- years. Only in 36.2% of the patients, the diagnostic and therapeutic biomarkers had been checked, and CK7 was positive in 88.9% of the cases in which the biomarker had been checked. Conclusion: Despite to similar Iranian studies, the most common histopathologic type of lung cancer among the patients was adenocarcinoma that it may be attributed to the lower consumption of smoking in our population and their different genetic context. Molecular biomarkers had been checked in a small portion of the patients. More education of the clinicians along with the development of cancer molecular testing may lead to promote the personalized-based approach.

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