Analysis of reasons for Emergency Department (ED) visits and subsequent hospital admissions in patients with solid malignancies: A retrospective study from a cancer center in rural Maine.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 241-241
Author(s):  
Anannya Patwari ◽  
Vineel Bhatlapenumarthi ◽  
Courtney Brann ◽  
Jackson Waldrip ◽  
Victoria Caruso ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Cancer Patients ◽  
Cancer Chemotherapy ◽  
Hospital Admissions ◽  
Breast Cancer Patients ◽  
Fall Injury ◽  
Gi Cancer ◽  
Gi Symptoms ◽  
Ed Visits

241 Background: Reducing ED visits in patients with cancer is cost saving and is particularly relevant during the COVID pandemic. We aim to identify patterns of ED visits among various cancer patients and reduce preventable ED visits and hospital admissions. Methods: We analyzed the number of ED visits and hospital admissions that occurred in patients with breast, lung, and Gastrointestinal (GI) cancers between July12019 and October31 2020 including demographics, stage, treatment type preceding the month of ED visit, reason, time of the day, day of the week the visit occurred. Results: 308 patients had 519 ED visits, 111 breast cancer patients had 184, 102 lung cancer patients had 186 and 95 GI cancer patients had 149 ED visits. 38% had > 1 visit. 51%, (37% breast, 60% Lung and 58 % GI cancer) had stage 4 disease at the time of visit. There were no visits in the month of May 2020. 275 (53%) visits required hospital admissions, 60% of ED visits in lung cancer, 54% in GI and 46 % in breast cancer patients required hospitalization. Most common reason for ED visits in breast cancer patients was fall/injury (20%), with median age of 71 years, none were cancer/ chemotherapy induced. Among lung and GI cancer patients respiratory (24%) and GI related (24%) symptoms were the most common reasons respectively, majority were cancer/chemotherapy related. Most common symptoms requiring hospital admissions were respiratory 21%, GI 18%, cardiac 12%. 11% and 9% of ED visits were due to fall/injury and cancer related pain, of these 3.6% and 9% resulted in hospital admissions respectively. Lung and GI cancer patients were more likely to be referred to the ED from the oncologist office (23%) than breast cancer patients (11%). Conclusions: Reasons for ED visits vary by tumor types and some may be preventable. Fall/injury in breast cancer patients and cancer related pain in lung and GI cancer patients were frequent reasons for preventable ED visits. In lung and GI cancer patients, cancer/chemotherapy related respiratory, GI symptoms are felt to be less avoidable since they may be related to disease progression or presenting symptoms. We have initiated several strategies such as ‘’systematic physical therapy assessment’’ of our breast cancer patients over age 70 to reduce ED visits due to fall/injury. We are developing strategies to involve palliative care early to reduce the number of ED visits related to cancer related pain We now have “call us first campaign” to assess and intervene before going to ED since most visits occurred during working hours.[Table: see text]

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]

Antiestrogen use in breast cancer patients reduces the risk of subsequent lung cancer: A population-based study

2017 ◽  
Vol 48 ◽  
pp. 22-28 ◽  
Author(s):  
Sung-Chao Chu ◽  
Chia-Jung Hsieh ◽  
Tso-Fu Wang ◽  
Mun-Kun Hong ◽  
Tang-Yuan Chu
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Cancer Patients ◽  
Population Based ◽  
Breast Cancer Patients ◽  
Population Based Study

scholarly journals P09.27 Descriptive Review of Breast Cancer Patients With Subsequent Lung Cancer

2021 ◽  
Vol 16 (3) ◽  
pp. S302
Author(s):  
M. Noor ◽  
C. Lee ◽  
E. Miao ◽  
S. Cohen ◽  
H. Yang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Cancer Patients ◽  
Breast Cancer Patients

scholarly journals How are health literacy principles incorporated into breast cancer chemotherapy education? A review of the literature

2018 ◽  
Vol 8 (6) ◽  
pp. 77 ◽  
Author(s):  
Pearman D. Parker ◽  
Sue P. Heiney ◽  
Daniela B. Friedman ◽  
Tisha M. Felder ◽  
Robin Dawson Estrada ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Literacy ◽  
Cancer Patients ◽  
Cancer Chemotherapy ◽  
Cochrane Library ◽  
Breast Cancer Patients ◽  
Plain Language ◽  
Breast Cancer Chemotherapy ◽  
Mesh Terms ◽  
Written Materials

Background: Chemotherapy is commonly used in combination with other treatments for breast cancer. However, low adherence to chemotherapy is a growing concern, particularly among breast cancer patients. Side effects such as nausea and vomiting, fatigue, and arthralgia can contribute to reduced adherence. Other factors such as provider communication and limited insurance coverage can affect adherence. Studies have shown that as much as 28% of patients with breast cancer did not continue with their prescribed dose of chemotherapy. Research suggests that chemotherapy education materials can be critical to addressing problems with non-adherence, and may include written materials, verbal instruction, and multimedia programs. Despite this wide variety, the effectiveness and benefit of chemotherapy education hinges on the patients’ health literacy.  Breast cancer patients with low health literacy may be unclear about chemotherapy or face difficulty adhering to treatment if they do not understand the information provided to them. Thus, this scoping review summarizes the existing research on how health literacy principles are incorporated into breast cancer chemotherapy education materials.Methods: Using a combination of keywords (e.g. chemotherapy, education) and Medical subject headings (MeSH) terms (e.g., drug therapy, antineoplastic agents), we searched five databases (1977-2017): CINAHL, PubMed, PsycINFO, Cochrane Library, and Web of Science.Results: Eight of 4,624 articles met the inclusion criteria. Five articles incorporated health literacy principles (e.g., plain language, maintaining an active voice, using white space) into the development of written materials. Few articles used a theoretical framework to guide education material development (n = 3). Of the three articles that described pilot-testing of educational materials, two used post-tests only and one used a pre/post-test design.Conclusions: Findings indicated that limited research exists regarding the use of health literacy principles in chemotherapy education materials. Much of the development of chemotherapy education is not grounded in theory and the application of health literacy principles is limited. Implementing health literacy principles may improve overall comprehension of education thereby increasing adherence.

Does routine symptom screening with ESAS decrease ED visits in breast cancer patients undergoing adjuvant chemotherapy?

2015 ◽  
Vol 23 (10) ◽  
pp. 3025-3032 ◽  
Author(s):  
L. Barbera ◽  
R. Sutradhar ◽  
D. Howell ◽  
J. Sussman ◽  
H. Seow ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Symptom Screening ◽  
Ed Visits

scholarly journals PENGARUH KONSELING TERHADAP TINGKAT PEMAHAMAN PENYAKIT DAN EFEK SAMPING OBAT KEMOTERAPI PADA PASIEN KANKER PAYUDARA DI UNIT KEMOTERAPI SALAH SATU RUMAH SAKIT DI KOTA MALANG

2021 ◽  
Vol 1 (2) ◽  
pp. 36-41
Author(s):  
Angga Dian Prastowo
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Cancer Patients ◽  
Cancer Chemotherapy ◽  
Wilcoxon Test ◽  
P Value ◽  
Breast Cancer Patients ◽  
Breast Cancer Chemotherapy ◽  
Before And After ◽  
Level Of Understanding

AbstrakKanker payudara adalah penyebab kematian terbesar pada wanita. Salah satu hal yang penting untuk diperhatikan adalah pada pasien kanker payudara yang menjalani kemoterapi akan mengalami efek samping mual muntah, rambut rontok, nyeri, kehilangan nafsu makan dan lain- lain. Penelitian saat ini bertujuan untuk mengetahui pengaruh konseling terhadap tingkat pemahaman penyakit dan efek samping kemoterapi pasien kanker payudara Penderita kanker payudara perlu mengetahui penyakitnya dengan baik agar kualitas hidupnya dapat tetap terjaga. Edukasi yang dilakukan secara perseorangan maupun kelompok pada penderita tentang efek samping obat kemoterapi sangat diperlukan supaya penderita tidak merasa cemas apabila mengalami efek dari kemoterapi tersebut. Pemberian konseling oleh Apoteker pada pasien kemoterapi kanker payudara sangat penting karena dapat meningkatkan pengetahuan pasien, kepatuhan pasien dalam pengobatannya serta dapat meningkatkan kualitas hidup pasien. Tujuan penelitian ini untuk mengetahui pengaruh pemberian konseling oleh Apoteker terhadap tingkat pemahaman penyakit dan efek samping kemoterapi pada pasien kanker payudara di Unit Kemoterapi Salah Satu Rumkit Pemerintah Di Kota Malang..Penelitian ini merupakan studi kuantitatif dengan desain Pre-Experimental berupa pretest-postes design. Banyaknya sampel yang diambil didasarkan atas waktu yaitu selama satu bulan dan sampel diambil dengan metode consecutive sampling. Hasil penelitian menggunakan uji Wilcoxon menunjukkan terdapat perbedaan nilai sebelum dan sesudah diberikan konseling oleh apoteker terhadap pasien kemoterapi kanker payudara dengan nilai signifikansi sebesar 0,000 (P value< 0,05). Kesimpulan pada penelitian ini adalah pemberian konseling oleh apoteker dapat meningkatkan tingkat pemahaman penyakit dan efek samping dari kemoterapi kanker payudara.Kata kunci : konseling, pemahaman, penyakit kanker payudara, efek samping kemoterapi Abstract Breast cancer is the leading cause of death in women. One important thing to note is that breast cancer patients who undergo chemotherapy experience side effects of nausea and vomiting, hair loss, pain, loss of appetite and others. The current study aims to determine the effect of counseling on the level of understanding of the disease and the side effects of breast cancer chemotherapy patients Breast cancer patients need to know the disease well to the quality of life can be maintained. Education is done individually or in groups to the patient about the side effects of chemotherapy drugs is indispensable so that the patient does not feel anxious when experiencing the effects of chemotherapy. Provision of counseling by pharmacists in patients with breast cancer chemotherapy is very important because it can improve patient knowledge, patient compliance in the treatment and can improve the quality of life of patients. The purpose of this study to determine the effect of counseling by pharmacists to the level of understanding of the disease and the side effects of chemotherapy in breast cancer patients on Chemotherapy Unit One Government Hospital In Malang .. This research is a quantitative study with Pre-Experimental design in the form of a pretestposttest design. The number of samples taken based on the time that is for one month and samples were taken with consecutive sampling method. The results using the Wilcoxon test shows that there are differences in values before and after counseling by pharmacists to patients with breast cancer chemotherapy with a significance value of 0.000 (p value <0.05). Conclusion of this research is the provision of counseling by pharmacists can improve the level of understanding of the disease and the side effects of breast cancerchemotherapy. The results using the Wilcoxon test shows that there are differences in values before and after counseling by pharmacists to patients with breast cancer chemotherapy with a significance value of 0.000 (p value <0.05). Conclusion of this research is the provision of counseling by pharmacists can improve the level of understanding of the disease and the side effects of breast cancer chemotherapy. The results using the Wilcoxon test shows that there are differences in values before and after counseling by pharmacists to patients with breast cancer chemotherapy with a significance value of 0.000 (p value <0.05). Conclusion of this research is the provision of counseling by pharmacists can improve the level of understanding of the disease and the side effects of breast cancer chemotherapy. Keywords : Counseling, understanding, breast cancer, chemotherapy side effects

scholarly journals Acute Care Use by Breast Cancer Patients on Adjuvant Chemotherapy in Alberta: Demonstrating the Importance of Measurement to Improving Quality

2021 ◽  
Vol 28 (6) ◽  
pp. 4420-4431
Author(s):  
Che Hsuan David Wu ◽  
May Lynn Quan ◽  
Shiying Kong ◽  
Yuan Xu ◽  
Jeffrey Q. Cao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Acute Care ◽  
Population Based ◽  
Breast Cancer Patients ◽  
Increased Risk ◽  
Institutional Differences ◽  
Improvement Programs ◽  
Ed Visits

Breast cancer patients receiving adjuvant chemotherapy are at increased risk of acute care use. The incidence of emergency department (ED) visits and hospitalizations (H) have been characterized in other provinces but never in Alberta. We conducted a retrospective population-based cohort study using administrative data of women with stage I-III breast cancer receiving adjuvant chemotherapy. Rates of ED and H use in the 180 days following chemotherapy initiation were determined, and logistic regression was performed to identify risk factors. We found that 47% of women receiving adjuvant chemotherapy experienced ED or H, which compared favourably to other provinces. However, Alberta had the highest rate of febrile neutropenia-related ED visits, and among the highest chemotherapy-related ED visits. The incidence of acute care use increased over time, and there were significant institutional differences despite operating under a single provincial healthcare system. Our study demonstrates the need for systematic measurement and the importance of quality improvement programs to address this gap.

scholarly journals Bioinformatic Analysis of Peripheral Blood miRNA of Breast Cancer Patients in Relation With Anthracycline Cardiotoxicity

2019 ◽  
Author(s):  
Wang Yadi ◽  
Chen Shurui ◽  
Zhang Tong ◽  
Chen Suxian ◽  
Tong Qing ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Gene Expression ◽  
Cancer Patients ◽  
Cancer Chemotherapy ◽  
Bioinformatic Analysis ◽  
Expression Data ◽  
Breast Cancer Patients ◽  
Related Gene ◽  
Anthracycline Cardiotoxicity ◽  
Breast Cancer Chemotherapy

Abstract The current diagnostic methods and treatments still fail to lower the incidence of anthracycline-induced cardiotoxicity effectively. In this study, we aimed to (1) analyze the cardiotoxicity-related genes after breast cancer chemotherapy in gene expression database and (2) carry out bioinformatic analysis to identify cardiotoxicity-related abnormal expressions, the biomarkers of such abnormal expressions, and the key regulatory pathways after breast cancer chemotherapy. Cardiotoxicity-related gene expression data (GSE40447) after breast cancer chemotherapy was acquired from the GEO database. The biomarker expression data of women with chemotherapy-induced cardiotoxicity (group A), chemotherapy history but no cardiotoxicity (group B), and confirmatory diagnosis of breast cancer but normal ejection fraction before chemotherapy (group C) were analyzed to obtain the mRNA with differential expressions and predict the miRNAs regulating the differential expressions. The miRanda formula and functional enrichment analysis were used to screen abnormal miRNAs. Then, the gene ontology (GO) analysis was adapted to further screen the miRNAs related to cardiotoxicity after breast cancer chemotherapy. The data of differential analysis of biomarker expression of groups A, B, and C using the GSE40447-related gene expression profile database showed that there were 30 intersection genes. The differentially expressed mRNAs were predicted using the miRanda and TargetScan software, and a total of 2978 miRNAs were obtained by taking the intersections. Further, the GO analysis and targeted regulatory relationship between miRNA and target genes were used to establish miRNA-gene interaction network to screen and obtain 7 cardiotoxicity-related miRNAs with relatively high centrality, including hsa-miR-4638-3p, hsa-miR-5096, hsa-miR-4763-5p, hsa-miR-1273g-3p, hsa-miR6192, hsa-miR-4726-5p and hsa-miR-1273a. Among them, hsa-miR-4638-3p and hsa-miR-1273g-3p had the highest centrality. The PCR verification results were consistent with those of the chip data. There are differentially expressed miRNAs in the peripheral blood of breast cancer patients with anthracycline cardiotoxicity. Among them, hsa-miR-4638-3p and hsa-miR-1273g-3p are closely associated with the onset of anthracycline cardiotoxicity in patients with breast cancer. Mining, integrating, and validating effective information resources of biological gene chips can provide a new direction for further studies on the molecular mechanism of anthracycline cardiotoxicity.

scholarly journals RADI-22. CHARACTERIZING CLINICAL SURVIVAL PATTERNS USING MACHINE LEARNING: AN ANALYSIS OF BRAIN METASTASIS PATIENTS TREATED WITH STEREOTACTIC RADIOSURGERY

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i26-i26
Author(s):  
Ali Alattar ◽  
Rushikesh Joshi ◽  
Brian HIrshman ◽  
Kate Carroll ◽  
Osamu Nagano ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Machine Learning ◽  
Brain Metastasis ◽  
Disease Control ◽  
Stereotactic Radiosurgery ◽  
Cancer Patients ◽  
Systemic Disease ◽  
Breast Cancer Patients ◽  
Clinical Variables ◽  
Gi Cancer

Abstract INTRODUCTION: Increased sophistication in machine-learning algorithms and artificial intelligence have begun to unveil patterns that would be otherwise unappreciated in clinical medicine. Here we applied one such algorithm, Iterative Factorial Analysis of Mixed Data (IFAMD), to better understanding combinations of clinical variables that influence clinical survival of brain metastasis (BM) patients treated with stereotactic radiosurgery (SRS). METHODS: A dataset of 6,326 BM patients was collated from four SRS centers (University of California, San Diego, Katsuta Hospital Mito GammaHouse, Tsukiji Neurological Clinic, and Melanoma Institute of Australia). IFAMD was applied to the analysis of the following clinical variables: age, Karnofsky Performance Status (KPS), cumulative intracranial tumor volume (CITV), total number of metastases, histology (breast, gastrointestinal (GI) cancer, renal cell carcinoma (RCC), melanoma, and lung cancer), systemic disease control, and survival in months. RESULTS: Our machine learning algorithm defined three groups of patients who exhibited differential survival. The group who is most likely to die within 3 months of SRS included patients with lower KPS, poor systemic disease control, higher CITV, higher number of metastasis, and who carried a diagnosis of GI cancer. Patients who are most likely to survive beyond twelve months of SRS fall into two distinct categories. The first consisted of subsets of lung and breast cancer patients with higher KPS, controlled systemic disease, and lower CITV. The second consisted of young breast cancer patients with systemic disease control, independent of KPS, CITV, and the number of metastases. CONCLUSION: Clinical survival after SRS for BM is defined by combinations of known prognostic factors. A prognostic factor critical for survival prognosis in one sub-population of BM patients may bear little relevance in another patient sub-population.

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