Cancer care system strengthening (Pendharkar model) offers uninterrupted care continuum during COVID19 pandemic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13540-e13540
Author(s):  
Dinesh Pendharkar ◽  
Chandramauli Tripathi
Keyword(s):  
Palliative Care ◽  
Health System ◽  
Cancer Patients ◽  
Cancer Care ◽  
Health System Strengthening ◽  
Care Programme ◽  
Care Continuum ◽  
Chemotherapy Drugs ◽  
Outpatient Visits ◽  
Number Of Patients

e13540 Background: District cancer care programme is operational in more than 150 districts of India. This programme has created nodal cancer units n government run district general hospitals offering cancer related services including chemotherapy and palliative care. During pandemic (COVID19), due lockdown, cancer patients were not able to access tertiary level specialised cancer centres. Aim of this presentation is to reaffirm the necessity of health system strengthening at peripheral level. Methods: With the aim of decentralization and task shifting, district cancer care programme is being implemented in 8 states of India. One general duty medical officers and paramedical staff is trained to assist cancer patients. The physician work under 24 x7 mentorship of oncology team. The government has created a physical cancer care unit with availability of some essential chemotherapy drugs as well. Cancer patients can access these units for assistance in diagnostics, follow-up, toxicity care, chemotherapy and palliative care. Results: We analysed data from few districts in year 2020. The number of patients vesting the units showed an increase during months of total lockdown. Data from 14 districts were analysed. It shows that number of outpatient visits and chemotherapy sessions were higher during strict lockdown. From January 2020 to December 2020 there were 19,273 outpatient visits, and 9,788 inpatient visits. During months of a strict lockdown-March, April, May, June the number increased.7,729 sessions of chemotherapy were performed and more than 2,230 new cases were registered during this year. Conclusions: The pandemic has brought new challenges and has compelled us to learn ways of care continuum. The most important has been the necessity of decentralisation of specialised care, its evenly and equitable distribution. District cancer care programme, as a measure of health system strengthening, which is being evolved in India has further emphasized the importance of such a system building.

Strategies to embed palliative care into a culture of cancer care.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21678-e21678
Author(s):  
Angela Marie Taber ◽  
Susan F. Korber ◽  
Edward Martin ◽  
Anthony E. Mega
Keyword(s):  
Palliative Care ◽  
Health System ◽  
Cancer Patients ◽  
Cancer Care ◽  
Medical Oncology ◽  
National Study ◽  
Claims Analysis ◽  
Patient Centered ◽  
Medicare Claims ◽  
Multi Level

e21678 Background: In 2012, the 3 hospital Lifespan Health System launched a palliative care initiative. The hospitals and medical oncologists knew this was critical for patient centered and value-based cancer care, but recognized many barriers: physician practice patterns, lack of dedicated resources and systems, patient and family education gaps, and limited return on investment in the current environment. A multi-level inpatient and outpatient strategy was implemented and tracked over four years. Methods: External benchmarking data from a Medicare claims analysis of Vizient (academic health system consortium) member organizations and from ASCO QOPI data were used in the analysis. Internal data analysis included a study on symptom management for lung cancer patients, hospital reports on palliative care service utilization, ED visits and hospital admission trends for cancer patients. Multi-level interventions were employed: hospital investment in staff and systems, partnership with a community-based hospice and palliative care provider, a medical oncology physician champion with Board certification in palliative care, a palliative care inpatient consult service and daily ICU rounds, an oncology medical home, medical oncologist Saturday hours, electronic prompts for consults, and a cancer call triage center. Results: A Medicare claims analysis for 2012 to 2014 on cancer decedents with ICU stays in the last 30 days in the Vizient national study of health systems showed that Lifespan was at the 11th percentile, making them the 4th lowest (days in ICU) in performance (pre/post data requested). QOPI data on appropriate referrals to hospice or palliative care prior to death improved from 58% in 2010, which was below the QOPI benchmark of 61%, to 94% in 2016 which is above the QOPI benchmark of 74%. Other QOPI and hospital data will be included in the presentation. Conclusions: Palliative care, a crucial tool for the delivery of future cancer care, is challenging to implement effectively. This study shows that a hospital/medical oncology partnership can drive change to embed palliative care into the culture of cancer care and these strategies offer a roadmap for others to follow as they strive to offer patient centered and value-based cancer care.

scholarly journals Impact of COVID-19 pandemic on the oncologic care continuum: urgent need to restore patients care to pre-COVID-19 era

2021 ◽  
pp. 1-11
Author(s):  
Ernest Osei ◽  
Ruth Francis ◽  
Ayan Mohamed ◽  
Lyba Sheraz ◽  
Fariba Soltani-Mayvan
Keyword(s):  
Cancer Care ◽  
Healthcare Professionals ◽  
Negative Impact ◽  
System Level ◽  
Care Continuum ◽  
Cancer Services ◽  
Number Of Patients ◽  
Prevention Programmes ◽  
Screening And Prevention ◽  
The Impact

Abstract Background: Globally, cancer is the second leading cause of death, and it is estimated that over 18·1 million new cases are diagnosed annually. The COVID-19 pandemic has significantly impacted almost every aspect of the provision and management of cancer care worldwide. The time-critical nature of COVID-19 diagnosis and the large number of patients requiring hospitalisation necessitated the rerouting of already limited resources available for cancer services and programmes to the care of COVID-19 patients. Furthermore, the stringent social distancing, restricted in-hospital visits and lockdown measures instituted by various governments resulted in the disruption of the oncologic continuum including screening, diagnostic and prevention programmes, treatments and follow-up services as well as research and clinical trial programmes. Materials and Methods: We searched several databases from October 2020 to January 2021 for relevant studies published in English between 2020 and 2021 and reporting on the impact of COVID-19 on the cancer care continuum. This narrative review paper describes the impact of the COVID-19 pandemic on the cancer patient care continuum from screening and prevention to treatments and ongoing management of patients. Conclusions: The COVID-19 pandemic has profoundly impacted cancer care and the management of cancer services and patients. Nevertheless, the oncology healthcare communities worldwide have done phenomenal work with joint and collaborative efforts, utilising best available evidence-based guidelines to continue to give safe and effective treatments for cancer patients while maintaining the safety of patients, healthcare professionals and the general population. Nevertheless, several healthcare centres are now faced with significant challenges with the management of the backlog of screening, diagnosis and treatment cases. It is imperative that governments, leaders of healthcare centres and healthcare professionals take all necessary actions and policies focused on minimising further system-level delays to cancer screening, diagnosis, treatment initiation and clearing of all backlogs cases from the COVID-19 pandemic in order to mitigate the negative impact on cancer outcomes.

scholarly journals Clinical Overview of Cancer Patients in Province Two of Nepal: A Single Center Experience

2020 ◽  
Vol 42 (1) ◽  
pp. 78
Author(s):  
Anshu K Thakur ◽  
Anish Shah ◽  
Barun K Ray
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Medical Records ◽  
Treatment Strategies ◽  
Single Center Experience ◽  
Common Cancer ◽  
Number Of Patients ◽  
The Common ◽  
Carcinoma Of Gallbladder ◽  
Clinical Overview

Introduction The incidence of cancer is rising in Nepal. It is estimated to reach 38.5 per 100,000 for males and 41.5 per 100,000 for females by 2020. The studies to determine the cancer burden in Nepal at provincial level have been insufficient and those that have been done are more inclined to Province 3. With establishment of a dedicated cancer facility in this area, we present an overview of clinical scenario of cancer patients in Province 2. MethodsWe performed a single centered, retrospective review of 118 patients who were registered in Oncology Clinics between May 2019 and February 2020. Demographics, diagnoses and the treatment strategies were obtained from the medical records. ResultsMedian age of presentation for cancer was 55 years (range, 6 to 83 years) with maximum number of patients falling within range of 50-60 years (31.4%). 71 patients (60.2%) were female and 47 patients (39.8%) were male. The common presenting cancers were gastrointestinal (27.1%), breast (16.9%), head and neck (15.3), gynecological (13.6%), hematological (11.9%) and others (15.2%). Among the gastrointestinal cancers, carcinoma of gallbladder with 15 cases (46.9%) was the most frequently occurring, followed by colorectal cancer with 6 cases (18.8%) and esophageal cancer with 4 cases (12.5%). Among all, 78 patients (66.1%) received palliative care only, 25 patients (21.2%) received chemotherapy only, 8 patients (6.8%) underwent surgery only, 3 patients (2.5%) underwent surgery and received chemotherapy as well, 2 patients (1.7%) received both chemotherapy and palliative care and 2 patients (1.7%) were reassured and observed. ConclusionThe most common age of presentation for cancer of any type was 50-60 years, with most common cancer being gastrointestinal in origin. Most of the patients received palliative care owing to their advanced stage at presentation.

Cancer Patients' Information Needs across the Cancer Care Continuum: Evidence from the Cancer Information Service

2005 ◽  
Vol 10 (sup1) ◽  
pp. 15-34 ◽  
Author(s):  
Linda Squiers ◽  
Lila J. Finney Rutten ◽  
Katherine Treiman ◽  
Mary Anne Bright ◽  
Bradford Hesse
Keyword(s):  
Cancer Patients ◽  
Cancer Care ◽  
Information Needs ◽  
Information Service ◽  
Cancer Information ◽  
Cancer Information Service ◽  
Care Continuum ◽  
Cancer Care Continuum

Utilization of prescription-assistance program for medically uninsured cancer patients: A case study of a public hospital experience in New York state.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17537-e17537
Author(s):  
Limin Gao ◽  
Jivin Joseph ◽  
Marcelle Levy-Santoro ◽  
Vladimir Gotlieb ◽  
Alan S. Multz
Keyword(s):  
New York ◽  
Cancer Patients ◽  
Cancer Care ◽  
New York State ◽  
Safety Net ◽  
The United States ◽  
Emergency Department Visits ◽  
Assistance Program ◽  
Chemotherapy Drugs ◽  
Pharmacy Department

e17537 Background: With the advances in early detection, prevention, and treatment of some cancers, mortality rates in the United States have been consistently falling. However, with these successes have come substantial increases in the cost of cancer care. Antineoplastics are the leading therapeutic classes in hospital drug expenditures. Lack of insurance is associated with lower rates of cancer screening, later stage at diagnosis, and increased cancer mortality. Prescription assistance programs (PAPs) are offered by pharmaceutical manufacturers to provide medications at no out-of-pocket cost to medically indigent patients. To assist the Cancer Care Center at NUMC with drug costs for chemotherapies and maintain the quality care for patients, the Pharmacy department instituted a Patient Assistance Program (PAP) to obtain medication from the drug companies at no cost. NUMC is a “safety net” teaching hospital in suburban New York. It serves mostly an indigent population and is a Level 1 Trauma Center with over 77,000 emergency department visits per year. Methods: We followed all patients requiring assistance with chemotherapy who enrolled in our PAPs from January 1, 2011 to December 31, 2012. Individuals potentially eligible for PAPs were identified by Oncologists and by the pharmacy department. Medications included both oral and parenteral chemotherapy drugs and antiemetics. Results: The program served 341 patients in 2011 and 579 patients in 2012. The total number of visits in the clinic over 24 months was 9,405. The total cost savings of the medications was $908,944.11 in 2011 and $1,715,538.37 in 2012. Conclusions: PAPs provide a valuable safety net to ensure that cancer patients without insurance receive needed prescription medications. The rising cost of health care and the high proportion of indigent patients have financially burdened the hospital. A pharmacy-based program to procure free medications for uninsured cancer outpatients has helped to defray the Cancer Care Center’s expense of providing care at NUMC, increased patients’ compliance with chemo-protocols and allowed many patients to receive the treatment they otherwise would not be able to afford.

scholarly journals Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care

2020 ◽  
Author(s):  
Ellinor Christin Haukland ◽  
Christian von Plessen ◽  
Carsten Nieder ◽  
Barthold Vonen
Keyword(s):  
Palliative Care ◽  
Adverse Events ◽  
End Of Life ◽  
Cancer Patients ◽  
Cancer Care ◽  
Quality And Safety ◽  
Negative Consequences ◽  
Specialist Palliative Care ◽  
Early Integration ◽  
Anticancer Treatment

Abstract Background: Anticancer treatment exposes patients to negative consequences such as increased toxicity and decreased quality of life, and there are clear guidelines recommending limiting use of aggressive anticancer treatments for patients near end of life. The aim of this study is to investigate the association between anticancer treatment given during the last 30 days of life and adverse events contributing to death and elucidate how adverse events can be used as a measure of quality and safety in end-of-life cancer care Methods: Retrospective cohort study of 247 deceased hospitalised cancer patients at three hospitals in Norway. The Global Trigger Tool method were used to identify adverse events. We used Poisson regression and binary logistic regression to compare adverse events and association with use of anticancer treatment given during the last 30 days of life. Results: 30 % of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of life, mainly systemic anticancer treatment. These patients had 62 % more adverse events compared to patients not being treated last 30 days, 39 vs. 24 adverse events per 1 000 patient days (p<0.001, OR 1.62 (1.23 – 2.15). They also had twice the odds of an adverse event contributing to death compared to patients without such treatment, 33 vs. 18 % (p=0.045, OR 1.85 (1.01 – 3.36)). Receiving follow up by specialist palliative care reduced the rate of AEs per 1 000 patient days in both groups by 29 % (p= 0.02, IRR 0.71, CI 95% 0.53 – 0.96). Conclusions: Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events and related mortality. Patients receiving specialist palliative care had significantly fewer adverse events, supporting recommendations of early integration of palliative care in a patient safety perspective.

scholarly journals Demographic profile of patients and Geospatial mapping in Palliative Care: A hospital based study from Eastern part of India

2021 ◽  
Author(s):  
Rita Rani ◽  
Usha Singh ◽  
Vinita Trivedi ◽  
Richa Chauhan ◽  
Mukul Mishra ◽  
...  
Keyword(s):  
Palliative Care ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Policy Making ◽  
Demographic Profile ◽  
Number Of Patients ◽  
Demographic Patterns ◽  
Different Parts ◽  
Geospatial Mapping

Abstract Background: With the rising burden of cancer in India, there is a huge need to start and expand Palliative care (PC) services in different parts of the country. understanding the demographic profile of the Palliative care patients will help in customising the PC services. Aim of the study was to look into demographic details of the patients and to do Geospatial mapping of the patients referred for PC.Methods: Data was extracted from patient’s case records referred to PC OPD was put into Excel sheet analysed statistically along with Geospatial mapping.Results: Among a total of 1084 patients, 54.9% were men and about 24.2% were women. Maximum number of patients were in 4th decade of their life, relatively younger population. About 57% were poor and 47.1% were illiterate. About 37.2% were head and neck cancer patients with pain as the most commonly reported symptom among all patients. Bony metastasis was most common and majority of the patients belonged to Patna District of Bihar.Conclusions: This study of demographic patterns of patient and geospatial mapping will help in sensitising towards PC and establishing better PC services and policy making in different parts of the country.

scholarly journals Decision-making support for cancer patients and their families at a palliative care clinic in a designated regional cancer care hospital

2015 ◽  
Vol 10 (1) ◽  
pp. 324-328
Author(s):  
Hiroaki Watanabe ◽  
Miho Kojima ◽  
Yoshimi Okumura ◽  
Yuki Kato ◽  
Yuko Deguchi ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Cancer Patients ◽  
Cancer Care ◽  
Care Hospital ◽  
Care Clinic ◽  
Decision Making Support

scholarly journals Acupuncture as a complementary therapy for cancer care: acceptability and preferences of patients and informal caregivers

2020 ◽  
Author(s):  
Tessa Lefebvre ◽  
Laura Tack ◽  
Virginie Blieck ◽  
Lieselot Cool ◽  
Hans Pottel ◽  
...  
Keyword(s):  
Side Effects ◽  
Cancer Patients ◽  
Cancer Care ◽  
Informal Caregivers ◽  
Participation Rate ◽  
Complementary Therapy ◽  
Care Clinic ◽  
Supportive Cancer Care ◽  
Number Of Patients ◽  
To Receive

Abstract Background: Acupuncture provides a possible complementary therapy which can be used alongside or following cancer treatment to relieve side-effects for cancer patients and survivors, such as pain and depression. Equally, it can provide relief from symptoms such as anxiety and sleep disturbance, which are recognised as significant issues among caregivers of those with cancer. The aim of this study was to explore the acceptability and preferences of cancer patients, disease survivors and their informal caregivers in relation to acupuncture.Methods: A questionnaire was developed to explore acceptability and preferences of cancer patients, disease survivors and their caregivers in relation to acupuncture, including motivations to use acupuncture, preferred symptoms to be addressed, and practical issues (location; cost).Results: A participation rate of 94.5% was obtained, with 116 participating patients and survivors, and 54 caregivers. Acceptability of acupuncture was around 1/3 for patients (34.5%; 40/116) and almost half for informal caregivers (48.0%; 26/54). In terms of preferences, the day care clinic was the favoured location for patients (52.5%; 21/40) to undergo acupuncture, while there was no specific preference on location observed for caregivers. A large number of patients indicated they would be willing to pay to receive the complementary therapy (60%; 24/40). Symptoms of fatigue, feeling listless, and pain were most often identified as complaints patients and survivors would use acupuncture for (60.0%, 57.5%, and 47.5% respectively). For informal caregivers, 48.0% (26/54) expressed an interest in using acupuncture for their pain, stress and sleeping difficulties.Conclusions: This study indicates that many cancer patients, disease survivors and informal caregivers would accept acupuncture as a complementary therapy. They could further identify many symptoms they felt this therapy could relieve. This openness to acupuncture, and expressed preferences provide the foundations for this complementary therapy to be incorporated into holistic and supportive cancer care, both for patients and those supporting them.

scholarly journals Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care

2020 ◽  
Author(s):  
Ellinor Christin Haukland ◽  
Christian von Plessen ◽  
Carsten Nieder ◽  
Barthold Vonen
Keyword(s):  
Palliative Care ◽  
Adverse Events ◽  
End Of Life ◽  
Cancer Patients ◽  
Cancer Care ◽  
Quality And Safety ◽  
Negative Consequences ◽  
Specialist Palliative Care ◽  
Early Integration ◽  
Anticancer Treatment

Abstract Background: Anticancer treatment exposes patients to negative consequences such as increased toxicity and decreased quality of life, and there are clear guidelines recommending limiting use of aggressive anticancer treatments for patients near end of life. The aim of this study is to investigate the association between anticancer treatment given during the last 30 days of life and adverse events contributing to death and elucidate how adverse events can be used as a measure of quality and safety in end-of-life cancer careMethods: Retrospective cohort study of 247 deceased hospitalised cancer patients at three hospitals in Norway in 2012 and 2013. The Global Trigger Tool method were used to identify adverse events. We used Poisson regression and binary logistic regression to compare adverse events and association with use of anticancer treatment given during the last 30 days of life.Results: 30 % of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of life, mainly systemic anticancer treatment. These patients had 62 % more adverse events compared to patients not being treated last 30 days, 39 vs. 24 adverse events per 1 000 patient days (p<0.001, OR 1.62 (1.23 – 2.15). They also had twice the odds of an adverse event contributing to death compared to patients without such treatment, 33 vs. 18 % (p=0.045, OR 1.85 (1.01 – 3.36)). Receiving follow up by specialist palliative care reduced the rate of AEs per 1 000 patient days in both groups by 29 % (p= 0.02, IRR 0.71, CI 95% 0.53 – 0.96).Conclusions: Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events and related mortality. Patients receiving specialist palliative care had significantly fewer adverse events, supporting recommendations of early integration of palliative care in a patient safety perspective.

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