scholarly journals Keeping Pace With Oral Chemotherapy

2012 ◽  
Vol 8 (2) ◽  
pp. 71-71 ◽  
Author(s):  
Jeanette Barefoot ◽  
Carol S. Blecher
Keyword(s):  
Oral Chemotherapy ◽  
Cancer Center ◽  
Infusion Therapy ◽  
Successful Implementation ◽  
Care Providers ◽  
Invasive Treatment ◽  
Financial Barriers ◽  
Oral Agents ◽  
The Right

Purpose: Although the rising number of oral chemotherapy agents offers many patients with cancer a more convenient and less invasive treatment option compared with infusion therapy, multiple risks and challenges have been identified with the oral regimen, including dosing errors, drug interactions, and nonadherence or overadherence. Until recently, cancer care providers had maintained a considerable amount of control, including the certainty that the right drug was being administered in the right dose, via the right route, at the right time, and to the right patient—all of which were meticulously documented in patient records. In contrast, oral chemotherapy takes much of the control out of the clinician's hands and places tremendous responsibility on the patient, raising a number of adherence and control issues. Studies regarding oral hormonal therapy for breast cancer have described adherence rates ramping down from 83% to 77% within the first 2 years of therapy. These figures continue to decrease over time to a range of 50% to 64% within 4 to 5 years. On the basis of these data and a literature review, we developed a program to promote adherence to oral anticancer protocols. Methods: Our team took a proactive, team-focused approach and established protocols at a time when oral chemotherapies were still at a low volume. In addition to infrastructures, policies, and procedures promoting collaborative communications among physicians, nurses, and pharmacists, we developed an in-depth educational component that provides the linchpin for ensuring an effective oral chemotherapy program. Our program focuses on three key pillars: education, communication, and follow-up. Our project team first conducted an inclusive review of available literature, with the objective of designing processes that would help our program directly address existing risks and challenges. Then we introduced concepts for the formalized program to our cancer center physicians, whose support was paramount to successful implementation. The next step was to start the program with a mandatory in-service for all clinical staff, which included a presentation of the research evidence that prompted the creation of this model for oral chemotherapy. To enhance patient understanding, our team provides printed materials, individualized calendars, and in some cases preloaded pillboxes to assist patients. Concurrently, our nurses provide weekly telephone intervention for the second and third months and monthly phone interventions thereafter. Communication is key to the success of the program. This includes the use of a translation service to ensure effective communication with all non–English-speaking patients. We intervene early for those patients with financial barriers and offer a variety of referrals and resources for emotional, nutritional, and patient support services, including transportation issues. Results: Since the inception of the program, the in-service has been incorporated into our new employee orientation. At the same time, a growing number of cancer center physicians are embracing the program. The program has received the attention of the Oncology Roundtable, which developed a Webinar around the topic, and been described in a feature article in an oncology journal. Finally, our team has been tapped to educate other pharmacists regarding oral agents, toxicity profiles, and safe handling. Conclusion: By combining safeguards, patient education strategies, intensive follow-up, and a system of effective checks and balances, our center is taking significant steps to maximize patient safety and oral chemotherapy treatment effectiveness, while keeping pace with the rapidly occurring changes in oncology practice.

An automated system for insuring monitoring of myelosuppression in patients receiving self-administered oral chemotherapy.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 296-296
Author(s):  
Robert Morrell ◽  
Janet Tooze ◽  
Michele Harmon ◽  
Annette Carter ◽  
Alisha Detroye ◽  
...  
Keyword(s):  
Medical Information ◽  
Oral Chemotherapy ◽  
Automated System ◽  
Newly Diagnosed ◽  
Monitoring Methods ◽  
Team Members ◽  
Oral Agents ◽  
Grade 3 ◽  
Prototype Software

296 Background: Protracted outpatient oral chemotherapy regimens have created new challenges for monitoring patients for toxicity. Unlike IV chemotherapy which guarantees clinician access to the patient before proceeding with therapy, oral agents can continue to be taken despite missed follow-up visits and lab draws. After observing patients return from unrecognized lapses in monitoring with severe myelosuppression, we sought to retrospectively measure risks and to prospectively test a software-based monitoring system designed to flag and notify team members of missed lab monitoring. Methods: We evaluated 117 patients who had received a standard 42-day continuous course of oral temozolomide as therapy for newly diagnosed primary malignant brain tumors to assess monitoring compliance, as well as adverse events. Standard practice is to obtain a weekly CBC with differential and platelets during the 6 weeks of concurrent chemoradiation. Grade 3 or higher hematologic events were observed in 9 (7.7%) patients. Gaps in monitoring were defined as no testing for 10 days or more, and were classified as minor (10-12 days) and major (13-27 days). Results: 34 (29.1%) patients had one or more gaps during treatment; 19 (16.2%) had majors and 18 (15.4%) had minors. 2 of the patients with gaps in coverage exhibited grade 3 or 4 myelosuppression upon their return to monitoring. We have currently monitored 36 patients prospectively with prototype software designed to email staff whenever a patient was not monitored for 7 days or had scheduled visits too far in the future. The software uses data downloaded from the electronic medical record (12,889 labs, [908 pertinent], 441 visits) and was effective in finding patients that missed labs or did not get properly scheduled visits. Five such mistakes were detected and 4 were corrected based on the system flag. Problems encountered were mainly false positives associated with entry of chemotherapy stop dates. Conclusions: Monitoring failures pose risks to patients receiving oral chemotherapy and traditional medical information systems make detection of missing data difficult. Systems such as ours are simple to build and could be integrated with most EMR systems.

Sustaining safety and delivery of oral chemotherapy utilizing lean methodology.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 218-218
Author(s):  
Marc Steven Hoffmann ◽  
Adam Neiberger ◽  
Gloria Solis ◽  
Marshall Johnson ◽  
Debbie Fernandez
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
Safety Data ◽  
Production Method ◽  
Error Reduction ◽  
Oral Chemotherapy ◽  
Multidisciplinary Teams ◽  
Care Providers ◽  
Targeted Interventions ◽  
The Right

218 Background: An oral chemotherapy safety event in 2017 prompted analysis of related workflows utilizing lean quality improvement methodology. Three kaizen workshops utilizing lean methodology with primary objectives to 1) develop safety standards for oral chemotherapy as rigorous as those for intravenous chemotherapy; 2) improve efficiency; and 3) design workflows that enable data collection and process control were conducted. Since 2017, our goal has been to sustain developed workflows to ensure oral chemotherapy patients have the right oral chemotherapy agent, at the right dose, at the right time, with independent and efficient safety checks by all care providers. Methods: After multidisciplinary teams participated in three kaizen workshops to develop workflows, education plans were developed and results were incorporated into the lean management system. The lean production method of Training Within Industry (TWI) was used to train physician, nursing, and pharmacy teams to the workflows. Results were communicated to key stakeholders weekly to monitor progress on workflow creation, spread, and process metrics designed to signal defects in the workflow. When processes were deemed ‘out of control,’ clinical team members provided regular and targeted interventions. Safety data were collected and correlated to surrogate outcomes for long-term impact assessment. Results: Interventions resulted in the following outcomes: 62 consecutive weeks with 99% reduction in oral chemotherapy defects reaching pharmacy. 86 consecutive weeks with 51% error reduction processing oral chemotherapy though a single EMR workflow. 57 consecutive weeks with 62% error reduction processing oral chemotherapy though a single EMR workflow. No serious safety events have occurred since 2017. Conclusions: Comprehensive quality improvement in our oral chemotherapy process has resulted in sustained safety, efficiency, and a data collection to signal when process defects occur. Multidisciplinary teams utilizing established lean methodology were critical to success.

scholarly journals Barriers to Timely Surgery for Breast Cancer in Rwanda

2018 ◽  
Vol 4 (Supplement 1) ◽  
pp. 28s-28s
Author(s):  
Lauren E. Schleimer ◽  
Jean-Marie Vianney Dusengimana ◽  
John Butonzi ◽  
Catherine Kigonya ◽  
Abirami Natarajan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Disease Progression ◽  
Conflicts Of Interest ◽  
Stage I ◽  
Sub Saharan Africa ◽  
Cancer Center ◽  
Financial Barriers ◽  
Loss To Follow Up ◽  
Surgical Referral

Abstract 81 Purpose Surgery is the mainstay of treatment for nonmetastatic breast cancer. Little is known about the quality of breast surgical care in sub-Saharan Africa. Research at the Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer center, has suggested that access to timely surgery is inadequate, but barriers have not been systematically examined. The aim of the current study was to gain an understanding of the barriers to breast cancer surgery among patients who were diagnosed at BCCOE by investigating delays and interruptions in care. Methods We used a standardized chart abstraction instrument to collect demographic, treatment, and outcome data as of November 2017 for all patients who were diagnosed with breast cancer at BCCOE in 2014 and 2015. We recorded all visits and treatments received until surgery, disease progression, or loss to follow-up for all patients with stage I to III breast cancer. Results During 2014 and 2015, 91 patients were diagnosed with stage I to III breast cancer and were treated with curative intent—67 patients (74%) underwent surgery, with 22 undergoing surgery at BCCOE and 45 elsewhere. Of the 24 patients with no surgery, 16 were lost to follow-up and eight experienced disease progression before surgical evaluation. Median time from diagnosis to surgery was 103 days (range, 30 to 826 days) for patients without neoadjuvant chemotherapy (NAC) and 268 days (range, 108 to 794 days) for patients with NAC. We defined surgical delays as > 120 days from diagnosis without NAC or > 365 days from diagnosis if NAC was administered. Of the 67 patients who had surgery, 26 patients (39%) experienced delays. When documented, reasons for delay included patient factors, such as social and/or financial issues (n = 5), seeking alternate treatment (n = 2), refusing referral to Kigali (n = 3), or any surgery (n = 1); system factors, such as surgeon nonavailability (n = 1); and changes in clinical status, such as pregnancy (n = 5), treatment-associated adverse events (n = 4), or the need for a second surgical opinion (n = 2). Unexplained failure to complete the initial surgical referral (n = 5) and missed NAC treatment appointments (n = 6) were frequent contributors. Some patients had multiple reasons for delay. For five patients, there was no documented explanation. Conclusion We observed high rates of loss to follow-up, surgical delays, and lapses in care at the point of surgical referral. Identification of the barriers to completing referrals could guide strategies for improving access to timely surgery. Efforts are needed to address social and financial barriers and explore patients’ refusals to undergo surgery. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

scholarly journals Financial impact of oral chemotherapy wastage on society and the patient

2018 ◽  
Vol 25 (4) ◽  
pp. 824-830 ◽  
Author(s):  
Varun Monga ◽  
Chenise Meyer ◽  
Brandon Vakiner ◽  
Gerald Clamon
Keyword(s):  
Cancer Progression ◽  
Financial Burden ◽  
Wholesale Price ◽  
Oral Chemotherapy ◽  
Financial Impact ◽  
Insurance Companies ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Time Period ◽  
Oral Agents

Background Targeted oral agents are now increasingly being utilized in cancer treatment, but are expensive. Changing the dose of these medications due to toxicity or discontinuation secondary to disease progression or death causes waste from unused medication. Limiting waste is an important goal, as waste has a substantial financial impact on patients and insurance companies. Methods Patients started on oral targeted agents' sunitinib, everolimus, axitinib, or vemurafenib between January 2012 and February 2015 who obtained their medications at Holden Comprehensive Cancer Center specialty pharmacy were included in the analysis. We acquired dispensing data retrospectively for each of the agents and reviewed patient charts. Wasted tablets/capsules were calculated from their last fill to the dates of stoppage or dose adjustment. The amount associated with the wastage was calculated using the average wholesale price. Repository drug usage data during the same time period was obtained. Results Eighty-eight patients had their prescriptions filled at Holden Comprehensive Cancer Center during the study time period. Waste occurred in 41% of all patients with primary reasons attributed to cancer progression in 25 patients, death in five patients, toxicity in five patients and increase in dosage of targeted therapy in two patients. A total of 1179 tablets or capsules were wasted from all causes, priced at a total of $248,595.69. Conclusion Oral chemotherapy medications are associated with wastage, which is a significant financial burden to society. Progression of disease emerged as the single most important factor accounting for wastage. Novel ideas are needed to prevent wastage, thereby reducing healthcare costs.

scholarly journals Coping With the Oncology Workforce Shortage: Transitioning Oncology Follow-Up Care to Primary Care Providers

2010 ◽  
Vol 6 (4) ◽  
pp. 203-205 ◽  
Author(s):  
David Debono
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Cancer Center ◽  
Care Providers ◽  
Effective Response ◽  
Medical Societies ◽  
Community Oncology ◽  
Follow Up Care ◽  
Oncology Providers

An effective response to the impending shortage of oncology services will require different actions from governmental bodies, academic cancer center leaders, medical societies, and community oncology providers.

Oral chemotherapy adherence tracking program implementation at a medically underserved comprehensive community cancer center.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 294-294
Author(s):  
Abhinav Binod Chandra ◽  
Mary Sweigart ◽  
Angelic Alvarez ◽  
Vivek Kumar
Keyword(s):  
Emergency Room ◽  
Antineoplastic Agents ◽  
Oral Treatment ◽  
Oral Chemotherapy ◽  
Medically Underserved ◽  
Cancer Center ◽  
Special Focus ◽  
Successful Implementation ◽  
Emergency Room Visits ◽  
Care Plans

294 Background: The field of oncology has witnessed a significant increase in the number of oral antineoplastic agents over the last several years and their utilization is expected to grow. Several deficiencies in procedures for safe management and monitoring of oral chemotherapy regimens remain unaddressed. Rates of adherence to oral antineoplastic agents have varied in literature and not widely studied. There is paucity of data on impact of oral chemotherapy adherence to patient outcomes or emergency room visits. Methods: Baseline oral chemotherapy adherence was tracked in new oral treatment plans. This was supplemented with education of staff to run reports and increase chemotherapy tracking with special focus on education and follow ups. Over 9 month period, the oral chemotherapy tracking process was implemented with the goal of 80% tracking being achieved. Emergency room (ER) visits were calculated on patients having active oral chemotherapy care plans during a 3-month period before and after implementation of the program. Results: Reporting metric for compliance with oral tracking showed improvement from 5% completed reports to 84% completed reports over 9 months. The goal set to achieve 80% tracking was reached. The program was successfully implemented from January 2017 – September 2017. Prior to implementation of the program, over a 3-month period, 55 patients were receiving active oral chemotherapy care, with 56 encounters of ER visits by 30 patients related to their cancer. After successful implementation of the program and with consistent 80% chemotherapy tracking in place, we analyzed data for another 3-month period. During this 3-month period, 108 patients were receiving active oral chemotherapy, with 31 encounters of ER visits by 17 patients for their cancer. Conclusions: Implementation of a tracking program for oral chemotherapy led to 72% reduction in emergency room visits by patients on oral chemotherapy care plans. We were successfully able to implement an oral chemotherapy adherence tracking program in a medically underserved comprehensive community cancer program. A prospective study can further validate the findings of this study.

Implementation of survivorship care plans in the pediatric oncology clinic.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 55-55 ◽  
Author(s):  
Christine Moore Smith ◽  
Barron L. Patterson ◽  
Debra L. Friedman
Keyword(s):  
Pediatric Oncology ◽  
Standard Of Care ◽  
Primary Care Providers ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Survivorship Care ◽  
Care Providers ◽  
Care Plans

55 Background: Quality survivorship care and follow up have been well described in the pediatric oncology population to improve overall health of cancer survivors. Typically, a key component is the delivery of a survivorship care plan (SCP) in a dedicated survivorship program. Creation of an SCP in the immediate post-treatment period has not been commonly adopted. To address the Commission on Cancer's (CoC) requirement to provide SCPs within six months of ending therapy, our pediatric oncology clinic has used quality improvement (QI) methods to incorporate SCPs into clinic workflow with subsequent survivorship program referral. Our aim is to meet the CoC’s benchmark of 50% of eligible patients receiving SCPs by December 31, 2017. Our secondary goal is to improve the timeliness of delivery to patients, families, and primary care providers (PCP). Methods: Registry data from our cancer center was utilized to identify eligible patients. Upcoming appointments were then identified for a panel of eligible patients using the electronic medical record (EMR). Providers use a standardized SCP template which includes the components required by the CoC. The SCP is then reviewed with families, electronically sent to the PCP, and saved in the EMR. Evaluation of the process included subjective feedback from providers and Plan-Do-Study-Act cycles. Based on this feedback and cycles, iterations of the template have been progressively streamlined and the EMR panel has been updated. Results: Care plan creation and delivery is ongoing. At baseline, 28% of eligible patients had SCPs previously created in the survivorship program. After implementation of our QI methods, to date, we have increased the proportion of eligible patients with an SCP to 40.3%, approaching our goal of 50% by December 31, 2017. We have also decreased the time from end of therapy to delivery of a care plan from 22.9 months to 14 months. This is expected to further improve as the process continues. Conclusions: The QI process has been successful in implementing a new standard of care for delivery of SCPs. Ongoing use of QI methods will increase compliance with the CoC standards and result in improved survivorship care.

scholarly journals Implementation challenges and perception of care providers on Electronic Medical Records at St. Paul’s and Ayder Hospitals, Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alemayehu Bisrat ◽  
Dagne Minda ◽  
Bekalu Assamnew ◽  
Biruk Abebe ◽  
Teshome Abegaz
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Qualitative Data ◽  
Current Status ◽  
Successful Implementation ◽  
Care Providers ◽  
Gregorian Calendar ◽  
Management Commitment ◽  
Ict Infrastructure

Abstract Background In resources constrained settings, effectively implemented Electronic Medical Record systems have numerous benefits over paper-based record keeping. This system was implemented in the 2009 Gregorian Calendar in the two Ethiopian territory hospitals, Ayder and St. Paul’s. The pilot implementation and similar re-deployment efforts done in 2014 and 2017 Gregorian Calendar failed at St. Paul's. This study aimed to assess the current status, identify challenges, success factors and perception of health care providers to the system to inform on future roll-outs and scale-up plans. Methods A cross sectional study design with quantitative and qualitative methods was employed. A survey was administered October to December 2019 using a structured questionnaire. A total of 240 health care providers participated in the study based on a stratified random sampling technique. An interview was conducted with a total of 10 persons that include IT experts and higher managements of the hospital. Descriptive statistics were employed to summarize the survey data using SPSS V.21. Qualitative data were thematically presented. Results St. Paul’s hospital predominantly practiced the manual medical recording system. The majority of respondents (30.6%) declared that a lack of training and follow up, lack of management commitment, poor network infrastructure and hardware/software-related issues were challenges and contributed to EMR system failure at St. Paul’s. Results from the qualitative data attested to the above results. The system is found well-functioning at Ayder, and the majority of respondents (38%) noted that lack of training and follow-up was the most piercing challenge. As per the qualitative findings, ICT infrastructure, availability of equipment, incentive mechanisms, and management commitment are mentioned as supportive for successful implementation. At both hospitals, 70 to 95% of participants hold favorable perceptions and are willing to use the system. Conclusion Assessing the readiness of the hospital, selecting and acquiring standard and certified EMR systems, provision of adequate logistic requirements including equipment and supplies, and upgrading the hospital ICT infrastructure will allow sustainable deployment of an EMR system.

scholarly journals Breast Cancer Patients’ Experience and Wishes Regarding Communication on Sexual Health - The BEROSE Study

2021 ◽  
Author(s):  
Marion Aupomerol ◽  
Dan Chaltiel ◽  
Patricia Pautier ◽  
Delphine Wehrer ◽  
Lucie Véron ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Sexual Health ◽  
Health Care Providers ◽  
Care Pathway ◽  
Cancer Center ◽  
Care Providers ◽  
Breast Cancer Patients ◽  
Adequate Information ◽  
The Impact

Abstract Purpose: Although sexual health (SH) is a major concern for many patients with breast cancer (BC), only few of them receive adequate information on this topic throughout their whole care pathway. BEROSE is a single-center pilot cross-sectional observational study, which aimed at evaluating communication on SH between women with BC and their health-care providers.Methods: From June 12th to July 31st, 2020, a survey was distributed to patients consulting at Breast Cancer Unit of Gustave Roussy Cancer Center. The primary endpoint was the rate of women reporting to have received information on SH from health professionals throughout active treatment administration or BC follow-up.Results: Of 348 surveys collected, 318 were fully completed and included in the analysis. Sixty-one percent of women were older than 50 years and 65% had a localized BC. The majority (63%) was receiving hormone-therapy (37%) or chemotherapy (26%). Overall, 65% reported that they had not received any information about SH throughout their care, while 69% felt it would have been important to discuss sexual issues. For 31% of women, professionals, preferably oncologists or gynecologists, should have initiated the discussion on SH, during an in-person consultation. Concerning satisfaction on SH, 83% reported being satisfied or very satisfied before BC diagnosis, and only 30% at the time they completed the survey.Conclusion: Most of women undergoing treatment or follow-up for BC feel that they lack of adequate information regarding sexual issues associated to BC. The impact of BC diagnosis and treatment on SH should be discussed with all women from the first visit and then regularly readdressed.

scholarly journals Vertical Program of Screenings and Check-ups in the Russian Federation: Design, Implementation and Lessons Learnt

2021 ◽  
Author(s):  
Igor Sheiman ◽  
Sergey Shishkin ◽  
Svetlana Sazhina
Keyword(s):  
Primary Care ◽  
Russian Federation ◽  
Large Scale ◽  
Primary Care Providers ◽  
Successful Implementation ◽  
Care Providers ◽  
Local Conditions ◽  
Design And Implementation ◽  
The Russian Federation

Abstract Background. The Russian Federation has introduced a vertical large-scale program of ‘dispensarization’ (Program) that includes health check-ups and screenings for the entire adult population. It is expected to improve the results of medical interventions and ensure health gains at a relatively low cost. The major research question: Does the design and implementation of the program meet the expectations? Methods. We analyze regulatory acts and the literature on the design and the outcomes of the Program. Physicians’ surveys and interviews are conducted to understand the capacity of primary care providers to meet the requirements of the Program, as well as the link between the early identification of new illnesses and their follow-up management, administration of the program, the barriers to its successful implementation. Results. There is a substantial progress of the coverage of the population and increase in the number of identified illnesses. Some specific instruments of the Program implementation work well, others require more careful design and additional integrative and managerial activities. The capacity of primary care providers does not allow to provide high quality preventive services, as well as to ensure a continuum of preventive and curative work. The pattern of the Program administration facilitates its nation-wide implementation according to the unified rules, but makes it more difficult to account for the local conditions and limits the autonomy of professionals to choose specific population risk groups and a list of services. The interaction of providers in preventive activities is inadequate. Conclusion The expectations of the Program are too high due to the inconsistency in its design and implementation. The major lesson learnt is that the program like this should meet the capacity of primary care and be designed as a complex of interrelated activities to identify illnesses and provide their follow-up management.

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