scholarly journals Tobacco Use and Tobacco Treatment Referral Response of Patients With Cancer: Implementation Outcomes at a National Cancer Institute–Designated Cancer Center

2021 ◽  
pp. OP.20.01095
Author(s):  
Jessica L. Burris ◽  
Tia N. Borger ◽  
Brent J. Shelton ◽  
Audrey K. Darville ◽  
Jamie L. Studts ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Cancer Diagnosis ◽  
Program Implementation ◽  
National Cancer Institute ◽  
Retrospective Chart Review ◽  
Population Based ◽  
Adverse Outcomes ◽  
Cancer Center ◽  
Patients With Cancer ◽  
Tobacco Treatment

PURPOSE: Smoking after a cancer diagnosis is linked to cancer-specific and all-cause mortality, among other adverse outcomes. Yet, 10%-20% of US cancer survivors are current smokers. Implementation of evidence-based tobacco treatment in cancer care facilities is widely recommended, yet rarely accomplished. This study focuses on the early outcomes of a population-based tobacco treatment program integrated within an National Cancer Institute–designated cancer center. METHODS AND MATERIALS: The sample consists of 26,365 patients seen at the cancer center during the first 18 months of program implementation. The study is a retrospective chart review of patients' tobacco use and, among current users, patients' treatment referral response. RESULTS: More than 99% of patients were screened for tobacco use. Current (past month) use was observed in 21.05% of patients; cigarettes were the most popular product. Only 17.22% of current users accepted a referral for tobacco treatment; among current users who declined, the majority were not ready to quit (65.84%) or wanted to quit on their own (27.01%). Multiple demographic variables were associated with tobacco use and treatment referral response outcomes. CONCLUSION: Despite cancer diagnosis presenting a teachable moment for tobacco cessation, patients with cancer may not be ready to quit or engage with treatment. Clinically proven strategies to increase motivation, prompt quit attempts, and encourage treatment use should be key components of tobacco treatment delivery to patients with cancer.

scholarly journals How We Care for an Older Patient With Cancer

2017 ◽  
Vol 13 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Armin Shahrokni ◽  
Soo Jung Kim ◽  
George J. Bosl ◽  
Beatriz Korc-Grodzicki
Keyword(s):  
Predictive Models ◽  
Older Patients ◽  
Process Development ◽  
Adverse Outcomes ◽  
Added Value ◽  
Cancer Center ◽  
Multiple Chronic Conditions ◽  
Older Patient ◽  
Improve Patient Survival ◽  
Patients With Cancer

As the number of older patients with cancer is increasing, oncology disciplines are faced with the challenge of managing patients with multiple chronic conditions who have difficulty maintaining independence, who may have cognitive impairment, and who also may be more vulnerable to adverse outcomes. National and international societies have recommended that all older patients with cancer undergo geriatric assessment (GA) to detect unaddressed problems and introduce interventions to augment functional status to possibly improve patient survival. Several predictive models have been developed, and evidence has shown correlation between information obtained through GA and treatment-related complications. Comprehensive geriatric evaluations and effective interventions on the basis of GA may prove to be challenging for the oncologist because of the lack of the necessary skills, time constraints, and/or limited available resources. In this article, we describe how the Geriatrics Service at Memorial Sloan Kettering Cancer Center approaches an older patient with colon cancer from presentation to the end of life, show the importance of GA at the various stages of cancer treatment, and how predictive models are used to tailor the treatment. The patient’s needs and preferences are at the core of the decision-making process. Development of a plan of care should always include the patient’s preferences, but it is particularly important in the older patient with cancer because a disease-centered approach may neglect noncancer considerations. We will elaborate on the added value of co-management between the oncologist and a geriatric nurse practitioner and on the feasibility of adapting elements of this model into busy oncology practices.

scholarly journals Integrating Diversity, Equity, and Inclusion Approaches Into Treatment of Commercial Tobacco Use for Optimal Cancer Care Delivery

2021 ◽  
Vol 19 (Suppl_1) ◽  
pp. S4-S7
Author(s):  
_ _
Keyword(s):  
Tobacco Use ◽  
Cancer Care ◽  
Community Organization ◽  
Care Delivery ◽  
Cancer Control ◽  
Population Level ◽  
Cancer Center ◽  
Tobacco Treatment ◽  
Incidence And Mortality ◽  
Equity And Inclusion

Tobacco-related cancer incidence and mortality and commercial tobacco use have decreased steadily in recent decades, but improvements have not been equitably experienced across population subgroups. A complex interaction across socioecological domains of individual, interpersonal, community/organization, and societal/policy factors influence disparities in tobacco use, treatment, and related health outcomes. NCI’s Cancer Center Cessation Initiative (C3I) provides an ideal platform to examine and intervene on multilevel influences across the cancer control continuum to reduce any disproportionate tobacco-related burden and eliminate tobacco-related disparities. The C3I Diversity, Equity, and Inclusion (DEI) Working Group encourages cancer centers to develop, evaluate, and adopt evidence-based practices regarding DEI for prevention and treatment of commercial tobacco use across the cancer control continuum. This paper highlights how 3 C3I sites intervene to address socioecological influences on tobacco use among racially, ethnically, socioeconomically, and geographically diverse patient subgroups. It then outlines ways in which DEI considerations could be integrated into research with patients with cancer who use tobacco and practices related to standards of cancer care. Incorporating DEI considerations in the pursuit of optimal tobacco treatment could facilitate elimination of inequities in population-level cancer outcomes, spanning the full continuum of cancer care from prevention to survivorship.

scholarly journals Chemotherapy and COVID-19 Outcomes in Patients With Cancer

2020 ◽  
Vol 38 (30) ◽  
pp. 3538-3546 ◽  
Author(s):  
Justin Jee ◽  
Michael B. Foote ◽  
Melissa Lumish ◽  
Aaron J. Stonestrom ◽  
Beatriz Wills ◽  
...  
Keyword(s):  
Hematologic Malignancy ◽  
Cytotoxic Chemotherapy ◽  
Adverse Outcomes ◽  
Sensitivity Analyses ◽  
Cancer Center ◽  
Cancer Type ◽  
Patients With Cancer ◽  
Chemotherapy Administration ◽  
Lung Malignancies ◽  
Associated Risk Factors

PURPOSE Coronavirus-2019 (COVID-19) mortality is higher in patients with cancer than in the general population, yet the cancer-associated risk factors for COVID-19 adverse outcomes are not fully characterized. PATIENTS AND METHODS We reviewed clinical characteristics and outcomes from patients with cancer and concurrent COVID-19 at Memorial Sloan Kettering Cancer Center until March 31, 2020 (n = 309), and observed clinical end points until April 13, 2020. We hypothesized that cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis is associated with an increased hazard ratio (HR) of severe or critical COVID-19. In secondary analyses, we estimated associations between specific clinical and laboratory variables and the incidence of a severe or critical COVID-19 event. RESULTS Cytotoxic chemotherapy administration was not significantly associated with a severe or critical COVID-19 event (HR, 1.10; 95% CI, 0.73 to 1.60). Hematologic malignancy was associated with increased COVID-19 severity (HR, 1.90; 95% CI, 1.30 to 2.80). Patients with lung cancer also demonstrated higher rates of severe or critical COVID-19 events (HR, 2.0; 95% CI, 1.20 to 3.30). Lymphopenia at COVID-19 diagnosis was associated with higher rates of severe or critical illness (HR, 2.10; 95% CI, 1.50 to 3.10). Patients with baseline neutropenia 14-90 days before COVID-19 diagnosis had worse outcomes (HR, 4.20; 95% CI, 1.70 to 11.00). Findings from these analyses remained consistent in a multivariable model and in multiple sensitivity analyses. The rate of adverse events was lower in a time-matched population of patients with cancer without COVID-19. CONCLUSION Recent cytotoxic chemotherapy treatment was not associated with adverse COVID-19 outcomes. Patients with active hematologic or lung malignancies, peri–COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes. Interactions among antineoplastic therapy, cancer type, and COVID-19 are complex and warrant further investigation.

Epidemiology, Molecular Mycology, and Environmental Sources ofFusariumInfection in Patients with Cancer

2002 ◽  
Vol 23 (9) ◽  
pp. 532-537 ◽  
Author(s):  
Issam Raad ◽  
Jeffrey Tarrand ◽  
Hend Hanna ◽  
Maher Albitar ◽  
Erle Janssen ◽  
...  
Keyword(s):  
Dna Analysis ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Uninfected Control ◽  
Cancer Center ◽  
Retrospective Case ◽  
Patients With Cancer ◽  
Random Amplification ◽  
Immunocompromised Status ◽  
Control Study

Objective:To investigate the epidemiology and environmental sources of Fusarium infections in patients with cancer.Design:Retrospective case-control study conducted following surveillance environmental cultures and DNA analysis of isolated organisms.Setting:A tertiary-care, university cancer center.Methods:In 1996 and 1997, environmental cultures were performed on air samples and water systems. A retrospective chart review was performed for 70 patients with cancer identified with fusariosis between 1987 and 1997. Patients with fusariosis were compared with 49 uninfected control patients who occupied hospital rooms with positive environmental cultures for Fusarium. With the use of random amplification of polymorphic DNA organisms isolated from infected patients were compared with environmental organisms.Results:Most of the patients with Fusarium (40, 57%) were infected on or within 3 days of admission, indicating community rather than nosocomial acquisition. Patients were comparable in terms of underlying immunocompromised status to 49 uninfected control patients. However, the duration from admission to infection in the patients with fusariosis tended to be shorter than the duration from admission to discharge in the exposed control patients (P= .06). Water cultured from the hospital tanks and from sinks and water fountains was negative for Fusarium. With the use of polymerase chain reaction, environmental isolates did not match clinical ones. Quantitative air sampling showed that the quantitative outdoor Fusarium levels were eightfold higher than the indoor levels. During the rainy summer season, outdoor air concentrations of Fusarium were at their highest, coinciding with the peak incidence of fusariosis at our center.Conclusion:The most likely source of fusariosis was the external environment rather than nosocomial sources, such as water.

Lung Cancer Screening, Cancer Treatment, and Addressing the Continuum of Health Risks Caused by Tobacco

2016 ◽  
pp. 223-229 ◽  
Author(s):  
Graham W. Warren ◽  
Jamie S. Ostroff ◽  
John R. Goffin
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Treatment ◽  
Tobacco Use ◽  
Health Risks ◽  
Lung Cancer Screening ◽  
Adverse Outcomes ◽  
Evidence Based ◽  
Patients With Cancer ◽  
Preventable Risk Factor

Tobacco use is the largest preventable risk factor for the development of several cancers, and continued tobacco use by patients with cancer and survivors of cancer causes adverse outcomes. Worldwide tobacco control efforts have reduced tobacco use and improved health outcomes in many countries, but several countries continue to suffer from increased tobacco use and associated adverse health effects. Continued tobacco use by patients undergoing cancer screening or treatment results in continued risk for cancer-related and noncancer-related health conditions. Although integrating tobacco assessment and cessation support into lung cancer screening and cancer care is well justified and feasible, most patients with cancer unfortunately do not receive evidence-based tobacco cessation support. Combining evidence-based methods of treating tobacco addiction, such as behavioral counseling and pharmacotherapy, with practical clinical considerations in the setting of lung cancer screening and cancer treatment should result in substantial improvements in access to evidence-based care and resultant improvements in health risks and cancer treatment outcomes.

scholarly journals An Evaluation of the Process and Quality Improvement Measures of the University of Virginia Cancer Center Tobacco Treatment Program

2020 ◽  
Vol 17 (13) ◽  
pp. 4707 ◽  
Author(s):  
Kara P. Wiseman ◽  
Lindsay Hauser ◽  
Connie Clark ◽  
Onyiyoza Odumosu ◽  
Neely Dahl ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Tobacco Use ◽  
Treatment Program ◽  
Disease Recurrence ◽  
Cancer Center ◽  
Second Primary ◽  
University Of Virginia ◽  
Clinical Workflow ◽  
Tobacco Treatment ◽  
The University

Tobacco use after a cancer diagnosis can increase risk of disease recurrence, increase the likelihood of a second primary cancer, and negatively impact treatment efficacy. The implementation of system-wide comprehensive tobacco cessation in the oncology setting has historically been low, with over half of cancer clinicians reporting that they do not treat or provide a referral to cessation resources. This quality improvement study evaluated the procedures for assessing and documenting tobacco use among cancer survivors and referring current smokers to cessation resources at the University of Virginia Cancer Center. Process mapping revealed 20 gaps across two major domains: electronic health record (EHR), and personnel barriers. The top identified priority was inconsistent documentation of tobacco use status as it impacted several downstream gaps. Eleven of the 20 gaps were deemed a high priority, and all were addressed during the implementation of the resulting Tobacco Treatment Program. Prioritized gaps were addressed using a combination of provider training, modifications to clinical workflow, and EHR modifications. Since implementation of solutions, the number of unique survivors receiving cessation treatment has increased from 284 survivors receiving cessation support during Year 1 of the initiative to 487 in Year 3. The resulting Tobacco Treatment Program provides a systematic, personalized, and sustainable comprehensive cessation program that optimizes the multifaceted workflow of the Cancer Center and has the potential to reduce tobacco use in a population most in need of cessation support.

scholarly journals Population-based geographic access to parent and satellite National Cancer Institute Cancer Center Facilities

Cancer ◽  
2017 ◽  
Vol 123 (17) ◽  
pp. 3305-3311 ◽  
Author(s):  
Tracy Onega ◽  
Jennifer Alford-Teaster ◽  
Fahui Wang
Keyword(s):  
National Cancer Institute ◽  
Population Based ◽  
Cancer Center ◽  
Geographic Access

scholarly journals Determinants of Severity in Cancer Patients with COVID-19 Illness

2020 ◽  
Author(s):  
Elizabeth V. Robilotti ◽  
N. Esther Babady ◽  
Peter A. Mead ◽  
Thierry Rolling ◽  
Rocio Perez-Johnston ◽  
...  
Keyword(s):  
New York ◽  
Checkpoint Inhibitors ◽  
Severe Disease ◽  
Diagnostic Testing ◽  
New York State ◽  
Respiratory Illness ◽  
Population Based ◽  
Major Surgery ◽  
Cancer Center ◽  
Patients With Cancer

New York State had 180,458 cases of SARS-CoV-2 and 9385 reported deaths as of April 10th, 2020. Patients with cancer comprised 8.4% of deceased individuals1. Population-based studies from China and Italy suggested a higher COVID-19 death rate in patients with cancer2,3, although there is a knowledge gap as to which aspects of cancer and its treatment confer risk of severe COVID-19 disease4. This information is critical to balance the competing safety considerations of reducing SARS-CoV-2 exposure and cancer treatment continuation. Since March 10th, 2020 Memorial Sloan Kettering Cancer Center (MSKCC) performed diagnostic testing for SARS-CoV-2 in symptomatic patients. Overall, 40% out of 423 patients with cancer were hospitalized for COVID-19 illness, 20% developed severe respiratory illness, including 9% that required mechanical ventilation, and 9% that died. On multivariate analysis, age ≥ 65 years and treatment with immune checkpoint inhibitors (ICI) within 90 days were predictors for hospitalization and severe disease, while receipt of chemotherapy within 30 days and major surgery were not. Overall, COVID-19 illness is associated with higher rates of hospitalization and severe outcomes in patients with cancer. Association between ICI and COVID-19 outcomes will need interrogation in tumor-specific cohorts.

scholarly journals Sustainability of Tobacco Treatment Programs in the Cancer Center Cessation Initiative

2021 ◽  
Vol 19 (Suppl_1) ◽  
pp. S16-S20
Author(s):  
_ _
Keyword(s):  
Case Studies ◽  
Tobacco Use ◽  
Cancer Care ◽  
Working Group ◽  
Sustainability Assessment ◽  
Implementation Strategies ◽  
Treatment Programs ◽  
Cancer Center ◽  
Program Outcomes ◽  
Tobacco Treatment

The NCI’s Cancer Center Cessation Initiative (C3I) has a specific objective of helping cancer centers develop and implement sustainable programs to routinely address tobacco cessation with patients. Sustaining tobacco treatment programs requires the maintenance of (1) core program components, (2) ongoing implementation strategies, and (3) program outcomes evaluation. NCI funding of C3I included a commitment of resources toward sustainability. This article presents case studies to illustrate key strategies in developing sustainability capacity across 4 C3I-funded sites. Case studies are organized according to the domains of sustainability capacity defined in the Clinical Sustainability Assessment Tool (CSAT). We also describe the C3I Sustainability Working Group agenda to make scientific and practical contributions in 3 areas: (1) demonstrating the value of tobacco use treatment in cancer care, (2) identifying implementation strategies to support sustainability, and (3) providing evidence to inform policy changes that support the prioritization and financing of tobacco use treatment. By advancing this agenda, the Sustainability Working Group can play an active role in advancing and disseminating knowledge for tobacco treatment program sustainability to assist cancer care organizations in addressing tobacco use by patients with cancer within and beyond C3I.

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