Clinical Efficiency and Safety Outcomes of Virtual Care for Oncology Patients During the COVID-19 Pandemic

PURPOSE: Telehealth has been an integral response to the COVID-19 pandemic. However, no studies to date have examined the utility and safety of telehealth for oncology patients undergoing systemic treatments. Concerns of the adequacy of virtual patient assessments for oncology patients include the risk and high acuity of illness and complications while on treatment. METHODS: We assessed metrics related to clinical efficiency and treatment safety after propensity matching of newly referred patients starting systemic therapy where care was in large part replaced by telehealth between March and May 2020, and 206 newly referred patients from a similar time period in 2019 where all encounters were in-person visits. RESULTS: Patient-initiated telephone encounters that capture care or effort outside of visits, time to staging imaging, and time to therapy initiation were not significantly different between cohorts. Similarly, 3 month all-cause or cancer-specific emergency department presentations and hospitalizations, and treatment delays were not significantly different between cohorts. There were substantial savings in travel time with virtual care, with an average of 211.4 minutes saved per patient over a 3-month interval. CONCLUSION: Our results indicate that replacement of in-person care with virtual care in oncology does not lead to worse efficiency or outcomes. Given the increased barriers to patients seeking oncology care during the pandemic, our study indicates that telehealth efforts may be safely intensified. These findings also have implications for the continual use of virtual care in oncology beyond the pandemic.

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Immunomodulation Through Low-Dose Radiation for Severe COVID-19: Lessons From the Past and New Developments

Dose-Response ◽

10.1177/1559325820956800 ◽

2020 ◽

Vol 18 (3) ◽

pp. 155932582095680

Author(s):

Yannic N. Hanekamp ◽

James Giordano ◽

Jaap C. Hanekamp ◽

Mohammad K. Khan ◽

Maarten Limper ◽

...

Keyword(s):

Clinical Trials ◽

Low Dose ◽

Inflammatory Diseases ◽

Low Dose Radiation ◽

Immunomodulating Therapy ◽

State Radiation ◽

Oncology Care ◽

Treatment Safety ◽

Dose Radiation

Low-dose radiation therapy (LD-RT) has historically been a successful treatment for pneumonia and is clinically established as an immunomodulating therapy for inflammatory diseases. The ongoing COVID-19 pandemic has elicited renewed scientific interest in LD-RT and multiple small clinical trials have recently corroborated the historical LD-RT findings and demonstrated preliminary efficacy and immunomodulation for the treatment of severe COVID-19 pneumonia. The present review explicates archival medical research data of LD-RT and attempts to translate this into modernized evidence, relevant for the COVID-19 crisis. Additionally, we explore the putative mechanisms of LD-RT immunomodulation, revealing specific downregulation of proinflammatory cytokines that are integral to the development of the COVID-19 cytokine storm induced hyperinflammatory state. Radiation exposure in LD-RT is minimal compared to radiotherapy dosing standards in oncology care and direct toxicity and long-term risk for secondary disease are expected to be low. The recent clinical trials investigating LD-RT for COVID-19 confirm initial treatment safety. Based on our findings we conclude that LD-RT could be an important treatment option for COVID-19 patients that are likely to progress to severity. We advocate the further use of LD-RT in carefully monitored experimental environments to validate its effectiveness, risks and mechanisms of LD-RT.

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How will the cost of biosimilars affect patients’ willingness to receive them?

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18338 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18338-e18338

Author(s):

R Donald Harvey ◽

Megan McGrath ◽

John W. Cook ◽

Margie D Dixon ◽

Rebecca D. Pentz

Keyword(s):

Financial Burden ◽

Cost Savings ◽

Drug Market ◽

Oncology Patients ◽

Convenience Sample ◽

Anti Cancer ◽

Negative Perceptions ◽

Oncology Care ◽

The Cost ◽

Patients Experience

e18338 Background: The cost of oncology care is increasing. The NIH projects that the oncology drug market will reach $111.9 billion by 2020. Studies show that oncology patients experience considerable financial burden, regardless of insurance status and in general believe that oncology medications are too expensive. However, there is some evidence outside of oncology that suggests patients may not trust generics or cheaper medications. Therefore, there is a need to assess oncology patients’ views of a biosimilars and their potential to reduce costs. Methods: We surveyed a convenience sample of 79 oncology patients in clinics and the infusion center. The survey consisted of five questions on cost and patient participation in decision making. Results: Of 79 patients approached, 75 (95%) completed the survey. Fifty (66%) believed that expensive medications do not work better than less costly ones for the same disease; yet only 30 of those 50 (60%) and 44% overall (33/75) would prefer that their doctor prescribe them the cheaper version of their anti-cancer medication. Of the 20 respondents who believed that expensive drugs do not work better but still wanted the more expensive drugs for themselves, 8 believed cancer was too serious of an illness to take any chances with a cheaper medication, 5 wanted the most expensive that insurance would cover and 2 wanted the best possible medication. 90.67% respondents (68/75) wanted to know if their physician was prescribing a cheaper version of their drug. Conclusions: Our results show that, overall, oncology patients agree that cheaper medications work as well as more expensive ones, but there are definite concerns among some patients that drug price may be a proxy for quality, particularly in cancer. Overcoming these negative perceptions among patients will be important if optimal cost savings are going to be realized with expanded biosimilar use.

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COVD-19. COGNITION, CANCER, AND COVID: DELIVERING DIRECT-TO-HOME TELE-NEUROPSYCHOLOGY SERVICES TO NEURO-ONCOLOGY PATIENTS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.102 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii25-ii25

Author(s):

Melissa Gardner ◽

Farah Aslanzadeh ◽

Giuliana Zarrella ◽

Sarah Braun ◽

Ashlee Loughan ◽

...

Keyword(s):

Massachusetts General Hospital ◽

Healthcare Services ◽

Patient Acceptance ◽

Risk Of Infection ◽

Oncology Patients ◽

Testing Environment ◽

Clinical Encounters ◽

Increased Risk ◽

Oncology Care ◽

Virginia Commonwealth University

Abstract BACKGROUND The COVID-19 pandemic altered the delivery of healthcare services globally with a rapid adoption of telemedicine to meet patient’s needs. Telemedicine is critical for neuro-oncology patients who may be at an increased risk of infection, yet require continuity of care. An important aspect of neuro-oncology care includes neuropsychological assessment, which can be challenging to complete outside of a structured testing environment. Teleneuropsychology (TNP) has been explored under proctored conditions and proven feasible and reliable. Conducting TNP visits directly to the patients’ home (DTH-TNP) had minimal study prior to the pandemic, but was implemented to reduce COVID-19 exposure. METHODS We used surveys to examine patient acceptance and clinician feasibility of DTH-TNP at two regionally diverse medical institutions routinely providing neuropsychological assessments services to neuro-oncology patients from April to August 2020, Massachusetts General Hospital (MGH) and Virginia Commonwealth University (VCU). RESULTS 45 patients voluntarily responded (MGH=30, VCU=15) and 98 percent (MGH=100%, VCU=93%) of respondents were satisfied with the DTH-TNP experience. Nine percent (MGH=7%, VCU=13%) reported challenges (e.g., technological issues) during the appointment. Eighty-nine percent (MGH=90%, VCU=87%) would recommend the virtual visit to others. Patients perceived reduced risk of infection (MGH=77%, VCU=87%) and time traveling to clinic (MGH=87%, VCU=80%) as favorable aspects of DTH-TNP. 43 clinician surveys collected at MGH indicated that clinicians were able to achieve the goal of their appointment in 91% of clinical encounters. Common issues reported by clinicians included trouble connecting (7%) to the telemedicine platform and environmental disruptions (12%). DISCUSSION This preliminary data suggests neuro-oncology patients and clinicians find DTH-TNP to be an acceptable and feasible practice, while also recognizing its limitations. This study is limited in that voluntary patient surveys are subject to bias. These results suggest that further study of DTH-TNP (e.g., reliability, validity, and limitations) for neuro-oncology patients is warranted. Future directions are discussed.

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Where Your Data Is Going and Where It's Been

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2011.0127 ◽

2011 ◽

Vol 9 (Suppl_3) ◽

pp. S-10-S-12

Author(s):

Jane M. Quigley

Keyword(s):

Electronic Medical Records ◽

Medical Records ◽

Performance Metrics ◽

Standards Of Care ◽

Oncology Patients ◽

Quality Initiatives ◽

Electronic Transactions ◽

Oncology Care ◽

And Performance ◽

The Continuum

Collecting data is time-consuming and expensive. Electronic transactions, including electronic medical records and the unification of many billing procedures, have transformed the rate at which data are able to be extracted. Although obstacles remain, the rate at which data are de-identified, collected, and aggregated will help improve safety and standards of care for oncology patients. Everyone participating in the care of oncology patients must understand how important data are as the quality initiatives and performance metrics are numerous and growing; these initiatives cannot be successful without timely, accurate, and quantifiable data that address the continuum of oncology care.

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The academic oncology hospitalist—a model for improved teaching and patient care

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19630 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19630-19630

Author(s):

A. E. Denes ◽

J. F. DiPersio ◽

M. J. Ellis

Keyword(s):

Patient Satisfaction ◽

Patient Care ◽

Core Curriculum ◽

Symptom Control ◽

Full Time ◽

Research Activities ◽

The Status ◽

High Acuity ◽

Oncology Care ◽

Attending Physician

19630 Background: The care of hospitalized cancer patients in academic institutions is usually assigned to residents and fellows with supervision by a “rotating” attending oncologist. This approach ensures that, at a minimum, each patient’s care is reviewed and supervised by an attending physician. This model, however, has several shortcomings including: 1) lack of continuity of care 2) limited time for teaching 3) limited knowledge of diseases outside of the research or clinical interests of the attending 4) lack of consistent clinical leadership and 5) communication problems when the attending physician is in clinic, meetings, or research activities. Methods: We felt that a model in which a senior medical oncologist with an interest in patient care, teaching, and clinical research serves as the full time director of the inpatient oncology service would address these challenges. The organizational chart for this model will be presented. In this model, the attending oncologist meets with the “post call” intern/resident team, fellow, and hospitalist each morning to review and discuss all patients admitted to the service in the prior 24 hrs. The afternoons are spent visiting patients, reviewing the status of all patients on the service, and evaluating high acuity new admissions. An oncology core curriculum lecture series was developed with daily lectures. The trainees are encouraged to attend additional conferences as time permits. Results: The program was initiated in November 2005 and has been a universal success. Patient satisfaction has improved significantly and the number of graduating residents pursuing fellowships in oncology has increased from 3–4 to 7–8 per year. The attending physicians are able to continue their clinic schedules and research activities without interruption. We are planning to review this experience to evaluate additional changes in patient outcome such as length of stay, efficacy of symptom control, and readmission rates. Conclusions: Our model of inpatient oncology care has improved patient satisfaction, teaching, and faculty utilization. It lends itself to develop clinical trials of inpatient cancer care. We suggest it be considered in academic cancer centers to achieve similar goals. No significant financial relationships to disclose.

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Cancer, Cognition, and COVID: Delivering Direct-to-Home Tele-Neuropsychology Services to Neuro-Oncology Patients

Neuro-Oncology Practice ◽

10.1093/nop/npab021 ◽

2021 ◽

Author(s):

Melissa M Gardner ◽

Farah J Aslanzadeh ◽

Giuliana V Zarrella ◽

Sarah E Braun ◽

Ashlee R Loughan ◽

...

Keyword(s):

Neuropsychological Testing ◽

Risk Of Infection ◽

Oncology Patients ◽

Privacy Concerns ◽

Testing Environment ◽

Medical Institutions ◽

Included Patient ◽

Increased Risk ◽

Communication Challenges ◽

Oncology Care

Abstract Background The COVID-19 pandemic induced rapid adoption of telemedicine services for neuro-oncology patients at an increased risk of infection. Neuropsychological assessment is important to neuro-oncology care yet challenging to complete outside of a structured testing environment. Teleneuropsychology (TNP) has been explored in limited populations and proven feasible and reliable. Conducting TNP visits directly to patients' home (DTH) had minimal prior study. Methods We used two voluntary surveys to examine acceptance (patients) and feasibility (providers) of DTH-TNP at two regionally diverse medical institutions providing neuropsychological services to neuro-oncology patients from April to September 2020. Results A total of 119 patients were scheduled during the study period, 79 of whom completed neuropsychological testing via DTH-TNP. Neuropsychology providers completed surveys on 68 of these encounters (86%). In 98% of cases, neuropsychologists were able to achieve or partially achieve the individually defined goals of their assessment. Common problems reported included patient dysregulation (16%) and slow/unreliable internet (15%). Of the 52 patients who responded, 98% were satisfied with the DTH-TNP experience and 92% would recommend the virtual visit to others. All respondents felt understood by the examiner (100%) and the majority denied technical difficulties (90%), communication challenges (94%), or privacy concerns (98%). Patients reported reduced risk of infection and saved travel time as favorable aspects of DTH-TNP. Conclusions These preliminary results suggest neuro-oncology patients find DTH-TNP acceptable and neuropsychologists find it a feasible practice, while also recognizing its limitations. Results suggest that further study of DTH-TNP (e.g., reliability, validity) for neuro-oncology patients is warranted.

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Knowledge and perceptions of palliative care among oncology outpatients.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.118 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 118-118

Author(s):

Gillian McKie

Keyword(s):

Palliative Care ◽

Clinical Information ◽

Multivariate Regression Analysis ◽

Educational Strategies ◽

Oncology Patients ◽

Cross Sectional ◽

Convenience Sample ◽

Perceived Needs ◽

Palliative Care Services ◽

Oncology Care

118 Background: Palliative care is emerging as an integral component of oncology care. There is growing evidence of its benefits but providers struggle with how to integrate specialist palliative services for the oncology population. The purpose of this study was to measure patients’ knowledge and perceptions, and their intention to seek palliative services. This study helps inform and guide oncology and palliative providers in their efforts to bridge the gap for oncology patients. Methods: The study used a cross-sectional design. A convenience sample of adult oncology patients using ambulatory cancer services at a community hospital was surveyed using the Knowledge of Care Options (KOCO) and Perceptions of Palliative Care Instrument (PPCI). Clinical information was abstracted from their health records retrospectively. Descriptive statistics were used to describe all variables. The association between knowledge, perceptions, and intention was analyzed using Pearson’s r correlation and multivariate regression analysis. Results: The majority of the 139 participants enrolled were female (61.9%), white (76.7%), and had good functional status with ECOG of 0 or 1 (87.1%). Mean age was 63.4 years. The mean KOCO score was 84.4% although several items scored less than 70%. Overall intention to seek palliative care was low at 2.53 on a seven point scale; a majority of patients indicated that they were unlikely to seek palliative care. There was a positive correlation between overall perception and intention to seek palliative care in the next three months (r = 0.212, p = 0.02).In addition, patients with higher scores on perceived needs for palliative care were more likely to report an intention to seek palliative care (r = 0.308, p = 0.001). Conclusions: There remains a knowledge deficit about palliative care in the oncology population. Participants did not experience negative emotional or cognitive reactions in response to information about palliative care. Perceived needs were associated with intention to seek palliative care services. Routine screening for needs and effective educational strategies are needed to better integrate palliative and oncology care.

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Improving cancer pain control: Potential impact of CYP2D6 pharmacogenomic (PGx) testing in oncology (Onc) patients.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.12089 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 12089-12089

Author(s):

Natalie Reizine ◽

Keith Danahey ◽

Emily Schierer ◽

Tien Truong ◽

Mark J. Ratain ◽

...

Keyword(s):

At Risk ◽

Pain Control ◽

Opioid Analgesics ◽

P Value ◽

Cyp2d6 Genotype ◽

Oncology Patients ◽

Increased Risk ◽

Oncology Care ◽

The University ◽

Post Hoc

12089 Background: Several opioid analgesics have well-known germline PGx associations which may predict either inefficacy or exaggerated (toxic) responses, depending on the patient’s genotype. Despite this, germline PGx testing has not been routinely incorporated into oncology care. We hypothesized that CYP2D6 germline PGx profiling offers the potential to improve oncology patients’ pain control by identifying individuals at increased risk for inadequate analgesia with standard opioid dosing. Methods: We retrospectively analyzed the medication histories of over 81,000 adult oncology patients treated at the University of Chicago from 2012-2018 for exposure to opioids. CYP2D6 genotype (permitting assignment of metabolizer phenotype: normal metabolizer [NM], intermediate metabolizer [IM], or poor metabolizer [PM]) was determined post-hoc for 127 patients who were genotyped for other reasons unrelated to pain prescribing. The primary endpoint was the number of opioids required for pain control over the course of longitudinal care, comparing PM/IMs with NMs. The secondary endpoint was the number of hospitalizations for pain control. Results: Over 47,000 oncology patients were exposed to opioids, with an average of 2.67±1.6 different opioid medication exposures per patient. Thirteen percent of genotyped patients were IM/PM, who were at risk for inadequate analgesia. IM/PM patients demonstrated an increased number of different opioid exposures (4.5±2.1) compared to NM (2.7±2.1, P value = 0.002). IM/PM patients were also more likely to have a pain related hospitalization (OR 4.17, CI 1.3-13.2, P = 0.016). Conclusions: Based on population prevalence, we estimate that > 6000 oncology patients (1000 patients/year) who received opioids at our center were IM/PM and thus at risk for inadequate analgesia due to genetic predisposition. CYP2D6 germline PGx profiling offers the potential to improve oncology patients’ pain management.

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Effectiveness of individual feedback and coaching on shared decision-making consultations in oncology care: Study protocol for a randomized clinical trial (Preprint)

10.2196/preprints.35543 ◽

2021 ◽

Author(s):

Haske Van Veenendaal ◽

Loes J Peters ◽

Dirk T Ubbink ◽

Fabienne E Stubenrouch ◽

Anne M Stiggelbout ◽

...

Keyword(s):

Clinical Trial ◽

Decision Making ◽

Randomized Clinical Trial ◽

Shared Decision Making ◽

Intervention Group ◽

Control Group ◽

Decision Making Process ◽

Shared Decision ◽

Oncology Patients ◽

Oncology Care

BACKGROUND Shared decision-making (SDM) is particularly important in oncology since many treatments involve serious side effects, and treatment decisions involve a trade-off of benefits and risks. However, implementation of SDM in oncology care is challenging and clinicians state that it is difficult to apply SDM in their actual workplace. Training clinicians is known to be an effective means of improving SDM, but is considered time-consuming. OBJECTIVE This study addresses the effectiveness of an individual SDM training program, using the concept of deliberate practice. METHODS This multicentre single-blinded randomized clinical trial will be performed in 12 Dutch hospitals. Clinicians involved in decisions with oncology patients are invited to participate in the study and are allocated to the control group or intervention group. All clinicians will record 3 decision-making processes, with 3 different oncology patients. Clinicians in the intervention group receive the SDM-intervention: completing E-learnings, reflecting on feedback reports, doing a self-assessment and defining 1-3 personal learning questions, and participating in face-to-face coaching. Clinicians in the control group do not receive the SDM-intervention until the end of the study. The primary outcome will be the extent in which clinicians involve their patients in the decision-making process, as scored using the OPTION-5 instrument. As secondary outcome patients will rate their perceived involvement in the decision-making and the duration of the consultations will be registered. RESULTS We hypothesize that clinicians exposed to this intervention are more likely to adopt SDM behaviours than clinicians who do not. A secondary aim is to evaluate whether patients perceive more involvement in the decision-making process. CONCLUSIONS This theory-based and blended approach will increase our knowledge about effective and feasible training methods for clinicians in the field of SDM. The intervention will be tailored to the context of individual clinicians and will target knowledge, attitude and skills of clinicians. Patients are involved in the design and implementation of the study. CLINICALTRIAL This trial is retrospectively registered (Netherlands Trial Registry number NL9647; August 03, 2021, https://www.trialregister.nl/trial/9647). All participating clinicians and their patients will receive information about the study and complete an informed consent form beforehand. Approval for the study was obtained from the Ethical Review Board (medical research ethics committee Delft and Leiden, the Netherlands (N20.170)).

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The Safety of Systemic Treatments That Can Be Used for Geriatric Psoriasis Patients: A Review

Dermatology Research and Practice ◽

10.1155/2012/367475 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 9

Author(s):

Jillian W. Wong ◽

John Y. M. Koo

Keyword(s):

Geriatric Patients ◽

The Elderly ◽

Severe Psoriasis ◽

Age Group ◽

Elderly Age ◽

Geriatric Population ◽

Immune System Function ◽

Systemic Treatments ◽

Treatment Safety ◽

Systemic Agents

Background. Patients with moderate-to-severe psoriasis are often treated with systemic immunosuppressant agents that decrease immune system function. For the elderly, these medications are often problematic due to their already immunosuppressed state and comorbidities. However, there are few studies examining the effects of these medications on the elderly age group. Therefore, there is often discomfort among dermatologists treating elderly patients with psoriasis in utilizing systemic agents, frequently resulting in inadequate treatment.Objective. We review the safety profiles of systemic treatments often used to treat psoriasis and their possible adverse risks to the geriatric population.Methods. We conducted a search of PubMed’s Medline database of articles published from 2000 to 2011, which resulted in 14 articles.Conclusion. Treating geriatric patients with moderate-to-severe psoriasis remains a challenge due to immunosenescence and comorbidities. More studies focusing on psoriasis treatment safety in the geriatric population are needed.

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