scholarly journals Outcomes of Patients Placed in an Emergency Department Observation Unit of a Comprehensive Cancer Center

2021 ◽  
Author(s):  
Patrick Chaftari ◽  
Demis N. Lipe ◽  
Monica K. Wattana ◽  
Aiham Qdaisat ◽  
Pavitra P. Krishnamani ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Medical Records ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Patients With Cancer ◽  
Observation Units ◽  
Improve Cost Effectiveness ◽  
Hospital Resources ◽  
Improve Cost

PURPOSE Emergency department observation units (EDOUs) have been shown to decrease length of stay and improve cost effectiveness. Yet, compared with noncancer patients, patients with cancer are placed in EDOUs less often. In this study, we aimed to describe patients who were placed in a cancer center's EDOU to discern their clinical characteristics and outcomes. METHODS We performed a retrospective observational study that included all patients age 18 years and older who presented to our emergency department (ED) and were placed in the EDOU between March 1, 2019, and February 29, 2020. The patients' electronic medical records were queried for demographics, comorbidities, diagnosis at the time of placement in the EDOU, length of stay, disposition from the EDOU, ED return within 72 hours after discharge from the EDOU, and mortality outcomes at 14 and 30 days. RESULTS A total of 2,461 visits were eligible for analysis. Cancer-related pain was the main reason for observation in more than one quarter of the visits. The median length of stay in the EDOU was approximately 23 hours, and 69.6% of the patients were discharged. The ED return rate for unscheduled visits at 72 hours was 1.9%. The 14- and 30-day mortality rates were significantly higher for patients who were admitted than for those who were discharged (14 days: 1.7% v 0.3%, P < .001; 30 days: 5.9% v 1.8%, P < .001). CONCLUSION Our data suggest that placing patients with cancer in EDOUs is safe, reduces admissions, and reserves hospital resources for patients who can receive the most benefit without compromising care.

Withdrawing and Withholding Life Support in Patients With Cancer in an ICU Setting: A 5-Year Experience at a European Cancer Center

2016 ◽  
Vol 33 (7) ◽  
pp. 415-419 ◽  
Author(s):  
Márcio Tavares ◽  
Inês Neves ◽  
Sérgio Chacim ◽  
Fernando Coelho ◽  
Ofélia Afonso ◽  
...  
Keyword(s):  
Medical Records ◽  
Life Support ◽  
Simplified Acute Physiology Score ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Patients With Cancer ◽  
Evaluation Scores ◽  
Solid Malignancies ◽  
Male Patients ◽  
Limitation Of Therapy

Objective: This was an observational retrospective study aimed to examine the frequency and associated factors of withdrawing or withholding life support (WWLS) in the intensive care unit (ICU) of a comprehensive cancer center. Methods: Medical records of adult patients with cancer admitted to the ICU between January 2010 and December 2014 were reviewed. Patients who died during that period were classified into 2 groups: full life support and withdrawing and withholding life support. The relative impact of demographic and clinical factors was assessed using logistic regression. Results: A total of 247 patients died in our unit (mortality rate of 16.3%). Their median age was 62 (interquartile range [IQR] 51-73) years, there were 142 (57.5%) male patients, and they had predominantly solid malignancies (62.3%). The median Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation scores were 67 (IQR 54-80) and 29 (IQR 23-55), respectively. Ninety-six (38.9%) patients died after WWLS with no statistically significant differences in decisions to limit therapy during the study period. Patients with advanced age, solid malignancies, nonneutropenic, and longer duration of mechanical ventilation were more likely to die after WWLS. In multivariate analysis, presenting with neutropenia was independently associated with a lower likelihood of dying after WWLS (odds ratio: 0.34, 95% confidence interval: 0.15-0.80). Conclusion: Limitation of therapy has been a common practice in oncologic ICUs over recent years. Neutropenia is an independent predictor of limitation of therapy.

scholarly journals Fears, beliefs, and quality of life of patients with cancer vs the general population during the coronavirus disease 2019 (COVID-19) pandemic in Lombardy

2021 ◽  
pp. 030089162110228
Author(s):  
Carla Ida Ripamonti ◽  
Giacomo Massa ◽  
Daniela Insolvibile ◽  
Mauro Guglielmo ◽  
Guido Miccinesi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
General Population ◽  
Perceived Risk ◽  
Well Being ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Psychological Consequences ◽  
Patients With Cancer ◽  
Fear Of Cancer

Aim: To understand how patients with cancer reacted to the coronavirus disease 2019 (COVID-19) pandemic and whether their quality of life (QoL) was affected. Methods: In June 2020, 111 patients with cancer treated in the supportive care unit of a Comprehensive Cancer Center in Milan and 201 healthy controls from the general population were enrolled and assessed both quantitatively and qualitatively for fears and COVID-19–related beliefs as well as for QoL. Results: Fear of COVID-19 was significantly lower among patients (41% vs 57.6%; p = 0.007), as was fear of cancer (61.5% vs 85.6%; p < 0.001) and other diseases. The perceived risk of getting COVID-19 was lower among patients (25.2% vs 52.7%; p < 0.001), as was the belief of having been exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (18.1% vs 40.8%; p < 0.001). The physical component of QoL was better among the population (54.5 vs 43.8; p < 0.001); the reverse was true for patients’ psychological well-being (44.6 vs 39.6; p < 0.001). The qualitative data supported such results, showing a reduced psychological effect on the patients with cancer compared to the controls. Various reasons explain this result, including the awareness of being treated for cancer and nevertheless protected against getting infected in a cancer center of public health reorganized to continue treating patients by protecting them and personnel from the risk of infection. Conclusions: The experience of a cancer diagnosis, together with proper hospital reorganization, may act as protective factors from fears and psychological consequences of the COVID-19 outbreak.

Routine HIV Screening in Cancer Patients in the Emergency Department

2018 ◽  
Vol 17 (2) ◽  
pp. 91-95
Author(s):  
Terry W Rice ◽  
◽  
Patricia A. Brock ◽  
Carmen Gonzalez ◽  
Kelly W Merriman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hiv Testing ◽  
Cancer Patients ◽  
Linkage To Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Hiv Screening ◽  
Immunodeficiency Virus ◽  
Routine Hiv Screening ◽  
Incident Cases

Treatment of human immunodeficiency virus(HIV) in cancer patients improves outcomes and reduces transmission of this oncogenic virus. HIV testing rates of cancer patients are similar to the general population (15-40%), despite the association with cancer. Our aim was to increase HIV screening in the Emergency Department(ED) of a comprehensive cancer center through a quality initiative. Testing increased significantly during the intervention (p<0.001; 0.15/day to 2.69/day). Seropositive HIV rate was 1.4% (12/852), with incidence of 0.3%. All patients were linked to care. Incident cases were between 36 and 55 years of age. Barriers encountered included confusion regarding the need for written consent for HIV testing, failure to consider ordering the test, and concerns regarding linkage to care.

Artificial Intelligence Tool for Optimizing Eligibility Screening for Clinical Trials in a Large Community Cancer Center

2020 ◽  
pp. 50-59 ◽  
Author(s):  
J. Thaddeus Beck ◽  
Melissa Rammage ◽  
Gretchen P. Jackson ◽  
Anita M. Preininger ◽  
Irene Dankwa-Mullan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Clinical Trials ◽  
Language Processing ◽  
Medical Records ◽  
Cancer Center ◽  
Patients With Cancer ◽  
Attribute Extraction ◽  
Time Required ◽  
Manual Review

PURPOSE Less than 5% of patients with cancer enroll in clinical trials, and 1 in 5 trials are stopped for poor accrual. We evaluated an automated clinical trial matching system that uses natural language processing to extract patient and trial characteristics from unstructured sources and machine learning to match patients to clinical trials. PATIENTS AND METHODS Medical records from 997 patients with breast cancer were assessed for trial eligibility at Highlands Oncology Group between May and August 2016. System and manual attribute extraction and eligibility determinations were compared using the percentage of agreement for 239 patients and 4 trials. Sensitivity and specificity of system-generated eligibility determinations were measured, and the time required for manual review and system-assisted eligibility determinations were compared. RESULTS Agreement between system and manual attribute extraction ranged from 64.3% to 94.0%. Agreement between system and manual eligibility determinations was 81%-96%. System eligibility determinations demonstrated specificities between 76% and 99%, with sensitivities between 91% and 95% for 3 trials and 46.7% for the 4th. Manual eligibility screening of 90 patients for 3 trials took 110 minutes; system-assisted eligibility determinations of the same patients for the same trials required 24 minutes. CONCLUSION In this study, the clinical trial matching system displayed a promising performance in screening patients with breast cancer for trial eligibility. System-assisted trial eligibility determinations were substantially faster than manual review, and the system reliably excluded ineligible patients for all trials and identified eligible patients for most trials.

scholarly journals Active Mycobacterium tuberculosis infection at a comprehensive cancer center, 2006–2014

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joumana Kmeid ◽  
Prathit A. Kulkarni ◽  
Marjorie V. Batista ◽  
Firas El Chaer ◽  
Amrita Prayag ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Cancer Patients ◽  
Hematopoietic Cell Transplantation ◽  
Average Rate ◽  
Hematologic Malignancies ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Mycobacterium Tuberculosis Infection ◽  
Patients With Cancer ◽  
Disseminated Disease

Abstract Background Morbidity and mortality from Mycobacterium tuberculosis (Mtb) infection remain significant in cancer patients. We evaluated clinical characteristics, management, and outcomes in patients with active Mtb infection at our institution who had cancer or suspicion of cancer. Methods We retrospectively examined medical records of all patients with laboratory-confirmed active Mtb infection diagnosed between 2006 and 2014. Results A total of 52 patients with laboratory-confirmed active Mtb infection were identified during the study period, resulting in an average rate of 6 new cases per year. Thirty-two (62%) patients had underlying cancer, while 20 (38%) patients did not have cancer but were referred to the institution because of suspicion of underlying malignancy. Among patients with cancer, 18 (56%) had solid tumors; 8 (25%) had active hematologic malignancies; and 6 (19%) had undergone hematopoietic-cell transplantation (HCT). Patients with and without cancer were overall similar with the exception of median age (61 years in cancer patients compared to 53 years in noncancer patients). Pulmonary disease was identified in 32 (62%) patients, extrapulmonary disease in 10 (19%) patients, and disseminated disease in 10 (19%) patients. Chemotherapy was delayed in 53% of patients who were to receive such treatment. Eleven patients (all of whom had cancer) died; 3 of these deaths were attributable to Mtb infection. Conclusions Although not common, tuberculosis remains an important infection in patients with cancer. Approximately one-third of patients were referred to our institution for suspicion of cancer but were ultimately diagnosed with active Mtb infection rather than malignancy.

scholarly journals Unplanned 30-Day Readmissions in a General Internal Medicine Hospitalist Service at a Comprehensive Cancer Center

2015 ◽  
Vol 11 (5) ◽  
pp. 410-415 ◽  
Author(s):  
Joanna-Grace M. Manzano ◽  
Sahitya Gadiraju ◽  
Adarsh Hiremath ◽  
Heather Yan Lin ◽  
Jeff Farroni ◽  
...  
Keyword(s):  
Internal Medicine ◽  
General Internal Medicine ◽  
Readmission Rate ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Unplanned Readmission ◽  
General Internal ◽  
Patients With Cancer

The authors observed a high unplanned readmission rate among their population of patients with cancer.

Cardiopulmonary Resuscitation Outcomes in the Emergency Department of a Comprehensive Cancer Center

2014 ◽  
Vol 46 (2) ◽  
pp. 299-300
Author(s):  
M. Sandoval ◽  
A. Miller ◽  
K. Merriman ◽  
M. Wattana ◽  
V. Page ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiopulmonary Resuscitation ◽  
Comprehensive Cancer Center ◽  
Cancer Center

Improving the Pain Experience for Hospitalized Patients With Cancer

2019 ◽  
pp. 198-207,
Keyword(s):  
Pain Intensity ◽  
Hospitalized Patients ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Evidence Based ◽  
Pain Experience ◽  
Caring Behaviors ◽  
Patients With Cancer ◽  
Knowledge And Attitudes ◽  
Chemotherapy Administration

Purpose: To determine the effect of an evidence-based Pain Stoppers bundled intervention on pain management satisfaction scores and actual pain intensity scores of hospitalized patients with cancer, as well as nurses’ knowledge and attitudes on pain. Participants & Setting: Participants and nurses took part in a preintervention group (n = 173 and 11, respectively) and a postintervention group (n = 157 and 9, respectively) at a National Cancer Institute–designated comprehensive cancer center. Methodologic Approach: A pre- and postintervention design was used. Evidence-based strategies included staff education, improved staff communication, adoption of caring behaviors and timely responses, improved patient education, and efforts to maintain patients’ analgesic levels. Findings: Patient satisfaction with staff improved from preintervention to postintervention. No statistically significant differences were noted in actual pain intensity scores between the groups; however, fewer patients in the postintervention group received chemotherapy within 30 days, and more were admitted for symptom management versus chemotherapy administration. In addition, no difference was noted between RN group scores, although there was statistically significant improvement on individual questions in the postintervention group. Implications for Nursing: Implementation of a Pain Stoppers bundled intervention may be effective in improving the pain experience for hospitalized patients with solid tumor cancers.

Delirium assessment in patients with advanced cancer presenting to the emergency department of a comprehensive cancer center.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 217-217
Author(s):  
Ahmed F. Elsayem ◽  
Alan D. Valentine ◽  
Carla L. Warneke ◽  
Valda D Page ◽  
Eduardo Bruera ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mortality Rate ◽  
Advanced Cancer ◽  
Emergency Departments ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Poor Survival ◽  
Delirium Assessment ◽  
English Speaking ◽  
Md Anderson

217 Background: The exact frequency of delirium among patients with advanced cancer presenting to emergency departments (EDs) is unknown. The purpose of this study is to determine the prevalence of delirium among patients with advanced cancer who present to the ED at MD Anderson Cancer Center. Methods: The exact frequency of delirium among patients with advanced cancer presenting to emergency departments (EDs) is unknown. The purpose of this study is to determine the prevalence of delirium among patients with advanced cancer who present to the ED at MD Anderson Cancer Center. Results: A total of 624 patients were screen for this study, and 243 patients were enrolled. The main reasons for exclusion were: 1) cancer was not advanced, 2) the patient had been in the ED for over 12 hours and 3) the patient was non-English speaking. The median age for all patients enrolled was 62 years (range 19 – 89 years), 167 (69%) were white, and 120(49.4) were female. CAM was positive in 22(9%) of patients. The median MDAS score of CAM positive patients was 14 (range 9 – 22 out of 30). Ten (10%)of 99 patients aged 65 and older were delirious as compared to 12 (8%) of 144 patients younger than 65 years (p = 0.6). Physician correctly predicted delirium in 13 patients (59%). Among the patients who were CAM positive 18 (82%) were admitted to the hospital as compared to 115 (52%) of patients without delirium (p = 0.012). Patients with delirium had higher hospital, and six months mortality rate. Conclusions: Delirium was identified in 9% of patients with advanced cancer visiting an ED, and is associated with more hospitalization and poor survival.

Pastoral care of cancer patients: Defining utilization of services at a comprehensive cancer center.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24171-e24171
Author(s):  
Elizabeth Palmer ◽  
Anghela Paredes ◽  
Madison Hyer ◽  
Timothy M. Pawlik
Keyword(s):  
Pastoral Care ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Spiritual Care ◽  
Cancer Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Spiritual Needs ◽  
Active Listening ◽  
Patients With Cancer

e24171 Background: Addressing the religious/spiritual needs of patients is an important component of comprehensive cancer care. Patients often report that providers infrequently engage them about their needs during treatment. In addition, providers cite inadequate training as a significant barrier to providing spiritual care. While patients may benefit from the presence of a spiritual care specialist during cancer treatment, the utilization and content of these services are not well defined. We sought to characterize utilization of pastoral care (PC) services, as well as delineate differences in PC utilization among patients with cancer. Methods: Data on patients being treated for cancer at a Comprehensive Cancer Center between 2015-2018 were obtained from the electronic medical record. Overall utilization, type of PC services utilized, as well as factors associated with use of PC were assessed. Analyses included descriptive statistics and logistic regression. Results: Among 14,322 cancer patients, roughly one-third (n = 5166, 36.1%) had at least one PC encounter during their cancer treatment. Interventions most frequently provided by PC included supportive presence (93.5%) and active listening (86.6%), while the most frequently explored topics were treatment expectations (59.8%), issues with faith/beliefs (42.9%), and available coping mechanisms (35.4%). Patients diagnosed with colorectal (OR:1.42, 95%CI:1.07-1.89), liver (OR:2.41, 95%CI:1.80-3.24), or pancreatic cancer (OR:1.43, 95%CI:1.02-2.00) were more likely to utilize PC services compared with other cancers. Patients that identified as Catholic (OR:1.47, 95%CI:1.17-1.84) or Christian (OR:1.73, 95%CI:1.39-2.15) were more likely to request PC services (both p < 0.001) than individuals who had no religious preference/affiliation. Among surgical patients (n = 1,174), the majority of encounters with PC services were in the postoperative setting (n = 801, 70.6%). Patients most often reported that PC helped with verbalization of their feelings (93.6%) and helped reduce stress (76.9%). Conclusions: Over one-third of patients with cancer interacted with PC and received services that often addressed both psychosocial and spiritual concerns. Overall PC utilization and types of PC services rendered varied relative to demographic and religious factors. Providers should be aware of varying patient religious/spiritual needs so as to optimize the entire cancer care experience for patients.

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