scholarly journals Urologic Oncology Patient Perspectives During COVID-19 Treatment Delays

2021 ◽  
Author(s):  
Anna Faris ◽  
Lindsey Herrel ◽  
James Montie ◽  
Stephanie Chisholm ◽  
Ashley Duby ◽  
...  
Keyword(s):  
Treatment Delay ◽  
Ordinal Scale ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Oncology Patient ◽  
Urologic Oncology ◽  
Personalized Care ◽  
Phone Calls ◽  
Urologic Cancer ◽  
Clinically Significant

Abstract Purpose The COVID-19 pandemic led to delays in urologic cancer treatment. We sought the patient perspective on these delays. Methods We conducted a mixed methods study with an explanatory-sequential design. Survey findings are presented here. Patients from a Midwestern Comprehensive Cancer Center and the Bladder Cancer Advocacy Network provided demographic and clinical data and responded to statements asking them to characterize their experience of treatment delay, patient-provider communication and coping strategies. We quantified patient distress with an ordinal scale (0-10), based on the National Comprehensive Cancer Network Distress Thermometer (NCCN-DT). Results Forty-four consenting patients responded to the survey. Most were older than 61 years (77%) and male (66%). Their diagnoses included bladder (45%), prostate (30%) and kidney (20%) cancers. Median time since diagnosis was 6 months, 95% had plans for surgical treatment. Dominant reactions to treatment delay included fear that cancer would progress (50%) and relief at avoiding COVID-19 exposure (43%). Most patients reported feeling that their providers acknowledged their emotions (70%), yet 52% did not receive follow up phone calls and only 55% felt continually supported by their providers. Patients’ median distress level was 5/10 with 68% of patients reaching a clinically significant level of distress (≥4). Thematically grouped suggestions for providers included better communication (18%), more personalized support (14%), and better patient education (11%). Conclusion During the COVID-19 pandemic, a high proportion of urologic cancer patients reached a clinically significant level of distress. While they felt concern from providers, they desired more engagement and personalized care.

Characterization of unplanned 30-day medical oncology readmissions after discharge at an academic medical center with a comprehensive cancer center.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 269-269 ◽  
Author(s):  
Inga Tolin Lennes ◽  
Justin Eusebio ◽  
Nie Bohlen ◽  
Margaret Ruddy ◽  
David P. Ryan
Keyword(s):  
Readmission Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Unplanned Readmission ◽  
Oncology Patient ◽  
Hematopoietic Stem ◽  
Medical Oncologists ◽  
Increased Risk

269 Background: Hospital readmission rate is increasingly suggested as a quality care metric. Currently there are no standard criteria for an avoidable readmission in oncology. Although patients with cancer have been identified as being at increased risk of readmission, there has been little to examine the reasons for the oncology patient readmission. The aim was to examine the profiles of patients with an unplanned readmission within 30 days after discharge by an oncology provider and to measure the unplanned 30-day readmission rate. Methods: A retrospective review of oncology provider discharge encounters resulting in a 30-day unplanned readmission during the 2012 calendar year at a tertiary hospital with a comprehensive cancer center was conducted. Planned readmissions for chemotherapy, radiation therapy, hematopoietic stem cell transplantation, dialysis, and surgical procedures, as well as readmissions for rehabilitation, hospice, and psychiatry were excluded. Medical oncologists analyzed medical records for the primary reason of readmission and if the readmission was possibly preventable. Results: Of the 2,944 admissions, a final cohort of 441 unplanned readmissions from 321 unique patients for an unplanned 30-day readmission rate of 14.9% was observed. The average age at admission was 59 (SD 15.9). The cohort was mostly male (56.9%) and White/Caucasian (84.4%). Gastrointestinal (24.0%), lymphoma (18.6%), and leukemia (17.5%) were the most common cancer types. Of those with solid tumors types (n = 225), approximately 70% had metastatic disease. The median time to readmission was 10 days and 10.7% died within 30 days of readmission. Oncology reviewers most commonly assessed that readmission was primarily due to treatment-related effects (46.7%) and the progression of disease (42.2%). Approximately 20% of 30-day readmissions were determined to be possibly preventable, representing 3% of all admissions for the year. Conclusions: Oncology patients readmitted within 30-days frequently present with complicated, advanced disease. A review by medical oncologists suggests there is margin for intervention to reduce 30-day unplanned admissions.

Improving a Grief and Loss Program: Caring for Patients, Families, and Staff

2013 ◽  
Vol 67 (1-2) ◽  
pp. 233-239 ◽  
Author(s):  
Susan A. Wintermeyer-Pingel ◽  
Donna Murphy ◽  
Karen J. Hammelef
Keyword(s):  
Program Evaluation ◽  
Support Groups ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Grief And Loss ◽  
Staff Support ◽  
Care Services ◽  
Grief Support ◽  
Phone Calls ◽  
The University

The University of Michigan Comprehensive Cancer Center (UMCCC) Grief and Loss Program provides supportive care services during bereavement which is considered part of the care continuum. This program received 50 death notifications per month upon project initiation and currently receives approximately 125 per month. Initial program evaluation was conducted via a pilot survey of bereaved parents as well as verbal and written evaluations from the transdisciplinary staff of Patient and Family Support Services. Grief support prior to evaluation included mailings, phone calls as indicated, poorly attended bereavement support groups, and limited staff support. Based on program evaluation, grief support continues through the use of mail/e-mail and phone calls to those at risk for complicated grief. Three to four gatherings per year are offered rather than monthly support groups, and connections to community resources are provided. The Comfort And Resources at End of Life (C-A-R-E) program was implemented to support and educate staff. Next steps include further program evaluation and potential research to examine best practices for the bereaved.

scholarly journals Effects of Center-Based Delivery of Tai Chi and Qi Gong Group Classes on Self-Reported Symptoms in Cancer Patients and Caregivers

2020 ◽  
Vol 19 ◽  
pp. 153473542094160
Author(s):  
Gabriel Lopez ◽  
Santhosshi Narayanan ◽  
Aimee Christie ◽  
Catherine Powers-James ◽  
Wenli Liu ◽  
...  
Keyword(s):  
Tai Chi ◽  
Well Being ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Qi Gong ◽  
Cancer Symptoms ◽  
Significant Difference ◽  
Edmonton Symptom Assessment Scale ◽  
Clinically Significant ◽  
Global Distress

Background: There is increasing interest in complementary approaches such as Tai Chi (TC) and Qi Gong (QG) in oncology settings. We explored the effects of TC/QG delivered in group classes at a comprehensive cancer center. Methods: Patients and caregivers who participated in TC or QG completed assessments before and after an in-person group class. Assessments included questions about expectancy/satisfaction and common cancer symptoms (Edmonton Symptom Assessment Scale [ESAS]). ESAS distress subscales analyzed included global (GDS), physical (PHS), and psychosocial (PSS). Results: Three hundred four participants (184 patients, 120 caregivers) were included in the analysis. At baseline, caregivers had a greater expectancy for change in energy level as a result of class participation compared with patients (22.9% vs 9.9%). No significant difference was observed between baseline patient and caregiver PSS. Clinically significant improvement in well-being was observed among patients in TC classes (1.0) and caregivers in QG classes (1.2). For fatigue, patients (1.4) and caregivers (1.0) participating in QG experienced clinically significant improvement. Both TC and QG classes were associated with clinically significant improvements (ESAS GDS decrease ≥3) in global distress for patients (TC = 4.52, SD= 7.6; QG = 6.05, SD = 7.9) and caregivers (TC = 3.73, SD = 6.3; QG = 4.02, SD = 7.8). Eighty-nine percent of participants responded that their expectations were met. Conclusions: Patients and caregivers participating in TC or QG group classes were satisfied overall and experienced significant improvement in global distress. Additional research is warranted to explore the integration of TC and QG in the delivery of supportive cancer care.

Making treatment decisions at end of life in a comprehensive cancer center.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 51-51
Author(s):  
Anna Catherine Beck ◽  
Lee Ellington ◽  
Kathi Mooney
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Palliative Therapy ◽  
Treatment Decisions ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Optimal Timing ◽  
Phone Calls ◽  
Oncology Providers

51 Background: End of life treatment decisions are challenging for cancer patients and oncology providers. Patients must understand their prognosis and options, deciding if and when to increase palliative care and decrease tumor-focused therapy. Cancer centers committed to offering clinical trials and evaluate new therapies add complexity to these decisions. To better define crucial points for decision making, we reviewed the care patients received during the last 6 months of life at one comprehensive cancer center. Methods: A retrospective chart review was conducted of the 301 cancer patients who died during one calendar year and were treated at the Huntsman Cancer Institute. We abstracted the care documented from all clinic visits, phone calls and hospitalizations including referrals and resources utilized during the last 6 months of life. Results: Men and women were equally represented with a mean age of 61at death and a median survival of 13 months after diagnosis. Over 1780 outpatient visits were documented during the last 6 months of life with treatment decision conversations noted at 68% of visits. Results of these discussions included new chemotherapy initiated at 26% of visits, treatment termination at 19% of visits, palliative therapy only at 9% of visits, and no treatment change at 47% of visits. Of the 64% of patients receiving chemotherapy in the last 6 months, 32% continued therapy in the last 30 days of life. Similarly, 34% of patients received radiation therapy in the last 30 days. Hospice was used by 59% of patients, with a mean length from referral to death of 29 days. Conversations about hospice occurred in 65% of patients with a mean/median of 2 conversations/patient. Approximately 37% of these conversations resulted in hospice enrollment, 49% deferred a decision and in 14% the patient requested additional treatment. Conclusions: Defining optimal timing for stopping cancer directed therapy is challenging in medical and radiation oncology, with 1in 3 patients continuing treatment in the last month of life. Goals of care and hospice conversations were required on multiple occasions, underscoring the need for oncology providers to have highly honed communication skills to minimize futile care and maximize palliative care.

Oral oncolytic education and adherence monitoring in poor, rural and minority patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19212-e19212
Author(s):  
Tiffany Menhorn ◽  
Amy Zarick-Jones ◽  
Moises Harari Turquie ◽  
Shenthol Sasankan ◽  
Neda Hashemi-Sadraei ◽  
...  
Keyword(s):  
Native Americans ◽  
Poverty Rate ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
University Of New Mexico ◽  
Phone Calls ◽  
Adherence Monitoring ◽  
The University ◽  
Oral Oncolytics

e19212 Background: Oral oncolytics therapy use has been exponentially growing over the last several years necessitating education and monitoring. Pharmacy driven interventions have been shown to increase side effects detection, mitigation and ensure adherence. The University of New Mexico Comprehensive Cancer Center (UNMCCC) treats a unique population composed of poor (poverty rate 19.7%), rural (22.6%) and minority (Native Americans and Hispanics constitute 10.4% and 48% of the population respectively). Methods: New patients starting oral oncolytics were enrolled from May 2019 to January 2020 with an initial 30-minute educational visit with a pharmacist. UNMCCC initiated a pharmacy driven process of tracking patients via phone calls to monitor compliance, early presence of adverse events and issues surrounding the administration of oral oncolytics. Phone calls were conducted monthly for three months and then spaced out depending on patient and drug characteristics. Late education occurred when the initial education was performed after the patient started chemotherapy. Late first follow-ups occurred when the follow-up date was greater thirty-eight days after the start of chemotherapy. Results: A total of 196 patients started on oral chemotherapy of which 70% (139) received education following prescription, 17% (35) received late education and 11% (22) missed education. Newly started actively monitored patients significantly increased to 196 patients by the ninth month of the program. A total of 296 follow ups calls were performed within the first three months, 41% (111) were considered late follow-up. The first, second and third call were missed in 18% (49), 14% (40) and 16% (45) of patients. Conclusions: The UNMCCC cares for poor, rural and minority based patients and was able to reach the majority of patients in a timely manner for education and adherence monitoring. Our efforts were significantly hampered by the increasing number of active patients needing monitoring as the program progressed which will require further resources including, a close collaboration between physicians and pharmacists to provide a service that was previously absent and process changes which we are addressing as our next steps.

A pilot study about methods to reduce prescription errors in a chemotherapy day unit – Aspects to consider in pharmacist verification process

2021 ◽  
pp. 107815522110665
Author(s):  
Asta Kähkönen ◽  
Sanna Eestilä ◽  
Kirsi Kvarnström ◽  
Riikka Nevala
Keyword(s):  
Medication Errors ◽  
Clinical Pharmacist ◽  
University Hospital ◽  
Medical Documentation ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Prescribing Errors ◽  
Common Error ◽  
Training Requirements ◽  
Clinically Significant

Introduction Prescribing errors can happen unintentionally during the prescribing process, or when choosing a treatment therapy. Prescribing errors have the highest prevalence amongst common error types related to chemotherapy medication in outpatient settings. According to the Joint Commission International (JCI), prescriptions should be reviewed for appropriateness by someone else than the prescriber or practitioner to prevent medication errors. Aim The study was aimed to map out the existing type and amount of occurring deviations in prescribing and to clarify the current chemotherapy prescribing practices at the Comprehensive Cancer Center at Helsinki University Hospital. Similar research has not been published in Finland before. Methods and patients The researcher selected patients randomly from the daily outpatient attendance list following a predetermined numerical order. Data was collected by conducting a medication verification review in line with the JCI guidance by a clinical pharmacist the day before the patient's clinic appointment using the available medical documentation. A clinical pharmacist evaluated findings from prescriptions and contacted an oncologist if the findings were considered clinically significant. Results A clinical pharmacist verified prescriptions from 101 patients for appropriateness and found discrepancies in four percent of the prescriptions ( n = 4/101). The oncologist approved 50 percent of the suggested amendments by the pharmacist as clinically significant ( n = 2/4). The study revealed that patient’s regular home medications were not always correctly recorded into the database, so verification of medicine interactions could not be trusted as completely accurate. It took on average 16 min per patient to perform a medication verification review. The process was slowed down by the lack of detailed enough protocols for this purpose and the current patient care record system not having structural formatting of data entry. Conclusions Verification of prescriptions provides a tool to identify prescribing discrepancies and to prevent unintended medication errors affecting patients. The development of detailed protocols and guidelines, as well as an appropriate training program, would support pharmacists in compiling clinical medication reviews for chemotherapy patients. More research is needed to further develop the operating model in Finland. Information gathered from this study can be used for identifying training requirements.

Protection of Intraluminal Pathway with Zero Fluid Displacement Connector Reduces Catheter-Related Bloodstream Infections in a Comprehensive Cancer Center

2012 ◽  
Vol 17 (2) ◽  
pp. 86-89 ◽  
Author(s):  
Brenda Caillouet
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Bloodstream Infections ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Infusion Therapy ◽  
Oncology Patient ◽  
Fluid Displacement ◽  
Positive Displacement ◽  
Project Description

Abstract Background/Purpose: Although annual rates of catheter-related bloodstream infections (CR-BSI) in a comprehensive cancer center were below the national average, further reductions were sought. Research indicates that contamination of a catheter's intraluminal pathway is a major cause of CR-BSI. Connectors are the gateway to the intraluminal pathway and studies link positive displacement, negative displacement, and split septum connectors to CR-BSI. Project Description: The infusion therapy team piloted a zero fluid displacement (ZFD) connector based on the design of the ZFD, which appeared uniquely suited to CR-BSI prevention. A product trial was performed in intensive care units to compare the CR-BSI rates associated with the current split septum connector to the ZFD connector. The design was quantitative and quasiexperimental. Results: During the trial, CR-BSI rates decreased from 4.2 (2,331 catheter days) with the split septum connector, to 0.4 (2,477 catheter days) with the ZFD connector. Six months after institutional implementation of the ZFD connector there were zero CR-BSI in the intensive care units across 4,424 catheter days, despite the complexity and acuity of a largely immunocompromised oncology patient population. The previous 6 months with the split septum the CR-BSI rate was 2.24 across 4,920 catheter days. Conclusions: Our institution's success suggests that protecting the intraluminal pathway with a properly designed connector may be more crucial to the prevention bundle than is widely understood or practiced. Other hospitals may achieve comparable results by implementing a similar device.

scholarly journals Group Yoga Effects on Cancer Patient and Caregiver Symptom Distress: Assessment of Self-reported Symptoms at a Comprehensive Cancer Center

2018 ◽  
Vol 17 (4) ◽  
pp. 1087-1094 ◽  
Author(s):  
Gabriel Lopez ◽  
Alejandro Chaoul ◽  
Catherine Powers-James ◽  
Carol A Eddy ◽  
Smitha Mallaiah ◽  
...  
Keyword(s):  
Symptom Assessment ◽  
Well Being ◽  
Psychosocial Health ◽  
Assessment System ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Meaningful Improvement ◽  
Yoga Group ◽  
Before And After ◽  
Clinically Significant

Background. Complementary and integrative health approaches such as yoga provide support for psychosocial health. We explored the effects of group-based yoga classes offered through an integrative medicine center at a comprehensive cancer center. Methods. Patients and caregivers had access to two yoga group classes: a lower intensity (YLow) or higher intensity (YHigh) class. Participants completed the Edmonton Symptom Assessment System (ESAS; scale 0-10, 10 most severe) immediately before and after the class. ESAS subscales analyzed included global (GDS; score 0-90), physical (PHS; 0-60), and psychological distress (PSS; 0-20). Data were analyzed examining pre-yoga and post-yoga symptom scores using paired t-tests and between types of classes using ANOVAs. Results. From July 18, 2016, to August 8, 2017, 282 unique participants (205 patients, 77 caregivers; 85% female; ages 20-79 years) attended one or more yoga groups (mean 2.3). For all participants, we observed clinically significant reduction/improvement in GDS, PHS, and PSS scores and in symptoms (ESAS decrease ≥1; means) of anxiety, fatigue, well-being, depression, appetite, drowsiness, and sleep. Clinically significant improvement for both patients and caregivers was observed for anxiety, depression, fatigue, well-being, and all ESAS subscales. Comparing yoga groups, YLow contributed to greater improvement in sleep versus YHigh (−1.33 vs −0.50, P = .054). Improvement in fatigue for YLow was the greatest mean change (YLow −2.12). Conclusion. A single yoga group class resulted in clinically meaningful improvement of multiple self-reported symptoms. Further research is needed to better understand how yoga class content, intensity, and duration can affect outcomes.

Does a treatment delay affect the survival of octogenarian patient population?

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 149-149
Author(s):  
Ali Mehmood Raufi ◽  
Hassaan Jafri ◽  
Todd W. Gress
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Patient Population ◽  
Gynecological Cancer ◽  
Eastern Cooperative Oncology Group ◽  
Treatment Delay ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Cancer Management ◽  
The Impact

149 Background: The cancer management of the elderly patient is an increasingly important and challenging issue. The aim of this retrospective analysis is to evaluate the impact of treatment delay on survival outcome of cancer in octogenarian patients. Methods: From 2006 to 2015, established cancer patients age 80 and above who received treatment at our comprehensive cancer center were retrospectively reviewed. We evaluated the relationship between a delay in cancer treatment of more than 30 days in the octogenarian patient and survival using Kaplan-Meier survival and Cox proportional hazards models. Results: There were 235 octogenarian cancer patients available for evaluation and 115 of these had a delay in initiation of cancer treatment ( > 30 days). Mean age was 83.7 years the treatment delay (TD) group and 83.9 in the no treatment delay (NTD) group (p = 0.70) Eastern Cooperative Oncology Group (ECOG) score of 2 or more was present in 22.6% of the TD group and 18.3% of the NTD group (p = 0.42). Metastatic disease was higher in the NTD group (22.5% vs. 11.3% TD group; p = 0.051). There were more breast (36.5% TD vs. 12.5% NTD group) and lung cancer (26.9% TD vs. 18.3% NTD group) in the TD group, and more genitourinary (20.8% NTD vs. 9.6% TD group) and gynecological cancer (20.8% NTD vs. 15.6% TD group) in the NTD group (p < 0.001 for overall comparison). Median overall survival was higher in the TD group (50 vs. 24 months NTD group; p = 0.001). Treatment delay was still associated with improved survival even after adjusting for age, gender, ECOG, stage of disease, and type of tumor (HR 0.64, CI 0.44-0.92). Conclusions: We found that a delay in cancer treatment in the octogenarian patient was associated with better overall survivial. Bias in regards to the reasons for the treatment delay may exist and could have affected our results. We attempted to minimize this bias by adjusting for characteristics that influence treatment between our two study groups. Nevertheless, our findings suggest that a delay in cancer treatment at minimum did not adversely affect mortality in this older patient population.

Outpatient acupuncture effects on patient self-reported symptoms in oncology care: A retrospective analysis of real-world data.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 135-135
Author(s):  
Gabriel Lopez ◽  
M. Kay Garcia ◽  
Wenli Liu ◽  
Michael Spano ◽  
Susan Underwood ◽  
...  
Keyword(s):  
Initial Treatment ◽  
Hot Flashes ◽  
Well Being ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Poor Sleep ◽  
Real World Data ◽  
Edmonton Symptom Assessment Scale ◽  
Clinically Significant

135 Background: Increased access to complementary therapies such as acupuncture at academic medical centers has created new opportunities for management of cancer and cancer treatment related symptoms. Methods: Patients presenting for acupuncture treatment during calendar year 2016 at an outpatient integrative medicine clinic in a comprehensive cancer center were asked to complete a modified Edmonton Symptom Assessment Scale (ESAS; 16 symptoms, score 0-10, 10 worst possible) before and after each visit. ESAS subscales analyzed included global (GDS; score 0-90), physical (PHS, 0-60), and psychological distress (PSS, 0-20). ESAS symptom score change pre/post treatment and from baseline visit to first follow up were evaluated by paired t-test. Results: Of 375 participants [mean age 55.6, 68.3% female, 73.9% white, most common cancer diagnosis of breast (32.8%) and thoracic/head&neck (25.9%)], 73.3% had at least one follow-up treatment [mean 4.6 (SD 5.1) treatments]. Highest/worst symptoms at baseline were poor sleep (3.92), fatigue (3.43), well-being (3.31), and pain (3.29). Statistically significant reduction/improvement (pre/post) was observed for all ESAS symptoms and subscales for the initial treatment (p <0.001). Hot flashes had the highest mean reduction (-1.93), followed by fatigue (-1.72), numbness/tingling (-1.70), and nausea (-1.67). Clinically significant reductions were also observed for ESAS subscales of GDS (-12.2), PHS (-8.5), and PSS (-2.6). For symptom change from initial treatment to first follow-up (pre/pre), statistically and clinically significant improvement was observed for spiritual pain (-1.10; p<0.001) and ESAS subscale of GDS (-6.09; p=0.048). Clinical response rates (reduction ≥1) on follow-up were highest for symptoms of spiritual pain (58.9%), dry mouth (57.8%) and nausea (57.3%). Conclusions: Outpatient acupuncture was associated with immediate and longitudinal significant improvement across a range of symptoms commonly experienced by individuals during cancer care. Further research is needed to better understand frequency of treatments needed in clinical practice to help maintain benefit.

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