Clinical Vignettes: Integrated Care of Cancer Patients by Oncologists and Cardiologists

6081 Background: Breast carcinoma is a large health care concern for patients, physicians, and society. 2.5 million women have been treated for breast cancer and are candidates for surveillance in the US. We have documented dramatic variation in post-treatment surveillance strategies utilized by ASCO experts caring for such patients. Since it is often asserted that younger physicians order more tests than older physicians, we sought to measure the effect of clinician age on post-treatment surveillance intensity for breast cancer patients by analyzing a recent survey of ASCO members. Methods: We surveyed the 3245 ASCO members who indicated that breast cancer treatment was a major focus of their practice. 4 succinct clinical vignettes describing generally healthy women with breast cancer of varying prognoses and a menu of 12 surveillance modalities were offered. The menu was chosen after a literature search indicated that no other surveillance tests were commonly used. We analyzed data from one of the 4 idealized vignettes only (the patient with TNM IIA carcinoma) and stratified responses by clinician age. Practice patterns were compared by years after completion of training (0-10, 11-20, 21-30, 30-40, >40 years), a surrogate measure of physician age. Statistical analysis employed ANOVA. Results: There were 1012 responses; 915 were evaluable. Statistically significant differences were observed across age strata for CBC, liver function tests (LFTs), and serum CEA level only. For example, ASCO clinicians in practice for 0-10 years after completion of training recommended CBCs 1.3 + 1.4 (mean + SD) times in year 1. Those > 40 years after completion of training recommended CBCs 2.4 + 1.3 times in year 1 (p<0.001). Conclusions: Younger physicians recommend statistically significantly fewer CBCs, LFTs, and serum CEA levels during post-treatment surveillance than older physicians. However, the magnitude of the difference is clinically small for all 3 modalities and does not explain the known overall variation in surveillance practice among clinically active experts.

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What are the best terms in Portuguese to explain the concepts of “fatigue” and “depression” in cancer patients?

Palliative & Supportive Care ◽

10.1017/s1478951514000868 ◽

2014 ◽

Vol 13 (4) ◽

pp. 991-996

Author(s):

Carlos Eduardo Paiva ◽

Luciana Lopes Manfredini ◽

Bianca Sakamoto Ribeiro Paiva ◽

Estela Cristina Carneseca ◽

Sriram Yennurajalingam ◽

...

Keyword(s):

Cancer Patients ◽

English Language ◽

Rating Scales ◽

Pearson Correlation ◽

Depression Scale ◽

Cancer Related Fatigue ◽

Clinical Vignettes ◽

Pearson Correlation Analysis ◽

Positive Correlations ◽

Numeric Rating

AbstractObjective:Although “fatigue” and “depression” are well-accepted clinical terms in the English language, they are ill defined in many other languages, including Portuguese. We aimed to investigate the most appropriate words to describe cancer-related fatigue (CRF) and depression in Brazilian cancer patients.Method:The interviewers read to patients two clinical vignettes describing fatigued patients and two others describing depressed patients. Participants were asked to choose from among “fatigue,” “tiredness,” “weakness,” “depression,” and “sadness” the best and worst terms to explain the vignettes. In addition, they were administered an instrument containing numeric rating scales (NRSs), addressing common symptoms, including the aforementioned terms. Pearson correlation analysis and accuracy diagnostic tests were conducted using the Hospital Anxiety and Depression Scale (HADS) and the Functional Assessment of Cancer Treatment–Fatigue (FACIT–F) as references.Results:Among the 80 participants, 40% reported that the best term to explain the concept of CRF was “tiredness,” and 59% chose “sadness” as the best descriptor of depression. Regarding diagnostic accuracy, the areas under the curve (AUCs) for “fatigue,” “weakness,” and “tiredness” were 0.71, 0.81, and 0.76, respectively; the AUCs for “depression” and “sadness” ranged from 0.81 to 0.91 and 0.73 to 0.83, respectively. Negative correlations were found among FACIT–F fatigue subscale scores and NRS scores for “fatigue” (r = –0.58), “tiredness” (r = –0.67), and “weakness” (r = –0.62). Regarding depression, there were positive correlations between HADS–D scores and both NRS for “depression” (r = 0.61) and “sadness” (r = 0.54).Significance of results:“Tiredness” was considered the best descriptor of CRF. Taking into consideration the clinical correlation with depression scores, the term “depression” was accepted as the best term to explain the concept of depression.

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How the COVID-19 Pandemic Impacted on Integrated Care Pathways for Lung Cancer: The Parallel Experience of a COVID-Spared and a COVID-Dedicated Center

Frontiers in Oncology ◽

10.3389/fonc.2021.669786 ◽

2021 ◽

Vol 11 ◽

Author(s):

Giulia Pasello ◽

Jessica Menis ◽

Sara Pilotto ◽

Stefano Frega ◽

Lorenzo Belluomini ◽

...

Keyword(s):

Lung Cancer ◽

Integrated Care ◽

Cancer Patients ◽

Early Stage ◽

Locally Advanced ◽

University Hospital ◽

Care Pathways ◽

Systemic Treatments ◽

Integrated Care Pathways ◽

The Impact

IntroductionThe COVID-19 pandemic has proved to be a historic challenge for healthcare systems, particularly with regard to cancer patients. So far, very limited data have been presented on the impact on integrated care pathways (ICPs).MethodsWe reviewed the ICPs of lung cancer patients who accessed the Veneto Institute of Oncology (IOV)/University Hospital of Padua (Center 1) and the University Hospital of Verona (Center 2) before and after the COVID-19 pandemic, through sixteen indicators chosen by the members of a multidisciplinary team (MDT).ResultsTwo window periods (March and April 2019 and 2020) were chosen for comparison. Endoscopic diagnostic procedures and major resections for early stage NSCLC patients increased at Center 1, where a priority pathway with dedicated personnel was established for cancer patients. A slight decrease was observed at Center 2 which became part of the COVID unit. Personnel shortage and different processing methods of tumor samples determined a slightly longer time for diagnostic pathway completion at both Centers. Personnel protection strategies led to a MDT reshape on a web basis and to a significant selection of cases to be discussed in both Centers. The optimization of patient access to healthcare units reduced first outpatient oncological visits, patient enrollment in clinical trials, and end-of-life cancer systemic treatments; finally, a higher proportion of hypofractionation was delivered as a radiotherapy approach for early stage and locally advanced NSCLC.ConclusionsBased on the experience of the two Centers, we identified the key steps in ICP that were impacted by the COVID-19 pandemic so as to proactively put in place a robust service provision of thoracic oncology.

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New organizational model to foster good practice. Central venous access management in cancer patients

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.045 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

G Mastrandrea ◽

F Cangialosi ◽

P Notarangelo ◽

G Chetta ◽

E A Graps

Keyword(s):

Integrated Care ◽

Cancer Patients ◽

Medical Devices ◽

Remote Monitoring ◽

Central Venous Access ◽

Venous Access ◽

Access Management ◽

Central Venous ◽

Management Procedures ◽

Health And Social Care

Abstract Issue Central Venous Access positioning is a common practice in cancer patients, however improper devices' management lead to complications and multiple accesses to hospital services, increasing costs. Assessment and certification of Central Venous Access insertion site at hospital so as proper dressing at home, are required; patient empowerment in management of complex technologies is desirable to improve outcomes. Problem Description To tackle the abovementioned issues, PICC project was drawn up in joint action between the Strategic Health and Social care Agency and the Research Institute on Cancer in Puglia. The aim is to pilot an organisational model for central venous access positioning and remote monitoring barely technology driven and based on safe storage of outcomes pictures, patient/care-givers empowerment, integrated care approach. A sistematic review of good practices for Central Venous Access management was conducted in june 2019; besides an analysis of medical devices public procurement procedures was performed at national scale; a survey was edited to probe the existence of diverse organisational models to insert and manage Central Venous Access. Results Very preliminary data are avalaible. Procurement analysis showed: around 15 companies of Central Venous Access and related medical devices' producers; a spread of Central Venous Access location medical devices/supply of services based on few firms (including consumables). The analysis helps to identify the “least common multiple” in technologic equipment to support Central Venous Access management to develop a standard and applicable model, not driven by a conditioning “starting choice” (catheter selection, tip location, dressings). Lessons A standard Central Venous Access management certification procedure can be realized regardless of potential technology driven approach. A Central Venous Access remote monitoring model based on images and empowered patients can allow daily review fostering integrated care. Key messages Patients’ proper training, even in complex technologies usage, can increase self awareness and empowerment and promote compliance to innovative organizational models. Collaboration among patients – caregivers and professionals, set up of a dynamic pictures store to record Central Venous Access management procedures can improve oucomes avoiding added costs.

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A feasibility trial of geriatric assessment and integrated care plan for older cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.15_suppl.10054 ◽

2016 ◽

Vol 34 (15_suppl) ◽

pp. 10054-10054 ◽

Cited By ~ 2

Author(s):

Martine Puts ◽

Schroder Sattar ◽

Mary Ellen Macdonald ◽

Michael Kulik ◽

Kara McWatters ◽

...

Keyword(s):

Integrated Care ◽

Cancer Patients ◽

Geriatric Assessment ◽

Care Plan ◽

Feasibility Trial ◽

Older Cancer Patients

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Integrated care for cancer patients with depression is effective

The Pharmaceutical Journal ◽

10.1211/pj.2014.20066288 ◽

2014 ◽

Keyword(s):

Integrated Care ◽

Cancer Patients

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Professionally perceived effectiveness of psychosocial interventions for existential suffering of terminally ill cancer patients

Palliative Medicine ◽

10.1191/0269216303pm825oa ◽

2003 ◽

Vol 17 (8) ◽

pp. 688-694

Author(s):

Kei Hirai ◽

Tatsuya Morita ◽

Tetsuo Kashiwagi

Keyword(s):

Palliative Care ◽

Integrated Care ◽

Cancer Patients ◽

Terminally Ill ◽

Psychosocial Interventions ◽

Skills Training ◽

Underlying Structure ◽

Perceived Effectiveness ◽

Terminally Ill Cancer Patients ◽

Existential Suffering

Background: Although integrated care for existential suffering is an essential part of palliative care, little is known about its concept and efficacy as perceived by professionals. A questionnaire survey was carried out to 1) explore the underlying structure of psychosocial interventions recommended by specialists, 2) identify the professionally perceived effectiveness of each intervention for specific existential distress, and 3) examine the effects of specialty on their recommendations. Methods: A questionnaire with three scenarios representing terminally ill cancer patients with uncertainty-related anxiety, guilt feelings, and dependency-related meaninglessness was mailed to 701 Japanese psychiatrists, 118 psychologists, and 372 palliative care nurses. Results: A total of 456 responses were obtained (response rate = 38%). Recommended psychosocial interventions were classified into six subcategories: ’a supportive-expressive approach,fl’providing comfortable environments,fl’meaning-centered approach,fl’being,fl’education and coping skills training,fland ’a religious approach.flA ’supportive-expressive approachflwas consistently recommended in all vignettes. On the other hand, ’providing comfortable environmentsflwas most recommended for patients with uncertainty-related anxiety, and a ’meaning-centered approachfland ’beingflwere most recommended for patients feeling dependency-related meaninglessness. Psychiatrists estimated the effectiveness of psychopharmacological treatment significantly higher than psychologists and nurses, while nurses evaluated efficacy of all other interventions significantly higher than psychiatrists and psychologists. Conclusions: Experts evaluated a variety of clinical interventions as effective in palliating existential suffering, although the perceived levels of efficacy of each intervention differed according to the nature of suffering and their specialties. To effectively alleviate existential suffering in terminally ill cancer patients, an integrated care by an interdisciplinary team is necessary.

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