Addressing the Disparities and the Factors Related to Prolonged Inpatient Length of Stay for Solid Tumor Oncology Patients during the COVID-19 Pandemic: A Narrative Review

Solid tumor oncology treatments are primarily performed in the outpatient setting. However, hospitalizations are inevitable due to complications of cancer and treatment-related toxicities. With rising health care spending, the length of hospital stay (LOS) is increasingly considered a proxy for healthcare costs. There are several ongoing efforts to abbreviate the inpatient LOS and ensure a safe and timely discharge to the outpatient setting. In addition to the acute illness and the associated comorbidities, various factors affect the LOS: social determinants of health, nutritional status in cancer patients, and endof- life issues. Furthermore, it is unclear how the institutional policies on social distancing and visitation during the current coronavirus disease (COVID-19) pandemic may impact the LOS. The purpose of this article is to review various factors and barriers that lead to longer LOS for solid tumor patients during the COVID 19 pandemic, and identify the critical areas of quality improvement.

Download Full-text

Addressing the disparities and the factors related to prolonged inpatient length of stay for solid tumor oncology patients during the COVID-19 pandemic: A narrative review

Journal of Radiology and Oncology ◽

10.29328/journal.jro.1001038 ◽

2021 ◽

Vol 5 (3) ◽

pp. 046-053

Author(s):

S Kamaraju ◽

M Mohan ◽

T Wright ◽

J Charlson ◽

W Wiger ◽

...

Keyword(s):

Solid Tumor ◽

Length Of Hospital Stay ◽

Outpatient Setting ◽

Acute Illness ◽

Health Care Spending ◽

Tumor Patients ◽

Critical Areas ◽

Life Issues ◽

End Of Life Issues ◽

Inpatient Length Of Stay

Solid tumor oncology treatments are primarily performed in the outpatient setting. However, hospitalizations are inevitable due to complications of cancer and treatment-related toxicities. With rising health care spending, the length of hospital stay (LOS) is increasingly considered a proxy for healthcare costs. There are several ongoing eff orts to abbreviate the inpatient LOS and ensure a safe and timely discharge to the outpatient setting. In addition to the acute illness and the associated comorbidities, various factors aff ect the LOS: social determinants of health (SDOH), nutritional status in cancer patients, and end-of-life issues. Furthermore, it is unclear how the institutional policies on social distancing and visitation during the current coronavirus disease (COVID-19) pandemic may impact the LOS. The purpose of this article is to review various factors and barriers that lead to longer LOS for solid tumor patients during the COVID-19 pandemic, and identify the critical areas of quality improvement.

Download Full-text

A TTP-incorporated scoring model for predicting mortality of solid tumor patients with bloodstream infection caused by Escherichia coli

Supportive Care in Cancer ◽

10.1007/s00520-021-06442-z ◽

2021 ◽

Author(s):

Qing Zhang ◽

Hao-Yang Gao ◽

Ding Li ◽

Chang-Sen Bai ◽

Zheng Li ◽

...

Keyword(s):

Escherichia Coli ◽

High Risk ◽

Bloodstream Infection ◽

Solid Tumor ◽

Prognostic Scores ◽

Risk Scores ◽

Youden Index ◽

Tumor Patients ◽

Scoring Model ◽

Significant Difference

Abstract Background Few mortality-scoring models are available for solid tumor patients who are predisposed to develop Escherichia coli–caused bloodstream infection (ECBSI). We aimed to develop a mortality-scoring model by using information from blood culture time to positivity (TTP) and other clinical variables. Methods A cohort of solid tumor patients who were admitted to hospital with ECBSI and received empirical antimicrobial therapy was enrolled. Survivors and non-survivors were compared to identify the risk factors of in-hospital mortality. Univariable and multivariable regression analyses were adopted to identify the mortality-associated predictors. Risk scores were assigned by weighting the regression coefficients with corresponding natural logarithm of the odds ratio for each predictor. Results Solid tumor patients with ECBSI were distributed in the development and validation groups, respectively. Six mortality-associated predictors were identified and included in the scoring model: acute respiratory distress (ARDS), TTP ≤ 8 h, inappropriate antibiotic therapy, blood transfusion, fever ≥ 39 °C, and metastasis. Prognostic scores were categorized into three groups that predicted mortality: low risk (< 10% mortality, 0–1 points), medium risk (10–20% mortality, 2 points), and high risk (> 20% mortality, ≥ 3 points). The TTP-incorporated scoring model showed excellent discrimination and calibration for both groups, with AUC being 0.833 vs 0.844, respectively, and no significant difference in the Hosmer–Lemeshow test (6.709, P = 0.48) and the chi-square test (6.993, P = 0.46). Youden index showed the best cutoff value of ≥ 3 with 76.11% sensitivity and 79.29% specificity. TTP-incorporated scoring model had higher AUC than no TTP-incorporated model (0.837 vs 0.817, P < 0.01). Conclusions Our TTP-incorporated scoring model was associated with improving capability in predicting ECBSI-related mortality. It can be a practical tool for clinicians to identify and manage bacteremic solid tumor patients with high risk of mortality.

Download Full-text

Clinical prediction of bacteremia and early antibiotics therapy in patients with solid tumors

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.314 ◽

2021 ◽

pp. 1-7

Author(s):

Jonathan M. Hyak ◽

Mayar Al Mohajer ◽

Daniel M. Musher ◽

Benjamin L. Musher

Keyword(s):

Solid Tumors ◽

Solid Tumor ◽

Cardiopulmonary Arrest ◽

Tertiary Care ◽

Organ Transplant ◽

Antibiotic Use ◽

Care Hospital ◽

Tumor Patients ◽

Binomial Regression ◽

Sirs Criteria

Abstract Objective: To investigate the relationship between the systemic inflammatory response syndrome (SIRS), early antibiotic use, and bacteremia in solid-tumor patients. Design, setting, and participants: We conducted a retrospective observational study of adults with solid tumors admitted to a tertiary-care hospital through the emergency department over a 2-year period. Patients with neutropenic fever, organ transplant, trauma, or cardiopulmonary arrest were excluded. Methods: Rates of SIRS, bacteremia, and early antibiotics (initiation within 8 hours of presentation) were compared using the χ2 and Student t tests. Binomial regression and receiver operator curves were analyzed to assess predictors of bacteremia and early antibiotics. Results: Early antibiotics were administered in 507 (37%) of 1,344 SIRS-positive cases and 492 (22%) of 2,236 SIRS-negative cases (P < .0001). Of SIRS-positive cases, 70% had blood cultures drawn within 48 hours and 19% were positive; among SIRS negative cases, 35% had cultures and 13% were positive (19% vs 13%; P = .003). Bacteremic cases were more often SIRS positive than nonbacteremic cases (60% vs 50%; P =.003), but they received early antibiotics at similar rates (50% vs 49%, P = .72). Three SIRS components predicted early antibiotics: temperature (OR, 1.7; 95% CI, 1.31–2.29; P = .0001), tachycardia (OR, 1.4; 95% CI, 1.10–1.69; P < .0001), and white blood-cell count (OR, 1.8; 95% CI, 1.56–2.14; P < .0001). Only temperature (OR, 1.6; 95% CI, 1.09–2.41; P = .01) and tachycardia (OR, 1.5; 95% CI, 1.09–2.06; P = .01) predicted bacteremia. SIRS criteria as a composite were poorly predictive of bacteremia (AUC, 0.57). Conclusions: SIRS criteria are frequently used to determine the need for early antibiotics, but they are poor predictors of bacteremia in solid-tumor patients. More reliable models are needed to guide judicious use of antibiotics in this population.

Download Full-text

150O Clinical safety and activity from a phase 1 study of LOXO-101, a selective TRKA/B/C inhibitor, in solid-tumor patients with NTRK gene fusions

Annals of Oncology ◽

10.1093/annonc/mdw579.002 ◽

2016 ◽

Vol 27 (suppl_9) ◽

Cited By ~ 1

Author(s):

D.S. Hong ◽

A. Dowlati ◽

H.A. Burris ◽

J.J. Lee ◽

M.S. Brose ◽

...

Keyword(s):

Solid Tumor ◽

Phase 1 ◽

Gene Fusions ◽

Tumor Patients ◽

Phase 1 Study ◽

Clinical Safety

Download Full-text

A COMPARATIVE STUDY OF EFFICACY, POTENCY AND RECOVERY OF INTRATHECAL 0.5% ROPIVACAINE WITH FENTANYLAND 0.5% LEVOBUPIVACAINE WITH FENTANYL IN LOWER ABDOMINAL SURGERIES IN PATIENTS OF 18-60YEARS OF AGE

10.36106/ijsr/6220134 ◽

2021 ◽

pp. 74-76

Author(s):

Payel Mitra ◽

Archana Roy ◽

Aamir Huda

Keyword(s):

Comparative Study ◽

Motor Block ◽

Length Of Hospital Stay ◽

Cost Effective ◽

Outpatient Setting ◽

P Value ◽

Equal Concentration ◽

Medical College ◽

Institutional Ethics ◽

Care Surgery

INTRODUCTION:The recent trend in health care centres everywhere is to provide cost effective care to the patients. There is an increasing trend towards ambulatory day care surgery and rapid discharge of the patients. The operation of inguinal hernia or incisional hernia and even simple ligation surgeries are done without much complexities nowadays and can be completed in 60-90min without much intra or postoperative complications. Hence these have become an ideal procedure for outpatient setting and thereby reducing length of hospital stay. AIMS AND OBJECTIVE:A comparative study of efcacy, potency and recovery of intrathecal 0.5% ropivacaine with fentanyl and 0.5% levobupivacaine with fentanyl in lower abdominal surgeries in patients of 18-60years of age. MATERIALS AND METHOD: This is a prospective, comparative, observational study was conducted on 60 patients undergoing various lower abdominal surgeries under subarachnoid block (SAB) at Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal. This study was conducted over a period of 24-month. Approval of the Institutional Ethics Committee was taken. Awritten informed consent in the local language was taken from every patient. RESULT AND ANALYSIS: In RF 5 patients (17%) had onset at 3min, 17patients (57%) at 6min, 7 patients (23%) at 9min, 1 patient (3%) at 12min. In LBF 8 patients had onset at 0 min, 22 patients had onset at 3min. p value is less than 0.0001 which is statistically signicant. In RF, 23 patients (77%) had duration of motor block for 150min and 7 patients (23%) had for 180min. In LBF, 26 patients (87%) had duration of motor block for 210 min and 4 patients (13%) had for 180min. The p value is less than 0.0001, which is statistically signicant. SUMMARYAND CONCLUSION: This study was to compare potency, efcacy and recovery between the two groups of drugs. A potency of a drug is a measure of drug activity expressed in terms of the amount required to produce an effect of given intensity. Here both the drugs in comparison was given in equal concentration and found that levobupivacaine produced higher effect, reached Bromage 3 in lesser time than ropivacaine. So levobupivacaine was more potent drug. Efcacy is the ability to get a job done satisfactorily

Download Full-text