scholarly journals 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

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.

INTEGRATED CARE PATHWAYS IN LUNG CANCER: A QUALITY IMPROVEMENT PROJECT

2018 ◽  
Vol 34 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Gianpiero Fasola ◽  
Jessica Menis ◽  
Alessandro Follador ◽  
Elisa De Carlo ◽  
Francesca Valent ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Quality Improvement ◽  
Integrated Care ◽  
Real Life ◽  
University Hospital ◽  
Care Pathways ◽  
Improvement Project ◽  
Managerial Skills ◽  
Integrated Care Pathways ◽  
Nsclc Patients

Background:Non small cell lung cancer (NSCLC) diagnosis and treatment is a highly complex process, requiring managerial skills merged with clinical knowledge and experience. Integrated care pathways (ICPs) might be a good strategy to overview and improve patient's management. The aim of this study was to review the ICPs of NSCLC patients in a University Hospital and to identify areas of quality improvement.Materials and Methods:The electronic medical records of 169 NSCLC patients visited at the University Hospital were retrospectively reviewed. Quality of care (QoC) has been measured trough fifteen indicators, selected according main international Guidelines and approved by the multi-disciplinary team for thoracic malignancies. Results have been compared with those of a similar retrospective study conducted at the same hospital in 2008.Results:A total of 146 patients were considered eligible. Eight of fifteen indicators were not in line with the benchmarks. We compared the results obtained in the two separate periods. Moreover, we process some proposal to be discussed with the general management of the hospital, aimed to redesign NSCLC care pathways.Conclusions:ICPs confirm to be feasible and to be an effective tool in real life. The periodic measurement of QoC indicators is necessary to ensure clinical governance of patients pathways.

scholarly journals Real Life Data on Patient-Reported Outcomes and Neuro-Cognitive Functioning of Lung Cancer Patients: The PRO-Long Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Lotte Van Der Weijst ◽  
Veerle Surmont ◽  
Wim Schrauwen ◽  
Yolande Lievens
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Visual Memory ◽  
Patient Reported Outcomes ◽  
Post Treatment ◽  
Lung Cancer Patients ◽  
Systemic Treatments ◽  
Patient Reported ◽  
The Impact ◽  
Over Time

IntroductionThis report investigates the impact of systemic treatments (chemotherapy or immunotherapy) with(out) loco-regional radiotherapy, on HRQoL, toxicity and neurocognitive functioning (NCF) in locally advanced and metastatic non-small cell lung cancer patients enrolled in the PRO-Long study.Materials and MethodsData on patient-reported HRQoL and fourteen toxicities was collected, while NCF was tested, up to one-year post-treatment. HRQoL was assessed using the European Organisation for Research and Treatment of Cancer QLQ-C30. Lung cancer, treatment and neuro-psychological related toxicities were scored with the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events. NCF was evaluated with six neurocognitive tests. Mixed model analyses were conducted to determine statistical significance (p = .01). Meaningful clinical important differences (MCIDs) were applied for changes in HRQoL and NCF data, while toxicities were compared to baseline values.ResultsIn total, 50 patients were enrolled. Overall HRQoL (p = .357) nor its domains (physical, p = .643; role, p = .069; emotional, p = .254; cognitive, p = 494; social, p = .735) changed significantly over time. Meaningful improvements in overall HRQoL were seen in 22, 38 and 39% and deteriorations in 22, 5 and 28% of patients at 2–3, 6 and 12 months respectively post-treatment. Overall toxicity (p = .007), lack of appetite (p = .001), nausea (p = .004) and dysphagia (p = .000) significantly decreased over time. Treatment caused acute toxicity, such as dyspnoea (45%) and memory problems (42%), but also alleviated pre-existing symptoms, including lack of appetite (32%), anxiety (29%) and depression (28%) at 2/3 months. The NCF domains of visual memory (p = .000) and cognitive processing speed (p = .000) showed significant improvements over time. In terms of MCIDs, at 2–3 months (18%) and 6 months (15%), verbal memory was particularly impacted; at 12 months, visual memory (18%) and executive function (18%) deteriorated primarily.ConclusionThe results suggest that therapy has no significant negative impact on overall HRQoL, its domains, and NCF. About one-third of patients reported a meaningful improved HRQoL at 1 year post-treatment. Treatment caused toxicity, but also alleviated pre-existing symptoms.

Association of expression of bcl-2 with outcome in non-small cell lung cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22039-e22039
Author(s):  
V. Anagnostou ◽  
F. Lowery ◽  
K. Syrigos ◽  
K. Frangia ◽  
V. Zolota ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Protein Expression ◽  
Cancer Patients ◽  
Squamous Cell ◽  
Squamous Cell Carcinomas ◽  
University Hospital ◽  
Lung Cancer Patients ◽  
Protein Levels ◽  
Risk Of Death ◽  
The Impact

e22039 Background: BCL-2 promotes cell survival by inhibiting adapters needed for the activation and cleavage of caspases thus blocking the proteolytic cascade that ultimately dismantles the cell. It is preferentially expressed in squamous cell carcinomas of the lung and has been investigated as a potential prognostic parameter in lung cancer patients with conflicting results. Here, we quantitatively assessed BCL-2 protein expression in two large and independent data sets to investigate the impact of BCL-2 on patient survival. Methods: AQUA, a fluorescent-based method for analysis of in situ protein expression, was used to measure BCL-2 protein levels and classify tumor by BCL-2 expression in a cohort of 180 lung cancer patients from Yale New Haven Hospital (training set). An independent cohort of 360 lung cancer patients from Sotiria General Hospital and Patras University Hospital in Greece was used to validate BCL-2 classification and evaluate outcome (validation set). Results: Tumors expressed BCL-2 in 57% and 53% of the cases in training and validation cohorts respectively and squamous cell carcinomas expressed higher levels of BCL-2 expression compared to adenocarcinomas (mean AQUA score 42 and 26 respectively, p=0.007); BCL-2 was not associated with other standard clinical or pathological characteristics. Survival analysis showed that patients with high BCL-2 expression had a longer median overall survival compared to the low expressers (20 vs 15 months, log rank p=0.016). Multivariate analysis revealed an independent lower risk of death for lung cancer patients with BCL-2 expressing tumors (HR=0.58, 95% CI 0.39–0.86, p=0.006). Conclusions: BCL-2 expression defines a subgroup of patients with a favorable outcome and may be useful for prognostic stratification of lung cancer patients as well as incorporation of BCL-2 into clinical decisions. [Table: see text]

scholarly journals Adopting Integrated Care Pathways in Non–Small-Cell Lung Cancer: From Theory to Practice

2012 ◽  
Vol 7 (8) ◽  
pp. 1283-1290 ◽  
Author(s):  
Gianpiero Fasola ◽  
Simona Rizzato ◽  
Valentina Merlo ◽  
Marianna Aita ◽  
Tino Ceschia ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Integrated Care ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Care Pathways ◽  
Small Cell Lung ◽  
Theory To Practice ◽  
Integrated Care Pathways

scholarly journals Time-Dependent Changes of Plasma Concentrations of Angiopoietins, Vascular Endothelial Growth Factor, and Soluble Forms of Their Receptors in Nonsmall Cell Lung Cancer Patients Following Surgical Resection

ISRN Oncology ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Ewa Kopczynska ◽  
Maciej Dancewicz ◽  
Janusz Kowalewski ◽  
Roman Makarewicz ◽  
Hanna Kardymowicz ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Surgical Resection ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Plasma Concentrations ◽  
Nonsmall Cell Lung Cancer ◽  
Lung Cancer Patients ◽  
Endothelial Growth Factor ◽  
The Impact

Even when patients with nonsmall cell lung cancer undergo surgical resection at an early stage, recurrent disease often impairs the clinical outcome. There are numerous causes potentially responsible for a relapse of the disease, one of them being extensive angiogenesis. The balance of at least two systems, VEGF VEGFR and Ang Tie, regulates vessel formation. The aim of this study was to determine the impact of surgery on the plasma levels of the main angiogenic factors during the first month after surgery in nonsmall cell lung cancer patients. The study group consisted of 37 patients with stage I nonsmall cell lung cancer. Plasma concentrations of Ang1, Ang2, sTie2, VEGF, and sVEGF R1 were evaluated by ELISA three times: before surgical resection and on postoperative days 7 and 30. The median of Ang2 and VEGF concentrations increased on postoperative day 7 and decreased on day 30. On the other hand, the concentration of sTie2 decreased on the 7th day after resection and did not change statistically later on. The concentrations of Ang1 and sVEGF R1 did not change after the surgery. Lung cancer resection results in proangiogenic plasma protein changes that may stimulate tumor recurrences and metastases after early resection.

Chemoradiotherapy (CRT) for locally-advanced (LA) lung cancer patients with interstitial lung abnormalities (ILA).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20057-e20057
Author(s):  
Toshio Kubo ◽  
Hisao Higo ◽  
Takashi Ninomiya ◽  
Eiki Ichihara ◽  
Kadoaki Ohashi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Radiation Pneumonitis ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Patient Characteristics ◽  
University Hospital ◽  
High Resolution Computed Tomography ◽  
Lung Cancer Patients ◽  
Lung Abnormalities

e20057 Background: Interstitial lung disease (ILD) is an independent risk factor for lung cancer. The incidence of ILD in lung cancer patients is 5–10%. Although CRT is the standard treatment for LA lung cancer and has potential for long-term disease-free survival or cure, the treatment is avoided in patients with ILD because of the risk of severe radiation pneumonitis or acute ILD exacerbation. ILA has recently been evaluated using high-resolution computed tomography (HRCT) to assess interstitial changes. The aim of this study was to determine the feasibility and efficacy of CRT for LA lung cancer patients with ILA. Methods: Patients who underwent CRT for LA lung cancer at Okayama University Hospital between 2012 and 2015 were reviewed retrospectively. HRCT prior to treatment was evaluated by one pulmonologist and two radiologists using sequential reading. Results: Of 74 patients, ILA was present in 25 (33.8%) and indeterminate ILA was present in 23 (31.1%); 26 patients (35.1%) did not have ILA. Patient characteristics are shown below. Desaturation at rest (SpO2< 95%) and honeycombing on HRCT were not observed in patients with ILA. Only one patient with ILA had a low vital capacity (VC% of predicted, < 80%). Severe radiation pneumonitis (≥ grade 2) occurred in 32.0% of patients with ILA and 19.2% of patients without ILA (P=0.35). All radiation pneumonitis was controllable and grade 4 or 5 was not observed. Using multivariate analyses, treatment > 20 Gy involving > 25% of the lung volume was a predictive factor for severe radiation pneumonitis, but not ILA. The 2-year survival percentages of patients with and without ILA were 56.8% and 72.5%, respectively (hazard ratio, 1.21; 95% confidence interval, 0.76–1.90; P=0.42). Conclusions: Although severe radiation pneumonitis tended to increase, CRT was appropriate for patients with ILA without desaturation, low VC, and honeycombing on HRCT. [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document