scholarly journals A Study of Advanced Practice Provider Staffing Models and Professional Development Opportunities at National Comprehensive Cancer Network Member Institutions

2021 ◽  
Vol 12 (7) ◽  
Author(s):  
Annie Austin, MSN, AGACNP, AOCNP ◽  
Kellyann Jeffries, CNP ◽  
Diana Krause, MHA ◽  
Jessica Sugalski, MPPA ◽  
Karen Sharrah, DNP, APRN, FNPc ◽  
...  
Keyword(s):  
Professional Development ◽  
Leadership Development ◽  
National Comprehensive Cancer Network ◽  
Mixed Model ◽  
Network Member ◽  
Advanced Practice ◽  
Full Time ◽  
Full Time Equivalent ◽  
Cancer Network

Introduction: The National Comprehensive Cancer Network (NCCN) Best Practices Committee created an Advanced Practice Provider (APP) Workgroup to develop recommendations to support APP roles at NCCN Member Institutions. Methods: The Workgroup conducted three surveys to understand APP program structure, staffing models, and professional development opportunities at NCCN Member Institutions. Results: The total number of new and follow-up visits a 1.0 APP full-time equivalent conducts per week in shared and independent visits ranged from 11 to 97, with an average of 40 visits per week (n = 39). The type of visits APPs conduct include follow-up shared (47.2%), follow-up independent (46%), new shared (6.5%), and new independent visits (0.5%). Seventy-two percent of respondents utilize a mixed model visit type, with 15% utilizing only independent visits and 13% utilizing only shared visits (n = 39). Of the 95% of centers with APP leads, 100% indicated that leads carry administrative and clinical responsibilities (n = 20); however, results varied with respect to how this time is allocated. Professional development opportunities offered included posters, papers, and presentations (84%), leadership development (57%), research opportunities (52%), writing book chapters (19%), and other professional development activities (12%; n = 422). Twenty percent of APPs indicated that protected time to engage in development opportunities should be offered. Conclusion: As evidenced by the variability of the survey results, the field would benefit from developing standards for APPs. There is a lack of information regarding leadership structures to help support APPs, and additional research is needed. Additionally, centers should continuously assess the career-long opportunities needed to maximize the value of oncology APPs.

Psychology Staffing at Cancer Centers: Data From National Comprehensive Cancer Network Member Institutions

2020 ◽  
Vol 16 (11) ◽  
pp. e1343-e1354
Author(s):  
Laura Melton ◽  
Diana Krause ◽  
Jessica Sugalski
Keyword(s):  
National Comprehensive Cancer Network ◽  
Patient Care ◽  
Clinical Care ◽  
The United States ◽  
Direct Patient Care ◽  
Cancer Center ◽  
Network Member ◽  
Full Time ◽  
Cancer Centers ◽  
Cancer Network

PURPOSE: The field of psycho-oncology is relatively undeveloped, with little information existing regarding the use of psychologists at cancer centers. Comprising 30 leading cancer centers across the United States, the National Comprehensive Cancer Network (NCCN) set out to understand the trends in its Member Institutions. METHODS: The NCCN Best Practices Committee surveyed NCCN Member Institutions regarding their use of psychologists. The survey was administered electronically in the spring/summer of 2017. RESULTS: The survey was completed by 18 cancer centers. Across institutions, 94% have psychologists appointed to provide direct care to their cancer center patients. The number of licensed psychologist full-time equivalents (FTEs) on staff who provide direct patient care ranged from < 1.0 FTE (17%) to 17.0-17.9 FTEs (6%). Regarding psychologist appointments, 41% have both faculty and staff appointments, 41% have all faculty appointments, and 18% have all staff appointments. Forty-three percent of institutions indicated that some licensed psychologists at their centers (ranging from 1%-65%) do not provide any direct clinical care, and 57% indicated that all licensed psychologist on staff devote some amount of time to direct clinical care. The percent of clinical care time that is spent on direct clinical care ranged from 15%-90%. CONCLUSION: There is great variability in psychology staffing, academic appointments, and the amount of direct patient care provided by on-staff psychologists at cancer centers.

scholarly journals Benchmarks in Clinical Productivity: A National Comprehensive Cancer Network Survey

2007 ◽  
Vol 3 (1) ◽  
pp. 2-8 ◽  
Author(s):  
F. Marc Stewart ◽  
Robert L. Wasserman ◽  
Clara D. Bloomfield ◽  
Stephen Petersdorf ◽  
Robert P. Witherspoon ◽  
...  
Keyword(s):  
National Comprehensive Cancer Network ◽  
Fiscal Year ◽  
Clinical Activity ◽  
Full Time ◽  
Full Time Equivalent ◽  
Physician Practices ◽  
Cancer Centers ◽  
Physician Compensation ◽  
Potential Factors ◽  
Cancer Network

Purpose Oncologists in academic cancer centers usually generate professional fees that are insufficient to cover salaries and other expenses, despite significant clinical activity; therefore, supplemental funding is frequently required in order to support competitive levels of physician compensation. Relative value units (RVUs) allow comparisons of productivity across institutions and practice locations and provide a reasonable point of reference on which funding decisions can be based. Methods We reviewed the clinical productivity and other characteristics of oncology physicians practicing in 13 major academic cancer institutions with membership or shared membership in the National Comprehensive Cancer Network (NCCN). The objectives of this study were to develop tools that would lead to better-informed decision making regarding practice management and physician deployment in comprehensive cancer centers and to determine benchmarks of productivity using RVUs accrued by physicians at each institution. Three hundred fifty-three individual physician practices across the 13 NCCN institutions in the survey provided data describing adult hematology/medical oncology and bone marrow/stem-cell transplantation programs. Data from the member institutions participating in the survey included all American Medical Association Current Procedural Terminology (CPT®) codes generated (billed) by each physician during each organization's fiscal year 2003 as a measure of actual clinical productivity. Physician characteristic data included specialty, clinical full-time equivalent (CFTE) status, faculty rank, faculty track, number of years of experience, and total salary by funding source. The average adult hematologist/medical oncologist in our sample would produce 3,745 RVUs if he/she worked full-time as a clinician (100% CFTE), compared with 4,506 RVUs for a 100% CFTE transplant oncologist. Results and Conclusion Our results suggest specific clinical productivity targets for academic oncologists and provide a methodology for analyzing potential factors associated with clinical productivity and developing clinical productivity targets specific for physicians with a mix of research, administrative, teaching, and clinical salary support.

scholarly journals Benefit, burden, and impact for a cohort of post-approval cancer combination trials

2019 ◽  
Vol 17 (1) ◽  
pp. 18-29 ◽  
Author(s):  
Benjamin Gregory Carlisle ◽  
Adélaïde Doussau ◽  
Jonathan Kimmelman
Keyword(s):  
Overall Survival ◽  
Adverse Events ◽  
National Comprehensive Cancer Network ◽  
Drug Administration ◽  
Food And Drug Administration ◽  
Guideline Recommendation ◽  
Anti Cancer ◽  
Grade 3 ◽  
Cancer Network

Background: After approval, drug developers often pursue trials aimed at extending the uses of a new drug by combining it with other drugs. Little is known about the risk and benefits associated with such research. Methods: To establish a historic benchmark of risk and benefit, we searched Medline and Embase for clinical trials testing anti-cancer drugs in combination within 5 years of approval by the Food and Drug Administration of 12 anti-cancer “index” drugs first licensed 2005–2007 inclusive. Risk was assessed based on grade 3 or above drug-related adverse events; benefit was assessed based on efficacy outcomes and advancement of combinations into clinical practice guidelines or approval by the Food and Drug Administration. Results: We captured 323 published post-approval trials exploring combinations, including 266 unique combination–indication pairings and enrolling 29,835 patients. The pooled risk ratios for treatment-related grade 3–4 severe adverse events and deaths attributed to the study drugs for trials randomized between a combination arm and a comparator were 1.54 (1.33–1.79) and 1.51 (1.16–1.97), respectively. The pooled hazard ratios for overall survival and progression-free survival were 0.99 (0.92–1.05) and 0.85 (0.79–0.93), respectively. None of the combination–indication pairings launched after initial drug approval received approval by the Food and Drug Administration, and 13 pairings (4.9%) were recommended by the National Comprehensive Cancer Network within 5 years of the first trial within that pairing. The proportion of patients in our sample who participated in trials leading to an approval by the Food and Drug Administration or a National Comprehensive Cancer Network guideline recommendation was 12.7% with 5 years of follow-up, and 22.3% among pairings for which there were 8 years of follow-up. Conclusion: Patients were just as likely to benefit in the treatment arm as the control arm in terms of overall survival, but they were more likely to experience a treatment-related severe adverse event in post-approval trials of combination therapy.

Preferences in Oncology History Documentation Styles Among Clinical Practitioners

2021 ◽  
pp. OP.20.00756
Author(s):  
Daniel B. Martin ◽  
Peter D. Stetson ◽  
G. Weldon Gilcrease ◽  
Robert C. Stillman ◽  
Jessica M. Sugalski ◽  
...  
Keyword(s):  
National Comprehensive Cancer Network ◽  
Social Determinants ◽  
Care Coordination ◽  
Real World ◽  
Semantic Differential ◽  
Network Member ◽  
Convenience Sample ◽  
Clinical Notes ◽  
Narrative History ◽  
Cancer Network

PURPOSE: Clinical notes function as the de facto handoff between providers and assume great importance during unplanned medical encounters. An organized and thorough oncology history is essential in care coordination. We sought to understand reader preferences for oncology history organization by comparing between chronologic and narrative formats. METHODS: A convenience sample of 562 clinicians from 19 National Comprehensive Cancer Network Member Institutions responded to a survey comparing two formats of oncology histories, narrative and chronologic, for the same patient. Both histories were consensus-derived real-world examples. Each history was evaluated using semantic differential attributes ( thorough, useful, organized, comprehensible, and succinct). Respondents choose a preference between the two styles for history gathering and as the basis of a new note. Open-ended responses were also solicited. RESULTS: Respondents preferred the chronologic over the narrative history to prepare for a visit with an unknown patient (66% preference) and as a basis for their own note preparation (77% preference) ( P < .01). The chronologic summary was preferred in four of the five measured attributes ( useful, organized, comprehensible, and succinct); the narrative summary was favored for thoroughness ( P < .01). Open-ended responses reflected the attribute scoring and noted the utility of content describing social determinants of health in the narrative history. CONCLUSION: Respondents of this convenience sample preferred a chronologic oncology history to a concise narrative history. Further studies are needed to determine the optimal structure and content of chronologic documentation for oncology patients and the provider effort to use this format.

Psychosocial staffing at National Comprehensive Cancer Network member institutions: data from leading cancer centers

2015 ◽  
Vol 25 (2) ◽  
pp. 164-169 ◽  
Author(s):  
Teresa Deshields ◽  
Amanda Kracen ◽  
Shannon Nanna ◽  
Lisa Kimbro
Keyword(s):  
National Comprehensive Cancer Network ◽  
Network Member ◽  
Cancer Centers ◽  
Cancer Network

scholarly journals Radioembolization for Metastatic Neuroendocrine Tumors

2021 ◽  
Author(s):  
Ghassan El-Haddad ◽  
Jonathan Strosberg
Keyword(s):  
National Comprehensive Cancer Network ◽  
Disease Progression ◽  
Neuroendocrine Tumors ◽  
Short Term ◽  
Transarterial Radioembolization ◽  
Cancer Network ◽  
New Strategies ◽  
Yttrium 90

AbstractTransarterial radioembolization (TARE) using β-emitting yttrium-90 microspheres has been used for decades in patients with liver-dominant unresectable metastatic neuroendocrine tumors (mNETs). TARE is one of the embolotherapies supported by the National Comprehensive Cancer Network, among other guidelines, for progressive or symptomatic liver-dominant mNETs. Initial studies with relatively short-term follow-up have indicated that TARE is likely to be at least as effective in controlling symptoms and/or disease progression in the liver as bland or chemoembolization. However, more recent data have shed new light on the risk of long-term hepatotoxicity in patients with mNETs treated with TARE. In this article, we will discuss rationale for TARE, clinical indications, outcomes, and toxicity, as well as new strategies to enhance efficacy of TARE while reducing its toxicity in the treatment of liver-dominant mNETs.

Impact of primary Gleason grade 4 on biochemical recurrence after permanent interstitial brachytherapy in Japanese patients with low- or intermediate-risk prostate cancer.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 77-77
Author(s):  
T. Saika ◽  
T. Uesugi ◽  
K. Edamura ◽  
M. Kobuke ◽  
H. Nose ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
National Comprehensive Cancer Network ◽  
Biochemical Recurrence ◽  
Japanese Patients ◽  
Localized Prostate Cancer ◽  
Gleason Grade ◽  
Intermediate Risk ◽  
Nccn Guidelines ◽  
Cancer Network

77 Background: To reveal a predictive factor for biochemical recurrence (BCR) after permanent prostate brachytherapy (PPB) using iodine-125 (125I) seed implantation in patients with localized prostate cancer classified as low or intermediate risk based on the National Comprehensive Cancer Network (NCCN) guidelines. Methods: From January 2004 to December 2009, consecutive 418 Japanese patients with clinically localized prostate cancer classified as low or intermediate risk based on the National Comprehensive Cancer Network (NCCN) guidelines were treated by PPB. The clinical factors including pathological data reviewed by central pathologist and follow-up data were prospectively collected. Kaplan-Meier and Cox regression analyses were used to assess the factors associated with BCR. Results: Median follow-up was 36.0 months. The 2, 3, 4 and 5-year BCR free rates using Phoenix definition were 98.3%, 96.0%, 91.6% and 87.0% respectively. On univariate analysis, primary Gleason grade 4 in biopsy specimen was strong predicting factor (p<0.0001), while Gleason sum, age, initial PSA, initial PSA density, T stage and D90 were insignificant factors. Multivariate analysis indicated that primary Gleason grade 4 was most powerful prognostic factor associated with BCR (hazard ratio=10.101, 95% IC 3.080-33.126, p=0.0001). Conclusions: The primary Gleason grade 4 carried a worse BCR than the primary grade 3 in Gleason score 7 prostate cancer. Therefore, the indication for PPB in patients with Gleason sum 4+3 should deserve careful and thoughtful consideration. No significant financial relationships to disclose.

scholarly journals Management of Melanoma Patients by Non-Dermatologists in the Military Health System: A Retrospective Observational Study

2019 ◽  
Vol 185 (3-4) ◽  
pp. 506-511
Author(s):  
Kenneth J Helmandollar ◽  
Nathan C Lorei ◽  
Barak C Clement ◽  
Kara R Hoverson ◽  
Nicholas F Logemann
Keyword(s):  
Health System ◽  
National Comprehensive Cancer Network ◽  
Medical Center ◽  
Excision Biopsy ◽  
Military Health System ◽  
Military Health ◽  
Melanoma Patients ◽  
Cancer Network ◽  
The Military

Abstract Introduction Compared to their civilian counterparts, military personnel can have more exposure to sunlight and, as recent studies have shown, do have an increased incidence of melanoma. Given the inherent challenges service members may face in getting appropriate care whether because of operational tempo, deployments, and/or austere locations, many are initially diagnosed by specialties other than dermatology. In this study, we sought to determine if patients within the military health system were receiving appropriate follow-up management after biopsies by non-dermatologists led to the diagnosis of melanoma by pathology. Materials and Methods Using the Co-Path system, 1,000 patients were identified who had first time biopsies positive for melanoma. Of these, 73 were originally biopsied by non-dermatologists. Retrospective medical record review was performed to determine specialties of the non-dermatologists, staging of melanoma at diagnosis, referrals to specialists and dermatologists, and adherence to National Comprehensive Cancer Network guidelines. The study protocol was approved by the Walter Reed National Military Medical Center Institutional Review Board, protocol number WRNMMC-EDO-2017-0030, in compliance with all applicable federal regulations governing the protection of human subject research. Results Family medicine physicians made up the majority of non-dermatologists involved in performing biopsies that led to the diagnosis of melanoma in this study. Most patients were Stage I (pT1a), and the average time from initial biopsy to further wide excision biopsy was 18 days. Sixty-seven of the 73 patients biopsied by non-dermatologists received referrals to dermatologists, and 55 of the 67 patients followed through with being seen. Follow-up full body skin exams were performed on 55 of the 73 patients, with dermatologists conducting the majority of them. National Comprehensive Cancer Network guidelines were followed in 45 of the 73 patients, with an additional 24 patients having insufficient evidence to determine if guidelines were adhered to. Conclusion Our study demonstrated that a number of different specialties outside of dermatology are involved in performing biopsies on patients in which melanoma is a concern. Although the results show that the majority of patients biopsied by non-dermatologists received appropriate follow-up care, there is still room to improve to ensure that all melanoma patients receive referrals to and are seen by dermatologists after a diagnosis of melanoma.

scholarly journals Trends in Veteran population use of Veterans Affairs chiropractic care

2021 ◽  
Author(s):  
Ryan Burdick ◽  
Kelsey Corcoran ◽  
Xiwen Zhao ◽  
Anthony Lisi
Keyword(s):  
Mixed Model ◽  
Community Care ◽  
Care Delivery ◽  
Chiropractic Care ◽  
Geographic Region ◽  
Veterans Affairs ◽  
Full Time ◽  
Care Providers ◽  
Full Time Equivalent ◽  
Cross Sectional

Abstract Background The US Department of Veterans Affairs (VA) has initiated various approaches to provide chiropractic care to Veterans. Prior work has shown substantial increase in use of VA chiropractic care between fiscal years (FY) 2005-2016. However, the extent of the availability of these services to the Veteran population remains unclear. The purpose of this study was to analyze the rate of Veteran use of VA chiropractic services, both from on-site care at VA facilities and VA purchased care from community care providers. This study analyzed facility characteristics associated with chiropractic use by both care delivery mechanisms (on-site and in the community).Methods Cross-sectional analyses of administrative data were conducted for FY 2014-19. Data were obtained from VA’s Corporate Data Warehouse. The variables extracted included number of unique Veterans receiving VA chiropractic care on-site and in the community, total Veteran population of the VA facilities, size of the VA chiropractic workforce (measured as Full-Time Equivalent, FTE), and facility characteristics (geographic region and the facility complexity). Descriptive statistics, mixed model, and multivariant models were used to analyze data.Results Use of VA chiropractic care increased over the six-year period for both on-site and community care. National average for on-site use of the population was 1.27% in FY14 and 1.48% in FY19. Community care use was 0.29% and 1.76% for the same years. Use at individual facilities varied widely in each FY. Factors such as chiropractor FTE, geographic locations, and the complexity of the VA facility are associated with use of chiropractic services. ConclusionThe VA has expanded the non-pharmacologic treatments available to Veterans by providing chiropractic services, yet chiropractic use remains low compared to other US populations. As Veterans have a high prevalence of pain and musculoskeletal conditions, continued work to assess and achieve the optimal levels of chiropractic use in this population is warranted.

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