scholarly journals Impact of Geography on Care Delivery and Survival for Noncurable Pancreatic Adenocarcinoma: A Population-Based Analysis

2020 ◽  
Vol 18 (12) ◽  
pp. 1642-1650
Author(s):  
Elliott K. Yee ◽  
Natalie G. Coburn ◽  
Laura E. Davis ◽  
Alyson L. Mahar ◽  
Victoria Zuk ◽  
...  
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Geographic Distribution ◽  
Systemic Therapy ◽  
Cancer Care ◽  
Medical Oncology ◽  
Care Delivery ◽  
Population Based ◽  
Cancer Center ◽  
Relative Risks ◽  
Care System

Background: Little is known about how the geographic distribution of cancer services may influence disparities in outcomes for noncurable pancreatic adenocarcinoma. We therefore examined the geographic distribution of outcomes for this disease in relation to distance to cancer centers. Methods: We conducted a retrospective population-based analysis of adults in Ontario, Canada, diagnosed with noncurable pancreatic adenocarcinoma from 2004 through 2017 using linked administrative healthcare datasets. The exposure was distance from place of residence to the nearest cancer center providing medical oncology assessment and systemic therapy. Outcomes were medical oncology consultation, receipt of cancer-directed therapy, and overall survival. We examined the relationship between distance and outcomes using adjusted multivariable regression models. Results: Of 15,970 patients surviving a median of 3.3 months, 65.6% consulted medical oncology and 38.5% received systemic therapy. Regions with comparable outcomes were clustered throughout Ontario. Mapping revealed regional discordances between outcomes. Increasing distance (reference, ≤10 km) was independently associated with lower likelihood of medical oncology consultation (relative risks [95% CI] for 11–50, 51–100, and ≥101 km were 0.90 [0.83–0.98], 0.78 [0.62–0.99], and 0.77 [0.55–1.08], respectively) and worse survival (hazard ratios [95% CI] for 11–50, 51–100, and ≥101 km were 1.08 [1.04–1.12], 1.17 [1.10–1.25], and 1.10 [1.02–1.18], respectively), but not with likelihood of receiving therapy. Receipt of therapy seems less sensitive to distance, suggesting that distance limits entry into the cancer care system via oncology consultation. Regional outcome discordances suggest inefficiencies within and protective factors outside of the cancer care system. Conclusions: These findings provide a basis for clinicians to optimize their practices for patients with noncurable pancreatic adenocarcinoma, for future studies investigating geographic barriers to care, and for regional interventions to improve access.

Preparing for an Epidemic: Cancer Care in an Aging Population

2014 ◽  
pp. 133-137 ◽  
Author(s):  
Ya-Chen Tina Shih ◽  
Arti Hurria
Keyword(s):  
Older Adults ◽  
Cancer Care ◽  
Care Delivery ◽  
Quality Care ◽  
Aging Population ◽  
Population Based ◽  
Cancer Drug ◽  
Evidence Based ◽  
Evidence Based Care

The Institute of Medicine's (IOM) Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population was charged with evaluating and proposing recommendations on how to improve the quality of cancer care, with a specific focus on the aging population. Based on their findings, the IOM committee recently released a report highlighting their 10 recommendations for improving the quality of cancer care. Based on those recommendations, this article highlights ways to improve evidence-based care and addresses rising costs in health care for older adults with cancer. The IOM highlighted three recommendations to address the current research gaps in providing evidence-based care in older adults with cancer, which included (1) studying populations which match the age and health-risk profile of the population with the disease, (2) legislative incentives for companies to include patients that are older or with multiple morbidities in new cancer drug trials, and (3) expansion of research that contributes to the depth and breadth of data available for assessing interventions. The recommendations also highlighted the need to maintain affordable and accessible care for older adults with cancer, with an emphasis on finding creative solutions within both the care delivery system and payment models in order to balance costs while preserving quality of care. The implementation of the IOM's recommendations will be a key step in moving closer to the goal of providing accessible, affordable, evidence-based, high-quality care to all patients with cancer.

Choosing oncology as specialization: Medical students' perception after clinical rotation in cancer center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 10528-10528
Author(s):  
Omar Orlando Castillo Fernandez ◽  
Maria Lim ◽  
Lilian Hayde Montano ◽  
Gaspar Perez-Jimenez ◽  
Jhonattan Camaño ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Students ◽  
Radiation Oncology ◽  
Cancer Care ◽  
Medical Oncology ◽  
Surgical Oncology ◽  
Cancer Center ◽  
Clinical Rotation ◽  
Chi Square ◽  
Field Methods

10528 Background: Cancer is a leading cause of death worldwide and the demand for oncologist and palliative care specialists is increasing dramatically. Two years ago, The Universidad de Panama incorporated Oncology in the curriculum in order to face the shortage of professionals involved in cancer care. Little information is available concerning young medical students desire to pursue a career in oncology.The aim of this study is to evalute medical students perception about Oncology as a specialization field. Methods: An electronic survey was sent to medical students from Universidad de Panama after finishing Oncology rotation the last 2 years. Chi square and Mann Whitney U tests were used to compare variables. Results: 145 questionnaries were responded (40%). 60% female and 40% male. Median age was 25 years old. Clinical rotation during Oncology practices were: 37% in Medical Oncology, 24% in Surgical Oncology, 21% in Radiation Oncology and 18% in Palliative Care. 20% (29) of students are highly motivated to pursue a career in Oncology. 8 in Radiation Oncology. 8 in Surgical Oncology, 8 in Medical Oncology and 5 in Palliative Care. Variable associated with a oncology preference were: male gender (p=0.007), lack of human resources (p=0.009), contact with patients and family (p=0.005), good experience with mentor (p=0.002), nature and complexity of disease (p<0.001). Potential emotional burden was negatively asssociated (p=0.004) with oncology preference. 66% of students acknowledged that clinical rotation changed positively their perception about cancer patient care and a third of students haved not rule out the possibility to choose Oncology in the near future. Conclusions: Early exposition to medical student to cancer care might help to reduce the global shortage of oncologist and palliative specialists.

Access to care and outcomes for noncurative esophagogastric cancer: A population-based geographic study.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 284-284
Author(s):  
Elliott Kenneth Yee ◽  
Natalie Coburn ◽  
Victoria Zuk ◽  
Laura E Davis ◽  
Alyson Mahar ◽  
...  
Keyword(s):  
Access To Care ◽  
System Analysis ◽  
Medical Oncology ◽  
Care Delivery ◽  
Population Based ◽  
Curative Intent ◽  
Poisson Models ◽  
Esophagogastric Cancer ◽  
Choropleth Maps ◽  
Geographic Information System Analysis

284 Background: Esophagogastric cancer (EGC) carries a heavy mortality burden owing largely to high rates of unresectable disease at diagnosis. Among patients not undergoing curative-intent therapy, access to care may vary. We examined the geographic distribution of care delivery and survival across a jurisdiction, and its relationship with distance to cancer centres (CCs), for non-curative EGC. Methods: We conducted a population-based analysis of adults with non-curative EGC from 2005-2017 using linked administrative healthcare datasets in Ontario, Canada. Outcomes were medical oncology consultation, receipt of chemotherapy, and overall survival (OS). We used geographic information system analysis to map locations of CCs and outcomes across census divisions. Regions of discordance between care use and OS were identified with bivariate choropleth maps. Multivariable modified Poisson models assessed the relationship between distance to the nearest CC and outcomes, adjusting for demographic, clinical, and socioeconomic factors. Results: Of 10,228 patients surviving a median of 5.1 months (IQR: 2.0-12.0), 68.6% had medical oncology consultation and 32.2% received chemotherapy. Regions of comparable OS and care delivery were clustered throughout the province. CCs were distributed unevenly, with higher levels in Southern Ontario. Higher-level CCs clustered in regions with higher rates of consultation, chemotherapy use, and OS. Each increment in distance from location of residence to the nearest CC (11-50, 51-100, and ≥101 km) was associated with lower likelihood of seeing medical oncology and receiving chemotherapy, and inferior OS, compared to ≤10 km. Conclusions: A third of patients with non-curative EGC did not see medical oncology, and the majority did not receive chemotherapy. Care delivery and OS exhibited high geographic variability. Location of residence influenced access to care and OS, with inferior outcomes for those living further from a CC. These findings are important for designing interventions and policies to reduce disparities in access to care and outcomes for non-curative EGC.

scholarly journals Outpatient Care

2021 ◽  
pp. 21-33
Author(s):  
Ian Qianhuang Wu ◽  
Francesca Lorraine Wei Inng Lim ◽  
Liang Piu Koh
Keyword(s):  
T Cell ◽  
Cancer Care ◽  
Hospital Admissions ◽  
Care Delivery ◽  
Cost Effective ◽  
Outpatient Setting ◽  
Cancer Center ◽  
T Cell Therapy ◽  
Car T Cell Therapy ◽  
Near Future

AbstractManagement of haematology-oncology patients has historically been largely inpatient-based. With advances in the understanding of disease and improvements in supportive care, patients are increasingly being managed in the outpatient setting. This is especially evident in autologous stem cell transplantation, which is now routinely done as an outpatient procedure at various centres. As clinicians gain more experience in novel therapies such as chimeric antigen receptor (CAR)-T cell therapy and bispecific T cell engager (BiTE) therapy, these may potentially be administered in the outpatient setting in the near future with the adoption of a risk-stratified approach. Such a paradigm shift in the practice of haematology-oncology is inevitable and has been driven by several factors, including pressure from the institution/hospital to avoid unnecessary hospital admissions and for optimal use of inpatient resources to be more cost-effective and efficient. With favourable local regulations and funding, outpatient cancer care can be economically beneficial. The success of an outpatient cancer center is heavily dependent on planning the facility to be equipped with the appropriate infrastructure, together with the trained medical and supportive personnel in place. This, coupled with the utilization of emerging technology such as telemedicine, has the potential to revolutionize cancer care delivery in the outpatient setting.

scholarly journals Integrating Diversity, Equity, and Inclusion Approaches Into Treatment of Commercial Tobacco Use for Optimal Cancer Care Delivery

2021 ◽  
Vol 19 (Suppl_1) ◽  
pp. S4-S7
Author(s):  
_ _
Keyword(s):  
Tobacco Use ◽  
Cancer Care ◽  
Community Organization ◽  
Care Delivery ◽  
Cancer Control ◽  
Population Level ◽  
Cancer Center ◽  
Tobacco Treatment ◽  
Incidence And Mortality ◽  
Equity And Inclusion

Tobacco-related cancer incidence and mortality and commercial tobacco use have decreased steadily in recent decades, but improvements have not been equitably experienced across population subgroups. A complex interaction across socioecological domains of individual, interpersonal, community/organization, and societal/policy factors influence disparities in tobacco use, treatment, and related health outcomes. NCI’s Cancer Center Cessation Initiative (C3I) provides an ideal platform to examine and intervene on multilevel influences across the cancer control continuum to reduce any disproportionate tobacco-related burden and eliminate tobacco-related disparities. The C3I Diversity, Equity, and Inclusion (DEI) Working Group encourages cancer centers to develop, evaluate, and adopt evidence-based practices regarding DEI for prevention and treatment of commercial tobacco use across the cancer control continuum. This paper highlights how 3 C3I sites intervene to address socioecological influences on tobacco use among racially, ethnically, socioeconomically, and geographically diverse patient subgroups. It then outlines ways in which DEI considerations could be integrated into research with patients with cancer who use tobacco and practices related to standards of cancer care. Incorporating DEI considerations in the pursuit of optimal tobacco treatment could facilitate elimination of inequities in population-level cancer outcomes, spanning the full continuum of cancer care from prevention to survivorship.

scholarly journals Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tuya Pal ◽  
Pamela C. Hull ◽  
Tatsuki Koyama ◽  
Phillip Lammers ◽  
Denise Martinez ◽  
...  
Keyword(s):  
Rural Communities ◽  
Cancer Care ◽  
Care Delivery ◽  
Tumor Board ◽  
Cancer Center ◽  
Dissemination And Implementation ◽  
Link Type ◽  
Multi Level ◽  
Molecular Tumor Board ◽  
Facilitators And Barriers

Abstract Background Despite lower cancer incidence rates, cancer mortality is higher among rural compared to urban dwellers. Patient, provider, and institutional level factors contribute to these disparities. The overarching objective of this study is to leverage the multidisciplinary, multispecialty oncology team from an academic cancer center in order to provide comprehensive cancer care at both the patient and provider levels in rural healthcare centers. Our specific aims are to: 1) evaluate the clinical effectiveness of a multi-level telehealth-based intervention consisting of provider access to molecular tumor board expertise along with patient access to a supportive care intervention to improve cancer care delivery; and 2) identify the facilitators and barriers to future larger scale dissemination and implementation of the multi-level intervention. Methods Coordinated by a National Cancer Institute-designated comprehensive cancer center, this study will include providers and patients across several clinics in two large healthcare systems serving rural communities. Using a telehealth-based molecular tumor board, sequencing results are reviewed, predictive and prognostic markers are discussed, and treatment plans are formulated between expert oncologists and rural providers. Simultaneously, the rural patients will be randomized to receive an evidence-based 6-week self-management supportive care program, Cancer Thriving and Surviving, versus an education attention control. Primary outcomes will be provider uptake of the molecular tumor board recommendation and patient treatment adherence. A mixed methods approach guided by the Consolidated Framework for Implementation Research that combines qualitative key informant interviews and quantitative surveys will be collected from both the patient and provider in order to identify facilitators and barriers to implementing the multi-level intervention. Discussion The proposed study will leverage information technology-enabled, team-based care delivery models in order to deliver comprehensive, coordinated, and high-quality cancer care to rural and/or underserved populations. Simultaneous attention to institutional, provider, and patient level barriers to quality care will afford the opportunity for us to broadly share oncology expertise and develop dissemination and implementation strategies that will enhance the cancer care delivered to patients residing within underserved rural communities. Trial registration Clinicaltrials.gov, NCT04758338. Registered 17 February 2021 – Retrospectively registered, http://www.clinicaltrials.gov/

Systematic identification of metastatic population subsets for advance care planning (ACP) discussions: A scalable approach using electronic health record (EHR) technology.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 243-243
Author(s):  
Cynthia Taniguchi ◽  
Kevin Donald Olson ◽  
Deb Harrison ◽  
J. Russell Hoverman ◽  
Aimee Ginsburg Arlen ◽  
...  
Keyword(s):  
Clinical Data ◽  
Cancer Care ◽  
Care Delivery ◽  
Data Extraction ◽  
Disease Status ◽  
Extraction Process ◽  
Cancer Center ◽  
Patient Identification ◽  
Clinical Criteria ◽  
Data Elements

243 Background: Comprehensive cancer care embraces the concept of having timely discussions with patients about end of life care preferences regarding treatment interventions. Physicians and healthcare teams are frequently challenged with identifying patients who are clinically appropriate for these discussions and subsequent management of ACP work within the context of clinic resource capacity. A data extraction process is needed to systematically identify cancer population subsets for ACP based on clinical data elements maintained within an EHR database. Methods: Seven cancer center sites of service participated in a 90-day pilot study for delivering ACP services to discrete patient populations who it was believed would most benefit from ACP. Electronic methodology was developed and tested through the pilot process to systematically identify those patients having documented evidence of designated clinical criteria, including metastatic disease status. Metastatic status was determined using five clinical data elements. EHR technology enabled further targeting by cancer diagnoses and allowed this program to be scalable to individual practice capacity. Additional filtering capability was incorporated to exclude non-applicable patient records. Results: On a weekly basis, each pilot site received a report of eligible patients based on clinical criteria and practice-specific diagnoses. During the 90-day pilot period, sites collectively identified an average of 871 patients per week who met clinically-based selection criteria. Once a patient was identified, physicians were able to determine if the patient was appropriate for ACP introduction. The systematic patient identification process allowed ACP to be easily integrated into mainstream practice workflow. Conclusions: EHR technology is invaluable for strategically identifying cancer patient population subsets for clinically appropriate delivery of ACP services. Automated notification of eligible patients and the ability to filter the population enabled practices to engage the ACP process wholly within the scope of comprehensive cancer care delivery.

Tiers of service: Outpatient medical oncology services for British Columbia, Canada.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 40-40
Author(s):  
Shallen Letwin ◽  
Astra Pereira ◽  
Tammy Currie ◽  
Gary K. Pansegrau ◽  
Marie Hawkins
Keyword(s):  
British Columbia ◽  
Systemic Therapy ◽  
Service Provision ◽  
Cancer Care ◽  
Working Group ◽  
Medical Oncology ◽  
Regional Health ◽  
Level Of Confidence ◽  
Health Authorities ◽  
Regional Health Authorities

40 Background: The vision is for cancer care in British Columbia to be delivered in a coordinated, efficient manner, governed through effective partnerships between the Regional Health Authorities and BC Cancer. Systemic Therapy is delivered throughout BC by several providers, however service provision standards do not exist. BC Cancer and Fraser Health embarked on a process to develop a provincial Tiers of Service that outlines the responsibilities and requirements for the delivery of systemic therapy. Methods: From October 2017-April 2018, a working group drafted a Tiers of Service framework to be further approved by a Provincial Working Group. A scan of the literature and review of other jurisdiction's frameworks were evaluated. BC Cancer in partnership with the Regional Health Authorities have identified that the increased need for outpatient medical oncology services, combined with human resource and healthcare facility constraints requires a framework for organizing and delivering cancer care services in British Columbia. Therefore, a need to update the framework and shift nomenclature from the current “Levels of Service” to “Tiers of Service” was identified. Results: A survey of the working group was utilized to understand their level of confidence with regards to the development and utilization of the framework. Overall the working group increased their level of confidence from 33% to 100%. Conclusions: Tiers of Service: Outpatient Medical Oncology Services provides a practical framework which will be used to define and plan medical oncology services in British Columbia utilizing a common language and methodology. It describes the minimum responsibilities and requirements of each tier in providing a safe, sustainable and appropriate level of service. Tiers of Service will set standards and provide clarity for service provision, help build a capacity plan, plan where resources should be located, measure and monitor performance and improve the quality of the patient experience.

590 VARIATION IN RECEIPT OF THERAPY AND SURVIVAL WITH PROVIDER-VOLUME IN NON-CURATIVE ESOPHAGO-GASTRIC CANCER: A POPULATION-BASED ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Julie Hallet ◽  
Laura Davis ◽  
Alyson Mahar ◽  
Ying Lui ◽  
Victoria Zuk ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systemic Therapy ◽  
Medical Oncology ◽  
High Volume ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Income Quintile ◽  
Care Organization ◽  
Comorbidity Burden ◽  
Provider Volume

Abstract   While surgical care by high-volume providers for esophago-gastric cancer (EGC) yields better outcomes, volume-outcome relationships are unknown for systemic therapy. We examined receipt of therapy and outcomes in the non-curative management of EGC based on medical oncology provider-volume. Methods We conducted a population based retrospective cohort study of non-curative EGC over 2005–2017 by linking administrative healthcare datasets. The volume of new EGC consultations per medical oncology provider per year was calculated and divided into quintiles. High-volume (HV) providers were defined as the 4-5th quintiles. Outcomes were receipt of chemotherapy and overall survival (OS). Multivariate logistic and Cox-proportional hazards regressions examined the association between management by HV provider, receipt of systemic therapy, and OS. Results 7,011 EGC patients with non-curative management consulted with medical oncology. One-year OS was superior for HV providers (&gt;11 patients/year), with 28.4% (95%CI: 26.7–30.2%) compared to 25.1% (95%CI: 23.8–26.3%) for low-volume (p &lt; 0.001). After adjusting for age, sex, comorbidity burden, rurality, income quintile, and diagnosis year, HV provider was independently associated with higher odds of receiving chemotherapy (OR 1.13, 95%CI 1.01–1.26), and independently associated with superior OS (HR 0.89, 95%CI 0.84–0.93). Conclusion Medical oncology provider-volume was associated with variation in non-curative management and outcomes of EGC. Care by a HV provider was independently associated with higher odds of receiving chemotherapy and superior OS, after adjusting for case-mix. This information is important to inform disease care pathways and care organization; increase in the number of HV providers may reduce variation and improve outcomes.

Trends in Medical Oncology Outreach Clinics in Rural Areas

2014 ◽  
Vol 10 (5) ◽  
pp. e313-e320 ◽  
Author(s):  
Thomas S. Gruca ◽  
Inwoo Nam ◽  
Roger Tracy
Keyword(s):  
Vulnerable Populations ◽  
Affordable Care Act ◽  
Rural Areas ◽  
Cancer Care ◽  
Medical Oncology ◽  
Care Delivery ◽  
Rural Elderly ◽  
The Affordable Care Act

The Affordable Care Act seeks to expand access for vulnerable populations—for example, the rural elderly—making it critical to better understand the existing system of rural cancer care delivery.

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