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 Sustainability of Tobacco Treatment Programs in the Cancer Center Cessation Initiative

2021 ◽  
Vol 19 (Suppl_1) ◽  
pp. S16-S20
Author(s):  
_ _
Keyword(s):  
Case Studies ◽  
Tobacco Use ◽  
Cancer Care ◽  
Working Group ◽  
Sustainability Assessment ◽  
Implementation Strategies ◽  
Treatment Programs ◽  
Cancer Center ◽  
Program Outcomes ◽  
Tobacco Treatment

The NCI’s Cancer Center Cessation Initiative (C3I) has a specific objective of helping cancer centers develop and implement sustainable programs to routinely address tobacco cessation with patients. Sustaining tobacco treatment programs requires the maintenance of (1) core program components, (2) ongoing implementation strategies, and (3) program outcomes evaluation. NCI funding of C3I included a commitment of resources toward sustainability. This article presents case studies to illustrate key strategies in developing sustainability capacity across 4 C3I-funded sites. Case studies are organized according to the domains of sustainability capacity defined in the Clinical Sustainability Assessment Tool (CSAT). We also describe the C3I Sustainability Working Group agenda to make scientific and practical contributions in 3 areas: (1) demonstrating the value of tobacco use treatment in cancer care, (2) identifying implementation strategies to support sustainability, and (3) providing evidence to inform policy changes that support the prioritization and financing of tobacco use treatment. By advancing this agenda, the Sustainability Working Group can play an active role in advancing and disseminating knowledge for tobacco treatment program sustainability to assist cancer care organizations in addressing tobacco use by patients with cancer within and beyond C3I.

scholarly journals Cancerpedia: A Framework for Implementing Comprehensive Cancer Centres

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 244s-244s
Author(s):  
N. Abdelmutti ◽  
A. Chudak ◽  
M. Merali ◽  
T. Sullivan ◽  
M. Escaf ◽  
...  
Keyword(s):  
Palliative Care ◽  
Best Practices ◽  
Cancer Care ◽  
Care Delivery ◽  
Cancer Control ◽  
System Level ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Cancer Centers ◽  
Comprehensive Cancer Centers

Background and context: Comprehensive cancer centers or programs form a nucleus of cancer care delivery. Although there are frameworks for population cancer control, no similar published framework exists for cancer centers. Aim: We sought to develop a framework for designing and implementing a comprehensive cancer center or program within the context of a population-based model of cancer control that spans diagnosis, treatment, supportive care, and palliative care as well as integration with primary care and the community. Strategy/Tactics: The framework was constructed with the patient at the center and provides a system-level perspective as well as a granular view of the fundamental resources and structures needed to build and maintain individual cancer centers and programs. Due to its breadth, we focused the framework on essential information while linking to a wide range of vetted publications that detail additional standards, guidelines and best practices. Program/Policy process: “Cancerpedia” emerged as a cohesive framework for the delivery of high-quality cancer care within and beyond the cancer center. It provides an overview of the cancer control and care delivery framework, describes cancer care services (e.g., radiotherapy, chemotherapy, palliative care) and details infrastructure and core services (e.g., physical facilities, human resources). In addition to these services, the framework presents guidelines for governance that ensure oversight and quality, describes the critical need for integrating education and research and presents the best practices for engaging in philanthropy. Cancerpedia also outlines the role of the comprehensive cancer center in integration with the community and influencing policy and regulation. Over 30 chapters provide a detailed description of each element and include a description of the service or function, resources requirements such as people, equipment and facilities, management structures, quality performance guidelines and future trends in innovation. Outcomes: To our knowledge, no comparable published framework exists as a reference for developing comprehensive cancer centers. Cancerpedia was designed to serve as a global public good and is adaptable and applicable to diverse contexts and healthcare environments. It is relevant to high-, middle- and low-income countries alike and provides a reference point from which to structure a plan for growth. What was learned: While it is important to describe the various elements required for cancer care delivery, it is critical to consider and address the integration and interdependencies of these various elements. Future opportunities for learning include seeking input from a global audience to gauge the utility and applicability of Cancerperdia to local contexts.

scholarly journals State of Cancer Control in Rwanda: Past, Present, and Future Opportunities

2020 ◽  
pp. 1171-1177
Author(s):  
Fidel Rubagumya ◽  
Ainhoa Costas-Chavarri ◽  
Achille Manirakiza ◽  
Gad Murenzi ◽  
Francois Uwinkindi ◽  
...  
Keyword(s):  
Low Income ◽  
Cancer Care ◽  
Cancer Control ◽  
Public Hospitals ◽  
Hepatitis B Vaccination ◽  
Cancer Center ◽  
Cancer Awareness ◽  
Control Plan ◽  
Low Income Country ◽  
The Past

Rwanda is a densely populated low-income country in East Africa. Previously considered a failed state after the genocide against the Tutsi in 1994, Rwanda has seen remarkable growth over the past 2 decades. Health care in Rwanda is predominantly delivered through public hospitals and is emerging in the private sector. More than 80% of patients are covered by community-based health insurance (Mutuelle de Santé). The cancer unit at the Rwanda Biomedical Center (a branch of the Ministry of Health) is responsible for setting and implementing cancer care policy. Rwanda has made progress with human papillomavirus (HPV) and hepatitis B vaccination. Recently, the cancer unit at the Rwanda Biomedical Center launched the country’s 5-year National Cancer Control Plan. Over the past decade, patients with cancer have been able to receive chemotherapy at Butaro Cancer Center, and recently, the Rwanda Cancer Center was launched with 2 linear accelerator radiotherapy machines, which greatly reduced the number of referrals for treatment abroad. Palliative care services are increasing in Rwanda. A cancer registry has now been strengthened, and more clinicians are becoming active in cancer research. Despite these advances, there is still substantial work to be done and there are many outstanding challenges, including the need to build capacity in cancer awareness among the general population (and shift toward earlier diagnosis), cancer care workforce (more in-country training programs are needed), and research.

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 Tobacco Use and Tobacco Treatment Referral Response of Patients With Cancer: Implementation Outcomes at a National Cancer Institute–Designated Cancer Center

2021 ◽  
pp. OP.20.01095
Author(s):  
Jessica L. Burris ◽  
Tia N. Borger ◽  
Brent J. Shelton ◽  
Audrey K. Darville ◽  
Jamie L. Studts ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Cancer Diagnosis ◽  
Program Implementation ◽  
National Cancer Institute ◽  
Retrospective Chart Review ◽  
Population Based ◽  
Adverse Outcomes ◽  
Cancer Center ◽  
Patients With Cancer ◽  
Tobacco Treatment

PURPOSE: Smoking after a cancer diagnosis is linked to cancer-specific and all-cause mortality, among other adverse outcomes. Yet, 10%-20% of US cancer survivors are current smokers. Implementation of evidence-based tobacco treatment in cancer care facilities is widely recommended, yet rarely accomplished. This study focuses on the early outcomes of a population-based tobacco treatment program integrated within an National Cancer Institute–designated cancer center. METHODS AND MATERIALS: The sample consists of 26,365 patients seen at the cancer center during the first 18 months of program implementation. The study is a retrospective chart review of patients' tobacco use and, among current users, patients' treatment referral response. RESULTS: More than 99% of patients were screened for tobacco use. Current (past month) use was observed in 21.05% of patients; cigarettes were the most popular product. Only 17.22% of current users accepted a referral for tobacco treatment; among current users who declined, the majority were not ready to quit (65.84%) or wanted to quit on their own (27.01%). Multiple demographic variables were associated with tobacco use and treatment referral response outcomes. CONCLUSION: Despite cancer diagnosis presenting a teachable moment for tobacco cessation, patients with cancer may not be ready to quit or engage with treatment. Clinically proven strategies to increase motivation, prompt quit attempts, and encourage treatment use should be key components of tobacco treatment delivery to patients with cancer.

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.

scholarly journals An Evaluation of the Process and Quality Improvement Measures of the University of Virginia Cancer Center Tobacco Treatment Program

2020 ◽  
Vol 17 (13) ◽  
pp. 4707 ◽  
Author(s):  
Kara P. Wiseman ◽  
Lindsay Hauser ◽  
Connie Clark ◽  
Onyiyoza Odumosu ◽  
Neely Dahl ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Tobacco Use ◽  
Treatment Program ◽  
Disease Recurrence ◽  
Cancer Center ◽  
Second Primary ◽  
University Of Virginia ◽  
Clinical Workflow ◽  
Tobacco Treatment ◽  
The University

Tobacco use after a cancer diagnosis can increase risk of disease recurrence, increase the likelihood of a second primary cancer, and negatively impact treatment efficacy. The implementation of system-wide comprehensive tobacco cessation in the oncology setting has historically been low, with over half of cancer clinicians reporting that they do not treat or provide a referral to cessation resources. This quality improvement study evaluated the procedures for assessing and documenting tobacco use among cancer survivors and referring current smokers to cessation resources at the University of Virginia Cancer Center. Process mapping revealed 20 gaps across two major domains: electronic health record (EHR), and personnel barriers. The top identified priority was inconsistent documentation of tobacco use status as it impacted several downstream gaps. Eleven of the 20 gaps were deemed a high priority, and all were addressed during the implementation of the resulting Tobacco Treatment Program. Prioritized gaps were addressed using a combination of provider training, modifications to clinical workflow, and EHR modifications. Since implementation of solutions, the number of unique survivors receiving cessation treatment has increased from 284 survivors receiving cessation support during Year 1 of the initiative to 487 in Year 3. The resulting Tobacco Treatment Program provides a systematic, personalized, and sustainable comprehensive cessation program that optimizes the multifaceted workflow of the Cancer Center and has the potential to reduce tobacco use in a population most in need of cessation support.

Implementation Science for Global Oncology: The Imperative to Evaluate the Safety and Efficacy of Cancer Care Delivery

2016 ◽  
Vol 34 (1) ◽  
pp. 43-52 ◽  
Author(s):  
Neo M. Tapela ◽  
Tharcisse Mpunga ◽  
Nadine Karema ◽  
Ignace Nzayisenga ◽  
Temidayo Fadelu ◽  
...  
Keyword(s):  
Implementation Science ◽  
Treatment Program ◽  
Cancer Care ◽  
Care Delivery ◽  
Scale Up ◽  
Cancer Center ◽  
Resource Constrained ◽  
Resource Limited ◽  
Set Up ◽  
Treatment Safety

Purpose The development of cancer care treatment facilities in resource-constrained settings represents a challenge for many reasons. Implementation science—the assessment of how services are set up and delivered; contextual factors that affect delivery, treatment safety, toxicity, and efficacy; and where adaptations are needed—is essential if we are to understand the performance of a treatment program, know where the gaps in care exist, and design interventions in care delivery models to improve outcomes for patients. Methods The field of implementation science in relation to cancer care delivery is reviewed, and the experiences of the integrated implementation science program at the Butaro Cancer Center of Excellence in Rwanda are described as a practical application. Implementation science of HIV and tuberculosis care delivery in similar challenging settings offers some relevant lessons. Results Integrating effective implementation science into cancer care in resource-constrained settings presents many challenges, which are discussed. However, with carefully designed programs, it is possible to perform this type of research, on regular and ongoing bases, and to use the results to develop interventions to improve quality of care and patient outcomes and provide evidence for effective replication and scale-up. Conclusion Implementation science is both critical and feasible in evaluating, improving, and supporting effective expansion of cancer care in resource-limited settings. In ideal circumstances, it should be a prospective program, established early in the lifecycle of a new cancer treatment program and should be an integrated and continual process.

Effect of a gastrointestinal multidisciplinary clinic on the quality of pancreatic cancer care delivery at a community cancer center.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 378-378
Author(s):  
Laurence E. McCahill ◽  
Gerald P. Wright ◽  
Sunil Konduri ◽  
Mary May ◽  
Coralyn Martinez ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Care ◽  
Care Delivery ◽  
Clinical Stage ◽  
Quality Measures ◽  
Cancer Center ◽  
R0 Resection ◽  
Value Assessment ◽  
Periampullary Neoplasms

378 Background: Healthcare reform calls for measurements of value in services received. The 2002 IOM report Crossing the Quality Chasm emphasized deficits in efficiency, effectiveness, and patient centeredness. In 2009, a pancreatic cancer panel proposed 43 measures for high quality pancreatic cancer care. We incorporated these composite measures into a unique program of multidisciplinary (MD) care, nurse navigation (NN), and quality monitoring. Methods: A MD gastrointestinal cancer program was initiated in Jan 2010. Key components included a treatment planning conference followed immediately by a MD clinic. A GI NN coordinated staging, clinical evaluation, and treatment initiation. Patients with suspected /newly diagnosed pancreatic or periampullary neoplasms were included. We evaluated our quality of cancer care and outcomes proposed by the pancreatic cancer quality expert panel. Results: A total of 76 patients with pancreatic neoplasms were evaluated over 18 months, 55 subjects had confirmed malignancies. Of these, 20 were clinical Stage I/II, 15 stage III and 20 Stage IV. Quality measures in Table 1 focus on quality measures. 25 patients underwent resection. Mean OR time was 424 min, mean EBL 843 mL, morbidity 30%, mortality 4%, R0 resection rate 76%, mean nodes evaluated 24, and mean hospital LOS 10 days. Complete adherence with guidelines occurred in all 30 non-operative patients and 22 of 25 patients who undergoing resection. Overall compliance for all pancreatic cancer care guidelines was 99.7%. Conclusions: Comprehensive MD pancreatic cancer evaluation and care is feasible in a community cancer. We believe this study establishes new benchmarks of quality and value assessment for pancreatic cancer programs. [Table: see text]

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