Journal articles: 'Cancer Hospitals Liminality. Cancer Patient compliance' – Grafiati (2024)

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206 Background: Both negative margins and lymph node yields ≥ 18 from neck dissections in patients with head and neck mucosal squamous cell carcinomas (SCC) have been correlated with improved overall survival. It is unclear whether these patient-level metrics are applicable at the hospital level, and what compliance rates hospitals would need to achieve to show an improvement in survival. Methods: The National Cancer Database (NCDB) was used to identify patients who underwent primary surgery that included a neck dissection for mucosal SCC of the oral cavity, oropharynx, larynx, and hypopharynx. The percentage of patients at each institution with negative margins on primary resection and lymph node yields ≥ 18 from a neck dissection was quantified. A multivariate Cox proportional hazard regression was used to determine the association between hospital compliance rates with these metrics and overall survival. Results: There were 65,097 patients at 1,087 hospitals in the NCDB who underwent a neck dissection for mucosal SCC of the head and neck. A total of 221 hospitals (20%) had lymph node yields of 18 or higher in ≥ 80% of patients, and 137 hospitals (12.6%) achieved negative margins in ≥ 90% of patients. Patients treated at hospitals that attained the combined quality metric of ≥ 80% compliance rate with lymph node counts and a ≥ 90% compliance rate with negative margins, showed a significant improvement in overall survival (hazard ratio [HR] 0.93; 95% CI 0.89 to 0.98). This benefit in survival was independent of the patient level improvement seen from having negative margins (HR 0.73; 95% CI 0.70 to 0.75) and a lymph node count ≥ 18 (HR 0.85; 95% CI 0.83 to 0.88). Treatment at high volume or academic teaching hospitals was not independently associated with improved survival once the model controlled for margin status and lymph node count. Conclusions: Patients with head and neck mucosal SCC experience better survival when treated at hospitals achieving a combined quality metric based on lymph node counts and negative margin rates. National tracking of these modifiable quality metrics may identify facilities that would benefit from quality improvement measures.

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Objective: To calculate and compare adherence to pancreatic cancer care quality indicators and related outcomes at three hospitals within our health system and determine their relatedness. Design: Retrospective review of cancer registry data and patient charts from January 1, 2000 – December 31, 2010. Setting: Three hospitals performing pancreatic resections within a single health system. Patients: All patients undergoing resection for the treatment of pancreatic cancer. Main Outcome Measures: Adherence to published quality indicators, patient survival, and surgical and institutional variables related to mortality. Results: Complication, morbidity and mortality, and overall survival rates were similar between facilities and were comparable to previously reported values of similar volume facilities. Overall adherence to quality indicators was approximately 73%; compliance to indicators in the “outcome” and “efficiency” domains was highest, but adherence was not associated with clinical outcomes. Patient mortality was lowest at the highest volume hospital in our health system; however, surgeon volume was not predictive of outcomes. Conclusion: Use of quality indicators is valuable in determining quality of care and identifying weaknesses, allowing for a targeted approach to improve quality of care and the associated processes. However, adherence to these quality indicators is not necessarily indicative of outcomes.

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68 Background: The Ottawa CoP model for developing multidisciplinary practitioner networks and integrating them with organizational processes was established in 2007 as a platform improving access to quality cancer surgery in one of the health regions (population 1,276,370) of Ontario, Canada. The three inter-disciplinary CoP collaboratives in breast, colorectal, and prostate cancer involve 230 care providers from 9 hospitals performing over 2,000 cancer surgeries per year. Objectives: 1) to address lack of coordination and standardization of care, 2) develop a regional platform for quality initiatives, and 3) bridge the gap between academic and community hospitals. Methods: Using the model, an academic tertiary care hospital and eight community hospitals partnered to support a regional quality improvement initiative that combines 1) educational outreach with audit and feedback to address variations in practice and 2) a unique platform for knowledge generation and innovation. Regional interdisciplinary teams developed a set of regional quality indicators (18) linked to mutually agreed standards and pathways. Regional registry was established to provide data feedback on performance against both provincial and regional standards. Best practices, innovations, and implementation progress are reviewed through sustained interactions between CoP members. Patient and care provider surveys are conducted. Results: The development and implementation of regional care standards and clinical pathways for three disease sites in 9 hospitals. Regional pathway compliance ranged 65-94%. Other significant improvements include: rectal cancer surgery centralization (80-90% per annum), increase in use of sentinel lymph node biopsies in breast cancer surgery (60-77% per annum) and a decreased positive prostate cancer surgical margin rate form 45% to 22%. Compliance with provincial guidelines for colon cancer surgery improved (20% increase 2006/2007 vs. 2010/2011). Increase in patient access to high-quality cancer surgery closer to home. Conclusions: Participation in the regional CoPs is associated with quality improvements at the system, patient, and professional levels.

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Background and context: Nigeria, being the most populous African country has the highest cancer burden. Fragmentation of healthcare services leads to late presentation, inappropriate navigation, delay in diagnosis, intervention and an increased loss to follow-up. Aim: To have a harmonized and fast-tracked cancer diagnosis and management via providing an integrated cancer care and effective navigation to tertiary hospitals, when required. Strategy/Tactics: We set up a center to screen, diagnose and treat cancers in partnership with collaborators, at low cost to patients. Program/Policy process: The BWS (Breast Without Spot) Screening and Wellness Centre was set up in 2016 to offer cancer/NCD education, screening services for cancers and other noncommunicable diseases. A multidisciplinary volunteer team takes care of diagnostic ultrasound, ultrasound-guided biopsies, cryotherapy of premalignant cervical lesions, histopathology and chemotherapy. Where radiotherapy and surgery are indicated, patients are navigated appropriately to our collaborators in tertiary hospitals. Outcomes: 721 persons were seen. 112 men and 609 women, 14 men had PSA/DRE and 411 women had VIA and CBE. 58 women had sonomammography while 9 with suspicious masses had ultrasound-guided biopsies followed by histologic diagnosis and IHC for proven malignancy. In the women with proven breast cancer, 7 underwent chemotherapy while 8 were navigated to radiation therapy and surgery. What was learned: There is improved patient experience and compliance when there is an accessible “one stop” facility for their care. Early detection, prompt diagnosis and facilitated treatment improves prognosis. With prompt access to care, patients feel supported and eager to go through the entire cancer care process.

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Purpose The commencement of quality-improvement initiatives such as Pay for Performance and the Physician Consortium for Performance Improvement has underscored calls to evaluate the quality of cancer care on a patient level for nationally representative samples. Methods We sampled early-stage prostate cancer cases diagnosed in 2000 through 2001 from the American College of Surgeons National Cancer Data Base and explicitly reviewed medical records from 2,775 men (weighted total = 55,160 cases) treated with radical prostatectomy or external-beam radiation therapy. We determined compliance with 29 quality-of-care disease-specific structure and process indicators developed by RAND, stratified by race, geographic region, and hospital type. Results Overall compliance exceeded 70% for structural and pretherapy disease assessment indicators but was lower for documentation of pretreatment functioning (46.4% to 78.4%), surgical pathology (37.1% to 86.3%), radiation technique (62.6% to 88.3%), and follow-up (55%). Geographic variations were observed as higher compliance in the South Atlantic division than the New England division for having at least one board-certified urologist (odds ratio [OR], 9.2; 95% CI, 1.9 to 45.0), at least one board-certified radiation oncologist (OR, 3.3; 95% CI, 1.2 to 9.0), use of Gleason grading (OR, 4.1; 95% CI, 1.2 to 13.8), and administering total radiation dose ≥ 70 Gy (OR, 3.1; 95% CI, 1.6 to 6.1). Teaching/research hospitals and Comprehensive Cancer Centers had higher compliance than Community Cancer Centers, whereas racial differences were not observed for any indicator. Conclusion The significant and unwarranted variations observed for these quality indicators by census division and hospital type illustrate the inconsistencies in prostate cancer care and represent potential targets for quality improvement. The lack of racial disparities suggests equity in care once a patient initiates treatment.

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206 Background: Cancer screening, like other interventions, requires close patient-provider collaboration. By patient recall, key elements are often omitted from informed consent discussions. Most screening guideline compliance efforts focus on reducing underuse, but overuse is also harmful and may be influenced by distinct factors. Therefore, we are performing a prospective randomized trial of educational interventions to improve screening compliance for breast, cervical, colorectal, lung and prostate cancer at an urban academic medical center. Our hypothesis is that gender, age, prior screening experience, provider recommendations, anticipated benefit and distress, communication and informational support will affect compliance. Our primary data collection will be complete before the Symposium. Methods: We will enroll an age- and sex-stratified sample of 216 patients aged 40 to 89 years, 18 each treated by 12 primary care physicians at two affiliated hospitals, undergoing an annual physical examination in a cluster-randomized prospective trial of educational supports for screening. Screening guideline format (color-coding) and academic detailing will be randomly assigned independently. Patients and providers are surveyed immediately after the encounter to record their recollections of screening discussions and recommendations and their plans. Follow-up surveys at 3, 6 and 12 months assess concordance between expressed screening intentions and behaviors. Results: Pilot results indicate patient gender, age, anticipated screening-related distress and benefit, and prior screening experience affect screening recommendations and intentions. These factors vary by cancer. Patients recall less discussion than providers. Reasons not to screen are infrequently discussed. Conclusions: Cancer screening decisions are complex and vary by screening modality, patient and provider factors and communication. Improving underuse and overuse compliance may require distinct strategies. Screening overuse may be a “lower-stakes” environment to develop strategies to reduce overuse of cancer interventions of marginal or negative benefit, including treatment.

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10071 Background: The majority of colorectal cancer (CRC) patients present with resectable disease and benefit from future resection of second primary CRC, local recurrence, and oligometastases. Therefore, in addition to colonoscopy one year after diagnosis, American Society of Clinical Oncology (ASCO) offers consensus recommendations to monitor serum CEA and CT scans for early detection. Limited adherence to guidelines has been reported; we explore the impact of specific patient factors related to CRC on provider prescribing in the first year. Methods: At a single urban safety-net hospital, electronic medical records of patients diagnosed with stages I-III CRC from 2002-2014 were reviewed with IRB approval. Chi-square tests determined extent of associations between categorical variables. Two sample t-tests compared means for continuous outcomes across groups. Cut-off for Type 1 error was alpha = 0.05. Due to minimal change in surveillance guidelines, we applied ASCO 2005 recommendations. Results: Records for 357 patients included 52% females and 40% African-Americans. Median age was 63 years, ever tobacco abuse was 69%. BMI > 30 found in 38%, median weight at diagnosis was 79 kg. Incidence of surveillance and associated variables are in the Table. Conclusions: The providers of this young, urban, almost 40% obese population were < 50% compliant with first year colonoscopy and < 60% compliant with CEA tests. Providers did significantly survey patients with co-morbidities, such as higher weight at diagnosis, in this small study. Most patients complied with orders and primary care providers were least compliant (data not shown). The data supports verification in larger study of safety-net hospitals and future comparison regarding influence of new Survivorship Care Plans on guideline adherence. To improve provider compliance, etiology of nonadherence must be addressed. [Table: see text]

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108 Background: To assess quality in breast cancer care, standardized metrics are needed. Many accepted breast performance metrics are based on evidence-based practice; however, most fail to reflect patient choice in treatment decisions. Given the focus on patient-centered breast care, we sought to determine how compliance with established quality metrics correlates with receipt of breast cancer care impacted by patient preference. Methods: American College of Surgeons (ACS) National Cancer Data Base facilities were designated compliant or non-compliant based on Commission of Cancer (CoC) breast metrics MASTRT, BCSRT and HT*, which all improve survival. Compliant facilities met the expected performance rate (EPR) for all three metrics, while non-compliant facilities failed to meet the EPR for any. Rates of breast conserving surgery (BCS) for early stage cancer, immediate breast reconstruction (IBR), and contralateral prophylactic mastectomy (CPM) are proposed metrics that are impacted by patient preference. For these, quality is defined as high rates of BCS, high rates of IBR, and low rates of CPM. Multivariable logistic regression models were used to estimate the association between facility level rates on these measures and the probability of treatment at a CoC compliant facility. Results: 729 facilities were included in the analysis. Based on the CoC measures, 79 (10.8%) were considered compliant and 650 (89.2%) non-compliant. Rates of BCS and IBR did not differ between compliant and non-compliant facilities; however, women treated at compliant facilities were more likely to undergo CPM (26.3% vs 21.4%; p = 0.02). In a multivariate model treatment at compliant facilities was associated with higher rates of BCS, IBR, and CPM; however, the predictive value of these metrics was minimal (Estimated OR range: 1.01-1.03). Conclusions: Rates of preference driven therapies do not differentiate CoC compliant and non-compliant hospitals. The quality of a hospital’s breast care is likely poorly measured by metrics that are influenced by, but cannot account for patient values. *MASTRT (RT≤1yr of diagnosis in women with ≥4 +lymph nodes); BCSRT (RT ≤1yr of diagnosis for women ≤70 receiving BCS); HT (hormone therapy recommended ≤1yr of diagnosis for HR-positive breast cancer)

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91 Background: Lynch Syndrome (LS) is a genetically inherited autosomal dominant disease that is the result of germline mutations in mismatch repair (MMR) genes. LS is the most common cause of inherited colorectal cancer (CRC), causes cancer at a younger age, and increases other cancer risk (pancreas, endometrium). Thus, it is important to identify patients who have LS so that patients and affected family members can receive the proper surveillance and care. Hartford HealthCare Cancer Institute (HHCCI) has developed a standard of care to screen patients who may have LS by testing CRC specimens for loss of expression of MMR genes, as well as to refer all patients under 50 for counseling. The aim of this research project is to determine how well each of our healthcare system's five hospitals is meeting the standard. Methods: This retrospective study explored all cases of CRC at each of the five HHCCI hospitals from 2014-2015. Patients were identified from the Cancer Registry and data was extracted from patient charts, pathology and genetics reports. The study analyzed: age, gender, stage, presence of MMR testing, and genetics counseling and testing for MMR positive patients and patients under 50. Results: 423 CRC patients were diagnosed at HHC cancer centers, 45% male, 55% female, average age of 68.2. In total, HHCCI tested 81.3% of patients diagnosed with CRC in 2014-2015, ranging from 30.8 to 94.5% among the hospitals. 7.6% of patients had abnormal MMR results. Of patients with MMR+ results, 57.7% had genetic consult and 10 of the 15 consulted had a germline test. Seven patients (70%) tested positive for LS. Patients with LS were younger (average age 47.6), and the majority were male. Ten of 45 patients under 50 were referred for genetics consult (22%), with a range of 0-67% amongst the hospitals. Three were LS positive on testing. Conclusions: Clinicians on our GI cancer team assumed that the agreed upon standard of MMR testing in CRC and referral of younger patients for genetics counseling would result in 100% compliance. The study outcomes suggest a need for improved implementation strategies for CRC testing at HHCCI hospitals. Overall, the study demonstrates the importance and need of quality improvement measures to inform and improve patient care.

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Oxaliplatin-induced neuropathic pain limits treatment compliance. However, the variability of neuropathic pain symptoms in each cycle for individual patients and the impacts on treatment compliance remain untested. Data from 322 adult patients who received oxaliplatin-based chemotherapy were extracted based on pattern of chemotherapy, adverse events, and patient survival. Cox regression and survival analyses were employed. Seventy-eight percent of patients developed neuropathic pain that oscillated between a complete absence and presence on a cycle-by-cycle basis. Consequently, the presence of neuropathy in one cycle did not predict the incidence of neuropathy in subsequent cycles. This implies that neuropathic pain need not be a sufficient criterion to reduce, delay, or cease chemotherapy. In the case of multiple system adverse events during combined drug treatment, the responsible cause for dose reduction was not identified. Cox regression analysis revealed that middle age (61–78 years old,P=0.003) and oxaliplatin cumulative dose <850 mg/m2(P=0.002) were associated with patient mortality. Completion of chemotherapy (8 cycles) and cumulative dose >850 mg/m2of oxaliplatin prolonged the median survival time by 8 and 5 months, respectively. As oxaliplatin-induced neuropathic pain fluctuates across cycles in a manner that varies from patient-to-patient, current assumptions on the predictive nature of the emergence of neuropathy (and its impact on treatment compliance) need to be reconsidered. Detailed patient-by-patient analysis of adverse events should be applied to future studies in order to determine the efficacy of current treatments (and future interventions) and whether neuropathic pain should be retained as a criterion to vary the treatment. Additionally, when two or more system toxicities occurred in cases of combined drug treatment, the causes for drug reduction should be separately recorded.

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164 Background: SDM may vary by patient and clinical decision. In a randomized trial of physician (MD) educational interventions to improve cancer screening guideline compliance, we studied patient (PT) and MD recall of discussions and factors that affected recall. Methods: In a cluster-randomized trial of educational supports for MDs, we are enrolling an age- (30-89 years) and sex-stratified sample of 216 PTs who underwent a physical examination at 2 urban hospitals, 18 for each of 12 primary care MDs. Screening guideline formatting (color-coding) and academic detailing were randomly assigned in a 2x2 design. Immediate post-encounter surveys recorded PT and MD recall of screening discussions. Results: The first 174 participants were diverse (63% white) and highly educated (77% college degree). PTs and MDs differed in recall of screening discussions, and the differences varied by screening test. When MDs reported a colorectal cancer (CRC) screening discussion, 21% of PTs did not; 20% of MDs disagreed when PTs reported the discussion. The discrepancies were greater for prostate specific antigen (PSA) screening, 29% and 29%, respectively, but much less for mammograms (MAM), 8% and 5%, respectively. Recall of the MD recommendation also differed: 15% of PTs disagreed when their MD reported it, and 33% of MDs when their PT reported it. For PSA, disagreement was 26% and 33%, respectively, and for MAM, disagreement was 17% and 10%, respectively. Overall, agreement between all PTs and MDs on whether screening was recommended was fair for CRC, PSA and MAM: kappa = 0.33, 0.34 and 0.29, respectively. Older PT age ( > 70) sharply eroded agreement on recalled CRC and PSA recommendations (kappa = -0.02 and -0.03, respectively) but much higher for MAM (kappa = 0.39). Recall concordance improved when elements of SDM were recalled. For CRC, kappa rose from -0.12 to 0.52 if the MD recalled any MDM element. Conclusions: In a highly educated, diverse PT population, PTs and MDs surveyed immediately after their encounter often disagreed on what had occurred in screening discussions. Disagreement was greater for CRC and PSA vs. MAM, greater for older PTs but improved when SDM was recalled. Clinical trial information: NCT02430948.

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Here we investigated the establishment of multicenter cooperative treatment groups in China, as well as radiotherapy compliance and effectiveness among children with renal tumors. Medical records were reviewed for 316 children with renal tumors diagnosed by a multicenter cooperative group from 14 hospitals in China from 1998 to 2012. Median patient age was 29.5 months (range, 2–173 months old), and male-to-female ratio was 1.4 : 1. After a median follow-up of 22 months (range, 1–177 months), five-year event-free survival rates were 72% overall; 76.1% for favorable histology (251 cases); 59% for unfavorable histology (27 cases); and 91%, 75%, 71%, 53%, and 48.5%, respectively for Stages I, II, III, IV, and V. Following standardized criteria, radiation therapy was indicated for 153 patients, among whom five-year event-free survival was 72.8% for the 95 who received radiation and 24% for the 58 patients who did not. Our results are reasonable but can be further improved and show the feasibility of a multicenter cooperative group model for childhood renal tumor treatment in China. Radiation therapy is important for stage III and IV patients but remains difficult to implement in some parts of China. Government management departments and medical professionals must pay attention to this situation. This clinical trial is registered with ChiCTR-PRCH-14004372.

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100 Background: The Mount Sinai Health System and the Tisch Cancer Institute (TCI) includes 7 hospitals and 6 ambulatory oncology centers in New York City, with over 9,000 new cancer cases seen annually. In order to address PS across these multiple sites, we established a framework to enhance value encompassing 4 domains: Infrastructure, Responsibility, Outcomes and Monitoring. Methods: Infrastructure. A quality dashboard was developed and distributed across all system sites. Inpatient oncology Dyads (D) (inpatient medical director and nurse manager) and ambulatory oncology Triads (T) (ambulatory medical director, nurse manager and administrator) and Quadrads (Q) (including radiation therapist) were established. Responsibility. DTQs at each location were given collective responsibility for PS performance. Outcomes. The relevant HCAHPS and Press-Ganey PS scores were defined across all groups; expectations for initiatives to improve PS were delineated. Monitoring. Each DTQ reported PS performance and progress on initiatives at a quarterly system-wide meeting of the TCI QI committee. Results: The quality dashboard provided a comprehensive PS report for all system sites and the DTQs identified specific individuals responsible for PS at each site. Within 6 months, establishment of the value framework more than doubled the number of quality initiatives, including ones focused on pain management, goals of care discussions and distress screening. Required participation in the TCI QI committee resulted in 100% compliance with reporting to a high level oversight group. Conclusions: The value framework involved the complete reorganization of how PS was reviewed, which individuals were responsible, and how initiatives to improve the patient experience were developed and monitored across the health system. Standardized dashboard-based reporting of PS facilitated review of critical information and creation of the DTQ structure facilitated engagement by key stakeholders, leading to numerous quality initiatives. Regular reporting elevated the level of attention ascribed to PS and the oversight group provided ongoing guidance for the process.

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e18805 Background: Approximately 20% of newly diagnosed cancer patients are between the ages of 20 and 54, and many of these patients are also the primary caregivers of children. Qualitative studies focusing on this demographic indicate that patients who are parents struggle to balance their own care needs with those of their children. Further, a lack of childcare support during cancer treatments can negatively impact compliance and increase existing psychological stress for patients. In the efforts to establish a child-minding program at a major Canadian cancer centre, we carried out an environmental scan to evaluate the current state of childcare support for cancer patients. Methods: Firstly, a literature scan was conducted in order to assess current knowledge about childcare and cancer patients, which included the use of search engines, directed internet searches, a review of oncology conference proceedings and websites of oncology associations. Literature was selected based on pre-determined criteria. Secondly, 12 representatives from major Canadian cancer centres (CCC) completed a questionnaire assessing current childcare strategies at their respective institutions. Finally, a broad scan of the grey literature was conducted by investigating 161 Canadian and American hospitals for on-site childcare services, using lay-accessible searching techniques (hand-searching hospital websites, phone and email correspondences). Results: The literature scan identified seventeen primary articles, which focused largely on exploring the role strain faced by patients who are also parents. A single study explored the instrumental challenges of being a parent with cancer, and formally assessed the childcare needs of these patients. The questionnaire results indicated that only two of the twelve investigated CCCs had established an approach to child-minding for patients. The grey literature scan identified twenty-six on-site, patient-accessible child-minding centres at hospitals in Canada and the US based on pre-determined inclusion criteria. Of these, 76.9% of centres were associated with pediatric hospitals, and 69.2% were located in the United States. Most centres (76.9%) were open for over 30 hours per week, and 88.5% of centres were free of charge to users. Conclusions: These findings generally indicate that a minority of Canadian and American hospitals and cancer centres have formal childcare services in place to support patients who are also parents. As cancer patients are at increased risk for financial toxicity, they may be particularly in need of this kind of instrumental support. This highlights the importance of carrying out a targeted needs assessment in order to fully elucidate the need for patient-accessible childcare services at CCCs.

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99 Background: Inpatient palliative care (PC) teams have increased their presence over the past decade, with over 90% of hospitals having access to PC specialists. However, such growth has not been mirrored in the outpatient setting; this is relevant for patients living far from major medical centers. Memorial Sloan Kettering Cancer Center (MSK) has expanded its ambulatory care footprint beyond New York City (NYC) to sites where PC is not currently available. To address the need for PC delivery to a geographically dispersed patient population, we developed a clinical initiative utilizing telemedicine technology. Methods: The Telemedicine Palliative Care Program (TPCP) was initiated after planning with multiple stakeholders, including clinical, legal, billing, compliance, ambulatory care, information systems, and scheduling departments. The TPCP provides PC consultation and management of patients via a “hub-and-spoke” model, whereby PC specialists are located at the main campus in NYC and patients are scheduled to be seen at one of six regional ambulatory cancer sites within a 50-mile radius. Regional ambulatory sites have video teleconference rooms equipped with Cisco (San Jose, CA) TelePresence MX300 hardware and Jabber software allowing for secure, high fidelity, real-time video communication with clinicians at the main campus who use iPads installed with Jabber software during their consultation sessions. Results: The TPCP is currently active at two regional sites in New York and New Jersey. Patient satisfaction, perception of quality of care, and patient outcomes will be measured. Preliminary results indicate that both patients and providers find this clinical program to be an extremely valuable experience. Conclusions: The technologic infrastructure is now available to deliver telemedicine-enabled PC for cancer patients in a geographically distributed model. Our early experience suggests that our program will help enable the convenient delivery of concurrent PC to cancer patients across a wide geographic area. This innovative clinical initiative has the potential to enable all MSK patients to access high-quality palliative care in a geography-agnostic manner, and eventually deliver such care to patients in their homes.

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e18010 Background: To effectively assist lymphoma patients and their care-givers after their hospital discharge, a standard follow-up guideline for lymphoma patients was designed and encoded through a computer-interpret-able-guideline (CiG) engine and deployed through mobile-Web and mobile-Apps to ensure continuous care throughout the treatment and recovery processes. Methods: Scheduled tasks including ePRO questionnaires and requests for test results were sent for completion, and a virtual care management team was assigned to ensure compliance and respond to automatic triggered alerts. Attending oncologists also were given mobile-Apps to access the patients’ securely uploaded records and consult remotely to manage side-effects manifested after discharge. The out-of-hospital record management and care coordination enabled the adjustment of individual treatment plans and the optimization of clinical resources utilization. Results: During 2018, 1012 patients or their caregivers interacted with our team through the mobile platform after discharge. Out of these, 856 individual patients uploaded enough information to be initiated in the mobile follow-up program. Approximately 30% of these patients were Beijing residents while the rest came from all over China. Close to half of these patients had follow-up tests done in other 387 hospitals or 52 clinics. Based on ePRO questionnaires submitted, 218 patients had 616 side-effect-symptom alerts triggered and followed up, in addition to patient-initiated mobile consultation with their attending oncologists. Lab results especially white blood cell counts, platelet counts, and neutrophil counts, contributed to the majority of test alerts managed by our team. Analysis of the thousands anonymized questions identified clinical processes in need of optimization. A new patient education manual addressing frequently asked questions, and new processes such as chemo-regime scheduling were put in place. Conclusions: We have demonstrated the feasibility of a mobile-deployed care management process after discharge for lymphoma patients and their caregivers. We have initiated retrospective studies of impacts on our patients’ treatment compliance and quality of life. A randomized clinical trial in six cancer types assessing the value of such an approach is also under planning.

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Background and context: Breast cancer is one of the most common cancers in most resource-constrained environments worldwide. Although breast awareness has improved, lack of understanding of the diagnosis and management can cause patient anxiety, noncompliance and ultimately may affect survival through compromised or delayed care. South African women attending government hospitals are diverse, with differing levels of income, education and support available. Often there is a lack of access for them to appropriate information for their cancer care. Aim: A novel bioinformatics data management system was conceived through an innovative close collaboration between Wits Biomedical Informatics and Translational Science (Wits-BITS) and academic breast cancer surgeons. The aim was to develop a platform to allow acquisition of epidemiologic data but synchronously convert this into a personalised cancer plan and “take-home” information sheet for the patient. Strategy/Tactics: The concept of a clinician “customer” was used, in which the “currency” in which they rewarded the database service was accurate data. For this payment they received the “product” of an immediate personalised information sheet for their patient. Program/Policy process: A custom software module was developed to generate individualized patient letters containing a mixture of template text and information from the patient's medical record. The letter is populated with the patient's name and where they were seen, and an personalised explanation of the patient's specific cancer stage according to the TNM system. Outcomes: Through a process of continuous use with patient and clinician feedback, the quality of data in the system was improved. Patients enjoyed the personalised information sheet, allowing patient and family to comprehend and be reassured by the management plan. Clinicians found that the quality of the information sheet was instant feedback as to the comprehensiveness of their data input, and thus assured compliance and quality of data points. What was learned: Using a consumer model, through a process of cross-discipline collaboration, where there is normally poor access to appropriate patient information and poor data entry by overburdened clinicians, a low-cost model of high-quality data collection was achieved, in real-time, by clinicians best qualified to input correct data points. Patients also benefitted from participation in a database immediately, through personalised information sheets improving their understanding of their cancer care.

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491 Background: Venous thromboembolism (VTE), comprising deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major preventable source of postoperative complications. The risk of VTE in patients undergoing radical cystectomy (RC) for bladder cancer has been estimated at 6%, and the American Society of Clinical Oncology, American Urological Association, and National Comprehensive Cancer Network all recommend perioperative chemoprophylaxis. We performed a population-based analysis to determine the utilization of chemoprophylaxis against VTE in patients undergoing RC. Methods: Using the Premier Hospital Database (Premier, Inc., Charlotte, NC), we retrospectively identified patients who underwent RC for bladder cancer in the US between 2006 and 2015. Administration of chemoprophylaxis within 24 hours of surgery was deemed consistent with recommendations. A subgroup analysis of higher volume hospitals (³10 RC annually) compared outcomes of DVT, PE, and bleeding between patients in hospitals with uniform use versus no use of chemoprophylaxis. Multivariate analysis was used to evaluate predictors of under-utilization of chemoprophylaxis. Results: Among the cohort of 9,133 patients (48,714 patients after weighting adjustment) undergoing RC, 35.1% were administered recommended chemoprophylaxis, with an increase in utilization from 20.7% in 2006 to 49.6% in 2015. Characteristics associated with decreased likelihood of chemoprophylaxis administration included patient age ≥65 years, Charlson Comorbidity Index score ≥2, rural hospital location, commercial insurance, and year of surgery prior to 2010. Patients who received recommended chemoprophylaxis had significantly lower rates of VTE (5.1% vs 6.0%) and PE (2.0% vs 3.1%), but elevated rates of bleeding (12.8% vs 7.7%). Conclusions: The recommended utilization of chemoprophylaxis in a contemporary nationwide cohort of patients undergoing RC is limited despite its notable increase over the course of the study period. Greater compliance with recommended use of chemoprophylaxis following RC may be associated with decreased risk of PE and VTE, but also with increased risk of bleeding.

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e16124 Background: Neoadjuvant chemoradiation therapy (CRT) is a standard of care treatment for locally advanced rectal cancer (LARC). A pathologic complete response (pCR) following CRT is an early indicator of treatment benefit and associated with excellent survival outcomes. As capecitabine replaces infusional 5-fluorouracil (5-FU) as the fluoropyrimidine of choice in routine care of LARC, on the back of clinical trial data demonstrating equivalence, it is important to confirm that efficacy is maintained in the real-world setting. Methods: We analysed data from a prospectively maintained colorectal cancer database at 3 Australian hospitals including patients diagnosed January 2009 to December 2018. Pathological response was determined as either complete or incomplete and compared for patients receiving 5FU or capecitabine. Results: 657 patients were analysed, 498 receiving infusional 5-FU and 159 capecitabine. Capecitabine use has markedly increased from approval in 2014, now being used in more than 80% of patients. Patient characteristics were similar by treatment, including age, tumour location and pre-treatment stage. pCR was reported in 22/159 (13.8%) of capecitabine treated patients and 118/380 (23.7%) that received 5-FU (p = < 0.01). More capecitabine-treated patients received post-operative oxaliplatin (44.2% vs 6.3%, p < 0.01). Two-year progression free survival was similar (84.9% vs 88.0%, p = 0.34). Conclusions: Capecitabine is now the dominantly used neoadjuvant chemotherapy in LARC. Capecitabine use was associated with a lower rate of pCR versus infusional 5FU, a difference not explained by examined patient or tumour characteristics. Poor treatment compliance with an oral therapy in the real-world setting is one possible explanation.

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e24113 Background: Delivering bad news to patients is a delicate but required skill for doctors as part of patient care. There has been evidence that good communication from health care providers can improve patients' compliance to treatment as well as be beneficial emotionally. While many studies have been done in regards to patients' perceptions of receiving bad news, there are limited studies looking at a physicians' perspective, and even more so concerning residents' perceptions. In community hospitals, many patients are diagnosed with cancer, and resident physicians are often responsible for informing the patients and their families regarding the diagnosis. The manner in which the news is delivered is important, however it is unclear how much training is provided to residents before they are required to break bad news to patients. The lack of training can often result in improper delivery and poor patient care. Methods: We surveyed Internal Medicine and General Surgery residents at Mercy Catholic Medical Center, a conglomeration of two community teaching hospitals in Philadelphia, about prior training, confidence level, attitudes, and need for further education on delivering bad news to oncologic patients using a survey created after extensive research. The factors associated with confidence level were analyzed using paired T-test and ANOVA methods. Results: A total of 65 residents (72%) participated. No statistical significance was seen between American versus foreign medical graduates, MD vs. DO residents, or among those in different specialties when assessing their confidence in delivering bad news. Though only 62% of participants reported having had prior training in delivering bad news, residents with previous training (p1) or who have had to deliver bad news previously (p2) reported higher confidence when it came to delivering a new diagnosis of cancer (p1 0.03, p2 0.001), delivering news regarding the progression of cancer (p1 0.03, p2 0.02), delivering news regarding the recurrence of cancer (p1 0.04, p2 0.002), and delivering news regarding end-stage cancer with little to no treatment options left (p1 0.04, p2 0.003). 100% of participants thought communicating bad news is an important skill for a physician, and 92% of participants thought further education would help prepare them for similar scenarios in the future. Simulated patient scenarios (64%), grand rounds lectures/presentations (59%), and feedback from faculty after actual patient scenarios (57%) were the most requested whereas pamphlets/brochures (17%) and online training courses (20%) were less popular. Conclusions: Our study highlights the importance of prior training or exposure among residents in being able to deliver bad news to patients effectively. We propose that implementing further training in the form of simulated scenarios and lectures can improve residents' confidence at delivering bad news and result in a better physician-patient relationship.

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68 Background: Public reporting has been an established process for non-PPS exempt hospitals since the inception of the Core Measures in 2001; however, Cancer Centers were not subject to public reporting and had no standardized established formal mechanism to collect, analyze and report clinical quality data until the Affordable Care Act (ACA) of 2010. The first three Clinical Process/Oncology Care Measures must be submitted through the American College of Surgeons Rapid Quality Reporting (RQRS) system. Since registries are designed to provide a retrospective snapshot of the patient population during the first four months of the disease process, the change to longitudinal data collection, while critical for intervention in time to improve concordance, is extremely difficult for cancer centers with large volumes and complex cases. Our institution created a collaborative interdisciplinary model utilizing quality management nurses to support and enhance the submission process by utilizing an early identification and intervention process. Methods: Prior to implementation, the average submission time for the initial three oncology specific metrics was eight months due to the significant effort to determine the analytic population based on our volume of patients. In addition, many patients receive treatments outside the facility with little or no documentation that often resulted in the inability to determine metric concordance. Results: The new process identified patients at two months and created a robust follow up and validation process utilizing a model to ensure evidence based care is provided across the continuum. This enabled monthly submission to RQRS at the end of three months and leveraged the system to ensure that patients had the appropriate therapy documented in the system. This process shortened the submission time to less than half and initial projections indicate increased overall compliance. Conclusions: We enhanced the process of submission for federally mandated measures to RQRS by initiating early identification and follow up. This significantly impacted our ability to accurately represent the high quality care provided at our institution and provide documented concordance with national quality measures.

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160 Background: Shared decision making is recommended for prostate-specific antigen (PSA) screening. We are performing a prospective randomized trial of educational interventions to improve screening compliance at an urban academic medical center. We hypothesize that patient and provider characteristics providers will affect compliance. We report the first results for PSA screening. Methods: In a cluster-randomized trial of educational supports for providers, we are recruiting an age- and sex-stratified sample of 216 patients aged 30 to 89 years undergoing an annual physical examination, 18 patients of each of 12 primary care physicians at two affiliated hospitals. Screening guideline format (color-coding) and academic detailing were randomly assigned in a 2 x 2 design. Surveys occurred immediately post-encounter to record recollections of screening discussions, recommendations and plans. Results: We report on the first 44 of 108 planned male participants. Most were white (77%), had a college degree (83%), and currently married (59%). When providers reported a PSA discussion, 13% of patients disagreed, while 23% of patients disagreed when their provider reported a PSA discussion. Discrepancies also occurred on additional elements of informed decision-making (data not shown). Reports also disagreed on physician recommendations: 2 of 8 patients (25%) disagreed with the physician’s report of recommending screening and 6 of 12 patients (50%) disagreed with the physician’s report of not recommending it. Half of patients (49%) reported distress at getting PSA results, but only 5% reported “a lot” of distress. Over half (58%) reported that PSA testing protected against prostate cancer “a lot.” No physician reported recommending PSA testing to men under age 50 or over age 70, but 1 of 6 men under 50 and 3 of 3 men over 70 reported that their physician had recommended testing. Conclusions: In a highly educated population of men and physicians surveyed immediately after their encounter, reports of whether PSA screening had occurred, the information that had been discussed and the recommendation had important discrepancies. Important differences may exist between patients and physicians in perceptions of PSA screening discussions. Clinical trial information: NCT02430948.

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Abstract Objective: To evaluate the effects of multi-dimensional humanistic care on kids with hematological malignancies and their parents and facilitate the effective nursing experience and professional nursing in such clinical care. Methods: A total of 567 children with cancer and their parents were enrolled in this study. From January to December in 2017, multi-dimensional humanistic care was systematically implemented to provide care for all these patients and their family members. A warm and comfortable in-patient atmosphere was created with regular playing-games, health education meetings, and personal palliative care support were provided to all newly-diagnosed pediatric cancer patients and their parents who admitted to our department. In the meanwhile, case management were implemented by nurses. Children and parents in demand were referred to game therapists and social workers for visits, psychological counseling and emotional support. Financial assistance was also provided to care for those well-off families to support their systemic cancer treatment. Follow-up visits to hospitals were also offered. Results: The implementation of multi-dimensional humanistic care measures significantly reduced the anxiety level of hospitalized children with cancer and their parents, which in turn improve their treatment compliance. Next, more easier caregiving ability and compliance were also recorded. The results of satisfaction survey showed that the satisfaction to nursing care rose from 85.6% in 2016 to 96.9% in 2017 after the implementation of multi-dimensional humanistic care in our hospital. The nurses' service attitude, medication guidance, hospitalization guidance, timely bedside services, and nurses' operating technology satisfaction also increased by 10.86%, 12.17%, 8.3%, 12.80%, and 12.15% respectively. Conclusion: The multi-dimensional humanistic care effectively reduces the anxiety of kids with hematological malignancies and their parents, improves the caregiver's caring ability and compliance, and their satisfaction to nursing care. All these results point out the significance of systemic care services in the childhood cancer therapy, it is noteworthy to pour more attention and capacity to the clinics which may facilitate the cancer treatment. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

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Abstract Background HH is a key component to decrease infections in hospitals, but compliance in HCW remains low. We present a six-month strategy to empower patients’ caregivers on HCW HH compliance. Methods HH compliance in HCWs was evaluated between June 1 and August 31, 2017 as recommended by WHO. Between September 1, 2016 and March 31, 2017 we undertook the empowering in the hematology-oncology ward (50 beds) from Instituto Nacional de Cancerologia, a cancer referral, teaching hospital in Mexico. To empower patients and their caregivers, a member of the team visited the patient and their relatives during the first 24h of hospital admission. Standarized information on HH and the importance of HCW compliance was given, along with a printed cartoon on HH opportunities (5 moments from WHO). Patients and their caregivers were trained to observe and record HH opportunties, an were invited to remind HCWs if HH omissions were observed. Data on HH compliance was collected monthly during the empowerment and 1 month after. Data was compared with the HH compliance from the 6 previous. We compared overall compliance and for each 5 HH moments before and after the empowering (chi 2 test). Results We empowered 82 caregivers (M: 25.6%) and F: 74.4%), mean age 44 years. 24.4% had completed primary education, and 13.1% had higher education. Mothers and spouses were the primary caregivers (28.1% and 36.6%). HH compliance increased in all 5 moments: Before touching a patient (M1) (B: 9.5%, A: 57.6%, P = 0.005); before a clean or aseptic procedure (M2) (B: 7.9%, A: 48%, P = 0.002); after body fluid exposure (M3) (B: 10%, A: 59%, P = 0.0005), after touching a patient (M4) (B: 7.4%, A: 57.9%, P = 0.0005), and after touching patient surroundings (M5) (B: 2.4%, A: 77.4%, P = 0.0008). Nurses achieved a higher increase on compliance compared with physicians. Caregivers recognition on HH increased for each opporunity, being more notorious for M2 (B:31.7%, A: 61.5%); M3 (B: 7.3%, A: 31.5%), and M4, (B: 36.5%, A: 68.7%). Perception on the importance of preventing health-care-related infections increased from 80.5% to 90.3%. Conclusion Empowering patients’ primary caregivers was an effective intervention to increase HCWs HH compliance at a hematology-oncology ward. The effect of this intervention remains to be evaluated on the long-term basis, but demonstrate the importance of involving patients and their relatives on health-care delivery. Disclosures All authors: No reported disclosures.

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Purpose Forty percent of Egyptians have access to the public health system, and 60% are served by nongovernmental organizations and private centers. A problem exists, however, with the late presentation and inadequate access to services because of a lack of a structured screening program and awareness. The aim of this work was to present a model of breast cancer (BC) care in a low-resource setting and to assess risk factors for BC in Egypt, which has a high incidence of BC on the basis of registry estimates that indicate that approximately 22,000 new BC cases will be diagnosed by 2020. Methods In the Giza region, there was no mammographic reference service. Women with breast symptoms were referred to the National Cancer Institute, where they were offered services—diagnosis and treatment—with long wait times. Women age 20 years or older visiting one of the five participating centers were evaluated in a cross-sectional study, which included a data entry form questionnaire of risk factors for BC, including a family history of cancer, and the presence of breast symptoms, and breast examination by a trained professional—nurse or medical doctor. All patients with breast complaints or an abnormal physical exam were referred to the National Cancer Institute, MISR Cancer Center, Kasr El Aini, Agouza, and Bahia Hospital for additional evaluation. Women age 40 to 69 years were invited to participate in the screening both actively (digital invitations, Facebook groups, brochures distributed in governmental buildings, and WhatsApp groups) and passively (women who visited other hospitals in the region for any reason were called and delivered brochures and vouchers to join the project). The screening program was based on annual mammographies in women age 40 to 69 years, which are always preceded by physical examination by a breast surgeon or trained nurse. Close control of the frequency of visits was kept using a simple computer program with patient listing and reminder. Close contact and continuous feedback that helped adherence to the screening program. The proposal of the project includes the performance of all clinical, imaging, and pathology exams, as well as clinical visits and surgical treatment, in the same center, in the shortest time, and with the highest standards of care. The health care approach is multidisciplinary and includes nurses, breast surgeons, and a nutritionist. Results A high rate of compliance is the main strength of project. We achieved this with patient education on the importance of screening, intense contact with the primary trained staff with the provision of patient lists of those who should be screened next, and free transportation for women with low income. Every 3 to 4 months, we established jointly a charity workshop and projects of handmade cloths and bags for patients with BC and encouraged social clubs and societies to host parties and educational BC advocacy campaigns. Conclusion A simple project was successful and its cost effectiveness is balanced in Egypt as a developing country where mortality associated with BC is high. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

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532 Background: Participant characteristics affect shared decision making. In a randomized trial of physician (MD) educational interventions to improve cancer screening guideline compliance, we studied patient (PT) and MD recall of discussions and how PT characteristics affected recall. We report the first results for colorectal cancer screening. Methods: In a cluster-randomized trial of educational supports for MDs, we are enrolling an age- (30-89 years) and sex-stratified sample of 216 PTs who underwent a physical examination at two urban hospitals, 18 for each of 12 primary care MDs. Screening guideline formatting (color-coding) and academic detailing were randomly assigned to MDs in a 2x2 design. Immediate post-encounter surveys recorded PT and MD recall of screening discussions and recommendations. Results: We report on the first 174 participants. They were diverse (63% white) and well educated (77% college degree). When MDs reported a colorectal screening discussion, 20% of PTs did not, and MDs had similar disagreement when PTs reported the discussion. Greater disagreement occurred on the MD recommendation: 15% of PTs disagreed when the MD reported screening was recommended, and 33% of MDs disagreed when their patients reported they had recommended it. Agreement between PTs and MDs on whether screening was recommended was fair (kappa = 0.33), and there was no agreement for PTs over 70 years (kappa = -0.15). When PTs under 50 or 75 and older differed from their MDs on screening recommendations, it was for screening not against (8 vs. 2). PTs reported more elements of shared decision making than MDs (data not shown). Conclusions: In a highly educated population of PTs and MDs surveyed immediately after their encounter, reports of whether colorectal screening was discussed, the shared decision making elements and the MD recommendation had important discrepancies, especially for older PTs. Clinical trial information: NCT02430948.

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Purpose. Countries with nationwide quality programmes in colorectal cancer report an improved outcome. In Germany, a self-organized and self-financed observational quality assurance project exists, based on voluntary participation. The object of the present study was to ascertain whether this nationwide project also improves the outcome of colorectal cancer. Methods. The German Quality Assurance in Colorectal Cancer Project started in 2000 and by 2012 contained 85,000 patients. Inclusion criteria for the study were participation for the entire period of 13 years and treatment of rectal cancer. The following parameters were analysed: (1) patient related: age, gender, ASA classification, T-stage, and N-stage, (2) system related: frequency of preoperative CT and MRI, and (3) outcome related: CRM status, complications, and hospital mortality. Results. Forty-one of the 345 hospitals treating 11,597 patients fulfilled the inclusion criteria. The median age increased from 67 to 69 years (p=0.002). ASA stages III and IV increased from 32.0% to 37.6% (p=0.005) and from 2.0% to 3.3% (p=0.022), respectively. The use of CT rose from 67.2% to 88.8% (p<0.001) and that of MRI from 5.0% to 35.2% (p<0.001). The proportion of patients suffering from complications decreased from 7.9% to 5.3% (p<0.001) for intraoperative and from 28.0% to 18.6% (p<0.001) for postoperative surgical complications, but general postoperative complications increased from 25.8% to 29.5% (p=0.006). The distribution of histopathological stage, anastomotic leakage, and in-hospital mortality did not change significantly. Conclusion. Participation in a quality assurance project improves compliance with treatment standards, especially for diagnostic procedures. An improvement of surgical results will require further investment in training.

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239 Background: As a national network of five hospitals treating patients fighting complex cancers, continuous monitoring of clinical staff competence is a priority. Recognizing an opportunity for an enhanced structure for ongoing professional practice evaluation (OPPE), a process mandated by The Joint Commission, the network set out to create heightened accountability, reliability and understanding of the review of performance data. Methods: Two work groups were established. The first was charged with the selection of meaningful specialty specific measures applicable to the oncology patient population. The second tasked to leverage resources expended using existing software and limiting the need for manual intervention. This group was responsible for creation and implementation of a consistent workflow with defined roles for physicians, medical staff operations and quality reviewers. Results: Over 50 subspecialties were mapped to over 250 selected metrics, with overlap when applicable to more than one specialty. A standard network-wide policy was approved by each center’s medical executive team. A workflow was clearly defined to include responsibilities associated with (pre-review) analyst role, service chief and credential committee. The use of the network’s reporting tool was standardized for OPPE as well as additional sources of quality data identified outside of the tool as needed, specifically for low volume and non-patient facing providers. A review calendar was created to guide the process on a rolling basis. Lastly, an OPPE Toolkit was created to govern and educate on the process that includes a pocket guide, Q&A, and on-boarding materials for physicians to understand their data relevant to metrics for which they are accountable. Conclusions: This systemic and timely evaluation of practitioner specific data supports improvement of practitioner performance and provides objective information for credentialing and privileging decisions across the network. Physicians’ visibility into their own data has increased. Automating the majority of efforts associated with OPPE has reduced the time associated with fulfilling this external requirement and resulted in full compliance.

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Purpose Physician participation in philanthropy is important to marshal resources that allow hospitals to pursue their missions, but little is known about how physicians participate and their attitudes toward participation. Methods To characterize philanthropic roles physicians play and their attitudes about participation and its ethical acceptability, medical oncologists affiliated with the 40 National Cancer Institute–designated comprehensive cancer centers were randomly sampled and surveyed to evaluate experiences and attitudes regarding participation in philanthropy at their institutions. Responses were tabulated; significant associations by physicians' characteristics were explored. Results A total of 405 (52%) physicians responded; 62% were men, and 72% were white. Most (71%) had been exposed to their institution's fundraising/development staff; 48% of those were taught how to identify patients who would be good donors; 26% received information about ethical guidelines for soliciting donations from their patients; 21% were taught how their institution ensures Health Insurance Portability and Accountability Act compliance. A third (32%) of respondents had been asked to directly solicit a donation from their patients for their institution, of whom half declined to do so. Those who had solicited from their patients had been in practice significantly longer (mean, 19 v 13 years; P < .001). A substantial minority (37%) felt comfortable talking to their patients about donation (men more than women, 43% v 26%; P = .008); however, 74% agreed it could interfere with the physician-patient relationship, and 52% believe conflict of interest exists. Conclusion Institutions are asking physicians to directly solicit their patients for donations with variability in physicians' perceptions of the impact on relationships with patients and responses toward those requests.

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180 Background: Like other medical interventions, cancer screening requires shared decision-making (SDM). To better understand the process, we are performing a cluster-randomized trial of educational supports to improve screening guideline compliance for breast, cervical, colorectal, lung and prostate cancer at two urban academic medical centers. We present interim results that focus on recalled SDM discussions. Methods: We are enrolling an age- and sex-stratified sample of 216 patients aged 30 to 89 years, 18 treated by each of 12 primary care physicians at two affiliated hospitals before a periodic physical examination. Screening guideline format (color-coding) and academic detailing are independently assigned to providers. Patients and providers are surveyed immediately after the encounter to document SDM discussions, recommendations and beliefs. Screening guidelines (recommended, not or controversial) were determined by age, sex and risk factors. Results: The first 107 eligible enrolled patients were racially diverse (non-Hispanic Caucasian 65%) and well educated (college grad 84%). Patient-physician disagreement about whether screening had been discussed ranged from 6% (mammogram) to 36% (cervical cancer) and disagreement about whether the screening test had been recommended ranged from 17% (mammography) to 44% (PSA). In only 24 (12%) of 159 jointly recalled screening discussions did both patients and physicians agree that all 3 elements of SDM – reasons for screening, reasons against and that it is optional – were discussed, although patients and physicians separately reported all elements in 58 (36%) and 45 (28%), respectively. Conclusions: Even immediately after the encounter, many patients and physicians recalled whether screening had been discussed and recommendations differently, and most SDM discussions were incomplete. Clinical trial information: NCT02430948.

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Up to 50% of cancer patients and up to 90% of those in terminal stages experience pain associated with disease progression, poor quality of life, and social impact on caregivers. This study aimed to establish standards for the accreditation of oncological pain management in healthcare organizations. A mixed methods approach was used. First, a pragmatic literature review was conducted. Second, consensus between professionals and patients was reached using the Nominal Group and Delphi technique in a step that involved anesthesiologists, oncologists, family physicians, nurses, psychologists, patient representatives, and caregivers. Third, eight hospitals participated in a pilot assessment of the level of fulfillment of each standard. A total of 37 standards were extracted. The Nominal Group produced additional standards, of which 60 were included in Questionnaire 0 that was used in the Delphi Technique. Two Delphi voting rounds were performed to reach a high level of consensus, and involved 64 and 62 participants with response rates of 90% and 87%, respectively. Finally, 39 standards for the management of cancer pain were agreed upon. In the self-evaluation, the average range of compliance was between 56.4% and 100%. The consensus standards of the ACDON Project might improve the monitoring of cancer pain management. These standards satisfied the demands of professionals and patients and could be used for the accreditation of approaches in cancer pain management.

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Nausea and vomiting are commonly recognized side effects of chemotherapy. However, the incidence and duration of these effects have not been systematically studied in a large outpatient oncology population. This survey was conducted over two consecutive 6-week periods in the adult oncology clinics of two university teaching hospitals. The objectives were: (1) to document the incidence and duration of chemotherapy-induced nausea and vomiting; (2) to identify variables that influence nausea and vomiting; and (3) to describe patterns of antiemetic prescribing and compliance. One hundred thirty-eight completed patient-maintained diaries were returned (70% response rate). Anticipatory nausea and vomiting were reported by 9.4% and 6.5% of patients, respectively. Fifty percent and 27% of patients reported nausea and vomiting, respectively, on the day chemotherapy was administered (day 1: acute nausea and vomiting phase). Percentages fell to 22% and 11% by day three and 14% and 2.5% on day 5. Of patients who reported nausea and vomiting during the five-day period, 52% and 33% experienced nausea and vomiting, respectively, during the delayed period only (days 2 through 5: delayed emesis phase). Emetogenicity of chemotherapy significantly influenced incidence and duration of those symptoms. Sixty-seven percent of patients reported taking antiemetics on one or more days during the survey period. Of patients who reported antiemetic use, 92% reported antiemetics on day 1, 51% on day 3, and 31% on day 5. At-home antiemetic use was related to the emetogenicity of chemotherapy received. Patients who receive moderate to strong emetogens as defined in this report should receive antiemetic therapy for a minimum of three days. Increasing the dose of antiemetic prescribed both in the clinic and at home may be of benefit.

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Background Multidisciplinary tumor boards play a pivotal role in the patient-centered clinical management and in the decision-making process to provide best evidence-based, diagnostic, and therapeutic care to patients with cancer. Among the barriers to achieve an efficient multidisciplinary tumor board, lack of time and geographical distance play a major role. Therefore, the elaboration of an efficient virtual multidisciplinary tumor board (VMTB) is a key point to successfully obtain an oncology team and implement a network among health professionals and institutions. This need is stronger than ever during the COVID-19 pandemic. Objective This paper presents a research protocol for an observational study focused on exploring the structuring process and the implementation of a multi-institutional VMTB in Sicily, Italy. Other endpoints include analysis of cooperation between participants, adherence to guidelines, patients’ outcomes, and patient satisfaction. Methods This protocol encompasses a pragmatic, observational, multicenter, noninterventional, prospective trial. The study’s programmed duration is 5 years, with a half-yearly analysis of the primary and secondary objectives’ measurements. Oncology care health professionals from various oncology subspecialties at oncology departments in multiple hospitals (academic and general hospitals as well as tertiary centers and community hospitals) are involved in a nonhierarchic manner. VMTB employs an innovative, virtual, cloud-based platform to share anonymized medical data that are discussed via a videoconferencing system both satisfying security criteria and compliance with the Health Insurance Portability and Accountability Act. Results The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology units and departments spread in the Sicily region. The results of this study will particularly focus on the organization of VMTBs, involving oncology units present in different hospitals spread in the area, and creating a network to allow best patient care pathways and a hub-and-spoke relationship. The present results will also include data concerning organization skills and pitfalls, barriers, efficiency, number, and types with respect to clinical cases and customer satisfaction. Conclusions VMTB represents a unique opportunity to optimize patient management through a patient-centered approach. An efficient virtualization and data-banking system is potentially time-saving, a source for outcome data, and a detector of possible holes in the hull of clinical pathways. The observations and results from this VMTB study may hopefully be useful to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology. International Registered Report Identifier (IRRID) DERR1-10.2196/26220

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AbstractObjectivePain is a prevalent and distressing symptom in patients with cancer which has a significant impact on patients’ physical health, psychological well-being, and quality of life (QOL). Deficiency of pain care, inadequate pain communication, and reluctance toward pain medication contribute to the difficulties in improving the situation of patients with cancer pain. Fortunately, the integration of self-management and professional healthcare provides new opportunities for patients with cancer pain.MethodsA two-arm randomized controlled trial will be conducted to assess the effectiveness of self-management application compared with routine care among patients with cancer pain. Based on Orem's self-care theory and Naylor's transitional care theory, cancer pain self-management application “Pain-housekeeper” was developed with dual client: patient client and medical client. A total of 120 patients with cancer pain are recruited from two university-affiliated tertiary public hospitals in China. They are randomly assigned to the control group and the intervention group. The patients in the control group get routine care while the patients in the intervention group get routine care and Pain-housekeeper App. The intervention is delivered by registered doctors, nurses, and postgraduate nursing students specialized in pain care. Effect measurements for both groups are carried out with questionnaires at baseline (T0), after 4 weeks (T1) and after 12 weeks (T2). The primary outcomes include pain condition, self-efficacy, and QOL. The secondary outcomes include pain medication adherence, satisfaction, anxiety, and depression. Compliance of data submission, economic evaluation, usage, and clinical data are also considered in the test. Data for the evaluation are gathered continuously during the study period.DiscussionThis article provides insight into the effectiveness of a theory-based self-management mobile application intervention delivered to patients with uncontrolled cancer pain. The results are used to help patients to improve cancer pain control, self-efficacy, and QOL.ConclusionsThe findings of this article provide evidence to support the implementation of an innovative and easily accessible intervention that enhances health outcomes.Trial registrationChiCTR: ChiCTR1800020295, Registered 22 December, 2018.

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Background: Diagnosis and surgical treatment decision making for breast cancers has become increasingly complex. Recently, Canadian Partnership Against Cancer (CPAC) published pan-Canadian evidence-based surgical standards for the care of breast cancer patients. This study was undertaken to assess the degree to which these standards were currently met in practice and to further understand the determinants of their implementation nationally. Methods: This study was undertaken in two parts—(1) National survey of breast cancer surgeons to assess the perceived extent of implementation of these standards in their institution and province; (2) Formation of a focus group with a representative sample of breast surgeons across Canada to further understand the barriers and facilitators towards future breast standards implementation. Results: 35 surgeons participated in the survey: 66% were from community hospitals. There were four categories of standards that were the most significantly lacking across the country—(a) processes related to quality assurance, (b) turnaround time for pathology results (c) psychosocial and health-related support for the breast cancer patient and (d) breast reconstruction for patients undergoing mastectomy. The focus group included participants from all ten Canadian provinces. For each standard, the 134 determinants fell into three main categories—individual physician (n = 27, 20%); organizational (n = 46, 34%), and system (n = 61, 46%). While specific determinants were present for each category, surgical standards were more likely to be implemented in practice if (1) they aligned with organizational priorities standards; (2) the individual physicians or physician groups were accountable to the organization and/or cancer jurisdiction regarding compliance with the standard; and (3) if infrastructure or resources existed within the organization or system for the reliable collection of relevant, meaningful, practice changing data combined with the capability of benchmarking, peer–peer comparisons and timely feedback to the surgeons. Conclusion: The results of this study demonstrated variation, barriers and opportunities for the national implementation of CPAC’s breast cancer surgery standards and identified determinants of high-quality breast surgical care delivery.

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e549 Background: Participant characteristics affect shared decision making. In a randomized trial of physician (MD) educational interventions to improve cancer screening guideline compliance, we studied patient (PT) and MD recall of discussions and how PT characteristics affected recall. Methods: In a cluster-randomized trial of educational supports for MDs, we are enrolling an age- (30-89 years) and sex-stratified sample of 216 PTs who underwent a physical examination at two urban hospitals, 18 for each of 12 primary care MDs. Screening guideline formatting (color-coding) and academic detailing were randomly assigned in a 2x2 design. Immediate post-encounter surveys recorded PT and MD recall of screening discussions. Results: Of the first 174 participants, 92 were men. PTs were diverse (69% white) and well educated (73% college degree). When MDs reported a prostate specific antigen (PSA) screening discussion, 32% of PTs did not, and 26% of MDs disagreed when PTs reported the discussion occurred. Further, when the MD reported recommending screening, 26% of PTs disagreed, and 33% of MDs disagreed when their patients reported a recommendation. Overall, agreement between all PTs and MDs on whether screening was recommended was fair (kappa = 0.29) but there was no agreement for PTs over 70 years (kappa = -0.03). PTs reported more elements of shared decision making than MDs (data not shown). When both PT and MD or the MD alone reported that all elements of shared medical decision making had occurred, agreement on whether screening was recommended improved (kappa = 0.54 and 0.45, respectively). When PTs disagreed with their MD, they more often reported recommending for screening not against (11 vs. 4). Conclusions: In a highly educated, diverse PT population, PTs and MDs surveyed immediately after their encounter often disagreed on whether PSA screening was discussed and recommended. Disagreement was worse with older PT age but improved when both PT and MD or the MD alone reported all shared decision making elements. Clinical trial information: NCT02430948.

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Background. Ljubljana declaration (2006) states that the close cooperation between oncologists and oncopharmacologists is vitally important to provide an optimal medical care. Multiprofessional approach allows to increase the cost-effectiveness of treatment and to make it safer. Objective. To prove the importance of the multiprofessional approach and cooperation of various specialists in the oncology field. Materials and methods. Analysis of the literature data on this topic. Results and discussion. According to the questionnaires’ results, 59 % of the respondents want to receive information about drugs and their side effects from the pharmacist. It explains the importance of creation of European Society of Oncology Pharmacology (ESOP), which at the moment includes 63 countries. Key principles of ESOP are the compliance to the standards of treatment quality, continuous professional growth and multiprofessional collaboration. Tasks of ESOP include the increase of the compliance to the oral drugs for cancer treatment, the struggle with the lack of drugs in all the world and the providing safety for patients and healthcare workers, which works with cytotoxic drugs (CTD). According to the data of different authors, low adherence can be predicted by the depression and cognitive disorders, side effects of drugs, asymptomatic disease course, difficult and expensive treatment, unsatisfactory control of treatment, etc. Talking about lack of drugs, since 2000s their frequency has increased. Even the drugs, which are included in the List of the Essential Medicines, are not available in every country, that’s why doctors have to change treatment regimens, interchange drugs, decrease the doses and postpone treatment. Struggle to fight the environmental pollution by CTD is one more task of ESOP. Studies have revealed that the most polluted surfaces in hospitals include working surfaces, floors, counters, drug fridge doors. In general, such characteristics as patient-centricity, multidisciplinary and multiprofessional approach, general coordination of treatment process, defined responsibilities, strict treatment protocols, continuous education of medical stuff, and advanced information systems are the most important for high-quality medical care. ESOP also focuses on the increase of pharmacist’s influence, that’s why this organization provides specialized webinars, trainings and workshops in oncology pharmacy field. Conclusions. 1. High-quality of medical care in cancer needs a pharmacist involvement. 2. Key principles of the ESOP include the compliance to the standards of treatment quality, continuous professional growth and multiprofessional collaboration. 3. Tasks of ESOP include the increase of the compliance to the oral drugs for cancer treatment, the struggle with the lack of drugs in all the world and the providing safety for patients and healthcare workers.

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ObjectivesTo assess compliance with 2010 National Institute for Health and Care Excellence (NICE) guidance on cancer services relating to the management of basal cell carcinomas (BCC) in the community, where except in specific circ*mstances it is recommended that only low-risk BCCs should be excised routinely.Design and settingA retrospective observational study of the histopathology reports of BCC excisions received from primary care in two district general hospitals in the South of England. One hundred consecutive BCC excisions were analysed from each hospital.Outcome measuresThe numbers of high-risk BCCs excised in primary care according to histological subtype, anatomical site and age and if these excisions were compliant with NICE 2010 guidance. Completeness of excision and mention of BCC on histology request were secondary outcomes.ResultsHistologically high-risk subtypes were present in 32% (64/200) of BCCs excised in the community. Only 17/64 were excised by general practitioners (GPs) who were accredited to do so. Non-compliance regarding anatomical site occurred in 16% of samples; only one was non-compliant regarding patient age. There was a high overall rate of complete excision (94.5%) with variation in presence of the term BCC on histology request forms.ConclusionsNICE 2010 guidance relating to BCC excision in primary care was not followed in a considerable number of cases. Compliance with NICE 2010 guidance depends on the ability to recognise high-risk BCCs clinically and manage appropriately. It also shows that despite close supervision by secondary care, there are still failures of compliance.GP training in identification of subtypes of BCC might be improved, as well as an increase in numbers of GPs accredited to carry out high-risk BCC excisions. Difficulty in diagnosing high-risk histological subtypes of BCC preoperatively should be considered in any future revision of NICE guidance.

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IntroductionBreast cancer-related lymphoedema (BCRL) is a common phenomenon. When lymphoedema is diagnosed late, options for treatment are diminished. Therefore, early diagnosis and treatment are very important to alter the potential deleterious evolution. Lymphofluoroscopy visualises the superficial lymphatic architecture in detail, giving the opportunity to detect a disturbance in the lymphatic transport (ie, dermal backflow) before the lymphoedema is clinically visible.The main objective is to investigate if there is an additional effect of a compression garment on top of the usual care (ie, information and exercises) in patients with early disturbance of the lymphatic transport after breast cancer treatment. Development of clinical lymphoedema and/or deterioration of the dermal backflow visualised by lymphofluoroscopy is investigated.MethodologyAll patients scheduled for breast cancer surgery with unilateral axillary lymph node dissection or sentinel node biopsy in the Multidisciplinary Breast Clinic of the University Hospitals Leuven are being considered. Patients are assessed before surgery and at 1, 3, 6, 9, 12, 18, 24 and 36 months postoperatively. At each visit, a clinical assessment is performed determining the volume difference between both arms and hands (through circumference measurements and water displacement), the water content, the extracellular fluid, the pitting status and the skinfold thickness. Quality of life questionnaires are filled in. At each visit, a lymphofluoroscopy is performed as well. When a disturbance of the lymphatic transport is seen on lymphofluoroscopy, without the presence of clinical lymphoedema, the patient is randomised in either a control group receiving usual care or a preventive treatment group receiving usual care and a compression garment (whether or not combined with a glove).Ethics and disseminationThe trial is conducted in compliance with the principles of the Declaration of Helsinki (2008), the principles of Good Clinical Practice and in accordance with all applicable regulatory requirements. This protocol has been approved by the Ethical Committee of the University Hospitals Leuven. Results will be disseminated by peer-reviewed scientific journals and presentation at international congresses.Trial registration numberNCT03210311ConclusionThe investigators hypothesise that development of clinical BCRL can be prevented and/or the dermal backflow can be stabilised or improved, if a preventive treatment with compression garment is started in the early phase of disturbance.

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e15026 Background: High-dose VIP chemotherapy plus ABSCT given as first line treatment might be a strategy in patient with advanced germ cell tumors (GCT) with poor prognosis. The objective of the trial was to investigate the addition of darbepoetin alfa to HD-VIP in order to reduce anemia/red blood cell (RBC) transfusions. Methods: This was a randomized, open-label multicenter phase 2 study conducted in 20 hospitals. Darbepoetin 2.25 mcg/kg weekly or 500 mcg Q3W s.c., started with high dose VIP (dose level 6) was applied in arm B (arm A: HD-VIP alone). The primary objective was freedom from blood transfusions (FFT). Secondary objectives included objective remission rate (ORR) after chemotherapy, 24 mos PFS and OS, median course of hemoglobin (Hb) levels during 3 HD-VIP cycles as well as drug safety. Results: Between 7/2003 and 11/2008 108 pts were allocated to the study, and 106 were included in the intention-to-treat (ITT) analysis. By March 2011 the median follow-up time after randomization was 20 mos. Localisation of primary was gonadal in 66%, retroperitoneal in 19% and mediastinal in 14%s. A favourable treatment outcome (CR/NED/PR m-) in conjunction with secondary surgery (n = 76 pts) was achieved in 58% of pts with no difference between arms A and B. Overall FFT occurred in 2 pts (4.2%) in arm A and 3 pts (5.6%) in arm B, and in 23%/15%/15% and 15%/17%/19% of pts during cycles 1-3, respectively. No differences in baseline Hb, severity of anemia, no of RBC transfusions and area under the curve of Hb levels during HD-VIP was observed. Pts assigned to darbepoetin had similar treatment toxicity compared to those assigned to HD-VIP alone. 24-mos OS in arm A was 86.3% compared to 67.8% (p=.064) in Arm B. 2-year RFS was 66.8% in arm A vs 55.5% in Arm B (p=0.45). Darbopoetin was generally well tolerated with 2 pts discontinuing treatment due to thrombosis. Since compliance to study protocol was generally poor (6 out of 55 pts never received study drug during HD-VIP) a per-protocol analysis is in preparation. Conclusions: Based on ITT analysis, the addition of darbepoetin alfa to the high dose regimen compared to HD-VIP alone does not appear to impact on FFT, ORR, and 2-year survival rate in poor prognosis GCT pts (NCT00204633).

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Abstract Introduction. Hepatitis B Virus (HBV) reactivation is an important risk of Rituximab therapy, a potent immunosuppressant used as part of chemotherapy regimens against non-Hodgkin's lymphoma. HBV reactivation is a potentially fatal complication that can be largely prevented with antiviral prophylaxis and monitoring of HBV DNA. American Society of Clinical Oncology (ASCO) 2015 guidelines recommend that all patients be screened for both hepatitis B core antibody (anti-HBc) and surface antigen (HBsAg) before initiating Rituximab therapy. According to ASCO, the rates of screening for non-Hodgkin's lymphoma patients before the administration of Rituximab were less than 70% in 2014 for US centers participating in ASCO's Quality Oncology Practice Initiative. A 2014/15 study at the McGill University Health Centre found that about a third of patients were inadequately screened (A Lawandi, et al). Methods. The objective of this retrospective study was to assess the quality of HBV screening and monitoring at the partner hospitals of the Rossy Cancer Network (RCN). From the pharmacy database of the Jewish General Hospital, McGill University Health Centre, and St. Mary's Hospital Center, we obtained the set of patients with hematologic malignancies who began Rituximab treatment between April 2014 and March 2016. We then collected laboratory data on the screening of anti-HBc and HBsAg. Screening was considered appropriate if performed for both anti-HBc and HBsAg in the 6-month window preceding Rituximab administration and considered suboptimal if patients were tested outside this time frame, or for only one of the two tests. Additionally, patient chart reviews were used to collect follow-up information and outcomes for screened patients. Follow-up was considered appropriate when anti-viral treatment was given for infected patients and when patients at risk for reactivation received prophylactic treatment or HBV DNA monitoring. Results. Four hundred and seventy-four patients initiated Rituximab-containing treatment. Of those, 213 (45%) met the criteria for appropriate HBV screening and 138 (29%) for suboptimal screening. Of the patients that were screened (N=351), 6 were actively infected (HBsAg+/ anti-HBc+) and 41 were at risk for reactivation (HBsAg-/ anti-HBc+). All actively infected patients received antiviral treatment as per ASCO guidelines but only 18 (44%) of patients at risk for reactivation received appropriate follow-up, prophylactic treatment or HBV DNA monitoring. HBV reactivation was noted in 2 patients, one of whom died of a hepatic flare. Conclusion. Between 2014 and 2016, less than 50% of Rituximab-treated hematologic cancer patients within the RCN partnered hospitals were appropriately screened for HBV, and 44% of patients at risk for reactivation received appropriate follow-up. In response to these findings, the RCN Hematology Disease Site Group is developing RCN clinical practice guidelines to standardize HBV testing and management of patients at-risk for HBV reactivation. In close collaboration with virologists and hepatologists, the group will provide targeted education sessions to improve compliance with clinical practice guidelines. Additionally, the group aims to implement pharmacy-based interventions, such as coupling Rituximab prescriptions with standard orders for HBV testing, and providing pharmacist autonomy to order HBV testing. Disclosures Assouline: Novartis: Research Funding; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Honoraria, Research Funding, Speakers Bureau; Pfizer: Honoraria, Research Funding, Speakers Bureau; Roche: Honoraria, Research Funding, Speakers Bureau.

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Abstract Objective: Influenza infection is a significant cause of morbidity and mortality in patients with cancer, and thus the National Comprehensive Cancer Network (NCCN) recommends annual influenza vaccination for all individuals with cancer. We sought to examine the documentation rate of influenza vaccination administration, refusal, or discussion of vaccination in the first year after diagnosis of diffuse large B cell lymphoma (DLBCL) for patients across three hospitals in two healthcare systems. Methods: Medical records were reviewed for 114 patients with a new diagnosis of DLBCL between February 2015 and October 2017 who presented to either Emory St. Joseph Hospital (a community hospital setting), Winship Cancer Institute at Emory University (an academic medical center), or Grady Memorial Hospital (a county hospital). Documentation of administration, refusal, or discussion regarding influenza vaccination by physicians, advanced practice providers, or nursing staff during the period of influenza vaccine availability for the first influenza season after diagnosis was assessed. Results: Among 114 patients with newly diagnosed DLBCL, 54% were male, and 46% were over 60 years of age with a median age of 59 years (range 21-88 years). One patient was excluded from analysis as she was enrolled in hospice prior to influenza season. Documentation of influenza vaccination status within 1 year of diagnosis of DLBCL was performed for 56% (63/113) of patients. Nearly 75% (47/63) of documentation regarding vaccination was performed by inpatient nursing staff at time of admission. Documentation of influenza vaccination status was performed by the primary oncologist in 4% (5/113) of all cases and 8% of the documented cases respectively (5/63). The county hospital and the academic medical center had higher documentation of vaccination rates (62% [5/8] and 60% [27/45], respectively) compared with the community hospital (50% [5/10]). Of the patients with documentation of influenza vaccination status, vaccine refusal was documented for 41% (26/63) of patients, and counseling regarding the importance of vaccination was not documented for any patient. Conclusions: Our study shows that documentation of education and administration of influenza vaccination is suboptimal in these 2 healthcare systems. Although vaccinations that occurred outside of these healthcare systems by primary care providers, pharmacies, and other providers would not be recorded in this dataset unless the patient had a hospital admission, these data suggest a gap in patient care and education that could lead to increased risk of worse outcomes from influenza infection. Routine outpatient vaccination screening and counseling in oncology clinics will be explored to improve documentation of influenza vaccination and influenza vaccination rate. Additionally, strategies for sharing patient information about vaccination between providers in different healthcare systems could improve vaccination compliance in patients with lymphoma. Further work is needed to determine the effectiveness of routine influenza vaccination in patients receiving anti-cancer therapy. Disclosures Allen: Merck: Research Funding; Bayer: Consultancy. Flowers:BeiGene: Research Funding; Burroughs Wellcome Fund: Research Funding; Pharmacyclics/ Janssen: Consultancy; Genentech/Roche: Consultancy; Bayer: Consultancy; Denovo Biopharma: Consultancy; Eastern Cooperative Oncology Group: Research Funding; Gilead: Research Funding; Spectrum: Consultancy; Celgene: Research Funding; Karyopharm: Consultancy; Genentech/Roche: Research Funding; Janssen Pharmaceutical: Research Funding; TG Therapeutics: Research Funding; OptumRx: Consultancy; Millennium/Takeda: Research Funding; National Cancer Institute: Research Funding; V Foundation: Research Funding; Acerta: Research Funding; Abbvie: Research Funding; Pharmacyclics: Research Funding; Gilead: Consultancy; Abbvie: Consultancy, Research Funding.

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Background: 40% of Egyptians has access to public health system, 60% served by NGOs and private centers. The problem is the late presentation and inadequate access to services due to lack of a structured screening program and awareness. Aim: To present a model of breast cancer (BC) care in low resource setting (LRS) and to assess risk factors for BC in Egypt the high BC incidence country based on registry estimates stating that about 22000 new BC cases will be diagnosed by 2020. Strategy: In Giza region there used to be no mammographic (MMG) reference service. Women with breast symptoms were referred to the NCI, where they were offered the services (diagnosis, treatment). With very long waiting times. Women aged 20 years or older visiting one of the 5 participating centers were evaluated in a cross-sectional study, which included: (1) Data entry form questionnaire of risk factors for breast cancer - including family history of cancer - and presence of breast symptoms, and (2) Breast examination by a trained professional (nurse or medical doctor). All patients with breast complaints or an abnormal physical exam were referred to NCI, MISR Cancer Center, Kasr El Aini, Agouza and Bahia Hospital for further evaluation. Women 40-69 years of age were invited to participate in the screening both actively (digital invitations, Facebook groups, brochures distributed in governmental buildings and WhatsApp groups) and passively (women that attended for any reason to other hospitals in the region are called and delivered brochures and vouchers to join the project). The screening program is based on annual MMG in women between the ages of 40 and 69 years, which are always preceded by physical examination performed by a breast surgeon or a trained nurse. Program: Close control of the frequency of visits using a simple computer program with patient listing and reminder. The close contact and continuous feedback that helped adherence to the screening program. The proposal of the project includes the performance of all clinical, imaging and pathology exams, as well as clinical visits and surgical treatment, in the same center in the shortest time and the highest standards of care. The health care approach is multidisciplinary, including nurses, breast surgeons and a nutritionist. Outcomes: High rate of compliance is the main strength of project, achieved by patient education about the importance of the screening, intense contact with the primary trained staff, with provision of lists of patients who should come next visits. Free transportation for women with very low income is arranged. Every 3-4 months, we established jointly a charity workshops and projects of handmade cloths and bags for BCPs and encouraged social clubs and societies to adopt parties and to host educational BC advocacy campaigns. What was learned: A simple project is successful and its cost-effectiveness is balanced in Egypt as a developing country where the mortality associated with this disease is very high.

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Purpose: With the advances in early detection, prevention, and treatment of some cancers, mortality rates in the United States have been consistently falling. However, with these successes have come substantial increases in the cost of cancer care. Antineoplastics are the leading class in hospital drug expenditures. Cancer treatments are causing a serious financial burden for patients, families, hospitals, and society at large, especially for those who are uninsured. Prescription assistance programs (PAPs) are offered by pharmaceutical manufacturers to provide medications at no out-of-pocket cost to medically indigent patients. To assist the Cancer Care Center at Nassau University Medical Center (NUMC) with drug costs for chemotherapies, a clinical pharmacist–managed PAP was implemented to procure chemotherapy medications from pharmaceutical manufacturers. NUMC is a safety-net teaching hospital in suburban New York. It serves mostly an indigent population, and its Level I trauma center has more than 77,000 emergency department visits per year. Methods: We observed all patients requiring assistance with chemotherapy who enrolled in PAPs from January 1, 2011, through December 31, 2012. The total number of visits in the clinic over 24 months was 9,405. Individuals potentially eligible for the PAP were identified by oncologists. Patients received a referral to the PAP when they mentioned to office personnel that they had difficulty obtaining medications or expressed financial concerns related to management. Results: The clinical pharmacist spent the majority of his time assisting uninsured individuals, working with charity pools from the drug manufacturers, and obtaining medications through the PAP. The program served 341 patients in 2011 and 579 patients in 2012. Medications obtained for these patients included both oral and parenteral chemotherapy drugs and antiemetics. The total cost savings of the medications was $908,944.11 in 2011 and $1,715,538.37 in 2012. In 2012, a total of 783 prescriptions were processed, and 775 were approved by the manufacturers (98.9%). Conclusion: PAPs provide a valuable safety net to ensure that uninsured patients with cancer receive needed prescription medications. The rising cost of health care and the high proportion of indigent patients have financially burdened the hospital. For the pharmacy department, this has resulted in a lack of compensation for pharmaceuticals dispensed to indigent patients. A pharmacy-based program to procure free medications for uninsured patients with cancer has helped to defray the expenses of the Cancer Care Center in providing care at NUMC, increased patient compliance with chemotherapy protocols, and allowed many patients to receive the treatments they otherwise would not have been able to afford.

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Abstract Background Clostridium difficile infection (CDI) is one of the most common healthcare-associated infections. Timely diagnosis is key to reducing associated morbidity and costs. Healthcare-onset (HO) CDI is defined as infection diagnosed 72 hours after hospitalization. Centers for Medicare and Medicaid Services has established benchmarks for HO-CDI for hospitals, which are based on several factors including type of hospital and case mix index. There is a financial penalty if we are above the benchmark. In 2016, 20% of our community-onset C. difficile (CO-CDI) cases were misclassified as HO-CDI. In order to reduce this misclassification, we established a process to assist in early diagnosis. Methods We designed and implemented a nurse-driven C. difficile screening protocol to assist in early identification of CO-CDI. Every patient admitted to Keck Hospital (KH) (401 beds) and Norris Comprehensive Cancer Center (35 beds) was screened for diarrhea within the past 24 hours. If diarrhea was present, additional questions were used to capture CO-CDI cases. A nursing order for C. difficile testing was activated for patients who met any of these criteria. Additionally, we used Bristol stool scale (BSS) to standardize stool collection. Only Bristol stool type 7 was accepted by laboratory for processing. Our study period was January 1st through April 30th, 2017 and our baseline period was January 1st through April 30th, 2016. Results Screening protocol and BSS were introduced on January 1st, 2017. During the baseline period, a total of 351 orders were placed with 31% within first 3 days of admission. During the study period, a total of 200 orders were placed with 43% within 3 days of admission. Compliance with using the screening tool was nearly 100%. Inter-rater reliability between nurses and lab for identifying the correct BSS was 100%. Baseline misclassification rate was 16%. With the introduction of this screening tool, misclassification decreased to 9%. The HO-CDI rate for the baseline period was 11.5 per 10,000 patient-days and it decreased to 6.27 per 10,000 patient-days in the study period. Conclusion We have demonstrated a reduction in HO-CDI rates by establishing a process to assist in early identification of CO-CDI. Disclosures All authors: No reported disclosures.

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Abstract Introduction: Granulocyte colony-stimulating factors such as pegfilgrastim (Neulasta®) can reduce the incidence of febrile neutropenia, a life-threatening side effect of myelosuppressive chemotherapy. According to current FDA-approved prescribing information, pegfilgrastim should not be administered between 14 days before and 24 hours after administration of myelosuppressive chemotherapy. Previous research indicates that same- vs next-day administration of pegfilgrastim may be associated with worse patient outcomes, and current guidelines from both ASCO and NCCN recommend use of pegfilgrastim 1-3 days after chemotherapy. A recent health care claims database analysis has shown that same-day pegfilgrastim was administered in ~13% of chemotherapy cycles, but little is known about physician rationale for administering same-day pegfilgrastim. Here, we describe the results of a cross-sectional, web-based physician survey describing the practice- and patient-related factors that physicians report to have affected their decision to administer same-day pegfilgrastim. Methods: Survey invitations were sent via e-mail to a sample of US medical oncologists, hematologists, and hematologist-oncologists who were enrolled in a national physician panel. Physicians who reported experience prescribing same-day pegfilgrastim within the last 6 months and provided informed consent were included. Physician reasons for prescribing same-day pegfilgrastim were assessed. The analysis was descriptive; summary statistics are presented. Results: Of 17,478 physicians who were invited to participate, 386 were screened, and 186 (48%) reported administering same-day pegfilgrastim within the previous 6 months. A total of 183 physicians (47%) agreed to participate in the survey, and 151 (39%) completed the survey. Mean (SD) years in practice was 14.6 (8.2) years. Most physicians practiced in a private group practice (39%), at a cancer hospital/referral center (25%), or at other types of academic hospitals/clinics (23%). Physicians were relatively evenly distributed across the US and most (54%) practiced in towns with a population ≥250,000. Breast cancer and non-small cell lung cancer were the most common primary cancers in patients followed by the physicians. Physicians estimated that ~41% of their patients received pegfilgrastim, and that among patients who received pegfilgrastim, ~32% received same-day pegfilgrastim, with ~43% of those patients receiving same-day pegfilgrastim across all chemotherapy cycles. 36% of physicians relied primarily on clinical judgment when deciding to administer same-day pegfilgrastim. The most common patient risk factors reported by physicians as moderately or very important when deciding to administer same-day pegfilgrastim were previous febrile neutropenia (78%), presence of infection or open wounds (70%), and poor ECOG performance status (67%). When asked to rank 7 different clinical and logistic reasons to administer same-day pegfilgrastim (with 1 being most important), "it was more practical for the patient" was the most important reason (mean rank = 3.0; SD = 1.7), and "it was more practical for the practice due to patient scheduling burden/load" was the least important (mean rank = 4.2; SD = 1.7). 85% of physicians reported travel distance for the patient/caregiver and 79% reported method or availability of transportation for the patient/caregiver as moderately or very important patient-related factors for same-day administration of pegfilgrastim. The most important administrative consideration for same-day administration of pegfilgrastim was burden of actual prophylactic administration of pegfilgrastim on the next day and follow-up (65% of physicians cited as moderately or very important). Conclusions: Physicians rely primarily on clinical judgment when deciding whether to administer same-day pegfilgrastim, and clinical risk factors such as previous febrile neutropenia affect the decision to administer same-day pegfilgrastim. Additional physician considerations include patient/caregiver travel distance, method or availability of transportation, and burden of actual prophylactic administration of pegfilgrastim on the next day and follow-up. Continued education of patients and physicians on the potential risks of same-day pegfilgrastim administration could increase compliance and improve patient outcomes. Disclosures Darden: Amgen Inc: Research Funding; RTI Health Solutions: Employment. Off Label Use: This abstract assesses physician rationale for same-day administration of pegfilgrastim, which is an off-label use of pegfilgrastim. As noted in the abstract text, "According to current FDA-approved prescribing information, pegfilgrastim should not be administered between 14 days before and 24 hours after administration of myelosuppressive chemotherapy.". Price:Amgen Inc.: Research Funding; RTI Health Solutions: Employment. Kaye:Amgen Inc.: Research Funding; RTI Health Solutions: Employment. Sherif:Amgen Inc.: Research Funding; RTI Health Solutions: Employment. Marion:RTI Health Solutions: Employment; Amgen Inc.: Research Funding. Tzivelekis:Amgen Inc.: Employment, Equity Ownership. Garcia:Amgen Inc: Employment, Equity Ownership. Chandler:Amgen Inc.: Employment, Equity Ownership.

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Abstract Abstract 3964 Background: Bortezomib in combination with dexamethsone is administered twice a week for 2 weeks with excellent therapeutic outcome. However, in a proportion of patients it is associated with toxicities such as neuropathy and twice a week regimen is inconvenient especially in older patients. To improve convenience and compliance, we have investigated the efficacy and safety of a weekly bortezomib regimen. Methods: We conducted a phase II multi-center single-arm study in participating Veterans Hospitals (VA) nationwide evaluating bortezomib administered at 1.6 mg/m2 IV weekly for 4 weeks with 1 week off with dexamethasone 40mg PO on the day of and day after bortezomib for upto 6 cycles in newly diagnosed multiple myeloma patients not considered for autologous stem cell transplant. The objective is to evaluate overall response rate (ORR) and toxicity of this regimen. Results: We have enrolled all planned 50 patients (median age-71; range 50–89) at 12 VA Hospitals. Patients had significant co-morbidities including 86% with cardiovascular problems, 67% with diabetes and/or hyperlipidemia, 54% with renal dysfunction, 37% with respiratory problems, and 18% with history of cancer. All patients were on at least 5 daily medications. Of the 50 patients enrolled, 42 patients have received at least 1 cycle of therapy and were evaluable for toxicity and efficacy. With a median of 4 cycles administered, this regimen was very well tolerated. Ten patients experienced neuropathy: 6 patients experienced grade 1, two patients developed grade 2 neuropathy, while two patients who had grade 1 neuropathy at diagnosis increased to grade 2 neuropathy with pain, and the other patient increased to grade 3 neuropathy with pain, with an overall Grade 3 neuropathy rate of 2.4%.Dexamethasone dose was reduced in 30% while bortezomib dose was reduced in 10% of the patients. Additionally, grade ≥1 asthenia was observed in 52%, constipation in 38%, diarrhea in 34%, anemia in 64%, vomiting/nausea in 26%, and thrombocytopenia in 54%. Four patients have died of co-morbidities which were considered unrelated or probably unrelated to the treatment with bortezomib. Of the patients who received at least 1 cycle of therapy, 62% patients achieved ≥PR; 12% CR/nCR and an additional 14% achieved VGPR. Including MR in the analysis, ORR was observed in 90% of the evaluable patients. On intent to treat analysis including all 50 patients, ORR was observed in 76% patients and ≥ PR in 52% patients. Conclusions: Once a week bortezomib with dexamethasone regimen is effective and well tolerated even in older patients with significant co-morbidities and should be considered as an important option in multiple myeloma. Disclosures: Munshi: Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Millennium: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Onyx: Membership on an entity's Board of Directors or advisory committees. Yellapragada:Celgene: Research Funding; BMS: Research Funding. Roodman:Amgen: Consultancy; Millennium: Consultancy.

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Abstract Abstract 3061 The current bortezomib schedule involves administration of the drug twice a week at 1.3 mg/m2 for 2 weeks every 21 days. This regimen although effective is inconvenient and associated with side effects including neuropathy and gastrointestinal toxicities that limits its use in a proportion of patients. Therefore, to improve convenience and compliance, we have investigated efficacy and safety of a weekly regimen of bortezomib. In this one-stage phase II multi-center, open-label single-arm study bortezomib is administered once a week at 1.6 mg/m2 in combination with dexamethasone in newly-diagnosed multiple myeloma patients not considered for autologous stem cell transplant in participating Veterans Hospitals nationwide. The objective is to evaluate overall response rate and toxicity of this regimen. Patients received bortezomib at 1.6 mg/m2 IV weekly for 4 weeks followed by 1 week off and dexamethasone 40mg PO on the day of and day after each dose of bortezomib. Patients may receive 6 such 5-week cycles. At the current time 32 patients (median age - 73; range 50–88) have been enrolled at 11 Veterans Administration Hospital across the U.S. Patients had significant co-morbidities including 61% with cardiovascular problems, 58% with diabetes and/or hyperlipidemia, 58% with elevation of serum creatinine, 26% with respiratory problems and 23% with previous history of cancer. All patients were at least on 5 daily medications. Of the 32 patients enrolled, 25 patients have received at least one cycle of therapy and were evaluable for toxicity and efficacy, while 6 patients have received less than one cycle of therapy and one patient has inadequate data. With a median of 4 cycles administered, this regimen was well tolerated. None of the patients have developed grade 3 neuropathy, while grade 1 neuropathy was observed only in 2 patients and one patient with grade 1 neuropathy at diagnosis had increase to grade 2. Dexamethasone dose was reduced in 29% patients while 6% required reduction in bortezomib dose to 1.3 mg/m2. Additionally, Grade ≥1 asthenia was observed in 42%, diarrhea in 35%, and thrombocytopenia in 26%. Four patients have died of co-morbidities which were considered unrelated or probably unrelated to the treatment with bortezomib. The partial response or better was achieved in 68% patients receiving at least 1 cycle of therapy; 20% patients achieved CR/nCR and additional 12% achieved VGPR. Including MR in the analysis, overall response was observed in all evaluable patients. On intent to treat analysis including all 32 patients, overall response rate (≥ MR) was observed in 78% patients and PR or better in 53% patients. These preliminary results suggest that the once a week bortezomib regimen is effective and tolerable with reduced toxicity even in this older patient population with significant co-morbidities. Disclosures: Munshi: Millennium: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Onyx: Consultancy, Membership on an entity's Board of Directors or advisory committees. Roodman:Millennium: Consultancy; Amgen: Consultancy, Honoraria; Novartis: Honoraria, Research Funding; Celgene: Honoraria.

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Abstract Background: APL is a highly curable malignancy with reported survival above 90% in many co-operative group studies. However these spectacular results are not evident in the general population. US SEER data and other population based studies from Swedish Cancer Registry and Brazil showed that early deaths (ED) can be as high as 30%, leading to a considerably lower survival compared to clinical trials where ED is around 5-10%. Decreasing ED remains a global challenge and the highest priority at all leukemia treatment centers and will result in population wide survival in this most curable leukemia. We report results of our prospective trial using a set of simplified treatment guidelines along with expert support designed to decrease ED. Methods: A network of leukemia treatment centers was established in Georgia, South Carolina and neighboring states. An aggressive outreach effort was made by visiting most of the leukemia treatment centers to publicize the concept and educate treating physicians in the community about ED in APL. The protocol provides a simplified two page treatment algorithm that emphasizes quick diagnosis, prompt initiation of therapy and proactive and aggressive management of the major causes of death during induction. Expert and treating physician communication was established very early when a diagnosis of APL was suspected and was maintained until the completion of induction. Study was approved by local IRBs (if applicable) and funded by the Lymphoma Leukemia Society (LLS). Informed consent was obtained upon confirmation of a diagnosis of APL and there were no exclusion criteria. Patient accrual was initiated in July 2013 and continued till May 2016 when the accrual goal of 120 was met on an intent to treat basis. Statistics are descriptive. Results: Between 7/2013 and 5/2016, 120 patients were enrolled at 5 large leukemia centers (n=54, 45%) and 24 community hospitals (n=66, 55%). Only 3 hospitals treated more than 3 APL patients/year. Median age was 54 years (range 21-84 years). 68 were male. 84% were low risk (WBC < 10,000/mm3) and median WBC count was 4.3 (range 0.3-170,000/mm3). ATRA was initiated at suspicion of APL diagnosis in 100% of patients and was the only treatment in 2(1.5%) patients. Arsenic was combined with ATRA in 93 (81.5%) patients while the other 17% received chemotherapy. 15(13%) had bleeding complications at presentation. Treatment course was complicated by infection and differentiation syndrome (DS) in 31(28%) and 40(34%) patients respectively. There were 12 early deaths, of which 1 was a Jehovah's Witness who declined transfusions and 1 who enrolled 12 days after diagnosis while in multi-organ failure. Incidence of ED was 10/118 (8.5%). The cause of death was disseminated intravascular coagulation (DIC) (n=4), DS (n=2), infection (n=1), anemia (n=1), multi-organ failure (n=4). With a median follow-up of 10.6 months, 2 low risk patients relapsed: I due to non-compliance 1 year after diagnosis and 1 with CNS relapse 3 months after completing consolidation. With a median follow up of 320 days (range 1-965) overall survival (Figure 1) was 87%. There were four late deaths; relapse (n=1), second cancer (n=1) and non-APL related comorbidities (n=2). Conclusions: Results of this prospective trial showed that a simplified treatment algorithm along with support from experts and co-management with treating physicians in the community decreased induction mortality (8.5%) and improved survival (87%) compared to SEER data (1 year relative survival of 71%). We believe our experience warrants large scale implementation and is presently approved as an ECOG/ACRIN trial (EA9131). This model can be applicable to other cancers and life-threatening diseases. Figure Overall Survival Figure. Overall Survival Disclosures Jillella: Leukemia Lymphoma Society: Research Funding. Heffner:AbbVie: Research Funding; Pharmacyclics: Research Funding; Celgene: Research Funding; Millennium: Research Funding. Stuart:Astellas: Research Funding; Celator: Research Funding; Sunesis: Consultancy, Honoraria, Other: Travel, Accomodations, Expenses, Research Funding; Agios: Research Funding; Bayer: Research Funding; Incyte: Research Funding. Gerber:Seattle Genetics: Membership on an entity's Board of Directors or advisory committees; Spectrum: Membership on an entity's Board of Directors or advisory committees; Alexion: Membership on an entity's Board of Directors or advisory committees; Janssen: Research Funding. Grunwald:Medtronic: Equity Ownership; Incyte Corporation: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Alexion: Membership on an entity's Board of Directors or advisory committees; Ariad: Membership on an entity's Board of Directors or advisory committees; Forma Therapeutics: Research Funding; Amgen: Research Funding; Janssen: Research Funding. Kota:Pfizer: Membership on an entity's Board of Directors or advisory committees; Ariad Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Leukemia Lymphoma Society: Research Funding; Incyte: Membership on an entity's Board of Directors or advisory committees.

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Abstract:

Introduction: Lymphoma incidence continues to rise in France since early 80', although differently among subtypes. Recent improvements in patient survival in major lymphoma subtypes at populational level raise new questions about patient outcome (in specific subgroups) and survivorship (i.e. quality of life, long term sequelae). Numerous epidemiological studies have investigated factors related to lymphoma risk, but far fewer have addressed the extent to which socioeconomic status, social institutional context (i.e. healthcare system), social relationships, environmental context (exposures), individual behaviours (lifestyle) or genetic determinants influence lymphoma outcomes, especially in the general population. Moreover, the knowledge of the disease behaviour achieved from clinical trials data is partly biased because of patient selection. Study Design and Methods: The REALYSA ("REal world dAta in LYmphoma and Survival in Adults") study is a real-life multicentric cohort set in France areas mostly covered by population-based cancer registries to study the prognostic value of epidemiological, clinical and biological factors with a prospective 9-year follow up. ClinicalTrials.gov identifier is NCT03869619. We aim to include 6000 patients over 4 years. Adult patients without lymphoma history and newly diagnosed of one of the following 7 lymphoma subtypes (diffuse large B cell (DLBCL), follicular (FL), marginal zone (MZL), mantle cell (MCL), Burkitt, Hodgkin (HL), T-cell (T-NHL)) are offered to participate during a medical consultation with their hematologist. Exclusion criteria are: having already received anti-lymphoma treatment (except pre-phase) and having a documented HIV infection. After having given signed informed consent, participants fill in three auto-questionnaires regarding lifelong history of residences and occupations, quality of life (QoL / QLQ-C30 questionnaire) and social support (SS / SSQ6 questionnaire). Patients are then interviewed to collect their sociodemographic characteristics, medical and familial history, professional and domestic exposures to major chemicals and pesticides, lifestyle and women health. Clinical data are obtained using patients medical records, including care pathway, medical history, concomitant treatments, initial diagnosis characteristics, nodal/extra-nodal involvement, exams performed, staging, laboratory data, serologic tests, geriatric screening (G8 questionnaire), treatments received (including pre-phase, detailed treatment phases and molecules, reasons for treatment discontinuation), progressions, and treatment response evaluation. Biological samples at baseline and during treatment are collected including plasma and peripheral mononuclear cells. Additionally, a virtual tumor biobank is constituted for baseline tumor samples. The diagnosis will be ensured thanks to the review of French Lymphopath network. Follow-up, including clinical outcomes, new morbidities, lifestyle, professional situation, QoL, SS, fertility, health behavior, are collected every 6 months in the first 3 years and every year thereafter. Results: A pilot phase was implemented between November 2018 and June 2019 in 7 French hospitals/clinics. By June 30, 328 patients were recruited. Biological samples at baseline were obtained for 81% of included patients (n=265). 52% were male and 48% were female. The median age was 62 years (range: 18-95). The histological subtypes were the following (n=308 patients with complete data): 132 DLBCL (42.8%); 59 FL (19.5%); 52 HL (16.9%); 29 MCL (9.4%); 22 MZL (7.1%); 13 T-NHL (4.2%); 1 other (0.3%). We observed a good adherence to clinical research process despite the complexity of data collection. An extension phase with 10 additional centres will be launched during the last 2019 trimester. Discussion: The pilot phase of REALYSA study showed a good compliance to study guidelines and a good quality of data collected at baseline. Consequently, the study design is prospectively feasible in real-life setting. This cohort will constitute an innovative platform for clinical, biological, epidemiological and socio-economical research projects. Disclosures Oberic: Takeda: Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria; Roche: Membership on an entity's Board of Directors or advisory committees. Salles:Amgen: Honoraria, Other: Educational events; Novartis, Servier, AbbVie, Karyopharm, Kite, MorphoSys: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Educational events; BMS: Honoraria; Roche, Janssen, Gilead, Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Educational events; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Educational events; Merck: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Autolus: Consultancy, Membership on an entity's Board of Directors or advisory committees; Epizyme: Consultancy, Honoraria.