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Beatrici E, Paciotti M, Nguyen DD, Filipas DK, Qian Z, Lughezzani G, Daniels D, Lipsitz SR, Kibel AS, Cole AP, Trinh QD. Estimating the impact of enhanced care at minority-serving hospitals on disparities in the treatment of breast, prostate, lung, and colon cancers. Cancer 2024; 130:2770-2781. [PMID: 38798127 DOI: 10.1002/cncr.35328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The objective of this study was to quantify disparities in cancer treatment delivery between minority-serving hospitals (MSHs) and non-MSHs for breast, prostate, nonsmall cell lung, and colon cancers from 2010 to 2019 and to estimate the impact of improving care at MSHs on national disparities. METHODS Data from the National Cancer Database (2010-2019) identified patients who were eligible for definitive treatments for the specified cancers. Hospitals in the top decile by minority patient proportion were classified as MSHs. Multivariable logistic regression adjusted for patient and hospital characteristics compared the odds of receiving definitive treatment at MSHs versus non-MSHs. A simulation was used to estimate the increase in patients receiving definitive treatment if MSH care matched the levels of non-MSH care. RESULTS Of 2,927,191 patients from 1330 hospitals, 9.3% were treated at MSHs. MSHs had significant lower odds of delivering definitive therapy across all cancer types (adjusted odds ratio: breast cancer, 0.83; prostate cancer, 0.69; nonsmall cell lung cancer, 0.73; colon cancer, 0.81). No site of care-race interaction was significant for any of the cancers (p > .05). Equalizing treatment rates at MSHs could result in 5719 additional patients receiving definitive treatment over 10 years. CONCLUSIONS The current findings underscore systemic disparities in definitive cancer treatment delivery between MSHs and non-MSHs for breast, prostate, nonsmall cell lung, and colon cancers. Although targeted improvements at MSHs represent a critical step toward equity, this study highlights the need for integrated, system-wide efforts to address the multifaceted nature of racial and ethnic health disparities. Enhancing care at MSHs could serve as a pivotal strategy in a broader initiative to achieve health care equity for all.
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Affiliation(s)
- Edoardo Beatrici
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marco Paciotti
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - David-Dan Nguyen
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Dejan K Filipas
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zhiyu Qian
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Danesha Daniels
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Stuart R Lipsitz
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam S Kibel
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander P Cole
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Drury A, Boland V, Dowling M. Patient-Reported Outcome and Experience Measures in Advanced Nursing Practice: What Are Key Considerations for Implementation and Optimized Use? Semin Oncol Nurs 2024; 40:151632. [PMID: 38658204 DOI: 10.1016/j.soncn.2024.151632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/10/2024] [Accepted: 03/17/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To discuss the opportunities and challenges of implementing patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) within advanced practice nursing services in cancer care. METHODS This discussion paper has been informed by an environmental scan of evidence from systematic reviews and primary studies evaluating the use and implementation of PROMs and PREMs. Literature from the contexts of cancer and chronic disease, including nursing and multidisciplinary supportive care literature, has been included. RESULTS Advanced practice nurses are well-positioned to evaluate and respond to PROMs and PREMs data; several studies have highlighted improved patient outcomes concerning quality of life, symptom distress, and functional status within nurse-led services. Nevertheless, the implementation of PROMs and PREMs in cancer care and nurse-led services is variable. Previous studies have highlighted implementation challenges, which can hinder comparability and generalizability of PROMs and PREMs instruments. Advanced practice nurses should consider these challenges, including ways to use standardized PROM instruments. Electronic PROMs, while efficient, may exclude individuals at risk of inequity. Complex, lengthy, and frequent administration of PROMs may also overburden people living with or after cancer, with people affected by cancer expressing preference for flexible use in some studies. Therefore, the involvement of people affected by cancer in planning for PROMs/PREMs implementation may overcome this challenge. Finally, organizational considerations in implementation should address financial investments, including initial costs for technology and training and consideration of the operationalization of PROMs within existing infrastructure for the seamless utilization of PROMs data. CONCLUSION Despite the potential of advanced practice nursing services to enhance patient-reported outcomes and experiences, variability in the implementation of PROMs and PREMs poses challenges. Use of validated measures, electronic or paper-based instruments, and the preferences of people affected by cancer for the use of PROMs and PREMs must be carefully considered in consultation with end users for successful implementation. IMPLICATIONS FOR PRACTICE In planning for the implementation of PROMs and PREMs within nurse-led services, implementation risks may be mitigated through establishing clear guidelines for their use, investment in the development of the required infrastructure, user education, and rigorous implementation processes, including patient involvement in PROMs/PREMs selection.
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Affiliation(s)
- Amanda Drury
- Associate Professor in General Nursing, School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin, Dublin, Ireland.
| | - Vanessa Boland
- Assistant Professor in General Nursing, School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Maura Dowling
- Associate Professor, School of Nursing and Midwifery, University of Galway, Ireland
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Factors Associated with the Decision to Decline Chemotherapy in Metastatic Non-Small Cell Lung Cancer. Cancers (Basel) 2023; 15:cancers15061686. [PMID: 36980573 PMCID: PMC10046757 DOI: 10.3390/cancers15061686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
(1) Background: Disparities in cancer treatment and outcomes have long been well-documented in the medical literature. With the eruption of advances in new treatment modalities, the long-existing disparities are now being further uncovered and brought to the attention of the medical community. While social health determinants have previously been linked to treatment disparities in lung cancer, we analyzed data from the National Cancer Database to explore sociodemographic and geographic factors related to accepting or declining physician-recommended chemotherapy. Patients diagnosed with metastatic lung cancer between 2004 and 2016 who declined chemotherapy recommended by their physicians were included in this study. Multivariate logistic regression analysis was performed. Cox Regression and Kaplan-Meier analyses were performed to look for survival characteristics. (2) Results: 316,826 patients with Stage IV lung cancer were identified. Factors related to a higher rate of refusal by patients included older age > 70, female sex, low income, lack of insurance coverage, residency in the New England region, and higher comorbidity. Patients living in areas with lower education were less likely to decline chemotherapy. (3) Conclusion: Further understanding of the factors impacting treatment decisions would be essential to improve the efficacy of care delivery in patients with cancer and reduce reversible causes of disparity.
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Scanferla E, de Bienassis K, Pachoud B, Gorwood P. How subjective well-being, patient-reported clinical improvement (PROMs) and experience of care (PREMs) relate in an acute psychiatric care setting? Eur Psychiatry 2023; 66:e26. [PMID: 36797203 PMCID: PMC10044307 DOI: 10.1192/j.eurpsy.2023.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly acknowledged as critical tools for enhancing patient-centred, value-based care. However, research is lacking on the impact of using standardized patient-reported indicators in acute psychiatric care. The aim of this study was to explore whether subjective well-being indicators (generic PROMs) are relevant for evaluating the quality of hospital care, distinct from measures of symptom improvement (disease-specific PROMs) and from PREMs. METHODS Two hundred and forty-eight inpatients admitted to a psychiatric university hospital were included in the study between January and June 2021. Subjective well-being was assessed using standardized generic PROMs on well-being, symptom improvement was assessed using standardized disease-specific PROMs, and experience of care using PREMs. PROMs were completed at admission and discharge, PREMs were completed at discharge. Clinicians rated their experience of providing treatment using adapted PREMs items. RESULTS Change in subjective well-being (PROMs) at discharge was significantly (p < 0.001), but moderately (r2 = 28.5%), correlated to improvement in symptom outcomes, and weakly correlated to experience of care (PREMs) (r2 = 11.0%), the latter being weakly explained by symptom changes (r2 = 6.9%). Patients and clinicians assessed the experience of care differently. CONCLUSIONS This study supports the case for routinely measuring patients' subjective well-being to better capture the unmet needs of patients undergoing psychiatric hospital treatment, and the use of standardized patient-reported measures as key indicators of high quality of care across mental health services.
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Affiliation(s)
- Elisabetta Scanferla
- CMME, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France.,Université Paris Cité, ED 450, Paris, France
| | | | | | - Philip Gorwood
- CMME, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France.,Université Paris Cité, INSERM, U1266 (Institute of Psychiatry and Neuroscience of Paris), Paris, France
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Tetzlaff ED, Hylton HM, Ruth KJ, Hasse Z, Hall MJ. Changes in Burnout Among Oncology Physician Assistants Between 2015 and 2019. JCO Oncol Pract 2022; 18:e47-e59. [PMID: 34292762 PMCID: PMC8757962 DOI: 10.1200/op.21.00051] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Burnout has significant implications for the individual provider, the oncology workforce, and the quality of care for patients with cancer. The primary aim of this study was to explore temporal changes in burnout among physician assistants (PAs) in oncology in 2019 compared with 2015. METHODS Oncology PAs were surveyed to assess for burnout using the Maslach Burnout Inventory according to the same cross-sectional design of the study performed in 2015. Comparison between oncology PAs in 2015 and 2019 in the prevalence of burnout and personal and professional characteristics was performed. RESULTS Two hundred thirty-four participants completed the full-length survey. The participants in 2015 and 2019 were similar in age (41.8 v 40.3 years), sex (88.8% v 86.3% female), number of years as a PA in oncology (9.6 v 10), and percentage involved in academic practice (55.2% v 59.2%). There was a significant increase in burnout in 2019 compared with 2015 with 48.7% of PAs reporting at least one symptom of burnout compared with 34.8% (odds ratio for burnout, 2019 v 2015 = 1.92 [95% CI, 1.40 to 2.65], P < 0.001). The odds of burnout remained higher in 2019 compared with 2015 when adjusted for age, sex, relationship status, practice setting, subspecialty, practice type, and hours worked. Factors associated with burnout in both 2015 and 2019 include the percentage of time spent on patient care, collaborative physician relationship, number of hours worked, and satisfaction with compensation. No new factors associated with burnout emerged in 2019 that were not identified in 2015. CONCLUSION The rate of burnout of oncology PAs has significantly increased. Burnout in oncology PAs is multifactorial, and the increase cannot be easily explained. Additional research is needed to better define the drivers of PA burnout.
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Affiliation(s)
- Eric D. Tetzlaff
- Fox Chase Cancer Center, Philadelphia, PA,Eric D. Tetzlaff, MHS, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111; e-mail:
| | - Heather M. Hylton
- Association of Physician Assistants in Oncology, Altamonte Springs, FL
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6
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Graff SL. Treatment of Premenopausal Women: Finding the Right-Sized Endocrine Therapy. JCO Oncol Pract 2021; 18:217-220. [PMID: 34780307 DOI: 10.1200/op.21.00720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Stephanie L Graff
- Lifespan Cancer Institute, Providence, RI.,Warren Alpert School of Medicine, Brown University, Providence, RI
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Belyea L, Acoba JD. Internal Medicine Residents' Perception of Cancer Prognosis. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:983-987. [PMID: 31161583 DOI: 10.1007/s13187-019-01552-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cancer is the second leading cause of death in the USA. Many internal medicine physicians feel uncomfortable having to prognosticate; however, oncology patients often ask this of them. The inability to provide an accurate prognosis could lead a patient to make a treatment decision incongruent with their true wishes. We conducted this study to assess resident and attending physicians' knowledge of cancer prognosis and to establish the source of residents' knowledge. We conducted a prospective, cross-sectional study to assess internal medicine resident and attending physician knowledge of median survival for seven different oncologic case scenarios. Correct answers were defined by results of randomized, phase III trials. Residents were asked to identify the source(s) of information that most significantly influenced their choices. All residents and attending physicians affiliated with the University of Hawaii were invited to participate. A total of 67 of 85 surveys (78.8%) were completed, representing 41 residents and 26 attending physicians. Overall, the respondents correctly estimated median survival 42.6% of the time. The respondents underestimated more often than overestimated median survival (46.3% vs. 14.9%, p = 0.0001). Seventy-three percent of residents cited inpatient experience as influencing their oncologic knowledge. Internal medicine residents and attending physicians correctly estimate median survival of cancer patients less than 50% of the time and often underestimate survival. Inpatient rotations, where residents care for the oncologic patients experiencing significant complications of their cancer and treatment, may be giving them an unbalanced perspective on cancer prognosis.
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Affiliation(s)
| | - Jared D Acoba
- Internal Medicine Department, University of Hawaii, Honolulu, HI, USA.
- University of Hawaii Cancer Center, Honolulu, HI, USA.
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Levit LA, Byatt L, Lyss AP, Paskett ED, Levit K, Kirkwood K, Schenkel C, Schilsky RL. Closing the Rural Cancer Care Gap: Three Institutional Approaches. JCO Oncol Pract 2020; 16:422-430. [DOI: 10.1200/op.20.00174] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Patients in rural areas face limited access to medical and oncology providers, long travel times, and low recruitment to clinical trials, all of which affect quality of care and health outcomes. Rural counties also have high rates of cancer-related mortality and other negative treatment outcomes. On April 10, 2019, ASCO hosted Closing the Rural Cancer Care Gap, the second event in its State of Cancer Care in America series. The event focused on two aspects of rural cancer care: a review of the major issues and concerns in delivering rural cancer care and a discussion of creative solutions to address rural-nonrural disparities. This article draws from the event and supporting literature to summarize the challenges to delivering high-quality care in rural communities, update ASCO’s workforce data on the geographic distribution of oncologists, and highlight 3 institutional approaches to addressing these challenges in diverse rural settings. The experience of the 3 institutions featured in the article suggests that increasing rural patients’ access to care requires expanding services and decreasing travel distances, mitigating financial burdens when insurance coverage is limited, opening avenues to clinical trial participation, and creating partnerships between providers and community leaders to address local gaps in care. Because the characteristics of rural communities, health care resources, and patient populations are not homogeneous, rural health disparities require local solutions that are based on community needs, available resources, and trusting and collaborative partnerships.
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Affiliation(s)
| | - Leslie Byatt
- New Mexico Minority Underserved NCORP, New Mexico Cancer Care Alliance, Albuquerque, NM
| | - Alan P. Lyss
- Heartland Cancer Research NCORP, Missouri Baptist Medical Center, St Louis, MO
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Youn JC, Chung WB, Ezekowitz JA, Hong JH, Nam H, Kyoung DS, Kim IC, Lyon AR, Kang SM, Jung HO, Chang K, Oh YS, Youn HJ, Baek SH, Kim HC. Cardiovascular disease burden in adult patients with cancer: An 11-year nationwide population-based cohort study. Int J Cardiol 2020; 317:167-173. [PMID: 32360647 DOI: 10.1016/j.ijcard.2020.04.080] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/19/2020] [Accepted: 04/27/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is an important cause of morbidity and mortality in patients with cancer. However, the real-world CVD burden of adult cancer patients has not been well established. This study aimed to evaluate the prevalence and mortality of pre-existing and new-onset CVD in patients with cancers. METHODS We analysed the prevalence and mortality of pre-existing and new-onset CVD in 41,034 adult patients with ten common solid cancers in a single payer system using data from the Korean National Health Insurance Service-National Sample Cohort from 2002 to 2013. RESULTS When all types of cancer were included, 11.3% (n = 4647) of patients had pre-existing CVD when they were diagnosed with cancer. After excluding patients with pre-existing CVD, 15.7% of cancer patients (n = 5703) were newly diagnosed with CVD during the follow-up period (median 68 months). Both pre-existing and new-onset CVD were associated with increased risk of overall mortality and 5-year mortality. Multivariate analysis to predict all-cause mortality indicated both pre-existing and new-onset CVD, male sex, old age, prior history of diabetes or chronic kidney disease, suburban residential area, and low-income status as significant factors. CONCLUSIONS Eleven percent of cancer patients had pre-existing CVD at the time of cancer diagnosis, and about 16% of cancer patients without pre-existing CVD were newly diagnosed with CVD, mostly within 5 years after the cancer diagnosis. Proper management of pre-existing CVD is necessary and pre-emptive prevention of new-onset CVD may alter treatment options and outcomes.
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Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Justin A Ezekowitz
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Jung Hwa Hong
- Department of Health Insurance Research, NHIS Medical Center, Ilsan Hospital, Goyang, Republic of Korea
| | - Hyewon Nam
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Republic of Korea
| | - Dae-Sung Kyoung
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Republic of Korea
| | - In-Cheol Kim
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton & Harefield NHS Foundation Trust and the National Heart & Lung Institute, Imperial College London, London, UK
| | - Seok-Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Seog Oh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hong Baek
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyeon Chang Kim
- Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Wang F, Wang C, Hu Y, Weiss J, Alford-Teaster J, Onega T. Automated delineation of cancer service areas in northeast region of the United States: A network optimization approach. Spat Spatiotemporal Epidemiol 2020; 33:100338. [PMID: 32370938 DOI: 10.1016/j.sste.2020.100338] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/03/2020] [Accepted: 02/28/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Derivation of service areas is an important methodology for evaluating healthcare variation, which can be refined to more robust, condition-specific, and empirically-based automated regions, using cancer service areas as an exemplar. DATA SOURCES/STUDY SETTING Medicare claims (2014-2015) for the nine-state Northeast region were used to develop a ZIP-code-level origin-destination matrix for cancer services (surgery, chemotherapy, and radiation). This population-based study followed a utilization-based approach to delineate cancer service areas (CSAs) to develop and test an improved methodology for small area analyses. DATA COLLECTION/EXTRACTION METHODS Using the cancer service origin-destination matrix, we estimated travel time between all ZIP-code pairs, and applied a community detection method to delineate CSAs, which were tested for localization, modularity, and compactness, and compared to existing service areas. PRINCIPAL FINDINGS Delineating 17 CSAs in the Northeast yielded optimal parameters, with a mean localization index (LI) of 0.88 (min: 0.60, max: 0.98), compared to the 43 Hospital Referral Regions (HRR) in the region (mean LI: 0.68; min: 0.18, max: 0.97). Modularity and compactness were similarly improved for CSAs vs. HRRs. CONCLUSIONS Deriving cancer-specific service areas with an automated algorithm that uses empirical and network methods showed improved performance on geographic measures compared to more general, hospital-based service areas.
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Affiliation(s)
- Fahui Wang
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA, United States
| | - Changzhen Wang
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA, United States
| | - Yujie Hu
- Department of Geography, University of Florida, Gainesville, FL, United States; UF Informatics Institute, University of Florida, Gainesville, FL, United States
| | - Julie Weiss
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Jennifer Alford-Teaster
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Norris Cotton Cancer Center, Lebanon, NH, United States; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Tracy Onega
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Norris Cotton Cancer Center, Lebanon, NH, United States; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.
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Slivnick J, Vallakati A, Addison D, Wallner A, Tong MS. Personalized Approach to Cancer Treatment-Related Cardiomyopathy. Curr Heart Fail Rep 2020; 17:43-55. [PMID: 32125627 DOI: 10.1007/s11897-020-00453-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Cancer treatment-related cardiotoxicity (CTRC) represents a significant cause of morbidity and mortality worldwide. The purpose of our review is to summarize the epidemiology, natural history, and pathophysiology of cardiotoxicity-related to cancer treatment. We also summarize appropriate screening, surveillance, and management of CTRC. While cardiotoxicity is characteristically associated with anthracyclines, HER2-B antagonists, and radiation therapy (XRT), there is growing recognition of toxicity with immune checkpoint inhibitors (ICI), tyrosine kinase inhibitors, and proteasome inhibitors. RECENT FINDINGS Patients at risk for cardiotoxicity should be screened based on available guidelines, generally with serial echocardiograms. The role of medical heart failure (HF) therapies is controversial in patients with asymptomatic left ventricular dysfunction but may be considered in some instances. Once symptomatic HF has developed, treatment should be in accordance with ACC/AHA guidelines. The goal in caring for patients receiving cancer treatment is to optimize cardiac function and prevent interruptions in potentially lifesaving cancer treatment.
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Affiliation(s)
- Jeremy Slivnick
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ajay Vallakati
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, The Ohio State University, Columbus, OH, USA.,Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Alexander Wallner
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - Matthew S Tong
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, The Ohio State University, Columbus, OH, USA.
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Yen TWF, Laud PW, McGinley EL, Pezzin LE, Nattinger AB. Prevalence and scope of advanced practice provider oncology care among Medicare beneficiaries with breast cancer. Breast Cancer Res Treat 2020; 179:57-65. [PMID: 31542875 DOI: 10.1007/s10549-019-05447-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Advanced practice providers (APPs) have increasingly become members of the oncology care team. Little is known about the scope of care that APPs are performing nationally. We determined the prevalence and extent of APP practice and examined associations between APP care and scope of practice regulations, phase of cancer care, and patient characteristics. METHODS We performed an observational study among women identified from Medicare claims as having had incident breast cancer in 2008 with claims through 2012. Outpatient APP care included at least one APP independently billing for cancer visits/services. APP scope of practice was classified as independent, reduced, or restricted. A logistic regression model with patient-level random effects was estimated to determine the probability of receiving APP care at any point during active treatment or surveillance. RESULTS Among 42,550 women, 6583 (15%) received APP care, of whom 83% had APP care during the surveillance phase and 41% during the treatment phase. Among women who received APP care during a given year of surveillance, the overall proportion of APP-billed clinic visits increased with each additional year of surveillance (36% in Year 1 to 61% in Year 4). Logistic regression model results indicate that women were more likely to receive APP care if they were younger, black, healthier, had higher income status, or lived in a rural county or state with independent APP scope of practice. CONCLUSIONS This study provides important clinical and policy-relevant findings regarding national practice patterns of APP oncology care. Among Medicare beneficiaries with incident breast cancer, 15% received outpatient oncology care that included APPs who were billing; most of this care was during the surveillance phase. Future studies are needed to define the degree of APP oncology practice and training that maximizes patient access and satisfaction while optimizing the efficiency and quality of cancer care.
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Affiliation(s)
- Tina W F Yen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of Surgical Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Purushottam W Laud
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Emily L McGinley
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Liliana E Pezzin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ann B Nattinger
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
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Coyle YM, Ogola GO, MacLachlan CR, Hinshelwood MM, Fleming NS. Acute care model that reduces oncology-related unplanned hospitalizations to promote quality of care and reduce cost. J Cancer Policy 2019. [DOI: 10.1016/j.jcpo.2019.100193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Chiang AC, Lake J, Sinanis N, Brandt D, Kanowitz J, Kidwai W, Kortmansky J, LaSala J, Orell J, Sabbath K, Tara H, Engelking C, Shomsky L, Fradkin M, Adelson K, Uscinski K, Vest K, Lyons C, Lemay A, Lopman A, Fuchs CS, Lilenbaum R. Measuring the Impact of Academic Cancer Network Development on Clinical Integration, Quality of Care, and Patient Satisfaction. J Oncol Pract 2019; 14:e823-e833. [PMID: 30537462 DOI: 10.1200/jop.18.00419] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Many US academic centers have acquired community practices to expand their clinical care and research footprint. The objective of this assessment was to determine whether the acquisition and integration of community oncology practices by Yale/Smilow Cancer Hospital improved outcomes in quality of care, disease team integration, clinical trial accrual, and patient satisfaction at network practice sites. METHODS We evaluated quality of care by testing the hypothesis that core Quality Oncology Practice Initiative measures at network sites that were acquired in 2012 were significantly different after their 2016 integration into the network. Clinical and research integration were measured using the number of tumor board case presentations and total accruals in clinical trials. We used Press-Ganey scores to measure patient satisfaction pre- and postintegration. RESULTS Mean Quality Oncology Practice Initiative scores at Smilow Care Centers were significantly higher in 2016 than in 2012 for core measures related to improvement in tumor staging ( z = 1.33; P < .05), signed consent and documentation plans for antineoplastic treatment ( z = 2.69; P < .01; and z = 2.36; P < .05, respectively), and appropriately quantifying and addressing pain during office visits ( z = 2.95; P < .05; and z = 3.1; P < .01, respectively). A total of 493 cases were presented by care center physicians at the tumor board in 2017 compared with 45 presented in 2013. Compared with 2012, Smilow Care Center clinical trial accrual increased from 25 to 170 patients in 2017. Last, patient satisfaction has remained at greater than the 90th percentile pre- and postintegration. CONCLUSION The process of integration facilitates the ability to standardize cancer practice and provides a platform for quality improvement.
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Affiliation(s)
- Anne C Chiang
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Jessica Lake
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Naralys Sinanis
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Debra Brandt
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Jane Kanowitz
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Wajih Kidwai
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Jeremy Kortmansky
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Johanna LaSala
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Jeffrey Orell
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Kert Sabbath
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Harold Tara
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Constance Engelking
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Lisa Shomsky
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Monica Fradkin
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Kerin Adelson
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Kathleen Uscinski
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Kevin Vest
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Catherine Lyons
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Arthur Lemay
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Abe Lopman
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Charles S Fuchs
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Rogerio Lilenbaum
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
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Berrett-Abebe J, Cadet T, Nekhlyudov L, Vitello J, Maramaldi P. Impact of an Interprofessional Primary Care Training on Fear of Cancer Recurrence on Clinicians' Knowledge, Self-Efficacy, Anticipated Practice Behaviors, and Attitudes Toward Survivorship Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:505-511. [PMID: 29429145 DOI: 10.1007/s13187-018-1331-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There are an estimated 15.5 million cancer survivors in the United States, with numbers projected to increase. Many cancer survivors are receiving survivorship care in primary care settings, yet primary care providers report a need for additional training on addressing medical and psychosocial concerns of cancer survivors. This paper presents findings from a pilot study on the effectiveness of a novel training for interprofessional primary care providers on the clinically significant issue of fear of cancer recurrence. The on-site training was provided to a total of 46 participants, including physicians (61%), physician assistants (11%), nurse practitioners (7%), nurses (17%), and social workers (4%) in six different primary care practices. The average number of years of professional experience was 18.8, with standard deviation of 10.9. Results of paired-sample t tests indicated that the training increased knowledge and self-efficacy of providers in identifying and addressing FCR. The training was well-received by participants, who had high confidence in implementing practice behavior changes, although they also identified barriers. Results suggest the feasibility of a brief training for continuing education and have implications for models of care delivery in cancer survivorship.
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Affiliation(s)
- Julie Berrett-Abebe
- Simmons College School of Social Work, Boston, MA, USA.
- Massachusetts General Hospital, Boston, MA, USA.
| | - Tamara Cadet
- Simmons College School of Social Work, Boston, MA, USA
| | - Larissa Nekhlyudov
- Primary Care Associates, Longwood, Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Joan Vitello
- Graduate School of Nursing, UMass Medical School, Worcester, MA, USA
| | - Peter Maramaldi
- Simmons College School of Social Work, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Priority setting in head and neck oncology in low-resource environments. Curr Opin Otolaryngol Head Neck Surg 2019; 27:198-202. [PMID: 30870186 DOI: 10.1097/moo.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Most information about priority setting comes from developed countries. In low-resource settings, many factors should be considered to select the best candidate for the treatments that are available. The physician is always under pressure to obtain better results in spite of the lower quantity of resources. This exposes physicians to daily ethical dilemmas and increases their anxiety and burnout. RECENT FINDINGS Most low-resource settings have restrictions in major treatments, and the number of specialized centers that have all the services is low. The surgeon has to navigate through the system as a patient advocate, taking the responsibilities of other health system actors, has to 'negotiate' to design a treatment based on outdated results or to wait for new results and has to decide whether to start or to wait for other treatments to be ready to comply with protocol recommendations. SUMMARY The surgeons face the dilemma of offering the best treatment with scarce resources but with a higher possibility of completion. Finally, we must do the best we can with what we have.
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Khorana AA, Tullio K, Elson P, Pennell NA, Grobmyer SR, Kalady MF, Raymond D, Abraham J, Klein EA, Walsh RM, Monteleone EE, Wei W, Hobbs B, Bolwell BJ. Time to initial cancer treatment in the United States and association with survival over time: An observational study. PLoS One 2019; 14:e0213209. [PMID: 30822350 PMCID: PMC6396925 DOI: 10.1371/journal.pone.0213209] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background Delays in time to treatment initiation (TTI) for new cancer diagnoses cause patient distress and may adversely affect outcomes. We investigated trends in TTI for common solid tumors treated with curative intent, determinants of increased TTI and association with overall survival. Methods and findings We utilized prospective data from the National Cancer Database for newly diagnosed United States patients with early-stage breast, prostate, lung, colorectal, renal and pancreas cancers from 2004–13. TTI was defined as days from diagnosis to first treatment (surgery, systemic or radiation therapy). Negative binomial regression and Cox proportional hazard models were used for analysis. The study population of 3,672,561 patients included breast (N = 1,368,024), prostate (N = 944,246), colorectal (N = 662,094), non-small cell lung (N = 363,863), renal (N = 262,915) and pancreas (N = 71,419) cancers. Median TTI increased from 21 to 29 days (P<0.001). Aside from year of diagnosis, determinants of increased TTI included care at academic center, race, education, prior history of cancer, transfer of facility, comorbidities and age. Increased TTI was associated with worsened survival for stages I and II breast, lung, renal and pancreas cancers, and stage I colorectal cancers, with hazard ratios ranging from 1.005 (95% confidence intervals [CI] 1.002–1.008) to 1.030 (95% CI 1.025–1.035) per week of increased TTI. Conclusions TTI has lengthened significantly and is associated with absolute increased risk of mortality ranging from 1.2–3.2% per week in curative settings such as early-stage breast, lung, renal and pancreas cancers. Studies of interventions to ease navigation and reduce barriers are warranted to diminish potential harm to patients.
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Affiliation(s)
- Alok A. Khorana
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
- * E-mail:
| | - Katherine Tullio
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Paul Elson
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Nathan A. Pennell
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Stephen R. Grobmyer
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Matthew F. Kalady
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Daniel Raymond
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Jame Abraham
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Eric A. Klein
- Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - R. Matthew Walsh
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Emily E. Monteleone
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Wei Wei
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Brian Hobbs
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Brian J. Bolwell
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
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Stephens JM, Bensink M, Bowers C, Hollenbeak CS. Risks and consequences of travel burden on prophylactic granulocyte colony-stimulating factor administration and incidence of febrile neutropenia in an aged Medicare population. Curr Med Res Opin 2019; 35:229-240. [PMID: 29661043 DOI: 10.1080/03007995.2018.1465906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Granulocyte colony-stimulating factors (G-CSFs) decrease the incidence of febrile neutropenia (FN) in patients receiving myelosuppressive chemotherapy. This study examines the impact patient travel burden has on administration of prophylactic G-CSFs and the subsequent impact on FN incidence. METHODS Medicare claims data were used to identify a cohort of beneficiaries age 65+ with non-myeloid cancers at high risk for FN between January 2012 and December 2014. Driving distance and time were calculated from patient residence ZIP code to the location of G-CSF and/or chemotherapy administration. Regression models were used to estimate the odds of G-CSF prophylaxis relative to patient driving distance and time, and odds of FN incidence relative to timing of G-CSF administration (optimal [days 2-4 after chemotherapy], sub-optimal [same day], or none). RESULTS The 52,389 study patients had a mean age of 73.5 years, and were 82% female and 89% white race; 49% had female breast cancer, 12% lung cancer, 15% ovarian cancer, and 24% non-Hodgkin's lymphoma. Of these high FN risk patients, 69% had at least one prophylactic G-CSF administration within at least one chemotherapy cycle. The percentage of patients receiving prophylactic G-CSFs in the first cycle was 56%. Median travel time was slightly longer for patients who did not receive G-CSFs and patients receiving short-acting vs long-acting G-CSFs. The odds of receiving no G-CSFs were 26-52% higher (depending on cancer type) for patients with a >80-min one-way travel time, compared to patients traveling <20-min. Concurrently, the odds of FN (using a "narrow" definition) were 18-93% higher for patients who did not receive G-CSFs in the first cycle of chemotherapy. CONCLUSIONS Travel burden, linked to clinic visits for G-CSF administration following myelosuppressive chemotherapy, is associated with sub-optimal use of G-CSF prophylaxis, which may result in a higher incidence of FN.
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Nonzee NJ, Luu TH. The Drug Shortage Crisis in the United States: Impact on Cancer Pharmaceutical Safety. Cancer Treat Res 2019; 171:75-92. [PMID: 30552658 DOI: 10.1007/978-3-319-43896-2_6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Drug shortages pose a significant public health concern in the United States, and cancer drugs are among those most affected. Shortages present serious safety risks for patients and substantial burden on providers and the healthcare system. Multifaceted drivers of this complex problem include manufacturing disruptions, raw material shortages, regulatory issues, market dynamics, and limited financial incentives that reward quality and production of off-patent drugs. Oncology drugs in short supply have resulted in substitution of less effective or more toxic alternatives, medication errors, and treatment delays, and are especially concerning for medications with no adequate substitute. Consequently, patient outcomes such as disease progression and survival have been adversely affected. Furthermore, emerging gray markets have contributed to cost-prohibitive markups and introduction of counterfeit products that compromise patient safety. The Food and Drug Administration plays a key role in preventing and managing pharmaceutical shortages, largely through regulations requiring early notification of manufacturing interruptions. Other proposed strategies similarly target upstream causes and center on reducing regulatory hurdles for manufacturers and increasing incentives for market entry and quality improvement. Despite progress in preventing supply disruptions, continued exploration of underlying systemic drivers remains critical to informing long-term solutions and alleviating the clinical and economic impact of drug shortages.
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Affiliation(s)
- Narissa J Nonzee
- Department of Health Policy and Management, University of California, Los Angeles, CA, USA.
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Wang TQ, Samuel JN, Brown MC, Vennettilli A, Solomon H, Eng L, Liang M, Gill G, Merali Z, Tian C, Cheng NYH, Campbell M, Patel D, Liu AX, Liu G, Howell D. Routine Surveillance of Chemotherapy Toxicities in Cancer Patients Using the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Oncol Ther 2018; 6:189-201. [PMID: 32700029 PMCID: PMC7360011 DOI: 10.1007/s40487-018-0065-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Systematic documentation of chemotoxicities in outpatient clinics is challenging. Incorporating patient-reported outcome (PRO) measures in clinical workflows can be an efficient strategy to strengthen the assessment of symptomatic treatment toxicities in oncology clinical practice. We compared the adequateness, feasibility, and acceptability of toxicity documentation using systematic, prospective, application of the PRO Common Toxicity Criteria for Adverse Events (PRO-CTCAE) tool. Methods At a comprehensive cancer center, data abstraction of electronic health record reviews elucidated current methods and degree of chemotoxicity documentation. Web-based 32-item PRO-CTCAE questionnaires, administered in ambulatory clinics of patients receiving chemotherapy, captured chemotoxicities and respective severities. Patient telephone surveys assessed whether healthcare providers had addressed chemotoxicities to the patients’ satisfaction. Results Over a broad demographic of 497 patients receiving chemotherapy, 90% (95% CI 84–96%) with significant chemotoxicities (n = 107) reported that their providers had discussed toxicities with them; of these, 70% received a therapy management change, while among the rest, 17% desired a change in management. Of patients surveyed, 91% (95% CI 82–99%) were satisfied with their current chemotoxicity management. Clinician chart documentation varied greatly; descriptors rather than numerical grading scales were typically used. Although 93% of patients were willing to complete the PRO survey, only 50% thought that it would be acceptable to complete this survey at routine clinic visits. Conclusion Use of PRO-CTCAE in routine clinical practice promotes systematic evaluation of symptomatic toxicities and improves the clarity, consistency, and efficiency of clinician documentation; however, methods to improve patient willingness to complete this tool routinely are needed.
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Affiliation(s)
- Tian Qi Wang
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | | | | | | | - Lawson Eng
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Mindy Liang
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | - Zahra Merali
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Chenchen Tian
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | - Matthew Campbell
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ai Xin Liu
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Center, Toronto, ON, Canada.
| | - Doris Howell
- Princess Margaret Cancer Center, Toronto, ON, Canada
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Stephens JM, Bensink M, Bowers C, Hollenbeak CS. Travel burden associated with granulocyte colony-stimulating factor administration in a Medicare aged population: a geospatial analysis. Curr Med Res Opin 2018; 34:1351-1360. [PMID: 28722536 DOI: 10.1080/03007995.2017.1358158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Prophylaxis with granulocyte colony-stimulating factors (G-CSFs) is recommended for patients receiving myelosuppressive chemotherapy regimens with a high risk of febrile neutropenia (FN). G-CSFs should be administered starting the day after chemotherapy, necessitating return trips to the oncology clinic at the end of each cycle. We examined the travel burden related to prophylactic G-CSF injections after chemotherapy in the US. METHODS We used 2012-2014 Medicare claims data to identify a national cohort of beneficiaries age 65+ with non-myeloid cancers who received both chemotherapy and prophylactic G-CSFs. Patient travel origin was based on residence ZIP code. Oncologist practice locations and hospital addresses were obtained from the Medicare Physician Compare and Hospital Compare websites and geocoded using the Google Maps Application Programming Interface (API). Driving distance and time to the care site from each patient ZIP code tabulation area (ZCTA) were calculated using Open Street Maps road networks. Geographic and socio-economic characteristics of each ZCTA from the US Census Bureau's American Community Survey were used to stratify and analyze travel estimates. RESULTS The mean one-way driving distance to the G-CSF provider was 23.8 (SD 30.1) miles and the mean one-way driving time was 33.3 (SD 37.8) minutes. When stratified by population density, the mean one-way travel time varied from 12.1 (SD 10.1) minutes in Very Dense Urban areas to 76.7 (SD 72.1) minutes in Super Rural areas. About 48% of patients had one-way travel times of <20 minutes, but 19% of patients traveled ≥50 minutes one way for G-CSF prophylaxis. Patients in areas with above average concentrations of aged, poor or disabled residents were more likely to experience longer travel. CONCLUSIONS Administration of G-CSF therapy after chemotherapy can present a significant travel burden for cancer patients. Technological improvements in the form and methods of drug delivery for G-CSFs might significantly reduce this travel burden.
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Polite BN, Seid JE, Levit LA, Kirkwood MK, Schenkel C, Bruinooge SS, Grubbs SS, Kamin DY, Schilsky RL. A New Look at the State of Cancer Care in America. J Oncol Pract 2018; 14:397-399. [DOI: 10.1200/jop.18.00150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Blase N. Polite
- University of Chicago, Chicago, IL; Great Lakes Cancer Management Specialists, Macomb, MI; American Society of Clinical Oncology, Alexandria, VA
| | - Jerome E. Seid
- University of Chicago, Chicago, IL; Great Lakes Cancer Management Specialists, Macomb, MI; American Society of Clinical Oncology, Alexandria, VA
| | - Laura A. Levit
- University of Chicago, Chicago, IL; Great Lakes Cancer Management Specialists, Macomb, MI; American Society of Clinical Oncology, Alexandria, VA
| | - M. Kelsey Kirkwood
- University of Chicago, Chicago, IL; Great Lakes Cancer Management Specialists, Macomb, MI; American Society of Clinical Oncology, Alexandria, VA
| | - Caroline Schenkel
- University of Chicago, Chicago, IL; Great Lakes Cancer Management Specialists, Macomb, MI; American Society of Clinical Oncology, Alexandria, VA
| | - Suanna S. Bruinooge
- University of Chicago, Chicago, IL; Great Lakes Cancer Management Specialists, Macomb, MI; American Society of Clinical Oncology, Alexandria, VA
| | - Stephen S. Grubbs
- University of Chicago, Chicago, IL; Great Lakes Cancer Management Specialists, Macomb, MI; American Society of Clinical Oncology, Alexandria, VA
| | - Deborah Y. Kamin
- University of Chicago, Chicago, IL; Great Lakes Cancer Management Specialists, Macomb, MI; American Society of Clinical Oncology, Alexandria, VA
| | - Richard L. Schilsky
- University of Chicago, Chicago, IL; Great Lakes Cancer Management Specialists, Macomb, MI; American Society of Clinical Oncology, Alexandria, VA
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Organization, quality and cost of oncological home-hospitalization: A systematic review. Crit Rev Oncol Hematol 2018; 126:145-153. [DOI: 10.1016/j.critrevonc.2018.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/24/2018] [Accepted: 03/21/2018] [Indexed: 11/23/2022] Open
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Somayaji D, Chang YP, Casucci S, Xue Y, Hewner S. Exploring Medicaid claims data to understand predictors of healthcare utilization and mortality for Medicaid individuals with or without a diagnosis of lung cancer: a feasibility study. Transl Behav Med 2018; 8:400-408. [DOI: 10.1093/tbm/iby023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | - Yu-Ping Chang
- University at Buffalo School of Nursing, Buffalo, NY, USA
| | - Sabrina Casucci
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA
| | - Yuqing Xue
- University at Buffalo School of Nursing, Buffalo, NY, USA
| | - Sharon Hewner
- University at Buffalo School of Nursing, Buffalo, NY, USA
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Alpert A, Hsi H, Jacobson M. Evaluating The Role Of Payment Policy In Driving Vertical Integration In The Oncology Market. Health Aff (Millwood) 2018; 36:680-688. [PMID: 28373334 DOI: 10.1377/hlthaff.2016.0830] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The health care industry has experienced massive consolidation over the past decade. Much of the consolidation has been vertical (with hospitals acquiring physician practices) instead of horizontal (with physician practices or hospitals merging with similar entities). We documented the increase in vertical integration in the market for cancer care in the period 2003-15, finding that the rate of hospital or health system ownership of practices doubled from about 30 percent to about 60 percent. The two most commonly cited explanations for this consolidation are a 2005 Medicare Part B payment reform that dramatically reduced reimbursement for chemotherapy drugs, and the expansion of hospital eligibility for the 340B Drug Discount Program under the Affordable Care Act (ACA). To evaluate the evidence for these explanations, we used difference-in-differences methods to assess whether consolidation increased more in areas with greater exposure to each policy than in areas with less exposure. We found little evidence that either policy contributed to vertical integration. Rather, increased consolidation in the market for cancer care may be part of a broader post-ACA trend toward integrated health care systems.
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Affiliation(s)
- Abby Alpert
- Abby Alpert is an assistant professor of health care management at the Wharton School, University of Pennsylvania, in Philadelphia
| | - Helen Hsi
- Helen Hsi was an analyst at the Health Policy Research Institute at the University of California, Irvine, when the analysis was conducted
| | - Mireille Jacobson
- Mireille Jacobson is an associate professor of economics and public policy at the Paul Merage School of Business, University of California, Irvine
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Intrastate Variations in Rural Cancer Risk and Incidence: An Illinois Case Study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 22:472-8. [PMID: 26193050 DOI: 10.1097/phh.0000000000000310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Although rural-urban cancer disparities have been explored with some depth, disparities within seemingly homogeneous rural areas have received limited attention. However, exploration of intrarural cancer incidence may have important public health implications for risk assessment, cancer control, and resource allocation. OBJECTIVE The objective of this study was to explore intrastate rural cancer risk and incidence differences within Illinois. DESIGN Illinois's 83 rural counties were categorized into northern, central, and southern regions (IL-N, IL-C, and IL-S, respectively). Chi-square test for independence and analysis of variance calculations were performed to assess regional differences in demographic characteristics, socioeconomic deprivation, smoking history, obesity, cancer-screening adherence, and density of general practitioners. Age-adjusted incidence rates were calculated for 5 cancer categories: all cancers combined, lung, colorectal, breast (female), and prostate cancers. Unadjusted and adjusted incidence rate ratios (IRRs) were calculated to evaluate regional differences in rates for each cancer category. RESULTS Socioeconomic deprivation varied by region: 4.5%, 6.9%, and 40.6% of IL-N, IL-C, and IL-S counties, respectively (P < .001). Smoking history also significantly differed by region. Mean former/current smoking prevalence in IL-N, IL-C, and IL-S counties was 46.4%, 48.2%, and 51.4%, respectively (P = .006). In unadjusted analysis, IL-C (IRR = 1.12; 95% confidence interval [CI], 1.02-1.23) and IL-S (IRR = 1.24; 95% CI, 1.13-1.35) had increased lung cancer incidence compared with IL-N. Elevated risk remained in IL-S after adjusting for relevant factors such as smoking and socioeconomic deprivation (IRR = 1.14; 95% CI, 1.04-1.26). CONCLUSIONS Socioeconomic deprivation, health behaviors, and lung cancer incidence varied across rural regions. Our findings underscore the importance of identifying cancer risk heterogeneity, even within a state, to effectively target risk factor reduction and cancer control interventions.
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Spinks T, Guzman A, Beadle BM, Lee S, Jones D, Walters R, Incalcaterra J, Hanna E, Hessel A, Weber R, Denney S, Newcomer L, Feeley TW. Development and Feasibility of Bundled Payments for the Multidisciplinary Treatment of Head and Neck Cancer: A Pilot Program. J Oncol Pract 2018; 14:e103-e112. [DOI: 10.1200/jop.2017.027029] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Despite growing interest in bundled payments to reduce the costs of care, this payment method remains largely untested in cancer. This 3-year pilot tested the feasibility of a 1-year bundled payment for the multidisciplinary treatment of head and neck cancers. Methods: Four prospective treatment-based bundles were developed for patients with selected head and neck cancers. These risk-adjusted bundles covered 1 year of care that began with primary cancer treatment. Manual processes were developed for patient identification, enrollment, billing, and payment. Patients were prospectively identified and enrolled, and bundled payments were made at treatment start. Operational metrics tracked incremental effort for pilot processes and average payment cycle time compared with fee-for-service (FFS) payments. Results: This pilot confirmed the feasibility of a 1-year prospective bundled payment for head and neck cancers. Between November 2014 and October 2016, 88 patients were enrolled successfully with prospective bundled payments. Through September 2017, 94% of patients completed the pilot with 6% still enrolled. Manual pilot processes required more effort than anticipated; claims processing was the most time-consuming activity. The production of a bundle bill took an additional 15 minutes versus FFS billing. The average payment cycle time was 37 days (range, 15 to 141 days) compared with a 15-day average under FFS. Conclusion: Prospective bundled payments were successfully implemented in this pilot. Additional pilots should study this payment method in higher-volume cancers. Robust systems are needed to automate patient identification, enrollment, billing, and payment along with policies that reduce administrative burden and allow for the introduction of novel cancer therapies.
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Affiliation(s)
- Tracy Spinks
- National Quality Forum, Washington, DC; The University of Texas MD Anderson Cancer Center, Houston, TX; Stanford University, Stanford, CA; Seoul National University, Seoul, South Korea; Baylor College of Medicine, Houston, TX; Deloitte Consulting, Dallas, TX; UnitedHealthcare, Minnetonka, MN; and Harvard Business School, Cambridge, MA
| | - Alexis Guzman
- National Quality Forum, Washington, DC; The University of Texas MD Anderson Cancer Center, Houston, TX; Stanford University, Stanford, CA; Seoul National University, Seoul, South Korea; Baylor College of Medicine, Houston, TX; Deloitte Consulting, Dallas, TX; UnitedHealthcare, Minnetonka, MN; and Harvard Business School, Cambridge, MA
| | - Beth M. Beadle
- National Quality Forum, Washington, DC; The University of Texas MD Anderson Cancer Center, Houston, TX; Stanford University, Stanford, CA; Seoul National University, Seoul, South Korea; Baylor College of Medicine, Houston, TX; Deloitte Consulting, Dallas, TX; UnitedHealthcare, Minnetonka, MN; and Harvard Business School, Cambridge, MA
| | - Seohyun Lee
- National Quality Forum, Washington, DC; The University of Texas MD Anderson Cancer Center, Houston, TX; Stanford University, Stanford, CA; Seoul National University, Seoul, South Korea; Baylor College of Medicine, Houston, TX; Deloitte Consulting, Dallas, TX; UnitedHealthcare, Minnetonka, MN; and Harvard Business School, Cambridge, MA
| | - Delrose Jones
- National Quality Forum, Washington, DC; The University of Texas MD Anderson Cancer Center, Houston, TX; Stanford University, Stanford, CA; Seoul National University, Seoul, South Korea; Baylor College of Medicine, Houston, TX; Deloitte Consulting, Dallas, TX; UnitedHealthcare, Minnetonka, MN; and Harvard Business School, Cambridge, MA
| | - Ron Walters
- National Quality Forum, Washington, DC; The University of Texas MD Anderson Cancer Center, Houston, TX; Stanford University, Stanford, CA; Seoul National University, Seoul, South Korea; Baylor College of Medicine, Houston, TX; Deloitte Consulting, Dallas, TX; UnitedHealthcare, Minnetonka, MN; and Harvard Business School, Cambridge, MA
| | - Jim Incalcaterra
- National Quality Forum, Washington, DC; The University of Texas MD Anderson Cancer Center, Houston, TX; Stanford University, Stanford, CA; Seoul National University, Seoul, South Korea; Baylor College of Medicine, Houston, TX; Deloitte Consulting, Dallas, TX; UnitedHealthcare, Minnetonka, MN; and Harvard Business School, Cambridge, MA
| | - Ehab Hanna
- National Quality Forum, Washington, DC; The University of Texas MD Anderson Cancer Center, Houston, TX; Stanford University, Stanford, CA; Seoul National University, Seoul, South Korea; Baylor College of Medicine, Houston, TX; Deloitte Consulting, Dallas, TX; UnitedHealthcare, Minnetonka, MN; and Harvard Business School, Cambridge, MA
| | - Amy Hessel
- National Quality Forum, Washington, DC; The University of Texas MD Anderson Cancer Center, Houston, TX; Stanford University, Stanford, CA; Seoul National University, Seoul, South Korea; Baylor College of Medicine, Houston, TX; Deloitte Consulting, Dallas, TX; UnitedHealthcare, Minnetonka, MN; and Harvard Business School, Cambridge, MA
| | - Randal Weber
- National Quality Forum, Washington, DC; The University of Texas MD Anderson Cancer Center, Houston, TX; Stanford University, Stanford, CA; Seoul National University, Seoul, South Korea; Baylor College of Medicine, Houston, TX; Deloitte Consulting, Dallas, TX; UnitedHealthcare, Minnetonka, MN; and Harvard Business School, Cambridge, MA
| | - Sandra Denney
- National Quality Forum, Washington, DC; The University of Texas MD Anderson Cancer Center, Houston, TX; Stanford University, Stanford, CA; Seoul National University, Seoul, South Korea; Baylor College of Medicine, Houston, TX; Deloitte Consulting, Dallas, TX; UnitedHealthcare, Minnetonka, MN; and Harvard Business School, Cambridge, MA
| | - Lee Newcomer
- National Quality Forum, Washington, DC; The University of Texas MD Anderson Cancer Center, Houston, TX; Stanford University, Stanford, CA; Seoul National University, Seoul, South Korea; Baylor College of Medicine, Houston, TX; Deloitte Consulting, Dallas, TX; UnitedHealthcare, Minnetonka, MN; and Harvard Business School, Cambridge, MA
| | - Thomas W. Feeley
- National Quality Forum, Washington, DC; The University of Texas MD Anderson Cancer Center, Houston, TX; Stanford University, Stanford, CA; Seoul National University, Seoul, South Korea; Baylor College of Medicine, Houston, TX; Deloitte Consulting, Dallas, TX; UnitedHealthcare, Minnetonka, MN; and Harvard Business School, Cambridge, MA
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Landercasper J, Fayanju OM, Bailey L, Berry TS, Borgert AJ, Buras R, Chen SL, Degnim AC, Froman J, Gass J, Greenberg C, Mautner SK, Krontiras H, Ramirez LD, Sowden M, Wexelman B, Wilke L, Rao R. Benchmarking the American Society of Breast Surgeon Member Performance for More Than a Million Quality Measure-Patient Encounters. Ann Surg Oncol 2018; 25:501-511. [PMID: 29168099 PMCID: PMC5758679 DOI: 10.1245/s10434-017-6257-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Nine breast cancer quality measures (QM) were selected by the American Society of Breast Surgeons (ASBrS) for the Centers for Medicare and Medicaid Services (CMS) Quality Payment Programs (QPP) and other performance improvement programs. We report member performance. STUDY DESIGN Surgeons entered QM data into an electronic registry. For each QM, aggregate "performance met" (PM) was reported (median, range and percentiles) and benchmarks (target goals) were calculated by CMS methodology, specifically, the Achievable Benchmark of Care™ (ABC) method. RESULTS A total of 1,286,011 QM encounters were captured from 2011-2015. For 7 QM, first and last PM rates were as follows: (1) needle biopsy (95.8, 98.5%), (2) specimen imaging (97.9, 98.8%), (3) specimen orientation (98.5, 98.3%), (4) sentinel node use (95.1, 93.4%), (5) antibiotic selection (98.0, 99.4%), (6) antibiotic duration (99.0, 99.8%), and (7) no surgical site infection (98.8, 98.9%); all p values < 0.001 for trends. Variability and reasons for noncompliance by surgeon for each QM were identified. The CMS-calculated target goals (ABC™ benchmarks) for PM for 6 QM were 100%, suggesting that not meeting performance is a "never should occur" event. CONCLUSIONS Surgeons self-reported a large number of specialty-specific patient-measure encounters into a registry for self-assessment and participation in QPP. Despite high levels of performance demonstrated initially in 2011 with minimal subsequent change, the ASBrS concluded "perfect" performance was not a realistic goal for QPP. Thus, after review of our normative performance data, the ASBrS recommended different benchmarks than CMS for each QM.
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Affiliation(s)
| | | | - Lisa Bailey
- Bay Area Breast Surgeons, Inc, Oakland, CA, USA
| | | | | | | | | | | | | | | | - Caprice Greenberg
- University of Wisconsin School of Public Health and Medicine, Madison, WI, USA
| | | | | | | | | | | | - Lee Wilke
- University of Wisconsin School of Public Health and Medicine, Madison, WI, USA
| | - Roshni Rao
- Columbia University Medical Center, New York, NY, USA
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Kotelnikova EA, Pyatnitskiy M, Paleeva A, Kremenetskaya O, Vinogradov D. Practical aspects of NGS-based pathways analysis for personalized cancer science and medicine. Oncotarget 2018; 7:52493-52516. [PMID: 27191992 PMCID: PMC5239569 DOI: 10.18632/oncotarget.9370] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 04/18/2016] [Indexed: 12/17/2022] Open
Abstract
Nowadays, the personalized approach to health care and cancer care in particular is becoming more and more popular and is taking an important place in the translational medicine paradigm. In some cases, detection of the patient-specific individual mutations that point to a targeted therapy has already become a routine practice for clinical oncologists. Wider panels of genetic markers are also on the market which cover a greater number of possible oncogenes including those with lower reliability of resulting medical conclusions. In light of the large availability of high-throughput technologies, it is very tempting to use complete patient-specific New Generation Sequencing (NGS) or other "omics" data for cancer treatment guidance. However, there are still no gold standard methods and protocols to evaluate them. Here we will discuss the clinical utility of each of the data types and describe a systems biology approach adapted for single patient measurements. We will try to summarize the current state of the field focusing on the clinically relevant case-studies and practical aspects of data processing.
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Affiliation(s)
- Ekaterina A Kotelnikova
- Personal Biomedicine, Moscow, Russia.,A. A. Kharkevich Institute for Information Transmission Problems, Russian Academy of Sciences, Moscow, Russia.,Institute Biomedical Research August Pi Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain
| | - Mikhail Pyatnitskiy
- Personal Biomedicine, Moscow, Russia.,Orekhovich Institute of Biomedical Chemistry, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Olga Kremenetskaya
- Personal Biomedicine, Moscow, Russia.,Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Dmitriy Vinogradov
- Personal Biomedicine, Moscow, Russia.,A. A. Kharkevich Institute for Information Transmission Problems, Russian Academy of Sciences, Moscow, Russia.,Lomonosov Moscow State University, Moscow, Russia
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Ediriweera MK, Tennekoon KH, Samarakoon SR, Thabrew I, de Silva ED. Protective Effects of Six Selected Dietary Compounds against Leptin-Induced Proliferation of Oestrogen Receptor Positive (MCF-7) Breast Cancer Cells. MEDICINES 2017; 4:medicines4030056. [PMID: 28930270 PMCID: PMC5622391 DOI: 10.3390/medicines4030056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 11/16/2022]
Abstract
Background: Obesity is considered as one of the risk factors for breast cancer. Leptin has been found to be involved in breast cancer progression. Therefore, novel approaches to antagonize biological effects of leptin are much needed. The objective of this study was to evaluate the protective effects of six dietary compounds (quercetin, curcumin, gallic acid, epigallocatechin gallate (EGCG), ascorbic acid and catechin) and assess the phosphorylation of extracellular signal-regulated kinase 1/2 (ERK1/2) in leptin-stimulated MCF-7 breast cancer cells in vitro. Methods: MCF-7 cells were exposed to leptin, leptin and compound and compound alone for 48 h. Cell viability was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide MTT and fluorometric assays after 48 h incubation. Phosphorylation of ERK1/2 was quantified by ELISA. Results: Only quercetin, curcumin and EGCG showed significant protective effects against leptin-induced proliferation of MCF-7 cells. Increase in ERK1/2 phosphorylation in response to leptin was reduced by the addition of quercetin, curcumin and EGCG. Conclusions: Considering the high prevalence of obesity, this observation provides a rationale for use of curcumin, quercetin and EGCG as antagonists of leptin in the treatment of obese breast cancer patients.
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Affiliation(s)
- Meran Keshawa Ediriweera
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, 90, Cumaratunga Munidasa Mawatha, Colombo 00300, Sri Lanka.
| | - Kamani Hemamala Tennekoon
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, 90, Cumaratunga Munidasa Mawatha, Colombo 00300, Sri Lanka.
| | - Sameera Ranganath Samarakoon
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, 90, Cumaratunga Munidasa Mawatha, Colombo 00300, Sri Lanka.
| | - Ira Thabrew
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, 90, Cumaratunga Munidasa Mawatha, Colombo 00300, Sri Lanka.
| | - E Dilip de Silva
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, 90, Cumaratunga Munidasa Mawatha, Colombo 00300, Sri Lanka.
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Lakdawalla DN, Shafrin J, Hou N, Peneva D, Vine S, Park J, Zhang J, Brookmeyer R, Figlin RA. Predicting Real-World Effectiveness of Cancer Therapies Using Overall Survival and Progression-Free Survival from Clinical Trials: Empirical Evidence for the ASCO Value Framework. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:866-875. [PMID: 28712615 DOI: 10.1016/j.jval.2017.04.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 03/23/2017] [Accepted: 04/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To measure the relationship between randomized controlled trial (RCT) efficacy and real-world effectiveness for oncology treatments as well as how this relationship varies depending on an RCT's use of surrogate versus overall survival (OS) endpoints. METHODS We abstracted treatment efficacy measures from 21 phase III RCTs reporting OS and either progression-free survival or time to progression endpoints in breast, colorectal, lung, ovarian, and pancreatic cancers. For these treatments, we estimated real-world OS as the mortality hazard ratio (RW MHR) among patients meeting RCT inclusion criteria in Surveillance and Epidemiology End Results-Medicare data. The primary outcome variable was real-world OS observed in the Surveillance and Epidemiology End Results-Medicare data. We used a Cox proportional hazard regression model to calibrate the differences between RW MHR and the hazard ratios on the basis of RCTs using either OS (RCT MHR) or progression-free survival/time to progression surrogate (RCT surrogate hazard ratio [SHR]) endpoints. RESULTS Treatment arm therapies reduced mortality in RCTs relative to controls (average RCT MHR = 0.85; range 0.56-1.10) and lowered progression (average RCT SHR = 0.73; range 0.43-1.03). Among real-world patients who used either the treatment or the control arm regimens evaluated in the relevant RCT, RW MHRs were 0.6% (95% confidence interval -3.5% to 4.8%) higher than RCT MHRs, and RW MHRs were 15.7% (95% confidence interval 11.0% to 20.5%) higher than RCT SHRs. CONCLUSIONS Real-world OS treatment benefits were similar to those observed in RCTs based on OS endpoints, but were 16% less than RCT efficacy estimates based on surrogate endpoints. These results, however, varied by tumor and line of therapy.
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Affiliation(s)
- Darius N Lakdawalla
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
| | | | - Ningqi Hou
- Precision Health Economics, Los Angeles, CA, USA
| | - Desi Peneva
- Precision Health Economics, Los Angeles, CA, USA
| | - Seanna Vine
- Precision Health Economics, Los Angeles, CA, USA
| | - Jinhee Park
- Novartis Pharmaceuticals, East Hanover, NJ, USA
| | - Jie Zhang
- Novartis Pharmaceuticals, East Hanover, NJ, USA
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Orlovic M, Marti J, Mossialos E. Analysis Of End-Of-Life Care, Out-Of-Pocket Spending, And Place Of Death In 16 European Countries And Israel. Health Aff (Millwood) 2017; 36:1201-1210. [DOI: 10.1377/hlthaff.2017.0166] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Martina Orlovic
- Martina Orlovic ( ) is a PhD candidate in the Department of Surgery and Cancer, Faculty of Medicine, Institute of Global Health Innovation, Imperial College London, in England
| | - Joachim Marti
- Joachim Marti is a lecturer in health economics at the Centre for Health Policy, Imperial College London
| | - Elias Mossialos
- Elias Mossialos is a professor of health policy and management at the Institute of Global Health Innovation, Imperial College London, and the Brian Abel-Smith Professor of Health Policy at the London School of Economics and Political Science
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Kao J, Zucker A, Mauer EA, Wong AT, Christos P, Kang J. Radiation Oncology Physician Practice in the Modern Era: A Statewide Analysis of Medicare Reimbursement. Cureus 2017; 9:e1192. [PMID: 28553570 PMCID: PMC5444915 DOI: 10.7759/cureus.1192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction In recent years, major changes in health care policy have affected oncology practice dramatically. In this context, we examined the effect of practice structure on volume and payments for radiation oncology services using the 2013 Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF) for New York State radiation oncologists. Methods The Medicare POSPUF data was queried, and individual physicians were classified into freestanding office-based and hospital-based practices. Freestanding practices were further subdivided into urology, hematology-oncology, and other ownership structures. Additional variables analyzed included gender, year of medical school graduation, and Herfindahl-Hirschman Index (HHI). Statistical analyses were performed to assess the impact of the above-mentioned variables on reimbursements. Results There were 236 New York State radiation oncologists identified in the 2013 Medicare POSPUF dataset, with a total reimbursement of $91,525,855. Among freestanding centers, the mean global Medicare reimbursement was $832,974. Global Medicare reimbursement was $1,328,743 for urology practices, compared to $754,567 for hematology-oncology practices and $691,821 for other ownership structures (p < 0.05). The mean volume of on-treatment visits (OTVs) was 240.5 per year, varying by practice structure. The mean annual OTV volumes for urology practices, hematology-oncology practices, other freestanding practices, and hospital-based programs were 424.6, 311.5, 247.5, and 209.3, respectively. After correcting for gender, physician experience, and HHI, practice structure was predictive of freestanding reimbursement and on treatment visit volume. Conclusion Higher Medicare payment was significantly predicted by the type of practice structure, with urology-based and hematology-oncology practices accounting for the highest total reimbursement and OTV volume.
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Affiliation(s)
- Johnny Kao
- Radiation Oncology, Good Samaritan Hospital Medical Center
| | - Amanda Zucker
- Radiation Oncology, Good Samaritan Hospital Medical Center
| | - Elizabeth A Mauer
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, New York-Presbyterian/Weill Cornell Medical Center
| | - Andrew T Wong
- Radiation Oncology, Good Samaritan Hospital Medical Center
| | - Paul Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, New York-Presbyterian/Weill Cornell Medical Center
| | - Josephine Kang
- Radiation Oncology, New York-Presbyterian/Weill Cornell Medical Center
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Simoni LJC, Brandão SCS. New Imaging Methods for Detection of Drug-Induced Cardiotoxicity in Cancer Patients. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9415-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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35
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Armenian SH, Lacchetti C, Lenihan D. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline Summary. J Oncol Pract 2017; 13:270-275. [DOI: 10.1200/jop.2016.018770] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Saro H. Armenian
- City of Hope, Duarte, CA; American Society of Clinical Oncology, Alexandria, VA; and Vanderbilt University, Nashville, TN
| | - Christina Lacchetti
- City of Hope, Duarte, CA; American Society of Clinical Oncology, Alexandria, VA; and Vanderbilt University, Nashville, TN
| | - Daniel Lenihan
- City of Hope, Duarte, CA; American Society of Clinical Oncology, Alexandria, VA; and Vanderbilt University, Nashville, TN
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Armenian SH, Lacchetti C, Barac A, Carver J, Constine LS, Denduluri N, Dent S, Douglas PS, Durand JB, Ewer M, Fabian C, Hudson M, Jessup M, Jones LW, Ky B, Mayer EL, Moslehi J, Oeffinger K, Ray K, Ruddy K, Lenihan D. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2017; 35:893-911. [DOI: 10.1200/jco.2016.70.5400] [Citation(s) in RCA: 652] [Impact Index Per Article: 93.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose Cardiac dysfunction is a serious adverse effect of certain cancer-directed therapies that can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. The purpose of this effort was to develop recommendations for prevention and monitoring of cardiac dysfunction in survivors of adult-onset cancers. Methods Recommendations were developed by an expert panel with multidisciplinary representation using a systematic review (1996 to 2016) of meta-analyses, randomized clinical trials, observational studies, and clinical experience. Study quality was assessed using established methods, per study design. The guideline recommendations were crafted in part using the Guidelines Into Decision Support methodology. Results A total of 104 studies met eligibility criteria and compose the evidentiary basis for the recommendations. The strength of the recommendations in these guidelines is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms. Recommendations It is important for health care providers to initiate the discussion regarding the potential for cardiac dysfunction in individuals in whom the risk is sufficiently high before beginning therapy. Certain higher risk populations of survivors of cancer may benefit from prevention and screening strategies implemented during cancer-directed therapies. Clinical suspicion for cardiac disease should be high and threshold for cardiac evaluation should be low in any survivor who has received potentially cardiotoxic therapy. For certain higher risk survivors of cancer, routine surveillance with cardiac imaging may be warranted after completion of cancer-directed therapy, so that appropriate interventions can be initiated to halt or even reverse the progression of cardiac dysfunction.
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Affiliation(s)
- Saro H. Armenian
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Christina Lacchetti
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Ana Barac
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Joseph Carver
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Louis S. Constine
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Neelima Denduluri
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Susan Dent
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Pamela S. Douglas
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Jean-Bernard Durand
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Michael Ewer
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Carol Fabian
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Melissa Hudson
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Mariell Jessup
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Lee W. Jones
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Bonnie Ky
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Erica L. Mayer
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Javid Moslehi
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Kevin Oeffinger
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Katharine Ray
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Kathryn Ruddy
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Daniel Lenihan
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
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Agarwal A, Freedman RA, Goicuria F, Rhinehart C, Murphy K, Kelly E, Mullaney E, St Amand M, Nguyen P, Lin NU. Prior Authorization for Medications in a Breast Oncology Practice: Navigation of a Complex Process. J Oncol Pract 2017; 13:e273-e282. [PMID: 28245148 DOI: 10.1200/jop.2016.017756] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The cost and burden associated with prior authorization (PA) for specialty medications are concerns for oncologists, but the impact of the PA process on care delivery has not been well described. We examined PA processes and approval patterns within a high-volume breast oncology clinic at a major academic cancer center. METHODS We met with institutional staff to create a PA workflow and process map. We then abstracted pharmacy and medical records for all patients with breast cancer (N = 279) treated at our institution who required a PA between May and November 2015 (324 prescriptions). We examined PA approval rates, time to approval, and associations of these outcomes with the type of medication being prescribed, patient demographics, and method of PA. RESULTS Seventeen possible process steps and 10 decision points were required for patients to obtain medications requiring a PA. Of the 324 PAs tracked, 316 (97.5%) were approved on the first PA request after an average time of 0.82 days (range, 0 to 14 days). Approximately half of PAs were for either palbociclib (26.5%) or pegfilgrastim (22.2%), and 13.6% of PAs were for generic hormonal therapy. Requirements to fax PA requests were associated with greater delay in approval time (1.31 v 0.17 days for online requests; P < .001). The use of specialty pharmacies increased staff burden and delays in medication receipt. CONCLUSION The PA process is complicated and labor intensive. Given the high PA approval rate, it is unlikely that PA requirements reduce medication utilization in practice, and these requirements may impose unnecessary burdens on patient care. The goals and requirements for PAs should be readdressed.
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Affiliation(s)
- Ankit Agarwal
- Dana-Farber Cancer Institute; and Boston University School of Medicine, Boston, MA
| | - Rachel A Freedman
- Dana-Farber Cancer Institute; and Boston University School of Medicine, Boston, MA
| | - Felicia Goicuria
- Dana-Farber Cancer Institute; and Boston University School of Medicine, Boston, MA
| | - Catherine Rhinehart
- Dana-Farber Cancer Institute; and Boston University School of Medicine, Boston, MA
| | - Kathleen Murphy
- Dana-Farber Cancer Institute; and Boston University School of Medicine, Boston, MA
| | - Eileen Kelly
- Dana-Farber Cancer Institute; and Boston University School of Medicine, Boston, MA
| | - Erin Mullaney
- Dana-Farber Cancer Institute; and Boston University School of Medicine, Boston, MA
| | - Myra St Amand
- Dana-Farber Cancer Institute; and Boston University School of Medicine, Boston, MA
| | - Phuong Nguyen
- Dana-Farber Cancer Institute; and Boston University School of Medicine, Boston, MA
| | - Nancy U Lin
- Dana-Farber Cancer Institute; and Boston University School of Medicine, Boston, MA
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Banegas MP, Guy GP, de Moor JS, Ekwueme DU, Virgo KS, Kent EE, Nutt S, Zheng Z, Rechis R, Yabroff KR. For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships. Health Aff (Millwood) 2017; 35:54-61. [PMID: 26733701 DOI: 10.1377/hlthaff.2015.0830] [Citation(s) in RCA: 189] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The rising medical costs associated with cancer have led to considerable financial hardship for patients and their families in the United States. Using data from the LIVESTRONG 2012 survey of 4,719 cancer survivors ages 18-64, we examined the proportions of survivors who reported going into debt or filing for bankruptcy as a result of cancer, as well as the amount of debt incurred. Approximately one-third of the survivors had gone into debt, and 3 percent had filed for bankruptcy. Of those who had gone into debt, 55 percent incurred obligations of $10,000 or more. Cancer survivors who were younger, had lower incomes, and had public health insurance were more likely to go into debt or file for bankruptcy, compared to those who were older, had higher incomes, and had private insurance, respectively. Future longitudinal population-based studies are needed to improve understanding of financial hardship among US working-age cancer survivors throughout the cancer care trajectory and, ultimately, to help stakeholders develop evidence-based interventions and policies to reduce the financial hardship of cancer.
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Affiliation(s)
- Matthew P Banegas
- Matthew P. Banegas is an investigator at the Kaiser Permanente Center for Health Research, in Portland, Oregon
| | - Gery P Guy
- Gery P. Guy Jr. is a health economist at the Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia
| | - Janet S de Moor
- Janet S. de Moor is a program director in the Division of Cancer Control and Population Sciences, at the National Cancer Institute (NCI), in Bethesda, Maryland
| | | | - Katherine S Virgo
- Katherine S. Virgo is an adjunct professor in the Department of Health Policy and Management at Emory University, in Atlanta
| | - Erin E Kent
- Erin E. Kent is an epidemiologist and program director in the Outcomes Research Branch, Applied Research Program, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, at the NCI
| | - Stephanie Nutt
- Stephanie Nutt is a program manager at the LIVESTRONG Foundation, in Austin, Texas
| | - Zhiyuan Zheng
- Zhiyuan Zheng is a senior epidemiologist at the American Cancer Society in Atlanta, Georgia
| | - Ruth Rechis
- Ruth Rechis is vice president of programs and strategy at the LIVESTRONG Foundation
| | - K Robin Yabroff
- K. Robin Yabroff is an epidemiologist in the Division of Cancer Control and Population Sciences at the NCI
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Shen C, Zhao B, Liu L, Shih YCT. Financial Burden for Patients With Chronic Myeloid Leukemia Enrolled in Medicare Part D Taking Targeted Oral Anticancer Medications. J Oncol Pract 2017; 13:e152-e162. [PMID: 28095170 DOI: 10.1200/jop.2016.014639] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The number of targeted oral anticancer medications (TOAMs) has grown rapidly in the past decade. The high cost of TOAMs raises concerns about the financial aspect of treatment, especially for patients enrolled in Medicare Part D plans because of the coverage gap. METHODS We identified patients with chronic myeloid leukemia (CML) who were new TOAM users from the SEER registry data linked with Medicare Part D data, from years 2007 to 2012. We followed these patients throughout the calendar year when they started taking the TOAMs and examined their out-of-pocket (OOP) payments and gross drug costs, taking into account their benefit phase, plan type, and cost share group. RESULTS We found that 726 (81%) of the 898 patients with CML who received TOAMs had reached the catastrophic phase of their Medicare Part D benefit within the year of medication initiation, with a large majority of patients reaching this phase in less than a month. Patients without subsidies showed a clear pattern of a spike in OOP payments when they began treatment with TOAMs. The OOP payment for patients with subsidies was substantially lower. The monthly gross drug costs were similar between patients with and without subsidies. CONCLUSION Patients experience quick entry and exit from the coverage gap (also called the donut hole) as a result of the high price of TOAMs. Closing the donut hole will provide financial relief during the initial month(s) of treatment but will not completely eliminate the financial burden.
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Affiliation(s)
- Chan Shen
- The University of Texas MD Anderson Cancer Center, Houston, TX; and Northwestern University, Chicago, IL
| | - Bo Zhao
- The University of Texas MD Anderson Cancer Center, Houston, TX; and Northwestern University, Chicago, IL
| | - Lei Liu
- The University of Texas MD Anderson Cancer Center, Houston, TX; and Northwestern University, Chicago, IL
| | - Ya-Chen Tina Shih
- The University of Texas MD Anderson Cancer Center, Houston, TX; and Northwestern University, Chicago, IL
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Becerra AZ, Aquina CT, Berho M, Boscoe FP, Schymura MJ, Noyes K, Monson JR, Fleming FJ. Surgeon-, pathologist-, and hospital-level variation in suboptimal lymph node examination after colectomy: Compartmentalizing quality improvement strategies. Surgery 2017; 161:1299-1306. [PMID: 28088321 DOI: 10.1016/j.surg.2016.11.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/05/2016] [Accepted: 11/22/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The goals of this study were to characterize the variation in suboptimal lymph node examination for patients with colon cancer across individual surgeons, pathologists, and hospitals and to examine if this variation affects 5-year, disease-specific survival. METHODS A retrospective cohort study was conducted by merging the New York State Cancer Registry with the Statewide Planning & Research Cooperative System, Medicaid, and Medicare claims to identify resections for stages I-III colon cancer from 2004-2011. Multilevel logistic regression models characterized variation in suboptimal lymph node examination (<12 lymph nodes). Multilevel competing-risks Cox models were used for survival analyses. RESULTS The overall rate of suboptimal lymph node examination was 32% in 12,332 patients treated by 1,503 surgeons and 814 pathologists at 187 hospitals. Patient-level predictors of suboptimal lymph node examination were older age, male sex, nonscheduled admission, lesser stage, and left colectomy procedure. Hospital-level predictors of suboptimal lymph node examination were a nonacademic status, a rural setting, and a low annual number of resections for colon cancer. The percent of the total clustering variance attributed to surgeons, pathologists, and hospitals was 8%, 23%, and 70%, respectively. Increasing the pathologist and hospital-specific rates of suboptimal lymph node examination were associated with worse 5-year, disease-specific survival. CONCLUSION There was a large variation in suboptimal lymph node examination between surgeons, pathologists, and hospitals. Collaborative efforts that promote optimal examination of lymph nodes may improve prognosis for colon cancer patients. Given that 93% of the variation was attributable to pathologists and hospitals, endeavors in quality improvement should focus on these 2 settings.
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Affiliation(s)
- Adan Z Becerra
- Department of Public Health Sciences, Division of Epidemiology, University of Rochester Medical Center, Rochester, NY; Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY.
| | - Christopher T Aquina
- Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Mariana Berho
- Department of Laboratory Medicine, Cleveland Clinic Florida, Weston, FL
| | - Francis P Boscoe
- New York State Cancer Registry, Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY
| | - Maria J Schymura
- New York State Cancer Registry, Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY
| | - Katia Noyes
- Department of Epidemiology and Environmental Health, Division of Health Services Policy and Practice, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - John R Monson
- Center for Colon and Rectal Surgery, Florida Hospital Medical Group, Florida Hospital, Orlando, FL
| | - Fergal J Fleming
- Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY
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Brooks GA, Bosserman LD, Mambetsariev I, Salgia R. Value-Based Medicine and Integration of Tumor Biology. Am Soc Clin Oncol Educ Book 2017; 37:833-840. [PMID: 28561700 DOI: 10.1200/edbk_175519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Clinical oncology is in the midst of a genomic revolution, as molecular insights redefine our understanding of cancer biology. Greater awareness of the distinct aberrations that drive carcinogenesis is also contributing to a growing armamentarium of genomically targeted therapies. Although much work remains to better understand how to combine and sequence these therapies, improved outcomes for patients are becoming manifest. As we welcome this genomic revolution in cancer care, oncologists also must grapple with a number of practical problems. Costs of cancer care continue to grow, with targeted therapies responsible for an increasing proportion of spending. Rising costs are bringing the concept of value into sharper focus and challenging the oncology community with implementation of value-based cancer care. This article explores the ways that the genomic revolution is transforming cancer care, describes various frameworks for considering the value of genomically targeted therapies, and outlines key challenges for delivering on the promise of personalized cancer care. It highlights practical solutions for the implementation of value-based care, including investment in biomarker development and clinical trials to improve the efficacy of targeted therapy, the use of evidence-based clinical pathways, team-based care, computerized clinical decision support, and value-based payment approaches.
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Affiliation(s)
- Gabriel A Brooks
- From the Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Linda D Bosserman
- From the Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Isa Mambetsariev
- From the Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ravi Salgia
- From the Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; City of Hope Comprehensive Cancer Center, Duarte, CA
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Mattes MD, Patel KR, Burt LM, Hirsch AE. A Nationwide Medical Student Assessment of Oncology Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:679-686. [PMID: 26123764 PMCID: PMC5533172 DOI: 10.1007/s13187-015-0872-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Cancer is the second leading cause of death in the USA, but there is minimal data on how oncology is taught to medical students. The purpose of this study is to characterize oncology education at US medical schools. An electronic survey was sent between December 2014 and February 2015 to a convenience sample of medical students who either attended the American Society for Radiation Oncology annual meeting or serve as delegates to the American Association of Medical Colleges. Information on various aspects of oncology instruction at participants' medical schools was collected. Seventy-six responses from students in 28 states were received. Among the six most common causes of death in the USA, cancer reportedly received the fourth most curricular time. During the first, second, and third years of medical school, participants most commonly reported 6-10, 16-20, and 6-10 h of oncology teaching, respectively. Participants were less confident in their understanding of cancer treatment than workup/diagnosis or basic science/natural history of cancer (p < 0.01). During the preclinical years, pathologists, scientists/Ph.D.'s, and medical oncologists reportedly performed the majority of teaching, whereas during the clinical clerkships, medical and surgical oncologists reportedly performed the majority of teaching. Radiation oncologists were significantly less involved during both periods (p < 0.01). Most schools did not require any oncology-oriented clerkship. During each mandatory rotation, <20 % of patients had a primary diagnosis of cancer. Oncology education is often underemphasized and fragmented with wide variability in content and structure between medical schools, suggesting a need for reform.
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Affiliation(s)
- Malcolm D Mattes
- Department of Radiation Oncology, West Virginia University School of Medicine, PO Box 9234, One Medical Center Drive, Morgantown, WV, USA.
| | - Krishnan R Patel
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA, USA
| | - Lindsay M Burt
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ariel E Hirsch
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA, USA
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Rocque GB, Williams CP, Jackson BE, Wallace AS, Halilova KI, Kenzik KM, Partridge EE, Pisu M. Choosing Wisely: Opportunities for Improving Value in Cancer Care Delivery? J Oncol Pract 2016; 13:e11-e21. [PMID: 27845867 DOI: 10.1200/jop.2016.015396] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Patients, providers, and payers are striving to identify where value in cancer care can be increased. As part of the Choosing Wisely (CW) campaign, ASCO and the American Society for Therapeutic Radiology and Oncology have recommended against specific, yet commonly performed, treatments and procedures. METHODS We conducted a retrospective analysis of Medicare claims data to examine concordance with CW recommendations across 12 cancer centers in the southeastern United States. Variability for each measure was evaluated on the basis of patient characteristics and site of care. Hierarchical linear modeling was used to examine differences in average costs per patient by concordance status. Potential cost savings were estimated on the basis of a potential 95% adherence rate and average cost difference. RESULTS The analysis included 37,686 patients with cancer with Fee-for-Service Medicare insurance. Concordance varied by CW recommendation from 39% to 94%. Patient characteristics were similar for patients receiving concordant and nonconcordant care. Significant variability was noted across centers for all recommendations, with as much as an 89% difference. Nonconcordance was associated with higher costs for every measure. If concordance were to increase to 95% for all measures, we would estimate a $19 million difference in total cost of care per quarter. CONCLUSION These results demonstrate ample room for reduction of low-value care and corresponding costs associated with the CW recommendations. Because variability in concordance was driven primarily by site of care, rather than by patient factors, continued education about these low-value services is needed to improve the value of cancer care.
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Affiliation(s)
| | | | | | | | | | | | | | - Maria Pisu
- University of Alabama at Birmingham, Birmingham, AL
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Jain AK, Fennell ML, Chagpar AB, Connolly HK, Nembhard IM. Moving Toward Improved Teamwork in Cancer Care: The Role of Psychological Safety in Team Communication. J Oncol Pract 2016; 12:1000-1011. [DOI: 10.1200/jop.2016.013300] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Effective communication is a requirement in the teamwork necessary for improved coordination to deliver patient-centered, value-based cancer care. Communication is particularly important when care providers are geographically distributed or work across organizations. We review organizational and teams research on communication to highlight psychological safety as a key determinant of high-quality communication within teams. We first present the concept of psychological safety, findings about its communication effects for teamwork, and factors that affect it. We focus on five factors applicable to cancer care delivery: familiarity, clinical hierarchy–related status differences, geographic dispersion, boundary spanning, and leader behavior. To illustrate how these factors facilitate or hinder psychologically safe communication and teamwork in cancer care, we review the case of a patient as she experiences the treatment-planning process for early-stage breast cancer in a community setting. Our analysis is summarized in a key principle: Teamwork in cancer care requires high-quality communication, which depends on psychological safety for all team members, clinicians and patients alike. We conclude with a discussion of the implications of psychological safety in clinical care and suggestions for future research.
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Affiliation(s)
- Anshu K. Jain
- Ashland Bellefonte Cancer Center, Ashland, KY; Yale University, New Haven, CT; Brown University, Providence, RI; and HK Communications, San Francisco, CA
| | - Mary L. Fennell
- Ashland Bellefonte Cancer Center, Ashland, KY; Yale University, New Haven, CT; Brown University, Providence, RI; and HK Communications, San Francisco, CA
| | - Anees B. Chagpar
- Ashland Bellefonte Cancer Center, Ashland, KY; Yale University, New Haven, CT; Brown University, Providence, RI; and HK Communications, San Francisco, CA
| | - Hannah K. Connolly
- Ashland Bellefonte Cancer Center, Ashland, KY; Yale University, New Haven, CT; Brown University, Providence, RI; and HK Communications, San Francisco, CA
| | - Ingrid M. Nembhard
- Ashland Bellefonte Cancer Center, Ashland, KY; Yale University, New Haven, CT; Brown University, Providence, RI; and HK Communications, San Francisco, CA
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Favicchio R, Thepaut C, Zhang H, Arends R, Stebbing J, Giamas G. Strategies in functional proteomics: Unveiling the pathways to precision oncology. Cancer Lett 2016; 382:86-94. [PMID: 26850375 DOI: 10.1016/j.canlet.2016.01.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/19/2016] [Accepted: 01/26/2016] [Indexed: 02/07/2023]
Abstract
Personalised strategies in cancer care are required to overcome the therapeutic challenges posed by variability between patients and disease subsets. To this end, enhanced precision tools must be developed to describe the molecular drivers of malignant proliferation. Such tools must also identify druggable targets and biomarkers in order to provide essential information regarding drug development and therapeutic outcome. Here we discuss how proteomics-based approaches provide a set of viable methodologies capable of delivering quantitative information throughout the main stages of personalised oncology and a ratiometric platform that delivers systems-wide methods for drug evaluation.
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Affiliation(s)
- Rosy Favicchio
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
| | - Chloe Thepaut
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - Hua Zhang
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - Richard Arends
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - Justin Stebbing
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - Georgios Giamas
- Department of Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Brighton BN1 9QG, UK.
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Murphy J, Mollica M. All Hands on Deck: Nurses and Cancer Care Delivery in Women's Health. Front Oncol 2016; 6:174. [PMID: 27500124 PMCID: PMC4956645 DOI: 10.3389/fonc.2016.00174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 07/07/2016] [Indexed: 12/04/2022] Open
Affiliation(s)
- Jeanne Murphy
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Michelle Mollica
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
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Landercasper J, Bailey L, Berry TS, Buras RR, Degnim AC, Fayanju OM, Froman J, Gass J, Greenberg C, Mautner SK, Krontiras H, Rao R, Sowden M, Tjoe JA, Wexelman B, Wilke L, Chen SL. Measures of Appropriateness and Value for Breast Surgeons and Their Patients: The American Society of Breast Surgeons Choosing Wisely (®) Initiative. Ann Surg Oncol 2016; 23:3112-8. [PMID: 27334216 PMCID: PMC4999471 DOI: 10.1245/s10434-016-5327-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Current breast cancer care is based on high-level evidence from randomized, controlled trials. Despite these data, there continues to be variability of breast cancer care, including overutilization of some tests and operations. To reduce overutilization, the American Board of Internal Medicine Choosing Wisely (®) Campaign recommends that professional organizations provide patients and providers with a list of care practices that may not be necessary. Shared decision making regarding these services is encouraged. METHODS The Patient Safety and Quality Committee of the American Society of Breast Surgeons (ASBrS) solicited candidate measures for the Choosing Wisely (®) Campaign. The resulting list of "appropriateness" measures of care was ranked by a modified Delphi appropriateness methodology. The highest-ranked measures were submitted to and later approved by the ASBrS Board of Directors. They are listed below. RESULTS (1) Don't routinely order breast magnetic resonance imaging in new breast cancer patients. (2) Don't routinely excise all the lymph nodes beneath the arm in patients having lumpectomy for breast cancer. (3) Don't routinely order specialized tumor gene testing in all new breast cancer patients. (4) Don't routinely reoperate on patients with invasive cancer if the cancer is close to the edge of the excised lumpectomy tissue. (5) Don't routinely perform a double mastectomy in patients who have a single breast with cancer. CONCLUSIONS The ASBrS list for the Choosing Wisely (®) campaign is easily accessible to breast cancer patients online. These measures provide surgeons and their patients with a starting point for shared decision making regarding potentially unnecessary testing and operations.
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Affiliation(s)
| | - Lisa Bailey
- Bay Area Breast Surgeons, Inc., Oakland, CA, USA
| | | | | | | | | | | | | | - Caprice Greenberg
- University of Wisconsin School of Public Health and Medicine, Madison, WI, USA
| | | | | | - Roshni Rao
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - Lee Wilke
- University of Wisconsin of Madison, Madison, WI, USA
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Tisnado D, Malin J, Kahn K, Landrum MB, Fletcher R, Klabunde C, Clauser S, Rogers SO, Keating NL. Variations in Oncologist Recommendations for Chemotherapy for Stage IV Lung Cancer: What Is the Role of Performance Status? J Oncol Pract 2016; 12:653-62. [PMID: 27271507 DOI: 10.1200/jop.2015.008425] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Chemotherapy prolongs survival in patients with advanced non-small-cell lung cancer. However, few studies have included patients with poor performance status. This study examined rates of oncologists' recommendations for chemotherapy by patient performance status and symptoms and how physician characteristics influence chemotherapy recommendations. METHODS We surveyed medical oncologists involved in the care of a population-based cohort of patients with lung cancer from the CanCORS (Cancer Care Outcomes Research and Surveillance) study. Physicians were queried about their likelihood to recommend chemotherapy to patients with stage IV lung cancer with varying performance status (Eastern Cooperative Oncology Group performance status 0 [good] v 3 [poor]) and presence or absence of tumor-related pain. Repeated measures logistic regression was used to estimate the independent associations of patients' performance status and symptoms and physicians' demographic and practice characteristics with chemotherapy recommendations. RESULTS Nearly all physicians (adjusted rate, 97% to 99%) recommended chemotherapy for patients with good performance status, and approximately half (adjusted rate, 38% to 53%) recommended chemotherapy for patients with poor performance status (P < .001). Compared with patient factors, physician and practice characteristics were less strongly associated with chemotherapy recommendations in adjusted analyses. CONCLUSION Strong consensus among oncologists exists for chemotherapy in patients with advanced non-small-cell lung cancer and good performance status. However, the relatively high rate of chemotherapy recommendations for patients with poor performance status despite the unfavorable risk-benefit profile highlights the need for ongoing work to define high-value care in oncology and to implement and evaluate strategies to align incentives for such care.
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Affiliation(s)
- Diana Tisnado
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Jennifer Malin
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Katherine Kahn
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Mary Beth Landrum
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Robert Fletcher
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Carrie Klabunde
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Steven Clauser
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Selwyn O Rogers
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
| | - Nancy L Keating
- California State University Fullerton; Anthem, Woodland Hills; David Geffen School of Medicine, University of California Los Angeles, Los Angeles; RAND Corporation, Santa Monica, CA; Harvard Medical School; Brigham and Women's Hospital, Boston, MA; National Cancer Institute, Bethesda, MD; Patient-Centered Outcomes Research Institute, Washington, DC; and University of Texas Medical Branch Health, Galveston, TX
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Affiliation(s)
- Zirui Song
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Carrie H. Colla
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Geisel School of Medicine at Dartmouth, Hanover, NH
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