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Arriola E, Jaal J, Edvardsen A, Silvoniemi M, Araújo A, Vikström A, Zairi E, Rodriguez-Mues MC, Roccato M, Schneider S, Ammann J. Feasibility and User Experience of Digital Patient Monitoring for Real-World Patients With Lung or Breast Cancer. Oncologist 2024; 29:e561-e569. [PMID: 38007400 PMCID: PMC10994260 DOI: 10.1093/oncolo/oyad289] [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: 03/31/2023] [Accepted: 09/23/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Digital patient monitoring (DPM) tools can facilitate early symptom management for patients with cancer through systematic symptom reporting; however, low adherence can be a challenge. We assessed patient/healthcare professional (HCP) use of DPM in routine clinical practice. MATERIALS AND METHODS Patients with locally advanced/metastatic lung cancer or HER2-positive breast cancer received locally approved/reimbursed drugs alongside DPM, with elements tailored by F. Hoffmann-La Roche Ltd, on the Kaiku Health DPM platform. Patient access to the DPM tool was through their own devices (eg, laptops, PCs, smartphones, or tablets), via either a browser or an app on Apple iOS or Android devices. Coprimary endpoints were patient DPM tool adoption (positive threshold: 60%) and week 1-6 adherence to weekly symptom reporting (positive threshold: 70%). Secondary endpoints included experience and clinical impact. RESULTS At data cutoff (June 9, 2022), adoption was 85% and adherence was 76%. Customer satisfaction and effort scores for patients were 76% and 82%, respectively, and 83% and 79% for HCPs. Patients spent approximately 10 minutes using the DPM tool and completed approximately 1.0 symptom questionnaires per week (completion time 1-4 minutes). HCPs spent approximately 1-3 minutes a week using the tool per patient. Median time to HCP review for alerted versus non-alerted symptom questionnaires was 19.6 versus 21.5 hours. Most patients and HCPs felt that the DPM tool covered/mostly covered symptoms experienced (71% and 75%), was educational (65% and 92%), and improved patient-HCP conversations (70% and 83%) and cancer care (51% and 71%). CONCLUSION The DPM tool demonstrated positive adoption, adherence, and user experience for patients with lung/breast cancer, suggesting that DPM tools may benefit clinical cancer care.
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Affiliation(s)
- Edurne Arriola
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Jana Jaal
- Department of Hematology and Oncology, University of Tartu, Tartu, Estonia
| | - Anne Edvardsen
- Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Maria Silvoniemi
- Department of Pulmonary Medicine, Turku University Hospital, Turku, Finland
| | - António Araújo
- Department of Medical Oncology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | | | - Eleni Zairi
- Medical Oncology Department, St. Luke’s Hospital, Thessaloniki, Greece
| | | | - Marco Roccato
- Program Manager Office (PMO), Kaiku Health, Helsinki, Finland
| | - Sophie Schneider
- Pharma Personalised Healthcare, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Johannes Ammann
- Global Product Development Medical Affairs, F. Hoffmann-La Roche Ltd, Basel, Switzerland
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2
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de Ligt KM, Koppert LB, de Rooij BH, van de Poll-Franse LV, Velikova G, Cardoso F. Seizing the moment: The time for harnessing electronic patient-reported outcome measures for enhanced and sustainable metastatic breast cancer care is now. Breast 2024; 74:103676. [PMID: 38359564 PMCID: PMC10877629 DOI: 10.1016/j.breast.2024.103676] [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: 10/20/2023] [Revised: 12/11/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
The sustainability of healthcare systems is under pressure. Unlike care for many other chronic diseases, cancer care has yet to empower patients in effectively self-managing both the medical and emotional consequences of their condition, including adapting to changes in lifestyle and work, which is essential to achieve optimal health and recovery. Although proposed as a potential solution for sustainable healthcare and support for optimal health and recovery already decades ago, practical implementation of digital care lags behind. We believe electronic patient reported outcome measures (ePROMs) could play an important role in creating sustainable healthcare, both to guide complex treatment pathways and to empower survivors to self-manage consequences of diagnosis and treatment. That is, ePROMs can be used for screening and monitoring of symptoms, but also for treatment decision-making and to facilitate communication about quality of life. We therefore see opportunities for improvements in quality of care, quality of life, and survival of cancer patients, as well as research opportunities, as ePROMs collection can lead to better understanding of care needs. The '10 Actions for Change report' of the Advanced Breast Cancer Global Alliance stresses a critical need for improvement of care for metastatic breast cancer (MBC) patients. We therefore in this paper focus on MBC care and research.
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Affiliation(s)
- K M de Ligt
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
| | - L B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - B H de Rooij
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands; Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Warandelaan 2, 5037 AB, Tilburg, the Netherlands.
| | - L V van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands; Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Warandelaan 2, 5037 AB, Tilburg, the Netherlands.
| | - G Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Woodhouse Lane, LS2 9JT, Leeds, United Kingdom; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett St, Harehills, LS9 7LP, Leeds, United Kingdom.
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Avenida Brasília s/n, 1400-038, Lisbon, Portugal.
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3
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Nguyen CA, Beaulieu ND, Wright AA, Cutler DM, Keating NL, Landrum MB. Organization of Cancer Specialists in US Physician Practices and Health Systems. J Clin Oncol 2023; 41:4226-4235. [PMID: 37379501 PMCID: PMC10852402 DOI: 10.1200/jco.23.00626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/01/2023] [Accepted: 05/25/2023] [Indexed: 06/30/2023] Open
Abstract
PURPOSE To describe the supply of cancer specialists, the organization of cancer care within versus outside of health systems, and the distance to multispecialty cancer centers. METHODS Using the 2018 Health Systems and Provider Database from the National Bureau of Economic Research and 2018 Medicare data, we identified 46,341 unique physicians providing cancer care. We stratified physicians by discipline (adult/pediatric medical oncologists, radiation oncologists, surgical/gynecologic oncologists, other surgeons performing cancer surgeries, or palliative care physicians), system type (National Cancer Institute [NCI] Cancer Center system, non-NCI academic system, nonacademic system, or nonsystem/independent practice), practice size, and composition (single disciplinary oncology, multidisciplinary oncology, or multispecialty). We computed the density of cancer specialists by county and calculated distances to the nearest NCI Cancer Center. RESULTS More than half of all cancer specialists (57.8%) practiced in health systems, but 55.0% of cancer-related visits occurred in independent practices. Most system-based physicians were in large practices with more than 100 physicians, while those in independent practices were in smaller practices. Practices in NCI Cancer Center systems (95.2%), non-NCI academic systems (95.0%), and nonacademic systems (94.3%) were primarily multispecialty, while fewer independent practices (44.8%) were. Cancer specialist density was sparse in many rural areas, where the median travel distance to an NCI Cancer Center was 98.7 miles. Distances to NCI Cancer Centers were shorter for individuals living in high-income areas than in low-income areas, even for individuals in suburban and urban areas. CONCLUSION Although many cancer specialists practiced in multispecialty health systems, many also worked in smaller-sized independent practices where most patients were treated. Access to cancer specialists and cancer centers was limited in many areas, particularly in rural and low-income areas.
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Affiliation(s)
- Christina A. Nguyen
- Massachusetts Institute of Technology, Cambridge, MA
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Nancy D. Beaulieu
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Alexi A. Wright
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - David M. Cutler
- Department of Economics, Harvard University, Cambridge, MA
- National Bureau of Economic Research, Cambridge, MA
| | - Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA
- Division of General Medicine, Brigham and Women's Hospital, Boston, MA
| | - Mary Beth Landrum
- Department of Health Care Policy, Harvard Medical School, Boston, MA
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4
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Mullangi S, Chen X, Pham T, Liu Y, Gordon AS, Debono D, Fisch MJ, Gönen M, Hershman DL. Association of Patient, Physician, and Practice-Level Factors with Uptake of Payer-Led Oncology Clinical Pathways. JAMA Netw Open 2023; 6:e2312461. [PMID: 37159199 PMCID: PMC10170335 DOI: 10.1001/jamanetworkopen.2023.12461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Importance Payers use oncology clinical pathways programs to increase evidence-based drug prescribing and control drug spending. However, compliance with these programs has been low, which may decrease their efficacy, and factors associated with pathway compliance are unknown. Objective To determine extent of pathway compliance and identify factors associated with pathway compliance using characteristics of patients, practices, and the companies that develop cancer treatment pathways. Design, Setting, and Participants This cohort study comprised patients with claims and administrative data from a national insurer and a pathways health care professional between July 1, 2018, and October 31, 2021. Adult patients with metastatic breast, lung, colorectal, pancreatic, melanoma, kidney, bladder, gastric, and uterine cancer being treated in the first line were included. Six months of continuous insurance coverage prior to the date of treatment initiation was required for determination of baseline characteristics. Stepwise logistic regression was used to identify factors associated with pathway compliance. Main Outcomes and Measures Use of a pathway program-endorsed treatment regimen in the first-line setting for metastatic cancer. Results Among 17 293 patients (mean [SD] age, 60.7 [11.2] years; 9183 [53.1%] women; mean [SD] Black patients per census block, 0.10 [0.20]), 11 071 patients (64.0%) were on-pathway, and 6222 (36.0%) were off-pathway. Factors associated with increased pathway compliance were higher health care utilization during the 6-month baseline period (measured in inpatient visits and emergency department visits) (5220 on-pathway inpatient visits [47.2%] vs 2797 off-pathway [45.0%]; emergency department visits, 3304 [27.1%] vs 1503 [24.2%]; adjusted odds ratio [aOR] for inpatient visits, 1.32; 95% CI, 1.22-1.43; P < .001), volume of patients with this insurance provider per physician (mean [SD] visits: on-pathway, 128.0 [258.3] vs off-pathway, 121.8 [161.4]; aOR, 1.12; 95% CI, 1.04-1.20; P = .002), and practice participation in the Oncology Care Model (on-pathway participation, 2601 [23.5%] vs 1305 [21.0%]; aOR, 1.13; 95% CI, 1.04-1.23; P = .004). Higher total medical cost during the 6-month baseline period were associated with decreased pathway compliance (mean [SD] costs: on-pathway, $55 990 [$69 706] vs $65 955 [$74 678]; aOR, 0.86; 95% CI, 0.83-0.88; P < .001). There was heterogeneity in odds of pathway compliance between different malignancies. Pathway compliance rates trended down from the reference year of 2018. Conclusions and Relevance In this cohort study, despite generous financial incentives, compliance with payer-led pathways remained at historically reported low rates. Factors such as increasing exposure to the program due to the number of patients impacted and participation in other value-based payment programs, such as the Oncology Care Model, were positively associated with compliance; factors such as the type of cancer and patient complexity may have played a role, but the directionality of potential effects was unclear.
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Affiliation(s)
- Samyukta Mullangi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Ying Liu
- Elevance Health Inc, Indianapolis, Indiana
| | | | | | | | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dawn L Hershman
- Department of Medicine, Columbia University Medical Center, New York, New York
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5
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Elkefi S, Asan O. The Impact of Patient-Centered Care on Cancer Patients' QOC, Self-Efficacy, and Trust Towards Doctors: Analysis of a National Survey. J Patient Exp 2023; 10:23743735231151533. [PMID: 36698621 PMCID: PMC9869234 DOI: 10.1177/23743735231151533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Patient-centered approaches impact cancer patients' perceptions and outcomes in different ways. This study explores the impact of patient-centered care practices on cancer patients' quality-of-care (QOC), self-efficacy, and trust in their doctors. We utilized cross-sectional national survey data from the National Cancer Institute collected between 2017 and 2020. All estimates were weighted using the jackknife method. We used multivariable logistic regression to test our hypotheses adjusted for the demographics of the 1932 cancer patients that responded to the survey. Findings indicate that patient-centered communication resulted in better QOC, self-efficacy, and trust in doctors. In addition, engagement in their care improved patients' trust in cancer-related information received from doctors. QOC and patients' trust in doctors were significantly improved with the patients' understanding of the next steps, addressing feelings, clear explanation of the problems, spending enough time with the clinicians, addressing uncertainty, and involvement in decisions. Patients who were given a chance to ask questions were significantly more likely to trust their doctors. Technology use did not impact any of these interactions. Patient-centered strategies should consider the needs of the patients in the cancer settings to improve overall outcomes. Organizations should also build strategies that are goal-oriented and centered around the patients' needs, as standard strategies cannot induce the wanted results.
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Affiliation(s)
- Safa Elkefi
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, USA
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6
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Bosserman LD, Mambetsariev I, Ladbury C, Barzi A, Johnson D, Morse D, Deaville D, Smith W, Rajurkar S, Merla A, Hajjar G, Kim D, Fricke J, Trisal V, Salgia R. Pyramidal Decision Support Framework Leverages Subspecialty Expertise across Enterprise to Achieve Superior Cancer Outcomes and Personalized, Precision Care Plans. J Clin Med 2022; 11:jcm11226738. [PMID: 36431215 PMCID: PMC9697355 DOI: 10.3390/jcm11226738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
The complexity of cancer care requires integrated and continuous support to deliver appropriate care. An expert network with complementary expertise and the capability of multidisciplinary care is an integral part of contemporary oncology care. Appropriate infrastructure is necessary to empower this network to deliver personalized precision care to their patients. Providing decision support as cancer care becomes exponentially more complex with new diagnostic and therapeutic choices remains challenging. City of Hope has developed a Pyramidal Decision Support Framework to address these challenges, which were exacerbated by the COVID pandemic, health plan restrictions, and growing geographic site diversity. Optimizing efficient and targeted decision support backed by multidisciplinary cancer expertise can improve individual patient treatment plans to achieve improved care and survival wherever patients are treated.
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Affiliation(s)
- Linda D. Bosserman
- Department of Medical Oncology and Therapeutics Research, City of Hope, Irwindale, CA 91706, USA
| | - Isa Mambetsariev
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA
| | - Colton Ladbury
- Department of Radiation Oncology, City of Hope, Duarte, CA 91010, USA
| | - Afsaneh Barzi
- Department of Medical Oncology and Therapeutics Research, City of Hope, Irwindale, CA 91706, USA
| | - Deron Johnson
- Department of Clinical Informatics, City of Hope, Duarte, CA 91010, USA
| | - Denise Morse
- Department of Quality, Risk and Regulatory Management, City of Hope, Duarte, CA 91010, USA
| | - Debbie Deaville
- Department of Enterprise Business Intelligence, City of Hope, Irwindale, CA 91706, USA
| | - Wade Smith
- Department of Medical Oncology and Therapeutics Research, City of Hope, Newport Beach, CA 92660, USA
| | - Swapnil Rajurkar
- Department of Medical Oncology and Therapeutics Research, City of Hope, Upland, CA 91784, USA
| | - Amartej Merla
- Department of Medical Oncology and Therapeutics Research, City of Hope, Antelope Valley, CA 93534, USA
| | - George Hajjar
- Department of Medical Oncology and Therapeutics Research, City of Hope, Mission Hills, CA 91345, USA
| | - Daniel Kim
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA
| | - Jeremy Fricke
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA
| | - Vijay Trisal
- Department of Medicine, City of Hope, Duarte, CA 91010, USA
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA
- Correspondence:
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7
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Henrikson NB, Anderson ML, Dickerson J, Ewing JJ, Garcia R, Keast E, King DA, Lewis C, Locher B, McMullen C, Norris CM, Petrik AF, Ramaprasan A, Rivelli JS, Schneider JL, Shulman L, Tuzzio L, Banegas MP. The Cancer Financial Experience (CAFÉ) study: randomized controlled trial of a financial navigation intervention to address cancer-related financial hardship. Trials 2022; 23:402. [PMID: 35562781 PMCID: PMC9099299 DOI: 10.1186/s13063-022-06344-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an urgent need for evidence on how interventions can prevent or mitigate cancer-related financial hardship. Our objectives are to compare self-reported financial hardship, quality of life, and health services use between patients receiving a financial navigation intervention versus a comparison group at 12 months follow-up, and to assess patient-level factors associated with dose received of a financial navigation intervention. METHODS The Cancer Financial Experience (CAFÉ) study is a multi-site randomized controlled trial (RCT) with individual-level randomization. Participants will be offered either brief (one financial navigation cycle, Arm 2) or extended (three financial navigation cycles, Arm 3) financial navigation. The intervention period for both Arms 2 and 3 is 6 months. The comparison group (Arm 1) will receive enhanced usual care. The setting for the CAFÉ study is the medical oncology and radiation oncology clinics at two integrated health systems in the Pacific Northwest. Inclusion criteria includes age 18 or older with a recent cancer diagnosis and visit to a study clinic as identified through administrative data. Outcomes will be assessed at 12-month follow-up. Primary outcomes are self-reported financial distress and health-related quality of life. Secondary outcomes are delayed or foregone care; receipt of medical financial assistance; and account delinquency. A mixed methods exploratory analysis will investigate factors associated with total intervention dose received. DISCUSSION The CAFÉ study will provide much-needed early trial evidence on the impact of financial navigation in reducing cancer-related financial hardship. It is theory-informed, clinic-based, aligned with patient preferences, and has been developed following preliminary qualitative studies and stakeholder input. By design, it will provide prospective evidence on the potential benefits of financial navigation on patient-relevant cancer outcomes. The CAFÉ trial's strengths include its broad inclusion criteria, its equity-focused sampling plan, its novel intervention developed in partnership with clinical and operations stakeholders, and mixed methods secondary analyses related to intervention dose offered and dose received. The resulting analytic dataset will allow for rich mixed methods analysis and provide critical information related to implementation of the intervention should it prove effective. TRIAL REGISTRATION ClinicalTrials.gov NCT05018000 . August 23, 2021.
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Affiliation(s)
- Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - John Dickerson
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - John J Ewing
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Robin Garcia
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Erin Keast
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Deborah A King
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Cara Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Blake Locher
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Carmit McMullen
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Consuelo M Norris
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Amanda F Petrik
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Arvind Ramaprasan
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | - Lisa Shulman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Matthew P Banegas
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- University of California San Diego, San Diego, CA, USA
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8
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Braun-Inglis C, Boehmer LM, Zitella LJ, Hoffner B, Shvetsov YB, Berenberg JL, Oyer RA, Benson AB. Role of Oncology Advanced Practitioners to Enhance Clinical Research. J Adv Pract Oncol 2022; 13:107-119. [PMID: 35369396 PMCID: PMC8955568 DOI: 10.6004/jadpro.2022.13.2.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Oncology advanced practitioners (APs), including nurse practitioners, clinical nurse specialists, physician assistants, and clinical pharmacists contribute significantly to quality cancer care. Advanced practitioners enhance value across the spectrum of cancer care. Research is an underdeveloped component of quality care, as well as an underdeveloped component of AP practice. Understanding research-related attitudes and roles of APs could lead to enhanced clinical trial accrual, conduct, and protocol development. Methods A nationwide survey addressing attitudes, beliefs, and roles of APs regarding clinical research was distributed by the Association of Community Cancer Centers (ACCC) and Harborside in early 2020. Results 408 oncology APs completed the survey. Thirty-five percent practice in an academic setting and 62% in the community. Nearly all respondents believe clinical trials are important to improve care, and over 90% report clinical trials are available at their practice. About 80% report being comfortable discussing the topic of clinical trials with patients and are involved in the care of trial participants. Sixty percent are comfortable discussing available trials, and 38% routinely explore available trials with patients. While 70% report approaching eligible patients about trials, only 20% report doing so "a great deal" or "a lot." Ninety percent report that APs should play a role in clinical research, and 73% want to be more involved. Barriers identified to greater AP clinical trial involvement include lack of time, inadequate awareness of trial specifics, and a lack of a formal role in protocol development and leadership. Conclusions Advanced practitioners are engaged and interested in clinical trials and believe clinical research is important to improve cancer care. Multidisciplinary team integration, trials-related education, and policy change are needed to employ APs to their full potential within cancer clinical trials.
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Affiliation(s)
- Christa Braun-Inglis
- From University of Hawaii School of Nursing and Dental Hygiene, Honolulu, Hawaii
- University of Hawaii Cancer Center, Honolulu, Hawaii
| | | | | | | | | | | | - Randall A. Oyer
- Ann B. Barshinger Cancer Institute, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Al B. Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
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9
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Banh C, Valsvik K, Arredondo A, Notbohm K, Elquza E, Babiker H, Kraft A, Boiles AR, Persky D, Ortega A, McBride A. Transitioning ifosfamide chemotherapy regimens to the ambulatory setting: reviewing cost savings and safety profile. Support Care Cancer 2022; 30:2755-2766. [PMID: 34825982 PMCID: PMC8617555 DOI: 10.1007/s00520-021-06653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 10/24/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To characterize and compare both the outcome and cost of treatment of outpatient (OP) and inpatient (IP) ifosfamide therapy. METHODS A single-center retrospective chart review of patients 18 years and older receiving ifosfamide therapy. The primary endpoint compares and evaluates the side effect profiles of ifosfamide-treated patients in the OP/IP settings. The adverse event grading system was characterized using the CTCAE Version 5.0. The highest grade was documented per cycle. The secondary endpoint of this study compares the costs of OP/IP therapy. It was assumed that the cost of medication was equivalent for IP/OP treatments. The cost saved with OP administration was determined by the average cost of hospital stay for IP admission. RESULTS Ifosfamide therapy of 86 patients (57 OP, 29 IP) was reviewed. The predominant OP regimens were doxorobucin-ifosfamide-mesna (AIM) with 43.9% and ifosfamide-etoposide (IE) with 29.8%. Grade 4 anemia, thrombocytopenia, and neutropenia were most frequent in IP vs OP therapies (22.9% IP vs 4.3% OP, 21.6% IP vs 9.2% OP, and 22.8% IP vs 19.6% OP respectively). Neutropenic fever (NF) occurred in 20 OP patients which were predominantly treated with AIM or IE and led to average hospital stay of 6 days. Neurotoxicity, treated with methylene blue (MB) occurred in 4 OP patients. OP therapy saved a total of 783 hospital days, leading to a cost savings of $2,103,921. CONCLUSIONS Transitioning ifosfamide to the OP setting is feasible for academic and community infusion centers with the OP administration being safe, well-tolerated, and associated with decreased total cost of care. The current processes allow for safe transition of chemotherapy of chemotherapy under times of COVID.
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Affiliation(s)
- Cindy Banh
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | | | | | - Kassie Notbohm
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | - Emad Elquza
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | - Hani Babiker
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | - Andrew Kraft
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | | | - Daniel Persky
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | - Alicia Ortega
- The University of Arizona Cancer Center, Tucson, AZ, USA
| | - Ali McBride
- The University of Arizona Cancer Center, Tucson, AZ, USA.
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10
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Hadid M, Elomri A, El Mekkawy T, Kerbache L, El Omri A, El Omri H, Taha RY, Hamad AA, Al Thani MHJ. Bibliometric analysis of cancer care operations management: current status, developments, and future directions. Health Care Manag Sci 2022; 25:166-185. [PMID: 34981268 DOI: 10.1007/s10729-021-09585-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 10/05/2021] [Indexed: 01/31/2023]
Abstract
Around the world, cancer care services are facing many operational challenges. Operations management research can provide important solutions to these challenges, from screening and diagnosis to treatment. In recent years, the growth in the number of papers published on cancer care operations management (CCOM) indicates that development has been fast. Within this context, the objective of this research was to understand the evolution of CCOM through a comprehensive study and an up-to-date bibliometric analysis of the literature. To achieve this aim, the Web of Science Core Collection database was used as the source of bibliographic records. The data-mining and quantitative tools in the software Biblioshiny were used to analyze CCOM articles published from 2010 to 2021. First, a historical analysis described CCOM research, the sources, and the subfields. Second, an analysis of keywords highlighted the significant developments in this field. Third, an analysis of research themes identified three main directions for future research in CCOM, which has 11 evolutionary paths. Finally, this paper discussed the gaps in CCOM research and the areas that require further investigation and development.
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Affiliation(s)
- Majed Hadid
- College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Adel Elomri
- College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar.
| | | | - Laoucine Kerbache
- College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | | | - Halima El Omri
- National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Ruba Y Taha
- National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Anas Ahmad Hamad
- National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
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11
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Ratnapradipa KL, Ranta J, Napit K, Luma LB, Robinson T, Dinkel D, Schabloske L, Watanabe‐Galloway S. Qualitative analysis of cancer care experiences among rural cancer survivors and caregivers. J Rural Health 2022; 38:876-885. [PMID: 35381622 PMCID: PMC9492624 DOI: 10.1111/jrh.12665] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Rural (vs urban) patients experience poorer cancer outcomes and are less likely to be engaged in cancer prevention, such as screening. As part of a community needs assessment, we explored rural cancer survivors' and caregivers' experiences, perceptions, and attitudes toward cancer care services. METHODS We conducted 3 focus groups (N = 20) in Spring 2021 in rural Nebraska. FINDINGS Three patterns of cancer diagnosis were regular care/screening without noticeable symptoms, treatment for symptoms not initially identified as cancer related, and symptom self-identification. Most participants, regardless of how diagnosis was made, had positive experiences with timely referral for testing (imaging and biopsy) and specialist care. Physician interpersonal skills set the tone for patient-provider communication, which colored the perception of overall care. Participants with physicians and care teams that were perceived as "considerate," "compassionate," and "caring" had positive experiences. Participants identified specific obstacles to care, including financial barriers, transportation, and lack of support groups, as well as more general cultural barriers. Survivors and caregivers identified organization-based supports that helped them address such barriers. CONCLUSIONS Rural populations have unique perspectives about cancer care. Our results are being used by the state cancer coalition, state cancer control program, and the National Cancer Institute-designated cancer center to prioritize outreach and interventions aimed to reduce rural cancer disparities, such as revitalizing lay cancer navigator programs, conducting webinars for primary care and cancer specialty providers to discuss these findings and identify potential interventions, and collaborating with national and regional cancer support organizations to expand reach in rural communities.
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Affiliation(s)
- Kendra L. Ratnapradipa
- Department of EpidemiologyCollege of Public HealthUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Jordan Ranta
- Sarpy/Cass Health DepartmentPapillionNebraskaUSA
| | - Krishtee Napit
- Department of EpidemiologyCollege of Public HealthUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Lady Beverly Luma
- Office of Community Outreach and EngagementFred & Pamela Buffett Cancer CenterOmahaNebraskaUSA
| | | | - Danae Dinkel
- School of Health & KinesiologyUniversity of Nebraska at OmahaOmahaNebraskaUSA
| | | | - Shinobu Watanabe‐Galloway
- Department of EpidemiologyCollege of Public HealthUniversity of Nebraska Medical CenterOmahaNebraskaUSA,Office of Community Outreach and EngagementFred & Pamela Buffett Cancer CenterOmahaNebraskaUSA
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12
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Hamel LM, Dougherty DW, Hastert TA, Seymour EK, Kim S, Assad H, Phalore J, Soulliere R, Eggly S. The DISCO App: A pilot test of a multi-level intervention to reduce the financial burden of cancer through improved cost communication ☆. PEC INNOVATION 2021; 1:100002. [PMCID: PMC10194252 DOI: 10.1016/j.pecinn.2021.100002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 05/30/2023]
Abstract
Objective Financial toxicity affects 30–50% of people with cancer in the US. Although experts recommend patients and physicians discuss treatment cost, cost discussions occur infrequently. We pilot-tested the feasibility, acceptability and influence on outcomes of the DIScussions of COst (DISCO) App, a multi-level communication intervention designed to improve cost discussions and related outcomes. Methods While waiting to see their physician, patients (n = 32) used the DISCO App on a tablet. Physicians were given a cost discussion tip sheet. Clinic visits were video recorded and patients completed pre- and post-intervention measures of self-efficacy for managing costs, self-efficacy for interacting with physicians, cost-related distress, and perceptions of the DISCO App. Coders observed the recordings to determine the presence of cost discussions, initiators, and topics. Results Most patients reported needing ≤15 min to use the DISCO App, and that it made it easier to ask cost-related questions. Findings showed increased self-efficacy for managing treatment costs (p = .02) and for interacting with physicians (p = .001). All visits included a cost discussion. Conclusions Prompting patients to discuss costs may improve cost treatment discussions and related outcomes. Innovation An app-based and tailorable treatment-cost communication intervention is feasible, acceptable, and demonstrates promise in prompting cost discussions and improving outcomes. Trial registration: Clinical Trials.gov registration number: NCT03676920 (September 19, 2018).
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Affiliation(s)
- Lauren M. Hamel
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R St, Detroit, MI, 48201, USA
| | - David W. Dougherty
- Dana-Farber Cancer Institute, 450 Brookline Ave DA 941, Boston, MA 02215, USA
| | - Theresa A. Hastert
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R St, Detroit, MI, 48201, USA
| | | | - Seongho Kim
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R St, Detroit, MI, 48201, USA
| | - Hadeel Assad
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R St, Detroit, MI, 48201, USA
| | - Jasminder Phalore
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R St, Detroit, MI, 48201, USA
| | | | - Susan Eggly
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R St, Detroit, MI, 48201, USA
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13
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Hamel LM, Dougherty DW, Kim S, Heath EI, Mabunda L, Tadesse E, Hill R, Eggly S. DISCO App: study protocol for a randomized controlled trial to test the effectiveness of a patient intervention to reduce the financial burden of cancer in a diverse patient population. Trials 2021; 22:636. [PMID: 34535162 PMCID: PMC8447769 DOI: 10.1186/s13063-021-05593-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 09/02/2021] [Indexed: 11/12/2022] Open
Abstract
Background Financial toxicity, the material and psychological burden of the cost of treatment, affects 30–50% of people with cancer, even those with health insurance. The burden of treatment cost can affect treatment adherence and, ultimately, mortality. Financial toxicity is a health equity issue, disproportionately affecting patients who are racial/ethnic minorities, have lower incomes, and are < 65 years old. Patient education about treatment cost and patient-oncologist cost discussions are recommended as ways to address financial toxicity; however, research shows cost discussions occur infrequently (Altice et al. J Natl Cancer Inst 109:djw205, 2017; Schnipper et al. J Clin Oncol 34:2925-34, 2016; Zafar et al. Oncologist 18:381-90, 2013; American Cancer Society Cancer Action Network 2010). Our overall goal is to address the burden of financial toxicity and work toward health equity through a tailorable education and communication intervention, the DISCO App. The aim of this longitudinal randomized controlled trial is to test the effectiveness of the DISCO App on the outcomes in a population of economically and racially/ethnically diverse cancer patients from all age groups. Methods Patients diagnosed with breast, lung, colorectal, or prostate cancer at a NCI-designated comprehensive cancer center in Detroit, MI, will be randomized to one of three study arms: one usual care arm (arm 1) and two intervention arms (arms 2 and 3). All intervention patients (arms 2 and 3) will receive the DISCO App before the second interaction with their oncologist, and patients in arm 3 will receive an intervention booster. The DISCO App, presented on an iPad, includes an educational video about treatment costs, ways to manage them, and the importance of discussing them with oncologists. Patients enter socio-demographic information (e.g., employment, insurance status) and indicate their financial concerns. They then receive a tailored list of questions to consider asking their oncologist. All patients will have up to two interactions with their oncologist video recorded and complete measures at baseline, after the recorded interactions and at 1, 3, 6, and 12 months after the second interaction. Outcome measures will assess discussions of cost, communication quality, knowledge of treatment costs, self-efficacy for treatment cost management, referrals for support, short- and longer-term financial toxicity, and treatment adherence. Discussion If effective, this intervention will improve awareness of and discussions of treatment cost and alleviate the burden of financial toxicity. It may be especially helpful to groups disproportionately affected by financial toxicity, helping to achieve health equity. Trial registration ClinicalTrials.gov NCT04766190. Registered on February 23, 2021
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Affiliation(s)
- Lauren M Hamel
- Wayne State University School of Medicine/Karmanos Cancer Institute, 4100 John R St., Detroit, MI, 48201, USA.
| | | | - Seongho Kim
- Wayne State University School of Medicine/Karmanos Cancer Institute, 4100 John R St., Detroit, MI, 48201, USA
| | - Elisabeth I Heath
- Wayne State University School of Medicine/Karmanos Cancer Institute, 4100 John R St., Detroit, MI, 48201, USA
| | - Lorna Mabunda
- Wayne State University School of Medicine/Karmanos Cancer Institute, 4100 John R St., Detroit, MI, 48201, USA
| | - Eyouab Tadesse
- Wayne State University School of Medicine, Detroit, MI, USA
| | - RaeAnn Hill
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Susan Eggly
- Wayne State University School of Medicine/Karmanos Cancer Institute, 4100 John R St., Detroit, MI, 48201, USA
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14
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Ridgeway JL, Boardman LA, Griffin JM, Beebe TJ. Tracing the potential of networks to improve community cancer care: an in-depth single case study. Implement Sci Commun 2021; 2:92. [PMID: 34433489 PMCID: PMC8390226 DOI: 10.1186/s43058-021-00190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/25/2021] [Indexed: 11/11/2022] Open
Abstract
Background Despite overall declines in cancer mortality in the USA over the past three decades, many patients in community settings fail to receive evidence-based cancer care. Networks that link academic medical centers (AMCs) and community providers may reduce disparities by creating access to specialized expertise and care, but research on network effectiveness is mixed. The objective of this study was to identify factors related to whether and how an exemplar AMC network served to provide advice and referral access in community settings. Methods An embedded in–depth single case study design was employed to study a network in the Midwest USA that connects a leading cancer specialty AMC with community practices. The embedded case units were a subset of 20 patients with young-onset colorectal cancer or risk-related conditions and the providers involved in their care. The electronic health record (EHR) was reviewed from January 1, 1990, to February 28, 2018. Social network analysis identified care, advice, and referral relationships. Within-case process tracing provided detailed accounts of whether and how the network provided access to expert, evidence-based care or advice in order to identify factors related to network effectiveness. Results The network created access to evidence-based advice or care in some but not all case units, and there was variability in whether and how community providers engaged the network, including the path for referrals to the AMC and the way in which advice about an evidence-based approach to care was communicated from AMC specialists to community providers. Factors related to instances when the network functioned as intended included opportunities for both rich and lean communication between community providers and specialists, coordinated referrals, and efficient and adequately utilized documentation systems. Conclusions Network existence alone is insufficient to open up access to evidence-based expertise or care for patients in community settings. In-depth understanding of how this network operated provides insight into factors that support or inhibit the potential of networks to minimize disparities in access to evidence-based community cancer care, including both personal and organizational factors.
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Affiliation(s)
- Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Lisa A Boardman
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Joan M Griffin
- Division of Health Care Delivery Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Timothy J Beebe
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, 55455, USA
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15
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Communication research at the National Cancer Institute, 2013-2019: a grant portfolio analysis. Cancer Causes Control 2021; 32:1333-1345. [PMID: 34313875 DOI: 10.1007/s10552-021-01481-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To analyze communication-focused grants funded by the National Cancer Institute (NCI) between fiscal years 2013 and 2019 to provide insight into the characteristics of funded projects and identify promising areas for future research. METHODS iSearch, a portfolio analysis tool, was queried to identify communication-related grants funded by NCI. Abstracts and specific aims were coded for key study characteristics. 344 unique competing grants with a substantial communication component were included in the final analysis. SAS version 9.4 was used to calculate code frequencies. RESULTS Most communication grants focused on cancer prevention (n = 197), with fewer targeting diagnosis, treatment, survivorship, or end-of-life. Tobacco product use was the most frequently addressed topic (n = 128). Most grants targeted or measured outcomes at the individual (n = 332) or interpersonal level (n = 127). Cancer patients/survivors (n = 101) and healthcare providers (n = 63) were often the population of focus, while caregivers or those at increased risk for cancer received less attention. Studies were often based in healthcare settings (n = 125); few studies were based in schools or worksites. Many grants employed randomized controlled trials (n = 168), but more novel methods, like optimization trials, were uncommon. CONCLUSION NCI's support of health communication research covers a diverse array of topics, populations, and methods. However, the current analysis also points to several promising opportunities for future research, including efforts focused on communication at later stages of the cancer control continuum and at multiple levels of influence, as well as studies that take advantage of a greater diversity of settings and leverage novel methodological approaches.
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16
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Bulls HW, Chang PH, Brownstein NC, Zhou JM, Hoogland AI, Gonzalez BD, Johnstone P, Jim HSL. Patient-reported symptom burden in routine oncology care: Examining racial and ethnic disparities. Cancer Rep (Hoboken) 2021; 5:e1478. [PMID: 34165256 PMCID: PMC8955049 DOI: 10.1002/cnr2.1478] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/07/2022] Open
Abstract
Background Racial and ethnic disparities are well‐documented in cancer outcomes such as disease progression and survival, but less is known regarding potential disparities in symptom burden. Aims The goal of this retrospective study was to examine differences in symptom burden by race and ethnicity in a large sample of cancer patients. We hypothesized that racial and ethnic minority patients would report greater symptom burden than non‐Hispanic and White patients. Methods and results A total of 5798 cancer patients completed the Edmonton Symptom Assessment Scale—revised (ESAS‐r‐CSS) at least once as part of clinical care. Two indicators of symptom burden were evaluated: (1) total ESAS‐r‐CSS score (i.e., overall symptom burden) and (2) number of severe symptoms (i.e., severe symptomatology). For patients completing the ESAS‐r‐CSS on multiple occasions, the highest score for each indicator was used. Zero‐inflated negative binomial regression analyses were conducted, adjusting for other sociodemographic and clinical characteristics. Symptomology varied across race. Patients who self‐identified as Black reported higher symptom burden (p = .016) and were more likely to report severe symptoms (p < .001) than self‐identified White patients. Patients with “other” race were also more likely to report severe symptoms than White patients (p = .032), but reported similar total symptom burden (p = .315). Asian and Hispanic patients did not differ from White or non‐Hispanic patients on symptom burden (ps > .05). Conclusion This study describes racial disparities in patient‐reported symptom burden during routine oncology care, primarily observed in Black patients. Clinic‐based electronic symptom monitoring may be useful to detect high symptom burden, particularly in patients who self‐identify their race as Black or other. Future research is needed to reduce symptom burden in racially diverse cancer populations.
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Affiliation(s)
- Hailey W Bulls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Pi-Hua Chang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.,School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jun-Min Zhou
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Peter Johnstone
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
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17
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Thomas HS, Lee AW, Nabavizadeh B, Namiri NK, Hakam N, Martin-Tuite P, Rios N, Enriquez A, Mmonu NA, Cohen AJ, Breyer BN. Characterizing online crowdfunding campaigns for patients with kidney cancer. Cancer Med 2021; 10:4564-4574. [PMID: 34102000 PMCID: PMC8267118 DOI: 10.1002/cam4.3974] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/16/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cancer patients incur high care costs; however, there is a paucity of literature characterizing unmet financial obligations for patients with urologic cancers. Kidney cancer patients are particularly burdened by costs associated with novel systemic treatments. This study aimed to ascertain the characteristics of GoFundMe® crowdfunding campaigns for patients with kidney cancer, in order to better understand the financial needs of this population. Methods We performed a cross‐sectional, quantitative, and qualitative analysis of all kidney cancer GoFundMe® campaigns since 2010. Fundraising metrics such as goal funds and amount raised, were extracted. Eight independent investigators collected patient, disease and campaign‐level variables from campaign stories (κ = 0.72). In addition, we performed a content analysis of campaign narratives spotlighting the primary appeal of the patient's life story. Results A total of 486 GoFundMe® kidney cancer campaigns were reviewed. The median goal funds were 10,000USD [IQR = 5000, 20,000] and the median amount raised was 1450USD [IQR = 578, 4050]. Most campaigns were for adult males (53%) and 62% of adults had children. A minority were for pediatric patients (17%). Thirty‐seven percent of adult patients were primary wage earners and 43% reported losing their job or substantially reducing hours due to illness. Twenty‐nine percent reported no insurance or insufficient coverage. Campaigns most frequently sought funds for medical bills (60%), nonmedical bills (27%), and medical travel (23%). Qualitative campaign narratives mostly emphasized patients’ hardship (46.3%) or high moral character (35.2%). Only 8% of campaigns achieved their target funds. Conclusions Despite fundraising efforts, patients with kidney cancer face persistent financial barriers, incurring both medical and nonmedical cost burdens. This may be compounded by limited or no insurance. Cancer care providers should be aware of financial constraints placed on kidney cancer patients, and consider how these may impact treatment regimens.
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Affiliation(s)
- Hannah S Thomas
- University of Edinburgh School of Medicine, Edinburgh, UK.,Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Austin W Lee
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Behnam Nabavizadeh
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Nikan K Namiri
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Nizar Hakam
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Patrick Martin-Tuite
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Natalie Rios
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Anthony Enriquez
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Nnenaya A Mmonu
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Andrew J Cohen
- The Brady Urological Institute at Johns Hopkins, Baltimore, MD, USA
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA.,Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, CA, USA
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18
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McGuire M, Olivo A, Yackzan S. Productivity Measures: Empowering Oncology Nurse Practitioners to Understand and Demonstrate Value in Practice. Clin J Oncol Nurs 2021; 25:247-250. [PMID: 34019016 DOI: 10.1188/21.cjon.247-250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oncology nurse practitioners (ONPs) are essential providers of oncology care who work in a variety of practice settings. ONPs add to productivity in practice, but the way in which productivity is measured may not capture their full contributions and value. A greater understanding of productivity measures can empower ONPs to communicate and demonstrate their full value in practice.
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19
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Basendowah M, Awlia AM, Alamoudi HA, Ali Kanawi HM, Saleem A, Malibary N, Hijazi H, Alfawaz M, Alzahrani AH. Impact of optional multidisciplinary tumor board meeting on the mortality of patients with gastrointestinal cancer: A retrospective observational study. Cancer Rep (Hoboken) 2021; 4:e1373. [PMID: 33739628 PMCID: PMC8388160 DOI: 10.1002/cnr2.1373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 12/24/2022] Open
Abstract
Background Multidisciplinary tumor board meetings (MDTs) have shown a positive effect on patient care and play a role in the planning of care. However, there is limited evidence of the association between MDTs and patient mortality and in‐hospital morbidity for mixed cases of gastrointestinal (GI) cancer. Aim To evaluate the influence of optional MDTs on care of patients with cancer to determine potential associations between MDTs and patient mortality and morbidity. Methods and results This was a retrospective observational study at the referral center of King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Among all adult patients diagnosed with GI cancer from January 2017 to June 2019, 130 patients were included. We categorized patients into two groups: 66 in the control group (non‐MDT) and 64 in the MDT group. The main outcome measure was overall mortality, measured by survival analysis. The follow‐up was 100% complete. Four patients in the MDT group and 13 in the non‐MDT group died (P = .04). The median follow‐up duration was 294 days (interquartile range [IQR], 140‐434) in the non‐MDT group compared with 176 days (IQR, 103‐466) in the MDT group (P = .20). There were no differences in intensive care unit or hospital length‐of‐stay or admission rates. The overall mortality at 2 years was 13% (95% confidence interval [CI], 0.06‐0.66) in the MDT group and 38% (95% CI, 0.10‐0.39) in the non‐MDT group (P = .08). The MDT group showed a 72% (adjusted hazard ratio [HR], 0.28; 95% CI, 0.08‐0.90; P = .03) decrease in mortality over time compared with the non‐MDT group. Conclusions MDTs were associated with decreased mortality over time. Thus, MDTs have a positive influence on patient care by improving survival and should be incorporated into care.
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Affiliation(s)
- Mohammed Basendowah
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Alaa M Awlia
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Hanin A Alamoudi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Hala M Ali Kanawi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdulaziz Saleem
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Nadim Malibary
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Hussam Hijazi
- Radiology Department, Radiation Oncology Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed Alfawaz
- Department of Medicine, University of Jeddah, Jeddah, Kingdom of Saudi Arabia
| | - Anas H Alzahrani
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.,Clinical Research Education Program, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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20
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Skubish S, Starrs C, McDonagh D. Exploring opportunities & pathways for advanced practice radiation therapy roles in the United States. Tech Innov Patient Support Radiat Oncol 2021; 17:59-62. [PMID: 34007908 PMCID: PMC8110941 DOI: 10.1016/j.tipsro.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/24/2022] Open
Abstract
Educational and regulatory frameworks do not exist for RTT scope expansion in the U.S. Institutions have tools through other AP roles and established international models. The APRT role could offer solutions to new pressures on the US health system. Institutional support, therapy initiated research and regulatory changes are required. Formal collaboration among institutions can revive efforts within the profession.
The evolution of practice of Radiation Therapy in the United States (U.S.) is inevitable. The scope of a radiation therapists role has progressed with advancing technology, implementation of special procedures and patient care requirements. Internationally, Canada, Australia and the United Kingdom have formalized this evolution through the Advanced Practice Radiation Therapist (APRT) role to provide new models of care, to meet growing demands in the practice of Radiation Oncology, to increase efficiency, decrease cost and retain skilled staff (Harnett et al., 2018; Society of Radiographers; Linden et al., 2019; Coleman et al., 2014) [1], [2], [3], [4]. Through evidence based practice, the APRT role has proven to provide benefits for multiple stakeholders including service-reconfiguration to reduce wait times, developing and retaining highly skilled radiation therapists, treatment review and most importantly improving patient care within much needed patient cohorts such as the palliative population (Duffton et al., 2019) [5]. The U.S. is no exception to requiring innovative care models and solutions to similar complex, care delivery challenges experienced internationally. The U.S. is experiencing an increase in demand for cancer services and a rapid rate of technological and treatment advancements. Under the current infrastructure, this has impacted the daily tasks of physicians; increasing workload, increasing the complexity of clinical decision making, increasing movement toward site specific subspecialty practice and pushing the scope of radiation therapists informally toward maximization, increased autonomy and a higher level of education and specialized skills (American Society of Clinical Oncology, 2016; ARRT, 2020; Vu et al., 2018) [6], [7], [8]. Objective The following reviews the current radiation therapy practice and professional landscape in the United States as it relates to advanced practice, exploring opportunities and challenges under the U.S. health care infrastructure. This broad analysis provides comparison to other countries and disciplines such as the Radiologist Assistant and Nurse Practitioner for potential pathways to establishing the role and describes current needs and value of the expanding scope of RT’s practicing in the U.S.
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Affiliation(s)
- Samantha Skubish
- Department of Radiation Oncology, Mount Sinai Health System, 1184 5 Avenue, New York, NY 10029, United States
- Corresponding author.
| | - Clodagh Starrs
- Department of Radiation Oncology, Mount Sinai Hospital, 1184 5 Avenue, New York, NY 10029, United States
| | - Danielle McDonagh
- Department of Radiation Oncology, Mount Sinai Beth Israel, 10 Union Square East, New York, NY 10003, United States
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A meta-analysis of Watson for Oncology in clinical application. Sci Rep 2021; 11:5792. [PMID: 33707577 PMCID: PMC7952578 DOI: 10.1038/s41598-021-84973-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/25/2020] [Indexed: 01/15/2023] Open
Abstract
Using the method of meta-analysis to systematically evaluate the consistency of treatment schemes between Watson for Oncology (WFO) and Multidisciplinary Team (MDT), and to provide references for the practical application of artificial intelligence clinical decision-support system in cancer treatment. We systematically searched articles about the clinical applications of Watson for Oncology in the databases and conducted meta-analysis using RevMan 5.3 software. A total of 9 studies were identified, including 2463 patients. When the MDT is consistent with WFO at the ‘Recommended’ or the ‘For consideration’ level, the overall concordance rate is 81.52%. Among them, breast cancer was the highest and gastric cancer was the lowest. The concordance rate in stage I–III cancer is higher than that in stage IV, but the result of lung cancer is opposite (P < 0.05).Similar results were obtained when MDT was only consistent with WFO at the "recommended" level. Moreover, the consistency of estrogen and progesterone receptor negative breast cancer patients, colorectal cancer patients under 70 years old or ECOG 0, and small cell lung cancer patients is higher than that of estrogen and progesterone positive breast cancer patients, colorectal cancer patients over 70 years old or ECOG 1–2, and non-small cell lung cancer patients, with statistical significance (P < 0.05). Treatment recommendations made by WFO and MDT were highly concordant for cancer cases examined, but this system still needs further improvement. Owing to relatively small sample size of the included studies, more well-designed, and large sample size studies are still needed.
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Zhu L, Zhu X, Zhou B, Mao WB, Wu Y, Cheng F. Multiple simple cystic metastases in the lateral neck at presentation with papillary thyroid microcarcinoma: A case report. Medicine (Baltimore) 2021; 100:e23866. [PMID: 33530180 PMCID: PMC7850743 DOI: 10.1097/md.0000000000023866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 11/24/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Metastasis of a papillary thyroid microcarcinoma (PTMC) in the lateral neck is characterized primarily by solid lymphadenopathy, although some cases may rarely present with a cervical cystic mass. We report a case of lateral cervical lymph node metastases of PTMC that appeared as a cystic lymphangioma of the lateral neck. PATIENT CONCERNS A 55-year-old man with a painless egg-sized mass in the right side of the neck that had been present for 1 month underwent physical examination, ultrasonography, computed tomography (CT), fine needle aspiration biopsy (FNAB), and intraoperative fast-frozen pathological examination, which indicated that the cystic masses in the neck were benign. However, the final pathology report identified the lateral neck masses as lymph node metastases of thyroid carcinoma. DIAGNOSIS The patient was diagnosed with PTMC of the right lobe of the thyroid gland with lateral neck metastases. INTERVENTIONS The patient underwent right cervical neck dissection together with a right thyroidectomy, followed by levothyroxine therapy and routine follow-up. OUTCOMES No postoperative complications were reported, and the thyroid-stimulating hormone inhibition target was <0.1 mmol/L; there was no detectable tumor recurrence on routine clinical follow-up for up to 16 months. CONCLUSIONS This case report emphasizes the need to consider cervical lymph node metastases of thyroid carcinoma in the differential diagnosis for patients with large, multiple, simple cystic neck masses.
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Affiliation(s)
- Lei Zhu
- Department of Thyroid and Breast Surgery, Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, Lishui
| | - Xi Zhu
- Department of Thyroid and Breast Surgery, Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, Lishui
| | - Bin Zhou
- Department of Thyroid and Breast Surgery, Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, Lishui
| | - Wei bo Mao
- Department of Pathology, Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, Lishui, Zhejiang Province, People's Republic of China
| | - Yong Wu
- Department of Thyroid and Breast Surgery, Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, Lishui
| | - Feng Cheng
- Department of Thyroid and Breast Surgery, Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, Lishui
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Sati N, Boyne DJ, Cheung WY, Cash SB, Arora P. Factors Modifying the Associations of Single or Combination Programmed Cell Death 1 and Programmed Cell Death Ligand 1 Inhibitor Therapies With Survival Outcomes in Patients With Metastatic Clear Cell Renal Cell Carcinoma: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2034201. [PMID: 33496794 PMCID: PMC7838936 DOI: 10.1001/jamanetworkopen.2020.34201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) inhibitors are immune checkpoint inhibitors widely used in the treatment of metastatic clear cell renal cell carcinoma (ccRCC) and other cancers. There is a lack of understanding regarding which factors are associated with therapeutic response. OBJECTIVES To conduct a systematic literature review of trials reporting on factors associated with differential response to PD-1/PD-L1 inhibitors among patients diagnosed with metastatic ccRCC and quantitatively synthesize the magnitude to which each factor modified the response to PD-1/PD-L1 inhibitors. DATA SOURCES The MEDLINE and Cochrane Register of Trials databases were searched for studies published in English from 2006 onward. Searches were last run on September 3, 2019. STUDY SELECTION This systematic review and meta-analysis assessed 662 phase 2/3 randomized clinical trials that provided subgroup analyses of any baseline characteristics regarding the treatment response to PD-1/PD-L1 inhibitors, alone or as part of a combination therapy, with respect to overall survival (OS) or progression-free survival (PFS) among patients with metastatic ccRCC. DATA EXTRACTION AND SYNTHESIS A novel quantitative approach was used to synthesize subgroup findings across trials. The ratio of the subgroup-specific hazard ratios (HRs) from each study were pooled using a random-effects meta-analysis whereby ratios of 1.00 would indicate that the subgroup-specific HRs were equal in magnitude. MAIN OUTCOMES AND MEASURES Main outcomes were OS and PFS. RESULTS From an initial 662 reports, 7 trials were considered eligible for inclusion. Meta-analyses suggested the treatment response to PD-1/PD-L1 inhibitors in patients with metastatic ccRCC was significantly associated with age (OS: ratio of HR for age ≥75 years to HR for age <65 years, 1.51; 95% CI, 1.01-2.26), PD-L1 expression (PFS: ratio of HR for PD-L1 < 1% to HR for PD-L1 ≥ 10%, 2.21; 95% CI, 1.14-4.27; ratio of HR for PD-L1 < 1% to HR for PD-L1 ≥ 1%, 1.36; 95% CI, 1.10-1.68), Memorial Sloan Kettering Cancer Center risk score (PFS: ratio of HR for immediate risk score to HR for poor risk score, 1.62; 95% CI, 1.14-2.29; ratio of HR for favorable risk score to HR for poor risk score, 1.53; 95% CI, 1.00-2.34; ratio of HR for favorable risk score to HR for intermediate risk score, 0.96; 95% CI, 0.70-1.30), and sarcomatoid tumor presence (PFS: ratio of HR for no sarcomatoid differentiation to HR for sarcomatoid differentiation, 1.54; 95% CI, 1.07-2.21). CONCLUSIONS AND RELEVANCE This analysis suggests that older age, low levels of PD-L1 expression, and the absence of sarcomatoid tumor differentiation are associated with a diminished response to anti-PD-1/PD-L1 immunotherapies with respect to survival outcomes among patients with metastatic ccRCC.
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Affiliation(s)
- Neha Sati
- Department of Biology, McMaster University, Hamilton, Ontario, Canada
- Cytel Inc, Toronto, Ontario, Canada
| | - Devon J. Boyne
- Cytel Inc, Toronto, Ontario, Canada
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Winson Y. Cheung
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Sarah B. Cash
- Department of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Paul Arora
- Cytel Inc, Toronto, Ontario, Canada
- Department of Public Health, University of Toronto, Toronto, Ontario, Canada
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Thana K, Lehto R, Sikorskii A, Wyatt G. Informal caregiver burden for solid tumour cancer patients: a review and future directions. Psychol Health 2021; 36:1514-1535. [PMID: 33393827 DOI: 10.1080/08870446.2020.1867136] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Recent shifts in healthcare delivery and treatment for solid tumour cancer patients have modified the responsibilities of informal caregivers. The objective of this study was to: review informal caregiver burden factors and determine areas where future research is needed. METHODS The Arksey and O'Malley's framework and a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in conducting this review. Research literature was systematically searched using five-electronic databases, including PubMed, PsycINFO, Cochrane, CINAHL, and SCOPUS, and reference lists from included studies to identify publications since 2010. Inclusion criterion was caregivers providing home-based care to a cancer patient. RESULTS The search yielded 43 eligible papers of 2119 reviewed, including articles from over 17 countries. Caregiver physical and psychological health, financial strain, and social isolation, as well as limited family and social support continued to be important factors contributing to high levels of caregiver burden. Less recognised factors affecting higher burden included caregivers' self-esteem, male gender, and the dynamic nature of cancer treatment. CONCLUSIONS This review updates the state of the science on informal caregiver burden when caring for patients with solid tumour cancers and informs future interventions on how to reduce this burden.
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Affiliation(s)
- Kanjana Thana
- Faculty of Nursing, Chiangmai University, Chiangmai, Thailand
| | - Rebecca Lehto
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University, East Lansing, MI, USA
| | - Gwen Wyatt
- College of Nursing, Michigan State University, East Lansing, MI, USA
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Zhou J, Zeng ZY, Li L. Progress of Artificial Intelligence in Gynecological Malignant Tumors. Cancer Manag Res 2020; 12:12823-12840. [PMID: 33364831 PMCID: PMC7751777 DOI: 10.2147/cmar.s279990] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022] Open
Abstract
Artificial intelligence (AI) is a sort of new technical science which can simulate, extend and expand human intelligence by developing theories, methods and application systems. In the last five years, the application of AI in medical research has become a hot topic in modern science and technology. Gynecological malignant tumors involves a wide range of knowledge, and AI can play an important part in these aspects, such as medical image recognition, auxiliary diagnosis, drug research and development, treatment scheme formulation and other fields. The purpose of this paper is to describe the progress of AI in gynecological malignant tumors and discuss some problems in its application. It is believed that AI improves the efficiency of diagnosis, reduces the burden of clinicians, and improves the effect of treatment and prognosis. AI will play an irreplaceable role in the field of gynecological malignant oncology and will promote the development of medicine and further promote the transformation from traditional medicine to precision medicine and preventive medicine. However, there are also some problems in the application of AI in gynecologic malignant tumors. For example, AI, inseparable from human participation, still needs to be more “humanized”, and needs to further protect patients’ privacy and health, improve legal and insurance protection, and further improve according to local ethnic conditions and national conditions. However, it is believed that with the continuous development of AI, especially ensemble classifier, and deep learning will have a profound influence on the future of medical technology, which is a powerful driving force for future medical innovation and reform.
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Affiliation(s)
- Jie Zhou
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning 530021, Guangxi, People's Republic of China.,Department of Gynecology, The Second Affiliated Hospital, University of South China, Hengyang 421001, Hunan, People's Republic of China
| | - Zhi Ying Zeng
- Department of Anesthesiology, The Second Affiliated Hospital, University of South China, Hengyang 421001, Hunan, People's Republic of China
| | - Li Li
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning 530021, Guangxi, People's Republic of China
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26
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Digitalized healthcare for head and neck cancer patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:434-440. [PMID: 33242658 DOI: 10.1016/j.jormas.2020.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022]
Abstract
The ongoing shortage in healthcare services and the increasing cancer incidence, highlight the need for new strategies to ensure optimal treatments, cares and follow-up for all patients. Digitalized healthcare, which includes various concepts (digital health, telemedicine, telemonitoring and digital therapeutics), are a promising option to meet these needs. In this scoping review, we provide an overview of the recent available research evidence on digitalized healthcare for HNC patients and caregivers. Through the interrogation of PubMed and Cochrane Library databases, a total of 32 relevant articles reporting the use of digitalized healthcare in different settings of HNC patients' care management, were analyzed. Overall, HNC patients as well as caregivers were highly satisfied, especially because digitalized healthcare allows the early detection of health disorders, improve patient's management, quality of life, self-confidence and communication. Furthermore, digitalized healthcare were significantly time- and cost-effective. While the benefits digitalized healthcare has been reported to be feasible and clinically relevant, our future efforts should focus on the demonstration of their clinical utility in well-designed clinical trials. It is tempting to anticipate that this approach will improve patients' management and quality of life and change the way patients interact with family and professional health care givers.
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27
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Shah H, Surujballi J, Awan AA, Hutton B, Arnaout A, Shorr R, Vandermeer L, Alzahrani MJ, Clemons M. A scoping review characterizing "Choosing Wisely®" recommendations for breast cancer management. Breast Cancer Res Treat 2020; 185:533-547. [PMID: 33156490 DOI: 10.1007/s10549-020-06009-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Choosing Wisely (CW)® was created by the American Board of Internal Medicine (ABIM) to promote patient-physician conversations about unnecessary medical interventions. Similarly, other countries created their own panels of experts called "CW® campaigns" which review recommendations submitted by that country's oncology societies. We performed a scoping review to consolidate CW® recommendations from different groups with respect to breast cancer care. METHODS A systematic search of Medline and Embase was designed by an information specialist for publications presenting CW® recommendations for breast cancer care practices from 2011-2020. We also reviewed the websites of all CW® campaigns and reference sections of each CW® recommendation. Two reviewers independently screened studies for inclusion and performed data extraction. Findings were summarized narratively. RESULTS Review of ABIM CW® recommendations showed 19 breast cancer-related recommendations pertaining to; screening (n = 4), radiological staging (n = 2), treatment (n = 10), surveillance (n = 2), and miscellaneous (genetic testing; n = 1). Of 22 countries with CW® campaigns, 10 published recommendations for breast cancer. Over half (57%) of recommendations were supported by more than one country. No recommendations were refuted between campaigns. Two campaigns developed 3 novel recommendations on new topics, including chemotherapy in ductal carcinoma in situ (Italy) and comparison of screening imaging modalities (Portugal). CONCLUSIONS CW® recommendations focus on reducing overutilization of investigations and treatments. There was a high rate of consensus between different CW® campaigns. As health care systems globally move attention to reduce low-value care, further studies are required to address adherence to these current recommendations and develop new recommendations.
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Affiliation(s)
- Hely Shah
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Julian Surujballi
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON, Canada
| | - Arif Ali Awan
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON, Canada
| | - Brian Hutton
- The University of Ottawa, School of Epidemiology and Public Health, and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Angel Arnaout
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | | | | | - Mashari Jemaan Alzahrani
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON, Canada
| | - Mark Clemons
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada. .,Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON, Canada. .,The University of Ottawa, School of Epidemiology and Public Health, and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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28
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Davis A, Bell JF, Reed SC, Kim KK, Stacey D, Joseph JG. Nurse-Led Telephonic Symptom Support for Patients Receiving Chemotherapy. Oncol Nurs Forum 2020; 47:E199-E210. [PMID: 33063775 DOI: 10.1188/20.onf.e199-e210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM STATEMENT The use of evidence-informed symptom guides has not been widely adopted in telephonic support. DESIGN This is a descriptive study of nurse-led support using evidence-based symptom guides during telephone outreach. DATA SOURCES Documentation quantified telephone encounters by frequency, length, and type of patient-reported symptoms. Nurse interviews examined perceptions of their role and the use of symptom guides. ANALYSIS Quantitative data were summarized using univariate descriptive statistics, and interviews were analyzed using directed descriptive content analysis. FINDINGS Symptom guides were viewed as trusted evidence-based resources, suitable to address common treatment-related symptoms. A threshold effect was a reported barrier of the guides, such that the benefit diminished over time for managing recurring symptoms. IMPLICATIONS FOR PRACTICE Telephone outreach using evidence-based symptom guides can contribute to early symptom identification while engaging patients in decision making. Understanding nurse activities aids in developing an economical and high-quality model for symptom support, as well as in encouraging nurses to practice at the highest level of preparation.
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29
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Mitchell KAR, Brassil KJ, Rodriguez SA, Tsai E, Fujimoto K, Krause KJ, Shay LA, Springer AE. Operationalizing patient-centered cancer care: A systematic review and synthesis of the qualitative literature on cancer patients' needs, values, and preferences. Psychooncology 2020; 29:1723-1733. [PMID: 32715542 PMCID: PMC7901502 DOI: 10.1002/pon.5500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Efficiently addressing patient priorities and concerns remains a challenge in oncology. Systematic operationalization of patient-centered care (PCC) can support improved assessment and practice of PCC in this unique care setting. This review aimed to synthesize the qualitative empirical literature exploring the National Academy of Medicine (NAM)'s PCC constructs of values, needs, and preferences among patients' during their cancer treatment experiences. METHODS A systematic review of qualitative studies published between 2002 and 2018 addressing adult patient values, needs, and preferences during cancer treatment was conducted. Medline, EMBASE, PsycINFO, and SCOPUS databases were searched on September 10, 2018. Methodological rigor was assessed using a modified version of the Evaluation Tool for Qualitative Studies. Included study findings were analyzed using line-by-line coding; and the emergent themes were compared to the National Academy of Medicine (NAM)'s PCC dimensions. RESULTS Twenty-nine primary studies were included in the synthesis. Descriptive themes for values (autonomy, being involved, family, hope, normality, and sincerity), needs (care coordination, information, privacy, support of physical well-being, emotional support (family/friends, peer, provider), and self-support), and preferences (care coordination, decision-making, information delivery, source of social support, and treatment) were identified. "Cancer care context" emerged as an important domain in which these constructs are operationalized. This thematic framework outlines PCC attributes that oncology care stakeholders can evaluate to improve patient experiences. CONCLUSIONS These findings build on previous PCC research and may contribute to the systematic assessment of patient priorities and the improvement of oncology care quality from the patient perspective.
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Affiliation(s)
- Kerri-Anne R. Mitchell
- Department of Health Behavior and Policy, Virginia
Commonwealth University School of Medicine, Richmond, Virginia
| | | | - Serena A. Rodriguez
- Department of Population and Data Sciences, University of
Texas Southwestern Medical Center, Dallas, Texas
| | - Edward Tsai
- Division of Public Health Sciences, Department of Surgery,
Washington University School of Medicine, St. Louis, Missouri
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences,
The University of Texas Health Science Center at Houston (UTHealth) School of Public
Health, Houston, Texas
| | - Kate J. Krause
- Research Medical Library, The University of Texas MD
Anderson Cancer Center, Houston, Texas
| | - L. Aubree Shay
- Department of Health Promotion & Behavioral Sciences,
UTHealth School of Public Health, San Antonio, Texas
| | - Andrew E. Springer
- Michael & Susan Dell Center for Healthy Living,
Department of Health Promotion & Behavioral Sciences, UTHealth School of Public
Health, Austin, Texas
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30
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Aapro M, Bossi P, Dasari A, Fallowfield L, Gascón P, Geller M, Jordan K, Kim J, Martin K, Porzig S. Digital health for optimal supportive care in oncology: benefits, limits, and future perspectives. Support Care Cancer 2020; 28:4589-4612. [PMID: 32533435 PMCID: PMC7447627 DOI: 10.1007/s00520-020-05539-1] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Digital health provides solutions that capture patient-reported outcomes (PROs) and allows symptom monitoring and patient management. Digital therapeutics is the provision to patients of evidence-based therapeutic interventions through software applications aimed at prevention, monitoring, management, and treatment of symptoms and diseases or for treatment optimization. The digital health solutions collecting PROs address many unmet needs, including access to care and reassurance, increase in adherence and treatment efficacy, and decrease in hospitalizations. With current developments in oncology including increased availability of oral drugs and reduced availability of healthcare professionals, these solutions offer an innovative approach to optimize healthcare resource utilization. DESIGN This scoping review clarifies the role and impact of the digital health solutions in oncology supportive care, with a view of the current segmentation according to their technical features (connection to sensors, PRO collection, remote monitoring, self-management in real time…), and identifies evidence from clinical studies published about their benefits and limitations and drivers and barriers to adoption. A qualitative summary is presented. RESULTS Sixty-six studies were identified and included in the qualitative synthesis. Studies supported the use of 38 digital health solutions collecting ePROs and allowing remote monitoring, with benefits to patients regarding symptom reporting and management, reduction in symptom distress, decrease in unplanned hospitalizations and related costs and improved quality of life and survival. Among those 38 solutions 21 provided patient self-management with impactful symptom support, improvement of QoL, usefulness and reassurance. Principal challenges are in developing and implementing digital solutions to suit most patients, while ensuring patient compliance and adaptability for use in different healthcare systems and living environments. CONCLUSIONS There is growing evidence that digital health collecting ePROs provide benefits to patients related to clinical and health economic endpoints. These digital solutions can be integrated into routine supportive care in oncology practice to provide improved patient-centered care.
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Affiliation(s)
- M Aapro
- Medical Oncology, Genolier Cancer Center, Clinique de Genolier, Genolier, Switzerland.
- Institut Multidisciplinaire d'Oncologie (IMO), Clinique de Genolier, Case Postale (PO Box) 100, 1 Route de Muids, CH-1272, Genolier, Switzerland.
| | - P Bossi
- Department of Medical Oncology, University of Brescia, Brescia, Italy
| | - A Dasari
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - L Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - P Gascón
- Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - M Geller
- Gynecologic Oncology, Department of Obstetrics, Gynecology and Women's Health (OBGYN), University of Minnesota, Minneapolis, MN, USA
| | - K Jordan
- Department of Medicine, Haematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - J Kim
- Medical Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - K Martin
- Gyneco-oncology, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - S Porzig
- Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Hennes ER, Reed M, Mably M, Jared J, Bergsbaken JJ, Deming D, Callander N, O’Regan R. Implementation of a chemotherapy stewardship process. Am J Health Syst Pharm 2020; 77:1243-1248. [DOI: 10.1093/ajhp/zxaa157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Purpose
To design and implement a chemotherapy stewardship process to optimize the location of chemotherapy administration in an effort to decrease the number of inappropriate inpatient anticancer regimen administrations and decrease institutional costs associated with inpatient administration.
Summary
As the costs of anticancer agents continue to rise, it is crucial that multidisciplinary efforts are aimed at managing anticancer medication utilization; this is especially important for high-cost medications, medications whose use requires increased monitoring due to safety concerns, and medications that do not exert effects quickly and, as such, can be more appropriately administered in the outpatient setting. It is imperative that pharmacists play a role in managing chemotherapy medication utilization, as pharmacists provide expertise in formulary management, a vast knowledge of financial impact and reimbursement processes, and clinical knowledge that can help predict the expected effectiveness and adverse effects of each anticancer regimen. Our institution sought to develop and implement a multidisciplinary chemotherapy stewardship program targeting the optimization of site of anticancer agent administration with a goal of decreasing both cost and inappropriate utilization of high-cost, high-risk anticancer agents.
Conclusion
Implementation of a chemotherapy stewardship service may decrease the number of inappropriate inpatient anticancer regimen administrations and decrease inpatient resource use, thereby decreasing costs to institutions. The concept of a chemotherapy stewardship process was well received by multidisciplinary healthcare colleagues, and a collaborative approach should be used to design and implement such processes.
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Affiliation(s)
| | | | | | | | | | - Dustin Deming
- Carbone Cancer Center, UW Health, Madison, WI, and University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Natalie Callander
- Carbone Cancer Center, UW Health, Madison, WI, and University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ruth O’Regan
- Division of Hematology and Oncology, Department of Medicine, Carbone Cancer Center, UW Health, Madison, WI
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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Saleem T, Qurashi H, Jamali M, Chan Gomez J, Kanderi T. Biosimilars as a Future, Promising Solution for Financial Toxicity: A Review with Emphasis on Bevacizumab. Cureus 2020; 12:e9300. [PMID: 32832297 PMCID: PMC7437115 DOI: 10.7759/cureus.9300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 12/30/2022] Open
Abstract
A biosimilar is a biochemical product like another already approved biologic agent, known as the reference agent. To be endorsed by the Food and Drug Administration (FDA), biosimilars must demonstrate that they are as safe and effective as their reference item, with no clinical distinction. Humanized monoclonal antibodies (mAb) are revolutionizing the treatment of gastrointestinal and gynecologic malignancies. Bevacizumab, trastuzumab, cetuximab, rituximab, and pegfilgrastim are the most widely used mAb products with oncologic indications. Due to the complexities of the regulatory system, it may take time for anti-cancer biosimilars to play a significant game-changing role. Over the last decade, the use of generics has saved billions of dollars every year, and it is expected that biosimilars will soon prove to be a cost-effective alternative and can play an important role in driving down healthcare costs globally. In this review, we provide a critical appraisal of biosimilars with an emphasis on bevacizumab-awwb (Avastin) and its clinico-pharmacologic characteristics, safety, efficacy, interchangeability, regulatory and oncologic perspectives, and overall clinical perception.
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Affiliation(s)
- Tabinda Saleem
- Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, USA
| | - Hafiz Qurashi
- Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, USA
| | - Munira Jamali
- Internal Medicine, Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Janet Chan Gomez
- Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, USA
| | - Tejaswi Kanderi
- Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, USA
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Abstract
The world of cardio-oncology is an evolving field involving the assessment of cardiovascular disease in patients suffering from cancer. Cancer and cardiovascular diseases are the two leading causes of morbidity and mortality in the developed world. Globally, cancer is diagnosed in 12.7 million patients annually, and cancer incidence is projected to increase by 40% in high-income countries from 2008 to 2030. Chemotherapy is the main treatment for most cancers and improves survival, but is associated with significant cardiotoxicity. In recent years, the introduction of new biological anti-cancer treatments in addition to "classic" chemotherapy has further improved survival, but has also introduced new cardiovascular side effects beyond "pure" myocardial damage. The increasing number of patients with cancer and cancer survivors, and the growing complexity of cancer treatment and cardiovascular side effects, call for teamwork including cardiologists with specific training and expertise working in teams with oncologists, hematologists, and others. The purpose of this review was to describe the clinical background and importance of cardio-oncology, with an emphasis on the use of imaging in this clinical setting.
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Coombs LA, Noonan K, Diane Barber F, Mackey H, Peterson ME, Turner T, LeFebvre KB. Oncology Nurse Practitioner Competencies: Defining Best Practices in the Oncology Setting. Clin J Oncol Nurs 2020; 24:296-304. [PMID: 32441678 PMCID: PMC8152155 DOI: 10.1188/20.cjon.296-304] [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] [Indexed: 01/22/2023]
Abstract
BACKGROUND The oncology nurse practitioner (ONP) role has evolved since the first ONP competencies were published by the Oncology Nursing Society in 2007. An update was completed in 2019 to reflect the rapidly expanding role. OBJECTIVES The purpose of this article is to describe the process of the ONP competency development and identify potential applications across a variety of oncology settings. METHODS The team performed an extensive literature review of the research about ONP practice across the cancer care continuum. Peer and expert review were conducted to ensure the competencies were comprehensive and relevant. FINDINGS The ONP competencies provide a solid, evidence-based benchmark to standardize the ONP role and practice, thereby ensuring that patients receive the highest-quality cancer care.
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Affiliation(s)
| | | | | | | | | | - Tamika Turner
- Franciscan Physician Alliance Hematology Oncology Specialists
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Dean LT, George M, Lee KT, Ashing K. Why individual-level interventions are not enough: Systems-level determinants of oral anticancer medication adherence. Cancer 2020; 126:3606-3612. [PMID: 32438466 PMCID: PMC7467097 DOI: 10.1002/cncr.32946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/15/2020] [Accepted: 01/30/2020] [Indexed: 02/06/2023]
Abstract
Nonadherence to oral anticancer medications (OAMs) in the United States is as low as 33% for some cancers. The reasons for nonadherence to these lifesaving medications are multifactorial, yet the majority of studies focus on patient-level factors influencing uptake and adherence. Individually based interventions to increase patient adherence have not been effective, and this warrants attention to factors at the payor, pharmaceutical, and clinical systems levels. Based on the authors' research and clinical experiences, this commentary brings fresh attention to the long-standing issue of OAM nonadherence, a growing quality-of-care issue, from a systems perspective. In this commentary, the key driving factors in pharmaceutical and payor systems (state and federal laws, payor/insurance companies, and pharmaceutical companies), clinical systems (hospitals and providers), and patient contexts that have trickle-down effects on patient adherence to OAMs are outlined. In the end, the authors' recommendations include examining the influence of laws governing OAM drug pricing, OAM supply, and provider reimbursement; reducing the need for prior authorization of long-approved OAMs; identifying cost-effective ways for providers to monitor nonadherence; examining issues of provider bias in OAM prescriptions; and further elucidating in which contexts patients are likely to be able to adhere. These recommendations offer a starting point for an examination of the chain of systems influencing patient adherence and may help to finally resolve persistently high levels of OAM nonadherence.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Marshalee George
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kimberley T Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kimlin Ashing
- City of Hope Comprehensive Cancer Center, Division of Health Equities, City of Hope, Duarte, California, USA
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Yadav S, Hu C, Hart SN, Boddicker N, Polley EC, Na J, Gnanaolivu R, Lee KY, Lindstrom T, Armasu S, Fitz-Gibbon P, Ghosh K, Stan DL, Pruthi S, Neal L, Sandhu N, Rhodes DJ, Klassen C, Peethambaram PP, Haddad TC, Olson JE, Hoskin TL, Goetz MP, Domchek SM, Boughey JC, Ruddy KJ, Couch FJ. Evaluation of Germline Genetic Testing Criteria in a Hospital-Based Series of Women With Breast Cancer. J Clin Oncol 2020; 38:1409-1418. [PMID: 32125938 PMCID: PMC7193748 DOI: 10.1200/jco.19.02190] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To determine the sensitivity and specificity of genetic testing criteria for the detection of germline pathogenic variants in women with breast cancer. MATERIALS AND METHODS Women with breast cancer enrolled in a breast cancer registry at a tertiary cancer center between 2000 and 2016 were evaluated for germline pathogenic variants in 9 breast cancer predisposition genes (ATM, BRCA1, BRCA2, CDH1, CHEK2, NF1, PALB2, PTEN, and TP53). The performance of the National Comprehensive Cancer Network (NCCN) hereditary cancer testing criteria was evaluated relative to testing of all women as recommended by the American Society of Breast Surgeons. RESULTS Of 3,907 women, 1,872 (47.9%) meeting NCCN criteria were more likely to carry a pathogenic variant in 9 predisposition genes compared with women not meeting criteria (9.0% v 3.5%; P < .001). Of those not meeting criteria (n = 2,035), 14 (0.7%) had pathogenic variants in BRCA1 or BRCA2. The sensitivity of NCCN criteria was 70% for 9 predisposition genes and 87% for BRCA1 and BRCA2, with a specificity of 53%. Expansion of the NCCN criteria to include all women diagnosed with breast cancer at ≤ 65 years of age achieved > 90% sensitivity for the 9 predisposition genes and > 98% sensitivity for BRCA1 and BRCA2. CONCLUSION A substantial proportion of women with breast cancer carrying germline pathogenic variants in predisposition genes do not qualify for testing by NCCN criteria. Expansion of NCCN criteria to include all women diagnosed at ≤ 65 years of age improves the sensitivity of the selection criteria without requiring testing of all women with breast cancer.
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Affiliation(s)
| | - Chunling Hu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Steven N. Hart
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Eric C. Polley
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jie Na
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Rohan Gnanaolivu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Kun Y. Lee
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Tricia Lindstrom
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Sebastian Armasu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | | | | | | | - Janet E. Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Tanya L. Hoskin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Susan M. Domchek
- Perelman School of Medicine, University of Pennsylvania, and Basser Center for BRCA, Philadelphia, PA
| | | | | | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Mitchell KAR, Brassil KJ, Fujimoto K, Fellman BM, Shay LA, Springer AE. Exploratory Factor Analysis of a Patient-Centered Cancer Care Measure to Support Improved Assessment of Patients' Experiences. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:351-361. [PMID: 32197731 PMCID: PMC7086403 DOI: 10.1016/j.jval.2019.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 08/26/2019] [Accepted: 10/20/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To increase the understanding of patient-centered care (PCC) and address the need for cross-cutting quality cancer care measures that are relevant to both patients and providers. METHODS An exploratory factor analysis (EFA) was performed on a short version of the Patients and the Cancer Care Experience Survey, a patient-reported measure of perceived importance of social, emotional, physical, and informational aspects of care, administered to adult patients (n = 104) at a National Cancer Institute-designated comprehensive cancer center. Relationships between PCC dimensions and patient characteristics were also assessed. Principal axis factoring was applied and bivariate analyses were performed using Wilcoxon rank-sum tests. RESULTS Most of our sample was over 60 years old (63.4%), female (57.4%), and white (74.2%), with either breast (41.2%) or prostate cancer (27.5%). A 5-factor model was identified: (1) quality of life (α = .91), (2) provider social support (α = .83), (3) psychosocial needs (α = .91), (4) nonprovider social support (α = .79), and (5) health information and decision-making support (α = .88). No statistically significant associations were found between these factors and patients' characteristics. CONCLUSIONS A preliminary factor structure for a cancer PCC measure was identified. Our findings reinforce the interrelated nature of PCC dimensions. The lessons learned from this study may be used to develop a single PCC measure that identifies patient priorities across the cancer care continuum. Data collected from such a measure can be used to support patient engagement in treatment planning and decision-making.
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Affiliation(s)
- Kerri-Anne R Mitchell
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | | | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA; Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Bryan M Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laura Aubree Shay
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, San Antonio, TX, USA
| | - Andrew E Springer
- Department of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
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Mambetsariev I, Wang Y, Chen C, Nadaf S, Pharaon R, Fricke J, Amanam I, Amini A, Bild A, Chu P, Erhunmwunsee L, Kim J, Munu J, Pillai R, Raz D, Sampath S, Vora L, Qiu F, Smith L, Batra SK, Massarelli E, Koczywas M, Reckamp K, Salgia R. Precision medicine and actionable alterations in lung cancer: A single institution experience. PLoS One 2020; 15:e0228188. [PMID: 32045431 PMCID: PMC7012442 DOI: 10.1371/journal.pone.0228188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/10/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Oncology has become more reliant on new testing methods and a greater use of electronic medical records, which provide a plethora of information available to physicians and researchers. However, to take advantage of vital clinical and research data for precision medicine, we must initially make an effort to create an infrastructure for the collection, storage, and utilization of this information with uniquely designed disease-specific registries that could support the collection of a large number of patients. MATERIALS AND METHODS In this study, we perform an in-depth analysis of a series of lung adenocarcinoma patients (n = 415) with genomic and clinical data in a recently created thoracic patient registry. RESULTS Of the 415 patients with lung adenocarcinoma, 59% (n = 245) were female; the median age was 64 (range, 22-92) years with a median OS of 33.29 months (95% CI, 29.77-39.48). The most common actionable alterations were identified in EGFR (n = 177/415 [42.7%]), ALK (n = 28/377 [7.4%]), and BRAF V600E (n = 7/288 [2.4%]). There was also a discernible difference in survival for 222 patients, who had an actionable alteration, with a median OS of 39.8 months as compared to 193 wild-type patients with a median OS of 26.0 months (P<0.001). We identified an unprecedented number of actionable alterations [53.5% (222/415)], including distinct individual alteration rates, as compared with 15.0% and 22.3% in TCGA and GENIE respectively. CONCLUSION The use of patient registries, focused genomic panels and the appropriate use of clinical guidelines in community and academic settings may influence cohort selection for clinical trials and improve survival outcomes.
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Affiliation(s)
- Isa Mambetsariev
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Yingyu Wang
- Center for Informatics, City of Hope, Duarte, California, United States of America
| | - Chen Chen
- Center for Informatics, City of Hope, Duarte, California, United States of America
| | - Sorena Nadaf
- Center for Informatics, City of Hope, Duarte, California, United States of America
| | - Rebecca Pharaon
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Jeremy Fricke
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Idoroenyi Amanam
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, California, United States of America
| | - Andrea Bild
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Peiguo Chu
- Department of Pathology, City of Hope, Duarte, California, United States of America
| | - Loretta Erhunmwunsee
- Department of Thoracic Surgery, City of Hope, Duarte, California, United States of America
| | - Jae Kim
- Department of Thoracic Surgery, City of Hope, Duarte, California, United States of America
| | - Janet Munu
- Center for Informatics, City of Hope, Duarte, California, United States of America
| | - Raju Pillai
- Department of Pathology, City of Hope, Duarte, California, United States of America
| | - Dan Raz
- Department of Thoracic Surgery, City of Hope, Duarte, California, United States of America
| | - Sagus Sampath
- Department of Radiation Oncology, City of Hope, Duarte, California, United States of America
| | - Lalit Vora
- Department of Diagnostic Radiology, City of Hope, Duarte, California, United States of America
| | - Fang Qiu
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Lynette Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Surinder K. Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Erminia Massarelli
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Marianna Koczywas
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Karen Reckamp
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
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Longacre CF, Neprash HT, Shippee ND, Tuttle TM, Virnig BA. Evaluating Travel Distance to Radiation Facilities Among Rural and Urban Breast Cancer Patients in the Medicare Population. J Rural Health 2019; 36:334-346. [PMID: 31846127 DOI: 10.1111/jrh.12413] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The distance patients travel for specialty care is an important barrier to health care access, particularly for those living in rural areas. This study characterizes the actual distance older breast cancer patients traveled to radiation treatment and the minimum distance necessary to reach radiation care, and examines whether any patient demographic or clinical factors are associated with greater travel distance. METHODS We used data from the Surveillance Epidemiology and End Results (SEER)-Medicare database. Our cohort included 52,317 women diagnosed with breast cancer between 2004 and 2013. Driving distances were calculated using Google Maps. We used generalized estimating equations to estimate associations between patient demographic and disease variables and travel distance. FINDINGS Patients living in rural areas traveled on average nearly 3 times as far as those from urban areas (40.8 miles vs 15.4 miles), and their nearest facility was more than 4 times farther away (21.9 miles vs 4.8 miles). Older age, being single or widowed, and lower household income were significantly associated with shorter actual travel distance, while increasing rurality was significantly associated with greater actual and minimum travel distance to radiation treatment. Disease severity (stage, grade, etc) was not significantly associated with actual or minimum travel distance. CONCLUSIONS In this insured population, travel distance to radiation facilities may pose a significant burden for breast cancer patients, particularly among those living in rural areas. Policymakers and patient advocates should explore service delivery models, reimbursement models, and social supports aimed at reducing the impact of travel to radiation treatment for breast cancer patients.
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Affiliation(s)
- Colleen F Longacre
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Hannah T Neprash
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Nathan D Shippee
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Beth A Virnig
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Huntington SF. Cure at what (systemic) financial cost? Integrating novel therapies into first-line Hodgkin lymphoma treatment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:252-259. [PMID: 31808838 PMCID: PMC6913455 DOI: 10.1182/hematology.2019000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Classic Hodgkin lymphoma (cHL) stands out as success story in the field of medical oncology, with multiagent chemotherapy with or without radiation leading to durable remission for most patients. Large-scale clinical trials during the past 40 years have sought to minimize toxicities while maintaining strong efficacy, including efforts to reduce the size of radiation fields, minimize alkylator chemotherapy, reduce the number of chemotherapy cycles, and omit radiation in select populations. The last decade has also ushered in novel therapies, including brentuximab vedotin (BV), that have improved clinical outcomes for patients with cHL resistant to standard cytotoxic therapies. More recently, a large randomized trial compared BV plus chemotherapy with chemotherapy alone for first-line treatment of advanced stage cHL. With ∼24 months of available follow-up, the BV containing regimen was found to be associated with a reduction in the risk of progression, death, or incomplete response to first-line treatment (modified progression-free survival). Whether this early signal of improved efficacy is worth the additional acute toxicities and added drug-related expenses associated with incorporating BV into first-line treatment remains controversial. This chapter provides historical background; reviews the cost-effectiveness of available cHL therapies; and summarizes potential ways to balance innovation, affordability, and patient access to novel therapeutics.
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Affiliation(s)
- Scott F. Huntington
- Department of Internal Medicine, Section of Hematology, Yale University, New Haven, CT
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Sorscher S. Universal Multigene Panel Testing in all Breast Cancer Patients. Am J Med 2019; 132:e765-e766. [PMID: 30946833 DOI: 10.1016/j.amjmed.2019.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Steven Sorscher
- Department of Medicine/Oncology Division, Wake Forest School of Medicine, Winston-Salem, NC.
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Howell K, Matuszak M, Maitz CA, Eisaman SH, Padilla L, Brown SL, Joiner MC, Dominello MM, Burmeister J. Three Discipline Collaborative Radiation Therapy (3DCRT) special debate: In the future, at least 20% of NIH funding for radiotherapy research should be allocated to non-oncologic applications. J Appl Clin Med Phys 2019; 21:7-13. [PMID: 31573150 PMCID: PMC7020985 DOI: 10.1002/acm2.12729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Krisha Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Charles A Maitz
- Veterinary Health Center, University of Missouri, Columbia, MO, USA
| | - Subarna H Eisaman
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA, USA
| | - Laura Padilla
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen L Brown
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Michael C Joiner
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Michael M Dominello
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jay Burmeister
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA.,Gershenson Radiation Oncology Center, Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
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Curtis ML, Eschiti VS. Geographic Health Disparities: Satellite Clinics for Cancer Care in Rural Communities. Clin J Oncol Nurs 2019; 22:500-506. [PMID: 30239508 DOI: 10.1188/18.cjon.500-506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cancer treatment is time-consuming and challenging for most patients, but particularly for those who live in geographically isolated areas. Satellite chemotherapy infusion centers offer a possible solution to geographic disparities in health care. OBJECTIVES This article analyzes a satellite chemotherapy infusion center on the island of Martha's Vineyard in Massachusetts. METHODS Interviews were conducted with staff of the infusion department of Martha's Vineyard Hospital, which has partnered with the cancer center at Massachusetts General Hospital to offer a satellite chemotherapy infusion center for island residents. FINDINGS High-quality community hospitals are increasingly able to offer specialized oncology treatment and nursing care at greater convenience for patients through the use of satellite clinics.
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Rajagopal PS, Nielsen S, Olopade OI. USPSTF Recommendations for BRCA1 and BRCA2 Testing in the Context of a Transformative National Cancer Control Plan. JAMA Netw Open 2019; 2:e1910142. [PMID: 31434110 DOI: 10.1001/jamanetworkopen.2019.10142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Sarah Nielsen
- Center for Clinical Cancer Genetics, The University of Chicago, Chicago, Illinois
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics, The University of Chicago, Chicago, Illinois
- Center for Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
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Tang W, Xie J, Kong F, Malone DC. Per-Prescription Drug Expenditure by Source of Payment and Income Level in the United States, 1997 to 2015. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:871-877. [PMID: 31426927 DOI: 10.1016/j.jval.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate expenditures and sources of payment for prescription drugs in the United States from 1997 to 2015. METHODS The Medical Expenditures Panel Survey (MEPS) was used for this analysis. Individuals with one or more prescription medicines were eligible for inclusion. Outcomes were the inflation-adjusted cost per prescription across all payment sources (self or family, public, private, and other sources) before and after the Medicare Part D benefit and the Affordable Care Act. RESULTS The cost per prescription increased from $38.56 in 1997 to $73.34 in 2015. Nevertheless, consumers' out-of-pocket expenditures decreased from $18.19 to $9.61, whereas public program expenditures per prescription increased from $5.61 to $34.43 over this time. Out-of-pocket expenditures of individuals in the low-income group and near-poor group had larger declined percentages from 51.4% to 20.4% and 46.5% to 17.2% relative to individuals in higher-income groups before and after implementation of the Medicare Part D, respectively. Over 90% prescription purchases were covered by medical insurance by 2015. The per-prescription cost for medications consumed by uninsured individuals increased at a lower rate from $31.83 to $54.96 versus $40.12 to $75.58 for privately insured and $36.00 to $70.96 for publicly insured (P < .001). CONCLUSIONS Prescription drugs expenditures have increased over the past 2 decades, but public sources now pay for a growing proportion of prescription drugs cost regardless of health insurance coverage or income level. Out-of-pocket expenditures have significantly decreased for persons with lower incomes since the implementation of Medicare Part D and the Affordable Care Act.
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Affiliation(s)
- Wenxi Tang
- Department of Health Economics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China; Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Arizona, USA
| | - Jing Xie
- Department of Health Economics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Fanxin Kong
- Department of Health Economics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Daniel C Malone
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Arizona, USA.
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Chirra M, Marsili L, Wattley L, Sokol LL, Keeling E, Maule S, Sobrero G, Artusi CA, Romagnolo A, Zibetti M, Lopiano L, Espay AJ, Obeidat AZ, Merola A. Telemedicine in Neurological Disorders: Opportunities and Challenges. Telemed J E Health 2019; 25:541-550. [PMID: 30136898 PMCID: PMC6664824 DOI: 10.1089/tmj.2018.0101] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction: Telemedicine represents an emerging model for the assessment and management of various neurological disorders. Methods: We sought to discuss opportunities and challenges for the integration of telemedicine in the management of common and uncommon neurological disorders by reviewing and appraising studies that evaluate telemedicine as a means to facilitate the access to care, deliver highly specialized visits, diagnostic consultations, rehabilitation, and remote monitoring of neurological disorders. Results: Opportunities for telemedicine in neurological disorders include the replacement of or complement to in-office evaluations, decreased time between follow-up visits, reduction in disparities in access to healthcare, and promotion of education and training through interactions between primary care physicians and tertiary referral centers. Critical challenges include the integration of the systems for data monitoring with an easy-to-use, secure, and cost-effective platform that is both widely adopted by patients and healthcare systems and embraced by international scientific societies. Conclusions: Multiple applications may spawn from a model based on digitalized healthcare services. Integrated efforts from multiple stakeholders will be required to develop an interoperable software platform capable of providing not only a holistic approach to care but also one that reduces disparities in the access to care.
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Affiliation(s)
- Martina Chirra
- Division of Hematology-Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
- Department of Oncology, Medical Oncology Unit, University of Siena, Siena, Italy
| | - Luca Marsili
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | - Linsdey Wattley
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Leonard L. Sokol
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Elizabeth Keeling
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | - Simona Maule
- Autonomic Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Gabriele Sobrero
- Autonomic Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Alberto Romagnolo
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Maurizio Zibetti
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Alberto J. Espay
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | - Ahmed Z. Obeidat
- Department of Neurology and Rehabilitation Medicine, The Waddell Center for Multiple Sclerosis, University of Cincinnati, Cincinnati, Ohio
| | - Aristide Merola
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
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Abstract
Animal-assisted interventions are part of the therapeutic plan in pediatric oncology. This is the first systematic review to summarize the literature and provide insights for new clinical approaches, policy, best practices, and standards. The results underline the potentially beneficial role for pediatric patients, parents, caregivers, and medical staff.
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Norden AD, Dankwa-Mullan I, Urman A, Suarez F, Rhee K. Realizing the Promise of Cognitive Computing in Cancer Care: Ushering in a New Era. JCO Clin Cancer Inform 2019; 2:1-6. [PMID: 30652560 DOI: 10.1200/cci.17.00049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | - Kyu Rhee
- All authors: IBM Watson Health, Cambridge MA
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Milliron KJ, Griggs JJ. Advances in Genetic Testing in Patients With Breast Cancer, High-Quality Decision Making, and Responsible Resource Allocation. J Clin Oncol 2018; 37:445-447. [PMID: 30526228 DOI: 10.1200/jco.18.01952] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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50
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Fingrut W, Beck LA, Lo D. Oncology communities of practice: insights from a qualitative analysis. Curr Oncol 2018; 25:378-383. [PMID: 30607112 PMCID: PMC6291282 DOI: 10.3747/co.25.4088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background A community of practice (cop) is formally defined as a group of people who share a concern or a passion for something they do and who learn how to do it better as they interact regularly. Communities of practice represent a promising approach for improving cancer care outcomes. However, little research is available to guide the development of oncology cops. In 2015, our urban community hospital launched an oncology cop, with the goals of decreasing barriers to access, fostering collaboration, and improving practitioner knowledge of guidelines and services in cancer care. Here, we share insights from a qualitative analysis of feedback from participants in our cop. The objective of the project was to identify participant perspectives about preferred cop features, with a view to improving the quality of our community hospital's oncology cop. Methods After 5 in-person meetings of our oncology cop, participants were surveyed about what the cop should start, stop, and continue doing. Qualitative methods were used to analyze the feedback. Results The survey collected 250 comments from 117 unique cop participants, including family physicians, specialist physicians, nurses, and allied health care practitioners. Analysis identified participant perspectives about the key features of the cop and avenues for improvement across four themes: supporting knowledge exchange, identifying and addressing practice gaps, enhancing interprofessional collaboration, and fostering a culture of partnership. Conclusions Based on the results, we identified several considerations that could be helpful in improving our cop. Our findings might help guide the development of oncology cops at other institutions.
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Affiliation(s)
- W Fingrut
- Faculty of Medicine, University of Toronto, Toronto, ON
| | - L A Beck
- Faculty of Medicine, University of Toronto, Toronto, ON
- Division of Hematology and Oncology, St. Joseph's Health Centre, Toronto, ON
| | - D Lo
- Faculty of Medicine, University of Toronto, Toronto, ON
- Division of Hematology and Oncology, St. Joseph's Health Centre, Toronto, ON
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