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Riano I, Alas-Pineda C, Reyes Garcia S, Murillo R, Gutiérrez-Delgado F, Cazap E, Pais Viegas CM, Torre MDL, Barahona KC, Sarria GJ, Del Castillo Bahi R, Luongo-Céspedes Á, Ovalles B, Umaña Herrera FV, Sánchez R, McVorran S, Williams B, Kascmar J, Kennedy LS, Lyons KD, Bejarano S, Wong SL. Community-Led Action Research in Oncology: Pandemic-Appropriate Radiotherapy Innovations Evaluated (CLARO PARTE) for Latin America and the Caribbean Countries. JCO Glob Oncol 2024; 10:e2400051. [PMID: 39159409 DOI: 10.1200/go.24.00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/03/2024] [Accepted: 06/18/2024] [Indexed: 08/21/2024] Open
Abstract
PURPOSE This study aimed to identify, evaluate, and rank suitable safety innovations developed during the COVID-19 pandemic in Latin American and Caribbean (LAC) radiation oncology centers. METHODS We conducted a multimodal participatory engagement collaboration with the Latin-American and Caribbean Society of Medical Oncology. The study consisted of four phases. Innovations were collected from a panel of radiotherapy experts representing a diverse group of 11 countries from LAC (Phase I). Next, a medical scientific team compared the innovations against international standards regarding their potential impact on risk of infection, clinical operation, and continuity of quality cancer care (Phase II). Their findings were supplied to the country representatives who rated the innovations for acceptability in their cancer centers (Phase III), resulting in a final report of the panel's recommendations (Phase IV). RESULTS A total of 81 innovations were reported by the country representatives and merged by the medical scientific team into 24 innovations that combined similar innovations. The 24 innovations were grouped into six categories including practices aimed at (1) reducing clinic crowding (n = 3), (2) increasing screening and vaccinations for COVID-19 disease (n = 5), (3) implementing social distancing (n = 6), (4) strengthening personal infection equipment and disinfection (n = 6), (5) avoiding delaying or shortening treatment protocols (n = 2), and (6) mixed procedures (n = 2). The medical scientific team found nearly all innovations were supported by international recommendations and rated as safe, efficient, and acceptable. CONCLUSION By using the lessons learned from the Community-Led Action Research in Oncology: Pandemic-Appropriate Radiotherapy Innovations Evaluated study, a manual of scalable practices in radiation oncology clinics may be developed to guide actions during future large-scale public health crises in low- and middle-income countries of LAC.
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Affiliation(s)
- Ivy Riano
- Division of Hematology and Oncology, Dartmouth Cancer Center, Dartmouth Health, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - César Alas-Pineda
- Division of Radiation Oncology, Liga Contra El Cáncer, San Pedro Sula, Honduras
| | - Sarahi Reyes Garcia
- Division of Radiation Oncology, Liga Contra El Cáncer, San Pedro Sula, Honduras
| | - Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Eduardo Cazap
- Latin-American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
| | - Celia Maria Pais Viegas
- Department of Radiation Oncology, Instituto Nacional de Cáncer, Brazil National Cancer Institute, Rio de Janeiro, Brazil
| | - Marcela de la Torre
- Division of Oncology, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Kaory C Barahona
- Division of Radiation Oncology, International Cancer Center, Diagnostic Hospital, San Salvador, El Salvador
| | - Gustavo J Sarria
- Dirección General de Control de Cancer, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Ramón Del Castillo Bahi
- Department of Radiation Oncology, Instituto Nacional de Oncología y Radiobiología, La Habana, Cuba
| | | | - Beatriz Ovalles
- Department of Radiation Oncology, Centro de Cancer Homs, Santiago de los Caballeros, Dominican Republic
| | | | - Ricardo Sánchez
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Shauna McVorran
- Department of Radiation Oncology and Applied Science, Dartmouth Cancer Center, Lebanon, NH
| | - Benjamin Williams
- Department of Radiation Oncology and Applied Science, Dartmouth Cancer Center, Lebanon, NH
| | - Joseph Kascmar
- Department of Surgery, Dartmouth Health, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Linda S Kennedy
- Strategic Initiatives & Global Oncology at the Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH
| | - Kathleen D Lyons
- Department of Occupational Therapy, Massachusetts General Hospital (MGH) Institute of Health Professions, Boston, MA
| | - Suyapa Bejarano
- Division of Radiation Oncology, Liga Contra El Cáncer, San Pedro Sula, Honduras
| | - Sandra L Wong
- Department of Surgery, Dartmouth Cancer Center, Dartmouth Health, Geisel School of Medicine at Dartmouth, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
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Levine MN, Kemppainen J, Rosenberg M, Pettengell C, Bogach J, Whelan T, Saha A, Ranisau J, Petch J. Breast cancer learning health system: Patient information from a data and analytics platform characterizes care provided. Learn Health Syst 2024; 8:e10409. [PMID: 39036532 PMCID: PMC11257056 DOI: 10.1002/lrh2.10409] [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: 10/11/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 07/23/2024] Open
Abstract
Purpose In a learning health system (LHS), data gathered from clinical practice informs care and scientific investigation. To demonstrate how a novel data and analytics platform can enable an LHS at a regional cancer center by characterizing the care provided to breast cancer patients. Methods Socioeconomic information, tumor characteristics, treatments and outcomes were extracted from the platform and combined to characterize the patient population and their clinical course. Oncologists were asked to identify examples where clinical practice guidelines (CPGs) or policy changes had varying impacts on practice. These constructs were evaluated by extracting the corresponding data. Results Breast cancer patients (5768) seen at the Juravinski Cancer Centre between January 2014 and June 2022 were included. The average age was 62.5 years. The commonest histology was invasive ductal carcinoma (74.6%); 77% were estrogen receptor-positive and 15.5% were HER2 Neu positive. Breast-conserving surgery (BCS) occurred in 56%. For the 4294 patients who received systemic therapy, the initial indications were adjuvant (3096), neoadjuvant (828) and palliative (370). Metastases occurred in 531 patients and 495 patients died. Lowest-income patients had a higher mortality rate. For the adoption of CPGs, the uptake for adjuvant bisphosphonate was very low, 8% as predicted, compared to 64% for pertuzumab, a HER2 targeted agent and 40.2% for CD4/6 inhibitors in metastases. During COVID-19, the provincial cancer agency issued a policy to shorten the duration of radiation after BCS. There was a significant reduction in the average number of fractions to the breast by five fractions. Conclusion Our platform characterized care and the clinical course of breast cancer patients. Practice changes in response to regulatory developments and policy changes were measured. Establishing a data platform is important for an LHS. The next step is for the data to feedback and change practice, that is, close the loop.
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Affiliation(s)
- Mark N. Levine
- Department of OncologyMcMaster UniversityHamiltonOntarioCanada
- Escarpment Cancer Research InstituteHamiltonOntarioCanada
| | - Joel Kemppainen
- Centre for Data Science and Digital HealthHamilton Health SciencesHamiltonOntarioCanada
| | - Morgan Rosenberg
- Centre for Data Science and Digital HealthHamilton Health SciencesHamiltonOntarioCanada
| | | | - Jessica Bogach
- Department of SurgeryMcMaster UniversityHamiltonOntarioCanada
| | - Tim Whelan
- Department of OncologyMcMaster UniversityHamiltonOntarioCanada
- Escarpment Cancer Research InstituteHamiltonOntarioCanada
| | - Ashirbani Saha
- Department of OncologyMcMaster UniversityHamiltonOntarioCanada
- Escarpment Cancer Research InstituteHamiltonOntarioCanada
| | - Jonathan Ranisau
- Centre for Data Science and Digital HealthHamilton Health SciencesHamiltonOntarioCanada
| | - Jeremy Petch
- Centre for Data Science and Digital HealthHamilton Health SciencesHamiltonOntarioCanada
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Population Health Research Institute, Hamilton Health SciencesHamiltonOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoHamiltonOntarioCanada
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3
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Weaver SJ, Breslau ES, Russell LE, Zhang A, Sharma R, Bass EB, Marsteller JA, Snyder C. Health-care organization characteristics in cancer care delivery: an integrated conceptual framework with content validation. J Natl Cancer Inst 2024; 116:800-811. [PMID: 38419574 DOI: 10.1093/jnci/djae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
Context can influence cancer-related outcomes. For example, health-care organization characteristics, including ownership, leadership, and culture, can affect care access, communication, and patient outcomes. Health-care organization characteristics and other contextual factors can also influence whether and how clinical discoveries reduce cancer incidence, morbidity, and mortality. Importantly, policy, market, and technology changes are transforming health-care organization design, culture, and operations across the cancer continuum. Consequently, research is essential to examine when, for whom, and how organizational characteristics influence person-level, organization-level, and population-level cancer outcomes. Understanding organizational characteristics-the structures, processes, and other features of entities involved in health care delivery-and their dynamics is an important yet understudied area of care delivery research across the cancer continuum. Research incorporating organizational characteristics is critical to address health inequities, test care delivery models, adapt interventions, and strengthen implementation. The field lacks conceptual grounding, however, to help researchers identify germane organizational characteristics. We propose a framework identifying organizational characteristics relevant for cancer care delivery research based on conceptual work in health services, organizational behavior, and management science and refined using a systematic review and key informant input. The proposed framework is a tool for organizing existing research and enhancing future cancer care delivery research. Following a 2012 Journal of the National Cancer Institute monograph, this work complements National Cancer Institute efforts to stimulate research addressing the relationship between cancer outcomes and contextual factors at the patient, provider, team, delivery organization, community, and health policy levels.
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Affiliation(s)
- Sallie J Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Erica S Breslau
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Lauren E Russell
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allen Zhang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ritu Sharma
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill A Marsteller
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
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Gordon EA, Gordon JW. Impact of Coronavirus Disease-era Clinical Trial Reform on Cancer Trial Access in Rural/Underserved Regions of the Midwest. Am J Clin Oncol 2024; 47:22-24. [PMID: 37815370 DOI: 10.1097/coc.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
OBJECTIVES The coronavirus disease 2019 pandemic refocused the cancer community on bringing clinical trials closer to patients and increasing access for traditionally underserved communities. Pandemic-era deregulation increased flexibility with telemedicine visits, less frequent testing, and the ability to have tests done locally. This study evaluates the impact of 2020 cancer clinical trial reform on trial accessibility in rural/underserved regions of the Midwest. METHODS Publicly available clinicaltrials.gov data was accessed from January 1, 2018 to September 30, 2022 for the 3 leading causes of new cancer cases in Kentucky, Tennessee, Illinois, and Indiana. Interventional trials were categorized based on location using corresponding "Rural-Urban Commuting Area" codes (urban/metropolitan, suburban/micropolitan, small town/rural, and isolated/rural) and categorized as pre versus postpandemic (using March 15, 2020, when national regulatory guidelines were modified). Locations of trial offerings from pre and postpandemic dates were analyzed by paired t test. Comparison of trial location category by state and cancer type was analyzed by 1-way analysis of variance with pairwise multiple comparisons made using the Tukey-Kramer method. RESULTS Pandemic-era deregulation had no impact on increasing trial availability in suburban and small-town/rural locales ( P = 0.1259). Only 18% of trials were offered outside of urban areas, with 15% in suburban and 3% in small town/rural areas. Results varied by state ( P < 0.0001) with Illinois offering the most suburban and small-town trial availability (27%) compared with Kentucky, Indiana, and Tennessee (18%, 6%, and 2%, respectively). Trial availability in rural versus urban areas did not differ by cancer type ( P = 0.07197). CONCLUSIONS More work must be done to increase access to cancer clinical trials in rural and suburban areas of the United States.
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Affiliation(s)
- Elizabeth A Gordon
- Department of Public & Community Health, Murray State University, Murray, KY
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Budisavljevic A, Kelemenic-Drazin R, Silovski T, Plestina S, Plavetic ND. Correlation between psychological resilience and burnout syndrome in oncologists amid the Covid-19 pandemic. Support Care Cancer 2023; 31:207. [PMID: 36897484 PMCID: PMC9999072 DOI: 10.1007/s00520-023-07660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Oncologists are predisposed to developing burnout syndrome. Like other health care professionals worldwide, oncologists have endured additional, extreme challenges during the Covid-19 pandemic. Psychological resilience presents a potential protective mechanism against burnout. This cross-sectional study examines whether psychological resilience eased burnout syndrome among Croatian oncologists during the pandemic. METHODS An anonymized self-reporting questionnaire was electronically distributed by the Croatian Society for Medical Oncology to 130 specialist and resident oncologists working in hospitals. Available for completion from September 6-24, 2021, the survey comprised demographic questions; the Oldenburg Burnout Inventory (OLBI), covering exhaustion and disengagement; and the Brief Resilience Scale (BRS). The response rate was 57.7%. RESULTS Burnout was moderate or high for 86% of respondents, while 77% had moderate or high psychological resilience. Psychological resilience was significantly negatively correlated with the OLBI exhaustion subscale (r = - .54; p < 0.001) and the overall OLBI score (r = - .46; p < 0.001). Scheffe's post hoc test showed that oncologists with high resilience scored significantly lower on the overall OLBI (M = 2.89; SD = 0.487) compared to oncologists with low resilience (M = 2.52; SD = 0.493). CONCLUSION The findings thus indicate that oncologists with high psychological resilience are at significantly lower risk of developing burnout syndrome. Accordingly, convenient measures to encourage psychological resilience in oncologists should be identified and implemented.
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Affiliation(s)
- Anuska Budisavljevic
- Department of Medical Oncology and Hematology, General Hospital Pula, Pula, Croatia
| | - Renata Kelemenic-Drazin
- Department of Hematology, Oncology and Clinical Immunology, General Hospital Varazdin, Varazdin, Croatia.
| | - Tajana Silovski
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Stjepko Plestina
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
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Paez D, Marengo M, Bomanji J, Dondi M. Quality improvement initiative of the IAEA in nuclear medicine: a tool to assess staffing needs within the QUANUM framework. Nucl Med Commun 2022; 43:967-969. [PMID: 35582856 PMCID: PMC9371058 DOI: 10.1097/mnm.0000000000001584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Application, International Atomic Energy Agency, Vienna, Austria
| | - Mario Marengo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospital, London, UK
| | - Maurizio Dondi
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Application, International Atomic Energy Agency, Vienna, Austria
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7
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Milch V, Nelson AE, Austen M, Hector D, Turnbull S, Sathiaraj R, Der Vartanian C, Wang R, Anderiesz C, Keefe D. Conceptual Framework for Cancer Care During a Pandemic Incorporating Evidence From the COVID-19 Pandemic. JCO Glob Oncol 2022; 8:e2200043. [PMID: 35917484 PMCID: PMC9470141 DOI: 10.1200/go.22.00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE With successive infection waves and the spread of more infectious variants, the COVID-19 pandemic continues to have major impacts on health care. To achieve best outcomes for patients with cancer during a pandemic, efforts to minimize the increased risk of severe pandemic infection must be carefully balanced against unintended adverse impacts of the pandemic on cancer care, with consideration to available health system capacity. Cancer Australia's conceptual framework for cancer care during a pandemic provides a planning resource for health services and policy-makers that can be broadly applied globally and to similar pandemics. METHODS Evidence on the impact of the COVID-19 pandemic on cancer care and health system capacity to June 2021 was reviewed, and the conceptual framework was developed and updated. RESULTS Components of health system capacity vary during a pandemic, and capacity relative to pandemic numbers and severity affects resources available for cancer care delivery. The challenges of successive pandemic waves and high numbers of pandemic cases necessitate consideration of changing health system capacity in decision making about cancer care. Cancer Australia’s conceptual framework provides guidance on continuation of care across the cancer pathway, in the face of challenges to health systems, while minimizing infection risk for patients with cancer and unintended consequences of delays in screening, diagnosis, and cancer treatment and backlogs because of service interruption. CONCLUSION Evidence from the COVID-19 pandemic supports continuation of cancer care wherever possible during similar pandemics. Cancer Australia's conceptual framework, underpinned by principles for optimal cancer care, informs decision making across the cancer care continuum. It incorporates consideration of changes in health system capacity and capacity for cancer care, in relation to pandemic progression, enabling broad applicability to different global settings.
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Affiliation(s)
- Vivienne Milch
- Cancer Australia, Sydney, New South Wales, Australia
- The University of Notre Dame, Sydney, New South Wales, Australia
| | - Anne E. Nelson
- Evidence Review Contractor, Sydney, New South Wales, Australia
| | | | - Debra Hector
- Cancer Australia, Sydney, New South Wales, Australia
| | | | | | | | - Rhona Wang
- Cancer Australia, Sydney, New South Wales, Australia
| | - Cleola Anderiesz
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- National Breast Cancer Foundation, Sydney, New South Wales, Australia
| | - Dorothy Keefe
- Cancer Australia, Sydney, New South Wales, Australia
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Valdiviezo N, Alcarraz C, Castro D, Salas R, Begazo-Mollo V, Galvez-Villanueva M, Medina Aguirre L, Garcia-León E, Quispe-Santivañez I, Cornejo-Raymundo C, Paz-Cornejo E, Sanchez-Vilela L, Bermudez-Alfaro V, Vargas-Nina JC, Pérez-Ramos C, Meza-Hoces A, Valdez Barreto PR, Huaringa-Leiva R, Muro-Cieza J, Aguilar-Vásquez V, Cuenca EY, Neciosup-Delgado S, Poma-Nieto N, Chavez-Gavino S, Fernandez-Rosas L, Araujo JM, Payet E, Gomez HL. Oncological Care During First Peruvian National Emergency COVID-19 Pandemic: A Multicentric Descriptive Study. Cancer Manag Res 2022; 14:1075-1085. [PMID: 35300062 PMCID: PMC8922040 DOI: 10.2147/cmar.s350038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/15/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Natalia Valdiviezo
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, Peru
- Correspondence: Natalia Valdiviezo, Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos 2520, Surquillo, Lima, 15038, Peru, Tel +51 992825055, Email
| | - Cindy Alcarraz
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, Peru
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
| | - Denisse Castro
- Departamento de Oncología Médica, Hospital Nacional Edgardo Rebagliati Martins, Lima, 15072, Peru
- Centro de Investigación de Medicina de Precisión, Universidad de San Martin de Porres, Lima, 15024, Peru
| | - Renzo Salas
- Departamento de Oncología Médica, Hospital Nacional Edgardo Rebagliati Martins, Lima, 15072, Peru
| | - Victor Begazo-Mollo
- Departamento de Medicina Oncológica, Instituto Regional de Enfermedades Neoplásicas Sur, Arequipa, Perú
| | - Marco Galvez-Villanueva
- Departamento de Medicina Oncológica, Instituto Regional de Enfermedades Neoplásicas Norte, La Libertad, Perú
| | - Luz Medina Aguirre
- Departamento de Medicina Oncológica, Hospital Goyeneche, Arequipa, 04600, Perú
| | - Elica Garcia-León
- Departamento de Medicina Oncológica, Hospital Regional de Lambayeque, Lambayeque, 14001, Perú
| | | | | | - Eduardo Paz-Cornejo
- Departamento de Medicina Oncológica, Hospital Nacional Alberto Sabogal Sologuren, Lima, Peru
| | - Luis Sanchez-Vilela
- Departamento de Medicina Oncológica, Hospital de Apoyo II Santa Rosa, Piura, Peru
| | - Vanessa Bermudez-Alfaro
- Departamento de Medicina Oncológica, Hospital Nacional Guillermo Almenara Irigoyen, Lima, 15033, Peru
| | | | - Carlos Pérez-Ramos
- Departamento de Medicina Oncológica, Hospital María Auxiliadora, Lima, Peru
| | - Andrea Meza-Hoces
- Departamento de Medicina Oncológica, Hospital II E de Lamas, San Martin, Peru
| | - Paolo R Valdez Barreto
- Departamento de Medicina Oncológica, Hospital de Alta complejidad Virgen de la Puerta, La Libertad, Peru
| | | | - Johanny Muro-Cieza
- Departamento de Medicina Oncológica, Hospital Regional Docente de Cajamarca, Cajamarca, Peru
| | - Valeria Aguilar-Vásquez
- Departamento de Promoción de la Salud, Prevención y Control del Cáncer, Instituto Regional de Enfermedades Neoplásicas Norte, La Libertad, Perú
| | - Eduardo Yache Cuenca
- Departamento de Epidemiología, Instituto Regional de Enfermedades Neoplásicas Norte, La Libertad, Perú
| | - Silvia Neciosup-Delgado
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, Peru
| | - Nathaly Poma-Nieto
- Departamento de Medicina Oncológica, Hospital Nacional Daniel Alcides Carrión, Lima, Perú
| | - Sheyla Chavez-Gavino
- Departamento de Medicina Oncológica, Hospital Regional Eleazar Guzmán Barrón, Ancash, Perú
| | - Lenin Fernandez-Rosas
- Departamento de Cirugía Oncológica, Hospital Regional Eleazar Guzmán Barrón, Ancash, Perú
| | - Jhajaira M Araujo
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
| | - Eduardo Payet
- Jefatura Institucional, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, Peru
| | - Henry L Gomez
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, Peru
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9
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Perumalswami CR, Chen E, Martin C, Goold SD, De Vries R, Griggs JJ, Jagsi R. "I'm Being Forced to Make Decisions I Have Never Had to Make Before": Oncologists' Experiences of Caring for Seriously Ill Persons With Poor Prognoses and the Dilemmas Created by COVID-19. JCO Oncol Pract 2022; 18:e89-e97. [PMID: 34324387 PMCID: PMC8758089 DOI: 10.1200/op.21.00119] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has created a new set of problems for clinicians. This study examines the experiences of oncologists providing care to seriously ill persons near the end of life in the context of the COVID-19 pandemic. METHODS Between January 2020 and August 2020, we conducted semistructured, in-depth individual interviews with 22 purposefully sampled oncologists from practices enrolled in the Michigan Oncology Quality Consortium. Deidentified transcripts of the interviews were examined using thematic analysis. RESULTS Our respondents described several novel problems created by the COVID-19 pandemic, including: (1) ethical challenges, (2) the need to manage uncertainty-physically and emotionally-on the part of both patients and oncologists, and (3) the difficulty of integrating technology and communication for seriously ill persons. These problems were made more complex by features of the pandemic: resource scarcity (and the need to fairly allocate poor resources), delays in care, high levels of fear, and the increased importance of advance care planning. Nonabandonment served as a way to cope with increased stress, and the use of telemedicine became an increasingly important medium of communication. CONCLUSION This study offers an in-depth exploration of the problems faced by oncologists as a result of the COVID-19 pandemic and how they navigated them. Optimal decision making for seriously ill persons with cancer during the COVID-19 pandemic must include open acknowledgment of the ethical challenges involved, the emotions experienced by both patients and their oncologists, and the urgent need to integrate technology with compassionate communication in determining patient preferences.
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Affiliation(s)
- Chithra R. Perumalswami
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Chithra R. Perumalswami, MD, MSc, Center for Bioethics and Social Sciences in Medicine, University of Michigan North Campus Research Complex, 2800 Plymouth Rd, Building 14-Room G011, Ann Arbor, MI 48109-2800; Twitter: @ChithraMD; e-mail:
| | - Emily Chen
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Carly Martin
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Susan D. Goold
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Department Internal Medicine, University of Michigan Medical School, Ann Arbor, MI,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Raymond De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Jennifer J. Griggs
- Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Department Internal Medicine, University of Michigan Medical School, Ann Arbor, MI,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI
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Vogl DT, Sallée V, Hendricks MC, Redlinger Tabery C, Blair ML, Dahlmeier E, Meagher EA, Cohen RB, Vonderheide RH. A unique window of opportunity for practical reform of cancer clinical trials. Cancer 2021; 127:2855-2860. [PMID: 33849079 DOI: 10.1002/cncr.33585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 11/11/2022]
Abstract
With rapid modifications in cancer clinical trial operations necessitated by the global pandemic over the last year, there is now an unprecedented opportunity to reform clinical research permanently and solidify innovative practices that have clearly been effective. On the basis of the authors' experience and recommendations from other institutions, a set of specific proposals for clinical trial reform are identified that can be implemented immediately by sponsors, regulators, and study sites. Improvements in clinical trial processes should include increased leverage of technology to facilitate remote trial activity and electronic documents, more efficient and effective communication of adverse event information, and better study design to optimize inclusion criteria, required research procedures, and data collection. The authors suggest that such reform will preserve patient safety and study integrity, address unnecessary and inefficient pre-pandemic constraints, improve access to clinical trials for patients, and speed improvements in cancer care.
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Affiliation(s)
- Dan T Vogl
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vicki Sallée
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maria C Hendricks
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Colleen Redlinger Tabery
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Meghan L Blair
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica Dahlmeier
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emma A Meagher
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roger B Cohen
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert H Vonderheide
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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11
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Ives A, Pusztai T, Keller J, Ahern E, Chan B, Gasper H, Wyld D, Kennedy G, Dickie G, Lwin Z, Roberts NA. Resilience and ongoing quality care for cancer clinical trials during COVID-19: Experience from a tertiary hospital in Australia. Asia Pac J Clin Oncol 2021; 18:e141-e147. [PMID: 33819387 PMCID: PMC8251164 DOI: 10.1111/ajco.13570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The COVID-19 pandemic has forced rapid system-wide changes to be implemented within cancer care at an alarming pace. Clinical trials are a key element of comprehensive cancer care. Ensuring the continuing safe conduct of cancer clinical trials in the context of a pandemic is challenging. METHODS We aimed to describe the COVID-19 pandemic response of a Cancer Care Clinical Research Unit (CRU) of a tertiary hospital in Queensland, Australia. We used a mixed methods approach for this case study. Emailed directives from CRU managers to all CRU staff sharing were qualitatively analysed and mapped against our unit activities over longitudinal time points. Data from patient recruitment and protocol deviations were analysed using descriptive statistics. RESULTS Mapping activity from 11 March to 30 September 2020 revealed rapid change during the first 2 weeks. Four key strategies to accommodate change were identified: supporting patients and families, introduction of telehealth, accessing investigational product, and social distancing. Early in the pandemic we recognised that our core key stakeholders were integral to our response. When compared to the previous 12 months, our recruitment numbers dropped markedly in early phases of the response but recovered over time, as we accommodated internal and external impacts. CONCLUSION Our experience of agility as a necessity, adapting to support patients, and managing both clinical research activity and sponsors during the height of the pandemic response is presented here in order to inform future disaster response planning by clinical trial organisations.
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Affiliation(s)
- Amy Ives
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Tricia Pusztai
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jacqui Keller
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Elizabeth Ahern
- Department of Oncology, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Bryan Chan
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,School of Medicine, Griffith University, Sunshine Coast, Queensland, Australia
| | - Harry Gasper
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - David Wyld
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - Glen Kennedy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - Graeme Dickie
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Natasha A Roberts
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,University of Queensland Centre for Clinical Research (UQCCR), Queensland, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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12
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Yerram P, Thackray J, Modelevsky LR, Land JD, Reiss SN, Spatz KH, Levoir AC, Pak TK, Dao PH, Buege MJ, Derespiris LM, Lau C, Orozco JS, Boparai M, Koranteng LA, Reichert KE, Yan SQ, Daukshus NP, Mathew S, Buie LW, Tizon RF, Freeswick S, Liu D, Harnicar S. Outpatient clinical pharmacy practice in the face of COVID-19 at a cancer center in New York City. J Oncol Pharm Pract 2021; 27:389-394. [PMID: 33459159 DOI: 10.1177/1078155220987625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE With the rapid spread of COVID-19 in New York City since early March 2020, innovative measures were needed for clinical pharmacy specialists to provide direct clinical care safely to cancer patients. Allocating the workforce was necessary to meet the surging needs of the inpatient services due to the COVID-19 outbreak, which had the potential to compromise outpatient services. We present here our approach of restructuring clinical pharmacy services and providing direct patient care in outpatient clinics during the pandemic. DATA SOURCES We conducted a retrospective review of electronic clinical documentation involving clinical pharmacy specialist patient encounters in 9 outpatient clinics from March 1, 2020 to May 31, 2020. The analysis of the clinical pharmacy specialist interventions and the impact of the interventions was descriptive. DATA SUMMARY As hospital services were modified to handle the surge due to COVID-19, select clinical pharmacy specialists were redeployed from the outpatient clinics or research blocks to COVID-19 inpatient teams. During these 3 months, clinical pharmacy specialists were involved in 2535 patient visits from 9 outpatient clinics and contributed a total of 4022 interventions, the majority of which utilized telemedicine. The interventions provided critical clinical pharmacy care during the pandemic and omitted 199 in-person visits for medical care. CONCLUSION The swift transition to telemedicine allowed the provision of direct clinical pharmacy services to patients with cancer during the COVID-19 pandemic.
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Affiliation(s)
- Prakirthi Yerram
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer Thackray
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lisa R Modelevsky
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Josiah D Land
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samantha N Reiss
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Krisoula H Spatz
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea C Levoir
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Terry K Pak
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Phuong H Dao
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael J Buege
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lauren M Derespiris
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carmen Lau
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer S Orozco
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Manpreet Boparai
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lauren A Koranteng
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kate E Reichert
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shirley Q Yan
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicole P Daukshus
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sherry Mathew
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Larry W Buie
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard F Tizon
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Scott Freeswick
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dazhi Liu
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen Harnicar
- Department of Pharmacy, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
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13
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Levine OH, McGillion M, Levine M. Virtual Cancer Care During the COVID-19 Pandemic and Beyond: A Call for Evaluation. JMIR Cancer 2020; 6:e24222. [PMID: 33180741 PMCID: PMC7717920 DOI: 10.2196/24222] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022] Open
Abstract
The interplay of virtual care and cancer care in the context of the COVID-19 pandemic is unique and unprecedented. Patients with cancer are at increased risk of SARS-CoV-2 infection and have worse outcomes than patients with COVID-19 who do not have cancer. Virtual care has been introduced quickly and extemporaneously in cancer treatment centers worldwide to maintain COVID-19-free zones. The outbreak of COVID-19 in a cancer center could have devastating consequences. The virtual care intervention that was first used in our cancer center, as well as many others, was a landline telephone in an office or clinic that connected a clinician with a patient. There is a lack of virtual care evaluation from the perspectives of patients and oncology health care providers. A number of factors for assessing oncology care delivered through a virtual care intervention have been described, including patient rapport, frailty, delicate conversations, team-based care, resident education, patient safety, technical effectiveness, privacy, operational effectiveness, and resource utilization. These factors are organized according to the National Quality Forum framework for the assessment of telehealth in oncology. This includes the following 4 domains of assessing outcomes: experience, access to care, effectiveness, and financial impact or cost. In terms of virtual care and oncology, the pandemic has opened the door to change. The lessons learned during the initial period of the pandemic have given rise to opportunities for the evolution of long-term virtual care. The opportunity to evaluate and improve virtual care should be seized upon.
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Affiliation(s)
- Oren Hannun Levine
- Department of Oncology, McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences - Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | - Mark Levine
- Department of Oncology, McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences - Juravinski Cancer Centre, Hamilton, ON, Canada
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