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Farrell MM, Jiang C, Moss G, Daly B, Weinstein E, Kemmann M, Gupta M, Lee RT. Associations between symptoms with healthcare utilization and death in advanced cancer patients. Support Care Cancer 2023; 31:183. [PMID: 36821057 PMCID: PMC9950186 DOI: 10.1007/s00520-023-07618-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/29/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION There is limited data about assessments that are associated with increased utilization of medical services among advanced oncology patients (AOPs). We aimed to identify factors related to healthcare utilization and death in AOP. METHODS AOPs at a comprehensive cancer center were enrolled in a Center for Medicare and Medicaid Innovation program. Participants completed the Edmonton Symptom Assessment Scale (ESAS) and the Functional Assessment of Cancer Therapy-General (FACT-G) scale. We examined factors associated with palliative care (PC), acute care (AC), emergency room (ER), hospital admissions (HA), and death. RESULTS In all, 817 AOPs were included in these analyses with a median age of 69. They were generally female (58.7%), white (61.4%), stage IV (51.6%), and represented common cancers (31.5% GI, 25.2% thoracic, 14.3% gynecologic). ESAS pain, anxiety, and total score were related to more PC visits (B=0.31, 95% CI [0.21, 0.40], p<0.001; B=0.24 [0.12, 0.36], p<0.001; and B=0.038 [0.02, 0.06], p=0.001, respectively). Total FACT-G score and physical subscale were related to total PC visits (B=-0.021 [-0.037, -0.006], p=0.008 and B=-0.181 [-0.246, -0.117], p<0.001, respectively). Lower FACT-G social subscale scores were related to more ER visits (B=-0.03 [-0.53, -0.004], p=0.024), while increased tiredness was associated with fewer AC visits (B=-0.039 [-0.073, -0.006], p=0.023). Higher total ESAS scores were related to death within 30 days (OR=0.87 [0.76, 0.98], p=0.027). CONCLUSIONS The ESAS and FACT-G assessments were linked to PC and AC visits and death. These assessments may be useful for identifying AOPs that would benefit from routine PC.
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Affiliation(s)
- Megan M Farrell
- Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA
| | - Cherry Jiang
- Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA
| | - Gabriel Moss
- Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA
| | - Barbara Daly
- Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA
| | - Elizabeth Weinstein
- Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA.,University Hospitals, 11100 Euclid Ave, Cleveland, OH, 44106, USA.,Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Matthew Kemmann
- University Hospitals, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Mona Gupta
- Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA.,University Hospitals, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Richard T Lee
- Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA. .,University Hospitals, 11100 Euclid Ave, Cleveland, OH, 44106, USA. .,City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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Chen E, Deshane A, Damico N, Kharouta M, Kim U, Kemmann M, Kyasaram R, Wu AK, Biswas T, Dorth J, Mansur D, Choi S, Bhatt A. An Analysis of Cancer Center-Provided Rideshare Utilization for Radiation Therapy. J Am Coll Radiol 2023; 20:40-50. [PMID: 36581084 DOI: 10.1016/j.jacr.2022.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The potential of rideshare services to facilitate timely radiation therapy (RT), especially for resource-limited patients, is understudied. METHODS Patients (n = 63) who received 73 courses of RT (1,513 fractions) and utilized free hospital-provided rideshare service (537 rides) were included in this retrospective study. A multidimensional analysis was conducted including a comparison of demographic, disease characteristics, and treatment completion data; a revenue analysis to evaluate the financial impact of rideshare services; and a geospatial analysis to evaluate community-level characteristics of patients. RESULTS Median age was 59; most were female (56%) and self-identified as Black or African American (56%), not working (91%), not partnered (83%), high school educated or less (78%), and insured with Medicaid (51%). Geospatial analysis revealed that patients lived in communities with significantly higher rates of resource deprivation. Median rideshare distance was 6.4 miles (interquartile range 3.4-11.2) with a median cost of $13.04 per rideshare (interquartile range 9-19). Of the rideshare-facilitated treatments, 100% were completed, with an overall course completion rate of 97.3% compared with 85.4% for those who did not use rideshare (P = .001); two patients discontinued RT for reasons unrelated to transportation. High rideshare utilization (n = 32), defined as utilization ≥ 45% of the treatment course, was associated with significantly shorter treatment courses and lower radiation doses compared with low rideshare utilization (P = .04). Total rideshare cost for high utilizers and whole cohort was $11,589 and $16,895, facilitating an estimated revenue of $401,952 and $1,175,119, respectively. CONCLUSIONS Free hospital-provided rideshare service is economically feasible and associated with high RT completion rates. It may help enhance quality radiation care for those who come from resource-limited communities.
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Affiliation(s)
- Eric Chen
- Resident, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Alok Deshane
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Medical Student, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nicholas Damico
- Resident, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Michael Kharouta
- Resident, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Uriel Kim
- Medical Student, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Matthew Kemmann
- Director, Strategic Planning and Analytics, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ravi Kyasaram
- Cancer Informatics Senior Data Architect, Cancer Informatics, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Anna K Wu
- Medical Student, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Tithi Biswas
- Thoracic Section Leader, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jennifer Dorth
- Head and Neck Section Leader, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Associate Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David Mansur
- Pediatric Section Leader, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Serah Choi
- CNS Section Leader, and Vice Chair of Laboratory Research, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Assistant Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Aashish Bhatt
- Professor, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Associate Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Kemmann M, Hien S, Horn P, Loersch F, Kuntz S, Schaible T. Einfluss der extrakorporalen Membranoxygenierung (ECMO) auf die zerebrale Oxygenierung, die regionale zerebrale Durchblutung und den intrakraniellen Druck beim neugeborenen Lamm. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-983102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hien S, Kemmann M, Kerl J, Horn P, Leheta O, Schaible T, Nützenadel W. Einfluss der arteriellen CO2 Konzentration auf den regionalen zerebralen Blutfluss (rCBF), die zerebrale Oxygenierung (PtiO2) und den zerebrovaskulären Widerstand (CVR) beim neugeborenen Lamm. Z Geburtshilfe Neonatol 2005. [DOI: 10.1055/s-2005-871343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shvarchuck I, Buggle C, Petrov DS, Dieckmann K, Zielonkowski M, Kemmann M, Tiecke TG, von Klitzing W, Shlyapnikov GV, Walraven JTM. Bose-Einstein condensation into nonequilibrium States studied by condensate focusing. Phys Rev Lett 2002; 89:270404. [PMID: 12513188 DOI: 10.1103/physrevlett.89.270404] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2002] [Indexed: 05/24/2023]
Abstract
We report the formation of Bose-Einstein condensates into nonequilibrium states. Our condensates are much longer than equilibrium condensates with the same number of atoms, show strong phase fluctuations, and have a dynamical evolution similar to that of quadrupole shape oscillations of regular condensates. The condensates emerge in elongated traps as the result of local thermalization when the nucleation time is short compared to the axial oscillation time. We introduce condensate focusing as a new method to extract the phase-coherence length of Bose-Einstein condensates.
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Affiliation(s)
- I Shvarchuck
- FOM Institute for Atomic and Molecular Physics, Kruislaan 407, 1098 SJ Amsterdam, The Netherlands
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