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Torreggiani M, Maselli D, Costi S, Guberti M. Models of Care in Providing Comprehensive Healthcare on Cancer Survivors: A Scoping Review with a TIDieR Checklist Analysis. Int J Environ Res Public Health 2024; 21:122. [PMID: 38397613 PMCID: PMC10888265 DOI: 10.3390/ijerph21020122] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND The study's aim is to identify the models of care used to provide survivorship care plans (SCPs) to cancer survivors in healthcare services, describing what kind of professionals are involved, in which settings and timings, and their feasibility. METHODS The Joanna Briggs Institute methodology for scoping reviews is followed. Studies that considered the SCPs applying different models of care, in any healthcare setting on any adult cancer survivors who completed oncological treatments, have been included. Pubmed, Embase, Cochrane Library, Scopus, and Cinahal were searched from 2013 to 2023 with these keywords: "Survivorship Care Plan", "Oncology", and "Program". The study selection process was reported with the PRISMA-ScR. A total of 325 records were identified, 42 were screened, and, ultimately, 23 articles were included. RESULTS The models of care include: SCP standardization in hospitals; self-support oriented; consultation-based; primary or specialist direct referral; shared care; a multimodal approach. Multidisciplinary teams were involved in the SCP models of care. The settings were private clinics or cancer centers. One-hour SCP interventions were most frequently delivered through in-person visits, by telephone, or online. CONCLUSIONS Implementing SCPs is feasible in healthcare contexts, but with challenges, like time and resource management. Patient-centered programs promoting coordinated care are promising models of care.
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Affiliation(s)
- Martina Torreggiani
- Health Professions Department, Azienda USL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Deborah Maselli
- International Doctorate School in Clinical and Experimental Medicine, Università degli Studi di Modena e Reggio Emilia, 41125 Reggio Emilia, Italy
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Monica Guberti
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy
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Taroeno-Hariadi KW, Herdini C, Briliant AS, Husodoputro HK, Dhamiyati W, Indrasari SR, Lestari SP, Widyastuti Y, Puspitaningtyas H, Rahmasari R, Rachmawati IN, Purwanto I, Setyawan NH, Ekaputra E, Hutajulu SH, Dwidanarti SR, Kurniawan T, Meidania L, Yanuarta SE, Hardianti MS, Kurnianda J. Multidisciplinary Team Meeting in the Core of Nasopharyngeal Cancer Management Improved Quality of Care and Survival of Patients. Health Serv Insights 2023; 16:11786329231204757. [PMID: 37850152 PMCID: PMC10578065 DOI: 10.1177/11786329231204757] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
Nasopharyngeal cancer (NPC) cases are often diagnosed in advanced stages. The complexity of clinical management for advanced-stage NPC requires thorough communication and shared decisions between medical professionals and allied teams. Incorporating a multidisciplinary team meeting (MDTM) for newly diagnosed NPC patients was chosen to facilitate collaboration and communication between physicians. This retrospective study aimed to compare the quality of care, clinical responses and survival between NPC patients treated with and without MDTM. Data on clinical responses, assessment visits, date of progression and death with progression-free survival (PFS), overall survival (OS), and hazard ratio (HR) were collected and analyzed with 95% confidence interval (CI) and significance set as P < .05. There were 87 of 178 NPC patients treated with MDTM. Revisions of diagnosis and stage occurred in 5.7% and 52.9% of cases during the MDTM. More clinical responses were achieved by patients treated with MDTM (69.0%vs 32.0%, P < .00). NPC patients who received MDTM treatment recommendation had a lower risk for progression (median PFS 59.89 months vs 12.68 months; HR 0.267, 95% CI: 0.17-0.40, P < .00) and mortality (median OS was not reached vs 13.44 months; HR 0.134, 95% CI: 0.08-0.24, P < .00) compared to patients without MDTM. Incorporating the MDTM approach into NPC management improves patients' clinical responses and survival.
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Affiliation(s)
- Kartika W Taroeno-Hariadi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Camelia Herdini
- Department of Ear, Nose and Throat, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Aulia S Briliant
- Department of Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Henry K Husodoputro
- Division of Radiodiagnosis, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Wigati Dhamiyati
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Sagung Rai Indrasari
- Department of Ear, Nose and Throat, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Setiyani P Lestari
- Department of Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | | | - Risa Rahmasari
- Tulip Cancer Clinic, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | - Ibnu Purwanto
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Nurhuda H Setyawan
- Division of Radiodiagnosis, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Ericko Ekaputra
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Susanna H Hutajulu
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Sri R Dwidanarti
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Torana Kurniawan
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Lidya Meidania
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Seize E Yanuarta
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Mardiah S Hardianti
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Johan Kurnianda
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
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Obeidat M, Nazzal J, Al Sharie S, Al-Azzam AM, Maswadeh A, Al-Abdallat H, Ismail L, Alkderat M, Hzayen R, Al-Sheble Y, Mansour A, Al-Hussaini M. Central nervous system tumors in patients coming from areas of conflict in the Middle East/North Africa region: an experience from King Hussein Cancer Center. Front Oncol 2023; 13:1087987. [PMID: 37265794 PMCID: PMC10231637 DOI: 10.3389/fonc.2023.1087987] [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: 11/02/2022] [Accepted: 04/11/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction The global cancer burden has been disproportionately shifting towards low- and middle-income countries (LMICs). Limited availability and accessibility to screening, treatment and surveillance, increase in the prevalence and lack of control of risk factors, and underdeveloped healthcare infrastructures have greatly contributed to the disparity in the global cancer burden. Methods A retrospective cohort study was conducted that included adult and pediatric patients with an established diagnosis of Central Nervous System (CNS) tumors including brain or spinal tumors of which different demographic, clinical characteristics, and financial burden were presented. Results 749 patients were included stemming from various countries in the Middle East/North Africa (MENA) region including Libya (34.2%), Palestine (19.8%), Iraq (15.4%), Syria (14.6%) Yemen (14.5%), and Sudan (1.5%). Most patients were adults (66%) with a median age of 34-year-old. 104 patients had died (13.9%), 80 patients were still alive (10.7%) and most of the patients (n= 565, 75.5%) were lost to follow-up. The added cost of managing these patients is 10,172,935 Jordanian Dinars (JOD), with King Hussein Cancer Foundation (KHCF) covering around 34.3% of the total cost. Conclusion Our study aimed at taking a closer look at patients coming from areas of conflict in the MENA region diagnosed and treated for CNS tumors at King Hussein Cancer Center (KHCC) over a 12-year period. It was found that even with the contributions of the Jordanian sources almost half of the patients were faced with the entire financial burden of treatment alone.
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Affiliation(s)
- Mouness Obeidat
- Department of Neurosurgery, King Hussein Cancer Center, Amman, Jordan
| | - Jamil Nazzal
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | | | | | - Ahmad Maswadeh
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | | | - Layan Ismail
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Marah Alkderat
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Ro’ya Hzayen
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
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4
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Frisardi V, Brunetti O, Abbinante V, Ardigò M, Caolo G, Di Turi A, Torsello A, Napoli C, Mancini R, Belleudi V, Addis A, Di Bella O, Ciliberto G, Neri A, Corsini R, Ruggieri P, Pollorsi C, Silvestris N. Impact of COVID-19 pandemic on outpatient visit volume in cancer patients: Results of COMETA multicenter retrospective observational study. Front Public Health 2023; 11:1077103. [PMID: 36866103 PMCID: PMC9971950 DOI: 10.3389/fpubh.2023.1077103] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023] Open
Abstract
Objective To evaluate the impact of the COVID-19 pandemic on first and follow-up visits for cancer outpatients. Methods This is a multicenter retrospective observational study involving three Comprehensive Cancer Care Centers (CCCCs): IFO, including IRE and ISG in Rome, AUSL-IRCCS of Reggio Emilia, and IRCCS Giovanni Paolo II in Bari) and one oncology department in a Community Hospital (Saint'Andrea Hospital, Rome). From 1 January 2020 and 31 December 2021, we evaluated the volume of outpatient consultations (first visits and follow-up), comparing them with the pre-pandemic year (2019). Results were analyzed by quarter according to the Rt (real-time indicator used to assess the evolution of the pandemic). IFO and IRCCS Giovanni Paolo II were "COVID-free" while AUSL-IRCCS RE was a "COVID-mixed" Institute. Depending on the Rt, Sain't Andrea Hospital experienced a "swinging" organizational pathway (COVID-free/ COVID-mixed). Results Regarding the "first appointments", in 2020 the healthcare facilities operating in the North and Center of Italy showed a downward trend. In 2021, only AUSL-IRCCS RE showed an upward trend. Regarding the "follow-up", only AUSL IRCCS RE showed a slight up-trend in 2020. In 2021, IFO showed an increasing trend, while S. Andrea Hospital showed a negative plateau. Surprisingly, IRCCS Giovanni Paolo II in Bari showed an uptrend for both first appointment and follow-ups during pandemic and late pandemic except for the fourth quarter of 2021. Conclusions During the first pandemic wave, no significant difference was observed amongst COVID-free and COVID-mixed Institutes and between CCCCs and a Community Hospital. In 2021 ("late pandemic year"), it has been more convenient to organize COVID-mixed pathway in the CCCCs rather than to keep the Institutions COVID-free. A swinging modality in the Community Hospital did not offer positive results in term of visit volumes. Our study about the impact of COVID-19 pandemic on visit volume in cancer outpatients may help health systems to optimize the post-pandemic use of resources and improve healthcare policies.
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Affiliation(s)
- Vincenza Frisardi
- Department of Neuromotor Diseases, Geriatric Unit, AUSL IRCCS of Reggio Emilia, Reggio Emilia, Italy,*Correspondence: Vincenza Frisardi ✉
| | - Oronzo Brunetti
- Istituto Tumori “Giovanni Paolo II” of Bari, IRCCS, Bari, Italy
| | | | - Marco Ardigò
- San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | | | | | | | - Christian Napoli
- Sapienza University of Rome, Saint'Andrea Hospital, Rome, Lazio, Italy
| | - Rita Mancini
- Sapienza University of Rome, Saint'Andrea Hospital, Rome, Lazio, Italy
| | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | | | - Antonino Neri
- Scientific Directorate, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Romina Corsini
- Scientific Directorate, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Patrizia Ruggieri
- Scientific Directorate, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Pollorsi
- Department of Neuromotor Diseases, Geriatric Unit, AUSL IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology “G. Barresi”, University of Messina, Messina, Italy
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5
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Tam S, Zatirka T, Neslund-Dudas C, Su WT, Cannella CE, Grewal JS, Mattour AH, Tang A, Movsas B, Chang SS. Real time patient-reported outcome measures in patients with cancer: Early experience within an integrated health system. Cancer Med 2023; 12:8860-8870. [PMID: 36670551 PMCID: PMC10134279 DOI: 10.1002/cam4.5635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/23/2022] [Revised: 12/13/2022] [Accepted: 01/08/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND While patient-reported outcome measures (PROMs) have benefit in cancer clinical trials, real-world applications are lacking. This study describes the method of implementation of a cancer enterprise-wide PROMs platform. METHODS After establishing a multispecialty stakeholder group within a large integrated health system, domain-specific instruments were selected from the National Institutes of Health's Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (pain interference, fatigue, physical function, and depression) and were administered at varying frequencies throughout each patient's cancer journey. All cancer patients with an oncologic visit were eligible to complete the PROMs prior to the visit using a patient portal, or at the time of the visit using a tablet. PROMs were integrated into clinical workflow. Clinical partnerships were essential for successful implementation. Descriptive preliminary data were compared using multivariable logistic regression to determine the factors associated with method of PROMs completion. RESULTS From September 16, 2020 to July 23, 2021, 23 of 38 clinical units (60.5%) implemented PROMs over 2392 encounters and 1666 patients. Approximately one third of patients (n = 629, 37.8%) used the patient portal. Black patients (aOR 0.70; 95% CI: 0.51-0.97) and patients residing in zip codes with higher percentage of unemployment (aOR: 0.07, 95% CI: 0.01-0.41) were among the least likely to complete PROMs using the patient portal. CONCLUSIONS Successful system-wide implementation of PROMs among cancer patients requires engagement from multispecialty stakeholders and investment from clinical partners. Attention to the method of PROMs collection is required in order to reduce the potential for disparities, such as Black populations and those residing in areas with high levels of unemployment.
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Affiliation(s)
- Samantha Tam
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Theresa Zatirka
- Division of Clinical and Quality Transformation, Transformation Consulting, Henry Ford Health, Detroit, Michigan, USA
| | | | - Wan-Ting Su
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Cara E Cannella
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Jeewanjot S Grewal
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ahmad H Mattour
- Department of Hematology-Oncology, Henry Ford Health, Detroit, Michigan, USA
| | - Amy Tang
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Steven S Chang
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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Scanlon LA, O’Hara C, Garbett A, Barker-Hewitt M, Barriuso J. Developing an Agnostic Risk Prediction Model for Early AKI Detection in Cancer Patients. Cancers (Basel) 2021; 13:cancers13164182. [PMID: 34439336 PMCID: PMC8393922 DOI: 10.3390/cancers13164182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/23/2022] Open
Abstract
Acute kidney injury (AKI) is a common complication among oncology patients associated with lower remission rates and higher mortality. To reduce the impact of this condition, we aimed to predict AKI earlier than existing tools, to allow clinical intervention before occurrence. We trained a random forest model on 597,403 routinely collected blood test results from 48,865 patients undergoing cancer treatment at The Christie NHS Foundation Trust between January 2017 and May 2020, to identify AKI events upcoming in the next 30 days. AKI risk levels were assigned to upcoming AKI events and tested through a prospective analysis between June and August 2020. The trained model gave an AUROC of 0.881 (95% CI 0.878-0.883), when assessing predictions per blood test for AKI occurrences within 30 days. Assigning risk levels and testing the model through prospective validation from the 1st June to the 31st August identified 73.8% of patients with an AKI event before at least one AKI occurrence, 61.2% of AKI occurrences. Our results suggest that around 60% of AKI occurrences experienced by patients undergoing cancer treatment could be identified using routinely collected blood results, allowing clinical remedial action to be taken and disruption to treatment by AKI to be minimised.
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Affiliation(s)
- Lauren A. Scanlon
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (C.O.); (A.G.); (M.B.-H.)
- Correspondence: (L.A.S.); (J.B.)
| | - Catherine O’Hara
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (C.O.); (A.G.); (M.B.-H.)
| | - Alexander Garbett
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (C.O.); (A.G.); (M.B.-H.)
| | - Matthew Barker-Hewitt
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (C.O.); (A.G.); (M.B.-H.)
| | - Jorge Barriuso
- Division of Cancer Sciences, Manchester Cancer Research Centre, The University of Manchester, Manchester M13 9PL, UK
- Correspondence: (L.A.S.); (J.B.)
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Luzzago S, Mistretta FA, Dossena E, Comandi G, Petralia G, Di Trapani D, Cozzi G, Galfano A, Ferro M, Bocciardi AM, Musi G, de Cobelli O. Uro-oncologic patient management during the COVID-19 pandemic: survey findings from an Italian oncologic hub. Future Oncol 2021; 17:3615-3625. [PMID: 34278823 PMCID: PMC8288285 DOI: 10.2217/fon-2021-0145] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aim: Patient and worker satisfaction at an oncologic hub during the COVID-19 pandemic has never been reported. We addressed this topic. Methods: We conducted a survey to test the views of patients (n = 64) and healthcare professionals (n = 52) involved with our operative protocol. Results: A moderate/severe grade of concern due to the COVID-19 emergency was recorded in 63% of patients versus 75% of hospital staff. High/very high versus low satisfaction grade about preventive strategies to reduce the risk of SARS-CoV-2 contagion was identified in the patients compared with the hospital staff group. Conclusion: Surgical treatment at a hub center of uro-oncologic patients coming from spoke centers is well accepted and should, therefore, be recommended. Preventive strategies to reduce the risk of SARS-CoV-2 contagion in hospital staff members should be implemented. We provide robust evidence that an oncologic hub center during COVID-19 pandemic represents a credible solution for management of non-deferrable uro-oncologic patients. Specifically, surgical treatment at a hub center of patients coming from spoke centers is well accepted by both patients and hospital staff members. Moreover, collaboration between healthcare workers from spoke and hub centers generates minimal levels of anxiety, while potentially being associated with clinical, surgical and scientific improvement. This said, a more specific focus on recommended strategies to reduce the risk of SARS-CoV-2 contagion at oncologic hub hospitals is warranted.
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Affiliation(s)
- Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Francesco A Mistretta
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Enza Dossena
- Nurse Director, Multidisciplinary Surgical Area, European Institute of Oncology, IRCCS, Milan, 20100, Italy
| | - Gianna Comandi
- Nurse Director, Multidisciplinary Surgical Area, European Institute of Oncology, IRCCS, Milan, 20100, Italy
| | - Giovanni Petralia
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Dario Di Trapani
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gabriele Cozzi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Aldo M Bocciardi
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.,Università degli Studi di Milano, Department of Oncology & Hematology-Oncology, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.,Università degli Studi di Milano, Department of Oncology & Hematology-Oncology, Milan, Italy
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8
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Perkons NR, Kim C, Boedec C, Keele LJ, Schneider C, Teitelbaum UR, Ben‐Josef E, Gabriel PE, Plastaras JP, Shulman LN, Wojcieszynski AP. Quantifying the impact of the COVID-19 pandemic on gastrointestinal cancer care delivery. Cancer Rep (Hoboken) 2021; 5:e1427. [PMID: 34137216 PMCID: PMC8420475 DOI: 10.1002/cnr2.1427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/17/2021] [Accepted: 05/04/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND AIM This study quantifies how changes in healthcare utilization and delivery during the first months of the COVID-19 pandemic have altered the presentation, treatment, and management of patients with gastrointestinal (GI) malignancies within an academic health system. METHODS AND RESULTS Patients diagnosed with a GI malignancy (ICD10: C15-C26) who received medical care within the health system during the observation period (first 44 weeks of 2019 and 2020) were identified for a retrospective cohort study. Deidentified patient encounter parameters were collected for this observation period and separated into pre-pandemic (weeks 1-10) and early pandemic (weeks 11-20) study periods. Difference-in-difference analyses adjusted for week-specific and year-specific effects quantified the impact of the COVID-19 pandemic on care delivery between pre-pandemic and early pandemic study periods in 2020. Across all GI malignancies, the COVID-19 pandemic has been associated with a significant decline in the number of patients with new patient visits (NPVs) (p = 1.2 × 10-4 ), Radiology encounters (p = 1.9 × 10-7 ), Surgery encounters (p = 1.6 × 10-3 ), Radiation Oncology encounters (p = 4.1 × 10-3 ), and infusion visits (6.1 × 10-5 ). Subgroup analyses revealed cancer-specific variations in changes to delivery. Patients with colorectal cancer (CRC) had the most significant decrease in NPVs (p = 7.1 × 10-5 ), which was significantly associated with a concomitant decrease in colonoscopies performed during the early pandemic period (r2 = 0.722, p = 2.1 × 10-10 ). CONCLUSIONS The COVID-19 pandemic has been associated with significant disruptions to care delivery. While these effects were appreciated broadly across GI malignancies, CRC, diagnosed and managed by periodic screening, has been affected most acutely.
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Affiliation(s)
| | - Casey Kim
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Chris Boedec
- Data Analytics CenterPerelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Luke J. Keele
- Department of Biostatistics, Epidemiology, and InformaticsPerelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Charles Schneider
- Department of MedicinePerelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | | | - Edgar Ben‐Josef
- Department of Radiation OncologyPerelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Peter E. Gabriel
- Department of Radiation OncologyPerelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - John P. Plastaras
- Department of Radiation OncologyPerelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Lawrence N. Shulman
- Department of MedicinePerelman School of MedicinePhiladelphiaPennsylvaniaUSA
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9
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Turon H, Hill D, Watson R, Hobden B, Millar J, Sanson-Fisher R. A patient-centred approach to determine optimal supportive care across the cancer trajectory: a cross-sectional study. Eur J Cancer Care (Engl) 2021; 30:e13455. [PMID: 33881182 DOI: 10.1111/ecc.13455] [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: 10/10/2020] [Revised: 02/04/2021] [Accepted: 04/05/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Supportive care is recognised as an integral component of cancer care. To comprehensively improve supportive care and to inform policy, it is essential to examine consumer's views of health services. This study aimed to develop and test a patient-centred approach by measuring consumer perspectives on the importance of aspects of supportive care to determine what patients consider highest quality or 'optimal' care. METHODS A cross-sectional survey was conducted in oncology outpatient clinics. Eligible patients were invited to complete the optimal care survey on an iPad. The survey consisted of 69 items assessing 14 care domains across five phases of the care trajectory. RESULTS A total of 359 participants completed the survey. Items in the 'preparation for treatment' and 'follow-up and end-of-life care' phases were endorsed as very important/essential to optimal care by most participants (79-97% and 80-100%, respectively). Items in the 'preparation for first appointment' (48-84%), 'first appointment' (51-97%) and 'receiving treatment' (32-93%) phases showed greater variation in endorsement. CONCLUSION This study provides a patient-centred tool for quantifying optimal supportive care for people with cancer across the treatment trajectory. This tool could be used by healthcare providers to evaluate existing care quality, develop policies and guide clinical service improvements.
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Affiliation(s)
- Heidi Turon
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - David Hill
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Cancer Council Victoria, Melbourne, VIC, Australia.,School of Population & Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Rochelle Watson
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Breanne Hobden
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Jeremy Millar
- Cancer Council Victoria, Melbourne, VIC, Australia.,Alfred Health Radiation Oncology Services, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
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10
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Booth JP, Kennerly-Shah JM, Hartman AD. Description of the role of pharmacist independent double checks during cognitive order verification of outpatient parenteral anti-cancer therapy. J Oncol Pharm Pract 2021; 28:381-386. [PMID: 33611975 DOI: 10.1177/1078155221994319] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To describe pharmacist interventions as a result of an independent double check during cognitive order verification of outpatient parenteral anti-cancer therapy. METHODS A single-center, retrospective analysis of all individual orders for outpatient, parenteral anti-cancer agents within a hematology/oncology infusion center during a 30 day period was conducted. The primary endpoint was error identification rates during first and second verification. Secondary endpoints included the type, frequency, and severity of errors identified during second verification using a modified National Coordinating Council for Medication Error Reporting and Prevention Index. RESULTS A total of 1970 anti-cancer parenteral orders were screened, from which 1645 received an independent double check and were included. The number of errors identified during first and second verification were 30 (1.8%) and 10 (0.6%) respectively; second verification resulted in a 33.3% increase in corrected errors. The 10 errors identified during second verification included: four rate transcriptions to optimize pump interoperability, three rate and/or volume modifications, two dosage adjustments, and one treatment deferral due to toxicity. The severity was classified as Category A for four (40%), Category C for three (30%), and Category D for three (30%) errors. This correlated to a low capacity for harm for seven (70%) and a serious capacity for three (30%) errors. CONCLUSIONS Second verification of outpatient, parenteral anti-cancer medication orders resulted in a 33.3% increase in corrected errors. Three errors detected during second verification were determined to have a serious capacity for harm, supporting the value of independent double checks during pharmacist cognitive order verification.
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Affiliation(s)
- Jennifer P Booth
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie M Kennerly-Shah
- The Arthur G. James Cancer Hospital and Richard Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amber D Hartman
- The Arthur G. James Cancer Hospital and Richard Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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11
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Offei-Nkansah G, Amerine LB. Conversion from paper to electronic acute care chemotherapy orders. Am J Health Syst Pharm 2020; 77:1516-1521. [PMID: 32699883 DOI: 10.1093/ajhp/zxaa201] [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] [Indexed: 11/12/2022] Open
Abstract
PURPOSE UNC Medical Center converted to an electronic health record (EHR) in 2014. This conversion allowed for the transition of paper chemotherapy orders to be managed electronically. This article describes the process for converting inpatient paper chemotherapy orders into the new EHR in a safe and effective manner. SUMMARY A collaborative interdisciplinary approach to the EHR transition enabled our organization to move from using paper chemotherapy orders to fully electronic chemotherapy treatment plans in both ambulatory and acute care areas. Active chemotherapy orders for acute care inpatients were reviewed and transcribed by two oncology pharmacists in the cancer hospital prior to being signed by an attending physician. The newly input orders were independently verified by two pharmacists in the cancer hospital inpatient pharmacy. Nurse review of the signed and verified treatment plans, along with reconciliation of the medication administration record ensured a safe transition to the new EHR workflow. Providers benefit from the ability to review treatment plans remotely, track changes, and include supportive medications in one consolidated location. The coordinated team effort allowed for a smooth transition with minimal interruptions to patient care. CONCLUSION The pharmacist-led, multidisciplinary conversion to electronic chemotherapy orders was safe, accurate, and occurred ahead of schedule for the EHR go-live. Advance communication and planning around scheduled inpatient admissions helped to minimize the impact of the transition from paper to electronic treatment plans. Both pharmacist and physician engagement were necessary to ensure a smooth transition for active inpatient treatment plans.
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Affiliation(s)
| | - Lindsey B Amerine
- UNC Health, Chapel Hill, NC, and UNC Eshelman School of Pharmacy, Chapel Hill, NC
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12
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Leung MST, Lin SG, Chow J, Harky A. COVID-19 and Oncology: Service transformation during pandemic. Cancer Med 2020; 9:7161-7171. [PMID: 32810386 PMCID: PMC7461476 DOI: 10.1002/cam4.3384] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has challenged healthcare systems around the world, where resources have refocused on increasing critical bed capacity to prepare for the peak in incidence of COVID-19. Oncology faces an unprecedented challenge as patients require multidisciplinary care and are more likely to be immunosuppressed. Services in oncology have been transformed using minimal resources over a short period of time. This transformation continues and telemedicine is playing a key role. AIMS We explore how services in oncology have transformed to deliver services including consultations, systemic anticancer therapy, and surgery for patients, while shielding them from contracting COVID-19. We assess the risks and benefits of the service transformation in the immediate, interim, and long term, and how telemedicine supports the process. METHODS We performed a comprehensive review of the literature using suitable keywords on the search engines of PubMed, SCOPUS, Google Scholar, and latest official data from May to June 2020. RESULTS Through the published literature on this topic, we discuss the transformations in oncology and the impact on patients and healthcare workers due to the COVID-19 pandemic. We reflect on the lessions from COVID-19 and assess the role of telemedicine in the future of oncology services. CONCLUSION Transformation of services in oncology effectively shields patients from COVID-19 infections, and telemedicine plays a role in virtual consultations. The long-term effects are yet to be seen, such as safety of home-based treatment, and effectiveness of virtual communication on patient care. As oncology requires a multidisciplinary approach, telemedicine will play a key role to improve patient-centered cancer care in the future.
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Affiliation(s)
- Marco Shiu Tsun Leung
- Department of Medical Oncology, St George's University Hospital NHS Foundation Trust, London, UK.,Faculty of Medicine, St George's Hospital Medical School, London, UK
| | - Shangzhe George Lin
- Department of Medical Oncology, St George's University Hospital NHS Foundation Trust, London, UK.,Faculty of Medicine, St George's Hospital Medical School, London, UK
| | - Jason Chow
- Department of Medical Oncology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Integrative Biology, Faculty of Life Sciences, University of Liverpool, Liverpool, UK
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13
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Cuypers M, Tobi H, Huijsmans CAA, van Gerwen L, Ten Hove M, van Weel C, Kiemeney LALM, Naaldenberg J, Leusink GL. Disparities in cancer-related healthcare among people with intellectual disabilities: A population-based cohort study with health insurance claims data. Cancer Med 2020; 9:6888-6895. [PMID: 32710528 PMCID: PMC7520346 DOI: 10.1002/cam4.3333] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/29/2020] [Accepted: 07/08/2020] [Indexed: 01/07/2023] Open
Abstract
Background Concerns have been raised about the accessibility and quality of cancer‐related care for people with intellectual disabilities (ID). However, there is limited insight into cancer incidence and the utilization of cancer care at the ID population level to inform targeted cancer control strategies. Therefore, we aimed to examine differences in the utilization of cancer‐related care between people with and without ID, identified through diagnostic codes on health insurance claims. Methods In a population‐based cohort study, Dutch individuals of all ages who received residential care through the Chronic Care Act due to an ID (n = 65 183) and an age and sex‐matched sample of persons without ID (1:2 ratio), who were cancer‐free at enrollment in 2013 were followed through 2015. Incidence rates (IRs) of newly started cancer care and IR ratios (IRRs) with 95% CIs were used to compare groups. Separate analyses were performed per cancer type. Results Individuals with ID received less cancer‐related care than individuals without (IRR = 0.64, 95% CI 0.62‐0.66). Differences increased with age and were larger for females than for males. Utilization of care for cancers within the national screening program (female breast, cervical, and colon cancer) was lower for people with ID compared to people without ID. Conclusion Cancer may be underdiagnosed and/or undertreated in people with ID, or cancer is truly less prevalent in this population. In particular, the differences detected between males and females with ID, and the potential underutilization of national screening programs, require urgent follow‐up investigations.
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Affiliation(s)
- Maarten Cuypers
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilde Tobi
- Biometris, Wageningen University & Research, Wageningen, The Netherlands
| | | | | | | | - Chris van Weel
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Health Services Research and Policy, Honorary Professor of Primary Health Care Research, Australian National University, Canberra, Australia
| | - Lambertus A L M Kiemeney
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jenneken Naaldenberg
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geraline L Leusink
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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14
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Mistretta FA, Luzzago S, Molendini LO, Ferro M, Dossena E, Mastrilli F, Musi G, de Cobelli O. A Guide for Oncologic Patient Management during Covid-19 Pandemic: The Initial Experience of an Italian Oncologic Hub with Exemplificative Focus on Uro-Oncologic Patients. Cancers (Basel) 2020; 12:cancers12061513. [PMID: 32531948 PMCID: PMC7352384 DOI: 10.3390/cancers12061513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022] Open
Abstract
The recent exponential increase in the number of COVID-19 patients in Italy led to the adoption of specific extraordinary measures, such as the need to convey treatment of all non-deferrable cancer patients to specialized centres (hubs). We reported a comprehensive summary of guidelines to create and run an oncologic hub during the COVID-19 pandemic. Oncologic hubs must fulfil some specific requirements such as a high experience in oncologic patient treatment, strict strategies applied to remain a “COVID-19-free” centre, and the creation of a dedicated multidisciplinary “hub team”. Cancer treatment of patients who belong to external centres, namely spoke centres, could be organized in different pathways according to the grade of involvement and/or availability of the medical team of the spoke centre. Moreover, dedicated areas should be created for the management and treatment of patients who developed COVID-19 symptoms after hospitalization (i.e., dedicated wards, operation rooms and intensive care beds). Lastly, hospital staff must be highly trained for both preventing COVID-19 contagion and treating patients who develop the infection. We provided a simplified, but complete and easily applicable guide. We believe that this guide could help those clinicians who have to treat oncologic patients during the COVID-19 pandemic.
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Affiliation(s)
- Francesco A. Mistretta
- Department of Urology, European Institute of Oncology, IRCCS, 20100 Milan, Italy; (M.F.); (G.M.)
- Correspondence: (F.A.M.); (S.L.); (O.d.C.); Tel.: +39-34-0598-9010 (F.A.M.); +39-33-3542-4928 (S.L.)
| | - Stefano Luzzago
- Department of Urology, European Institute of Oncology, IRCCS, 20100 Milan, Italy; (M.F.); (G.M.)
- Correspondence: (F.A.M.); (S.L.); (O.d.C.); Tel.: +39-34-0598-9010 (F.A.M.); +39-33-3542-4928 (S.L.)
| | - Luigi Orlando Molendini
- Risk Officer, Department of Medical Direction, European Institute of Oncology, IRCCS, 20100 Milan, Italy;
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology, IRCCS, 20100 Milan, Italy; (M.F.); (G.M.)
| | - Enza Dossena
- Nurse Director, Multidisciplinary Surgical Area, European Institute of Oncology, IRCCS, 20100 Milan, Italy;
| | - Fabrizio Mastrilli
- Chief Medical Officer, Department of Medical Direction, European Institute of Oncology, IRCCS, 20100 Milan, Italy;
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, IRCCS, 20100 Milan, Italy; (M.F.); (G.M.)
| | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology, IRCCS, 20100 Milan, Italy; (M.F.); (G.M.)
- Department of Oncology and Haematology-Oncology, Università degli studi di Milano, 20100 Milan, Italy
- Correspondence: (F.A.M.); (S.L.); (O.d.C.); Tel.: +39-34-0598-9010 (F.A.M.); +39-33-3542-4928 (S.L.)
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15
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Taniguchi LU, Ramos FJDS, Momma AK, Martins Filho APR, Bartocci JJ, Lopes MFD, Sad MH, Rodrigues CM, Pires Siqueira EM, Vieira JM. Subjective score and outcomes after discharge from the intensive care unit: a prospective observational study. J Int Med Res 2019; 47:4183-4193. [PMID: 31304841 PMCID: PMC6753551 DOI: 10.1177/0300060519859736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Intensive care unit (ICU) discharge is a decision process that is usually
performed subjectively. We evaluated whether a subjective score (Sabadell
score) is associated with hospital outcomes. Methods We conducted a prospective cohort study from August 2014 to May 2015 at a
tertiary-care private hospital in Brazil. We analyzed 425 patients who were
discharged alive from the ICU to the wards. We used univariate and
multivariate analysis to identify risk factors associated with a composite
endpoint of worse outcomes (later ICU readmission or ward death) during the
same hospitalization. Results Forty-three patients (10.1%) were readmitted after ICU discharge, and 19 died
in the ward. Compared with patients with successful outcomes, those with the
composite endpoint were older and more severely ill, had a nonsurgical
reason for hospitalization, more frequently came from the ward, were less
frequently independent during daily activities, had sepsis, had higher
C-reactive protein concentrations at ICU admission, and had higher Sabadell
scores at discharge. The multivariate analysis showed that sepsis and the
Sabadell score were independently and significantly associated with worse
outcomes. Conclusion Sepsis at admission and the Sabadell score were predictors of worse hospital
outcomes. The Sabadell score might be a promising predictive tool.
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Affiliation(s)
- Leandro Utino Taniguchi
- Hospital Sirio-Libanes, São Paulo, Brazil.,Emergency Medicine Discipline, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
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16
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Uprety A, Ozaki A, Higuchi A, Ghimire B, Sawano T, Tsuda K, Nomura S, Leppold C, Tsubokura M, Tanimoto T, Singh YP. Long-term trends of hospital admissions among patients with cancer following the 2015 earthquake: a single institution observational study in Kathmandu, Nepal. BMJ Open 2019; 9:e026746. [PMID: 31256023 PMCID: PMC6609058 DOI: 10.1136/bmjopen-2018-026746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Little is known regarding how natural disasters affect patients with cancer in low-income and middle-income countries. The objective of the present study was to assess the impact of the 2015 Nepal earthquake on the admission of patients with cancer at a core medical institution in Kathmandu. DESIGN, SETTING AND PARTICIPANTS We considered all 3520 cancer patient admissions to Tribhuvan University Teaching Hospital, from 25 April 2013 to 24 April 2017 (2 years before and 2 years after the earthquake). OUTCOME MEASURES The number of cancer patient admissions was calculated for each month. Using a negative binomial model, we estimated the incidence rate ratio (IRR) for admission numbers each month after the earthquake compared with the pre-earthquake baseline and investigated chronological change. RESULTS The total admission number in the first month after the earthquake was decreased compared with that of the predisaster baseline (IRR=0.66, 95% CI 0.43 to 1.00), which largely reflected decreased admissions of patients from outside of the most disaster-affected districts. From the second month, the admission number consistently exceeded the predisaster baseline for the remaining postdisaster period. In contrast to the month of the disaster, the continuation of increased admissions was most prominent among those from outside of the most affected districts. CONCLUSIONS After a transient decrease immediately following the 2015 Nepal earthquake, there was a long-term increase in cancer patient admissions in a core hospital in Kathmandu. These changes were seen most prominently in patients from outside the most disaster affected areas.
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Affiliation(s)
- Anup Uprety
- Department of Anesthesiology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Akihiko Ozaki
- Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Asaka Higuchi
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
| | - Bikal Ghimire
- Department of Gastrointestinal and General Surgery, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Toyoaki Sawano
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
- Department of Surgery, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
| | - Kenji Tsuda
- Department of Hematology and Rheumatology, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Shuhei Nomura
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Claire Leppold
- Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Masaharu Tsubokura
- Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
| | - Tetsuya Tanimoto
- Department of Internal Medicine, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Yogendra Prasad Singh
- Department of Gastrointestinal and General Surgery, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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17
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Lelorain S, Cortot A, Christophe V, Pinçon C, Gidron Y. Physician Empathy Interacts with Breaking Bad News in Predicting Lung Cancer and Pleural Mesothelioma Patient Survival: Timing May Be Crucial. J Clin Med 2018; 7:jcm7100364. [PMID: 30336582 PMCID: PMC6210310 DOI: 10.3390/jcm7100364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/03/2018] [Accepted: 10/15/2018] [Indexed: 12/15/2022] Open
Abstract
This study is the first to examine the prognostic role of physician empathy in interaction with the type of consultation (TC) (TC, bad news versus follow-up consultations) in cancer patient survival. Between January 2015 and March 2016, 179 outpatients with thoracic cancer and a Karnofsky performance status ≥60 assessed their oncologist’s empathy using the CARE questionnaire, which provides a general score and two sub-dimensions: listening/compassion and active/positive empathy. Survival was recorded until April 2018. Usual medical, social and psychological confounders were included in the Cox regression. The median follow-up time was 3.1 years. There was a statistical interaction between listening/compassion empathy and TC (p = 0.016) such that in bad news consultations, higher listening/compassion predicted a higher risk of death (hazard ratio (HR) = 1.13; 95% confidence interval (CI): 1.03–1.23; p = 0.008). In follow-up consultations, listening/compassion did not predict survival (HR = 0.94; 95% CI: 0.85–1.05; p = 0.30). The same results were found with the general score of empathy, but not with active/positive empathy. In bad news consultations, high patient-perceived physician compassion could worry patients by conveying the idea that there is no longer any hope, which could hasten death. Further studies are warranted to confirm these results and find out the determinants of patient perception of physician empathy.
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Affiliation(s)
- Sophie Lelorain
- University of Lille, CNRS, CHU Lille, UMR 9193-SCALab-Cognitive and Affective Sciences, F-59000 Lille, France.
| | - Alexis Cortot
- University of Lille, Department of Thoracic Oncology, Albert Calmette University Hospital, F-59000 Lille, France.
| | - Véronique Christophe
- University of Lille, CNRS, CHU Lille, UMR 9193-SCALab-Cognitive and Affective Sciences, F-59000 Lille, France.
| | - Claire Pinçon
- University of Lille, CHU Lille, EA 2694, Public Health: Epidemiology and Quality of Care, F-59000 Lille, France.
| | - Yori Gidron
- University of Lille, CNRS, CHU Lille, UMR 9193-SCALab-Cognitive and Affective Sciences, F-59000 Lille, France.
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18
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Ems D, Murty S, Loy B, Gallagher J, Happe LE, Rogstad TL, Finnel D, Fernandez JD. Alternative Payment Models in Medical Oncology: Assessing Quality-of-Care Outcomes Under Partial Capitation. Am Health Drug Benefits 2018; 11:371-378. [PMID: 30647824 PMCID: PMC6306101] [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] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 07/09/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Alternative payment models (APMs) in healthcare are emerging that reward quality of care over quantity of services. Most bundled payment programs that are described in published studies are related to episodes for a surgical inpatient hospital stay. With outpatient services, monthly capitated payments are an alternative to bundled payments for specialty services. OBJECTIVE To assess the association of a capitated contractual arrangement between a primary care physician group and an oncology clinic group with the quality of care received. METHODS We evaluated the effect of an oncology group's transition from a fee-for-service (FFS) arrangement to a partial-capitated-payment model with a primary care group. We compared outcomes for patients who received treatment after implementation of the new arrangement (ie, postcontract capitated group) with outcomes of patients receiving treatment before the change (ie, precontract capitated group). In addition, we conducted a parallel analysis of patients from a population that was not affected by the contract to assess temporal effects (ie, postcontract FFS group vs precontract FFS group). All patients were enrolled in Medicare Advantage plans of a single health plan (ie, Humana), and outcomes were measured using claims data provided by that company. Patients in the 2 precontract groups received treatment between July 1, 2010, and June 30, 2011; patients in the 2 postcontract groups received treatment between January 1, 2013, and December 31, 2013. Age- and sex-adjusted all-cause hospitalization, complications from cancer treatment, and ambulance transfers during 6 months of follow-up were evaluated. RESULTS In the population subject to the partial-capitated-payment model, the postcontract group (N = 305) was younger than the precontract group (N = 165). In a subset of patients in the 2 capitated groups who had Deyo-Charlson Comorbidity Index (CCI) RxRisk scores, the postcontract capitated group had significantly higher CCI scores. Adjusted odds ratios for the postcontract capitated group versus the precontract capitated group showed no difference in the likelihood that any of the outcomes would occur. However, the mean number of chemotherapy-related complications and ambulance transports were greater postcontract. In the parallel analysis of the population not affected by the new payment arrangement, no differences were found between the pre- and postcontract groups. This suggests that temporal changes potentially affecting patients in the capitated and FFS populations would not have influenced postcontract outcomes. CONCLUSIONS After the implementation of partial-capitated payments for medical oncology services in the oncology practice, the likelihood of a patient experiencing at least 1 event of a specific adverse outcome did not change; however, the average number of some adverse events did increase, which may in part be explained by a higher level of underlying morbidity in the postcontract group. The overall findings of this study suggest that quality of care was not compromised in this APM.
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Affiliation(s)
- Derek Ems
- Research Consultant, Comprehensive Health Insights, Humana, Louisville, KY, during the study
| | | | - Bryan Loy
- Medical Director, Oncology and Lab Strategies, Humana
| | | | | | | | - Debra Finnel
- Executive Vice President, MCCI Medical Group, San Antonio, TX
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Chiew KL, Sundaresan P, Jalaludin B, Vinod SK. A narrative synthesis of the quality of cancer care and development of an integrated conceptual framework. Eur J Cancer Care (Engl) 2018; 27:e12881. [PMID: 30028054 DOI: 10.1111/ecc.12881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 02/08/2018] [Revised: 04/17/2018] [Accepted: 05/31/2018] [Indexed: 12/11/2022]
Abstract
The general paradigms that exist to guide measures in quality of care do not sufficiently deal with the changing needs of cancer management. The aim of this study was to review the literature regarding the quality of cancer care and develop a conceptual framework relevant to current practice. A textual narrative review of the literature was conducted by searching electronic databases from the last 10 years. Articles were then screened and included if they were both relevant to the management of cancer and standards in quality of care. Thematic analysis of the included articles was performed. Eighty-three articles were included and 12 domains identified and integrated with current models to develop a conceptual framework. These included: healthcare delivery system; timeliness; access; appropriateness of care; multidisciplinary and coordinated care; patient experience; technical aspects; safety; patient-centred outcomes; disease-specific outcomes; innovation and improvement and value. We propose a conceptual framework for the quality of cancer care based on relevant and current oncology practice. This presents a more practical and comprehensive approach than general models, and can be used by healthcare providers, managers and policy makers to guide and identify the need for metrics for quality improvements.
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Affiliation(s)
- Kim-Lin Chiew
- Radiation Oncology, Sydney West Cancer Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Puma Sundaresan
- Radiation Oncology, Sydney West Cancer Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Bin Jalaludin
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,Epidemiology, Healthy People and Places Unit, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Shalini K Vinod
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Radiation Oncology, Liverpool Cancer Therapy Centre, South Western Sydney Local Health District Cancer Services, Sydney, New South Wales, Australia
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20
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Raeissi P, Sharifi M, Khosravizadeh O, Heidari M. Survey of Cancer Patient Safety Culture: A Comparison of Chemotherapy and Oncology Departments of Teaching Hospitals of Tehran. Asian Pac J Cancer Prev 2017; 18:2775-2779. [PMID: 29072411 PMCID: PMC5747403 DOI: 10.22034/apjcp.2017.18.10.2775] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Patient safety culture plays an important role in healthcare systems, especially in chemotherapy and oncology departments (CODs), and its assessment can help to improve quality of services and hospital care. Objective: This study aimed to evaluate and compare items and dimensions of patient safety culture in the CODs of selected teaching hospitals of Iran and Tehran University of Medical Sciences. Materials and Methods: This descriptive-analytical crosssectional survey was conducted during a six-month period on 270 people from chemotherapy and oncology departments selected through a cluster sampling method. All participants answered the standard questionnaire for “Hospital Survey of Patient Safety Culture” (HSOPSC). Statistical analyses were performed using SPSS/18 software. Results: The average score for patient safety culture was three for the majority of the studied CODs. Statistically significant differences were observed for supervisor actions, teamwork within various units, feedback and communications about errors, and the level of hospital management support. (p<0.05). Relationships between studied hospitals and patient safety culture were not statistically significant (p>0.05). Conclusion: Our results showed that the overall status of patient safety culture is not good in the studied CODs. In particular, teamwork across different units and organizational learning with continuous improvement were the only two properly operating items among 12 dimensions of patient safety culture. Therefore, systematic interventions are strongly required to promote communication.
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Affiliation(s)
- Pouran Raeissi
- Department of Health Management, School of Health Management and Information Sciences, International Campus (IUMS-IC), Tehran, Iran
| | - Marziye Sharifi
- Department of Health Management, School of Health Management and Information Sciences, International Campus (IUMS-IC), Tehran, Iran,For Correspondence:
| | - Omid Khosravizadeh
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Heidari
- Department of Medical and Surgical, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Abstract
BACKGROUND Opioids are the primary pharmacological treatment for cancer pain and, in the palliative care setting, are routinely used to manage symptoms at the end of life. Opioids are one of the most frequently reported drug classes in medication errors causing patient harm. Despite their widespread use, little is known about the incidence and impact of opioid medication errors in oncology and palliative care settings. AIM To determine the incidence, types and impact of reported opioid medication errors in adult oncology and palliative care patient settings. DESIGN A systematic review. DATA SOURCES Five electronic databases and the grey literature were searched from 1980 to August 2014. Empirical studies published in English, reporting data on opioid medication error incidence, types or patient impact, within adult oncology and/or palliative care services, were included. Popay's narrative synthesis approach was used to analyse data. RESULTS Five empirical studies were included in this review. Opioid error incidence rate was difficult to ascertain as each study focussed on a single narrow area of error. The predominant error type related to deviation from opioid prescribing guidelines, such as incorrect dosing intervals. None of the included studies reported the degree of patient harm resulting from opioid errors. CONCLUSION This review has highlighted the paucity of the literature examining opioid error incidence, types and patient impact in adult oncology and palliative care settings. Defining, identifying and quantifying error reporting practices for these populations should be an essential component of future oncology and palliative care quality and safety initiatives.
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Affiliation(s)
- Nicole Heneka
- School of Nursing, University of Notre Dame Australia, Darlinghurst Campus, Broadway, NSW, Australia
| | - Tim Shaw
- Research in Implementation Science and eHealth (RISe), Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Debra Rowett
- Drug and Therapeutics Information Service, Repatriation General Hospital, Adelaide, SA, Australia
| | - Jane L Phillips
- School of Nursing, University of Notre Dame Australia, Darlinghurst Campus, Broadway, NSW, Australia Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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22
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Ospina-Romero M, Portilla CA, Bravo LE, Ramirez O. Caregivers' Self-Reported Absence of Social Support Networks is Related to Treatment Abandonment in Children With Cancer. Pediatr Blood Cancer 2016; 63:825-31. [PMID: 26871640 DOI: 10.1002/pbc.25919] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 11/21/2015] [Accepted: 12/16/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment abandonment (TxA) is a primary cause of therapy failure in children with cancer in low-/middle-income countries. We explored the absence of social support network (SSN), among other predictive factors, and TxA in children with cancer in Cali, Colombia. PROCEDURE In this prospective cohort study, we included children diagnosed with cancer at a public university hospital. A social worker and a psychologist administered semistructured questionnaires to patients' caregivers. We extracted information from the questionnaires about social, economic, and psychological conditions of the patients' families. Outcomes were death, relapse, and TxA. Failure either to start or to continue the planned course of curative treatment for 4 weeks or more was defined as TxA. We identified events with Cali's childhood cancer outcomes surveillance system (VIGICANCER). We adjusted the hazard ratios (HRs) for potential confounders using multivariate Cox regression analyses. RESULTS Among 188 patients diagnosed from January 2011 to June 2013, 99 interviews were conducted. Median age was 5 years old (range: 0.3, 14.9), 53% were male, 17% were of Colombian-Indian ethnicity, and 68% lived in rural areas. The 2-year cumulative incidence of TxA was 21% (95% confidence interval [CI]: 13, 35) and the annual proportion was 14%. The adjusted HR for the absence of SSN was 4.9 (95% CI: 1.6, 15.3). CONCLUSIONS We found a strong association between the absence of SSN and TxA that was independent of other covariates, including surrogate measures of wealth. Our findings highlight the imperative understanding of social ties and support surrounding children's families for planning strategies to prevent TxA.
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Affiliation(s)
| | - Carlos Andrés Portilla
- School of Medicine, Universidad del Valle, Cali, Colombia.,Valley Public University Hospital, Cali, Colombia.,POHEMA Foundation, Cali, Colombia
| | - Luis Eduardo Bravo
- School of Medicine, Universidad del Valle, Cali, Colombia.,Population Based Cali Cancer Registry, Colombia
| | - Oscar Ramirez
- POHEMA Foundation, Cali, Colombia.,Imbanaco Medical Center, Cali, Colombia.,Population Based Cali Cancer Registry, Colombia
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Saunders CL, Abel GA, Lyratzopoulos G. Inequalities in reported cancer patient experience by socio-demographic characteristic and cancer site: evidence from respondents to the English Cancer Patient Experience Survey. Eur J Cancer Care (Engl) 2014; 24:85-98. [PMID: 25327713 PMCID: PMC4309492 DOI: 10.1111/ecc.12267] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 11/30/2022]
Abstract
Patient experience is a critical dimension of cancer care quality. Understanding variation in experience among patients with different cancers and characteristics is an important first step for designing targeted improvement interventions. We analysed data from the 2011/2012 English Cancer Patient Experience Survey (n = 69,086) using logistic regression to explore inequalities in care experience across 64 survey questions. We additionally calculated a summary measure of variation in patient experience by cancer, and explored inequalities between patients with cancers treated by the same specialist teams. We found that younger and very old, ethnic minority patients and women consistently reported worse experiences across questions. Patients with small intestine/rarer lower gastrointestinal, multiple myeloma and hepatobiliary cancers were most likely to report negative experiences whereas patients with breast, melanoma and testicular cancer were least likely (top-to-bottom odds ratio = 1.91, P < 0.0001). There were also inequalities in experience among patients with cancers treated by the same specialty for five of nine services (P < 0.0001). Specifically, patients with ovarian, multiple myeloma, anal, hepatobiliary and renal cancer reported notably worse experiences than patients with other gynaecological, haematological, gastrointestinal and urological malignancies respectively. Initiatives to improve cancer patient experience across oncology services may be suitably targeted on patients at higher risk of poorer experience.
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Affiliation(s)
- C L Saunders
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
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24
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Costa DDM, Kipnis A, Leão-Vasconcelos LSNDO, Rocha-Vilefort LO, Telles SA, André MCDPB, Tipple AFV, Lima ABM, Ribeiro NFG, Pereira MR, Prado-Palos MA. Methicillin-resistant Staphylococcus sp. colonizing health care workers of a cancer hospital. Braz J Microbiol 2014; 45:799-805. [PMID: 25477910 PMCID: PMC4204961 DOI: 10.1590/s1517-83822014000300006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 12/13/2013] [Indexed: 11/22/2022] Open
Abstract
The aim of the study was to analyze epidemiological and microbiological aspects of oral colonization by methicillin-resistant Staphylococcus of health care workers in a cancer hospital. Interview and saliva sampling were performed with 149 health care workers. Antimicrobial resistance was determined by disk diffusion and minimum inhibitory concentration. Polymerase Chain Reaction, Internal Transcribed Spacer-Polymerase Chain Reaction and Pulsed Field Gel Electrophoresis were performed for genotypic characterization of methicillin-resistant Staphylococcus. Risk factors were determined by logistic regression. Methicillin-resistant Staphylococcus colonization prevalence was 19.5%, denture wearing (p = 0.03), habit of nail biting (p = 0.04) and preparation and administration of antimicrobial (p = 0.04) were risk factors identified. All methicillin-resistant Staphylococcus were S. epidermidis, 94.4% of them had mecA gene. Closely related and indistinguishable methicillin-resistant S. epidermidis were detected. These results highlight that HCWs which have contact with patient at high risk for developing infections were identified as colonized by MRSE in the oral cavity, reinforcing this cavity as a reservoir of these bacteria and the risk to themselves and patients safety, because these microorganisms may be spread by coughing and talking.
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Affiliation(s)
- Dayane de Melo Costa
- Núcleo de Estudos e Pesquisa de Enfermagem em Prevenção e Controle de Infecções Relacionadas à Assistência à Saúde Faculdade de Enfermagem Universidade Federal de Goiás GoiâniaGO Brazil Núcleo de Estudos e Pesquisa de Enfermagem em Prevenção e Controle de Infecções Relacionadas à Assistência à Saúde, Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - André Kipnis
- Instituto de Patologia Tropical e Saúde Pública Universidade Federal de Goiás GoiâniaGO Brazil Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Lara Stefânia Netto de Oliveira Leão-Vasconcelos
- Instituto de Patologia Tropical e Saúde Pública Universidade Federal de Goiás GoiâniaGO Brazil Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | - Sheila Araújo Telles
- Faculdade de Enfermagem Universidade Federal de Goiás GoiâniaGO Brazil Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Maria Cláudia Dantas Porfírio Borges André
- Instituto de Patologia Tropical e Saúde Pública Universidade Federal de Goiás GoiâniaGO Brazil Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Anaclara Ferreira Veiga Tipple
- Faculdade de Enfermagem Universidade Federal de Goiás GoiâniaGO Brazil Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Ana Beatriz Mori Lima
- Secretaria Municipal de Saúde de Goiânia GoiâniaGO Brazil Secretaria Municipal de Saúde de Goiânia, Goiânia, GO, Brazil
| | | | - Mayara Regina Pereira
- Núcleo de Estudos e Pesquisa de Enfermagem em Prevenção e Controle de Infecções Relacionadas à Assistência à Saúde Faculdade de Enfermagem Universidade Federal de Goiás GoiâniaGO Brazil Núcleo de Estudos e Pesquisa de Enfermagem em Prevenção e Controle de Infecções Relacionadas à Assistência à Saúde, Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Marinésia Aparecida Prado-Palos
- Faculdade de Enfermagem Universidade Federal de Goiás GoiâniaGO Brazil Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia, GO, Brazil
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25
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Nakamura F, Higashi T, Saruki N, Fukuhara S, Sobue T. Understanding by the general public of newspaper reports on publicly reported cancer survival in Japan: a randomized controlled trial. Jpn J Clin Oncol 2014; 44:651-60. [PMID: 24821974 DOI: 10.1093/jjco/hyu058] [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] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study was aimed to examine how well readers of newspapers understand cancer survival rate data, and the effect of this understanding on their behavioral intent. METHODS We recruited 1950 persons who were 20 years old or older registered with a market research company. Participants were randomly divided into 10 groups; 9 were assigned one of nine newspaper articles, and the remaining group was assigned the excerpt of the official Association of Clinical Cancer Centers web pages. The primary outcome was the proportion of respondents with 'sufficient understanding', who gave 70% or more correct answers on a 10-item knowledge question. RESULTS The proportion of participants with sufficient understanding varied across the groups (range: 0.8-22.1%, overall, P<0.001). Only around 15% of participants answered that they would consider other hospitals in a scenario where the only hospital in the participants' area had a 5-year survival of 5% or less, and answers did not significantly vary between groups (range: 11.1-21.0%, overall P=0.77). CONCLUSIONS The level of understanding of cancer survival rate varied by variation in media reporting. However, the effect of behavioral intent on hospital choice did not differ between articles. TRIAL REGISTRATION UMIN CTR UMIN000004885.
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Affiliation(s)
- Fumiaki Nakamura
- Department of Public Health/Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Takahiro Higashi
- Division of Cancer Health Services Research, Center for Cancer Control and Information Services, The National Cancer Center, Tokyo
| | - Nobuhiro Saruki
- Department of Anesthesia, Gunma Prefectural Cancer Center, Gunma
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine, Kyoto
| | - Tomotaka Sobue
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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26
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Shea CM, Teal R, Haynes-Maslow L, McIntyre M, Weiner BJ, Wheeler SB, Jacobs SR, Mayer DK, Young MD, Shea TC. Assessing the feasibility of a virtual tumor board program: a case study. J Healthc Manag 2014; 59:177-193. [PMID: 24988672 PMCID: PMC4116610] [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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Multidisciplinary tumor boards involve various providers (e.g., oncology physicians, nurses) in patient care. Although many community hospitals have local tumor boards that review all types of cases, numerous providers, particularly in rural areas and smaller institutions, still lack access to tumor boards specializing in a particular type of cancer (e.g., hematologic). Videoconferencing technology can connect providers across geographic locations and institutions; however, virtual tumor board (VTB) programs using this technology are uncommon. In this study, we evaluated the feasibility of a new VTB program at the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center, which connects community-based clinicians to UNC tumor boards representing different cancer types. Methods included observations, interviews, and surveys. Our findings suggest that participants were generally satisfied with the VTB. Cases presented to the VTB were appropriate, sufficient information was available for discussion, and technology problems were uncommon. UNC clinicians viewed the VTB as a service to patients and colleagues and an opportunity for clinical trial recruitment. Community-based clinicians presenting at VTBs valued the discussion, even if it simply confirmed their original treatment plan or did not yield consensus recommendations. Barriers to participation for community-based clinicians included timing of the VTB and lack of reimbursement. To maximize benefits of the VTB, these barriers should be addressed, scheduling and preparation processes optimized, and appropriate measures for evaluating impact identified.
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Affiliation(s)
- Christopher M. Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Randall Teal
- Cecil G. Sheps Center for Health Services Research, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Lindsey Haynes-Maslow
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | | | - Bryan J. Weiner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie B. Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Sara R. Jacobs
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Deborah K. Mayer
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- School of Nursing, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Michael D. Young
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Thomas C. Shea
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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Haidet P, Fecile ML, West HF, Teal CR. Reconsidering the team concept: educational implications for patient-centered cancer care. Patient Educ Couns 2009; 77:450-455. [PMID: 19850437 PMCID: PMC2787698 DOI: 10.1016/j.pec.2009.09.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 07/15/2009] [Accepted: 09/11/2009] [Indexed: 05/28/2023]
Abstract
Patient-centered cancer care has become a priority in the oncology field. Increasing efforts to train oncologists in communication skills have led to a growing literature on patient-centered cancer education. In addition, systems approaches have led to an increased emphasis on the concept of teams as an organizing framework for cancer care. In this essay, we examine issues involved in educating teams to provide patient-centered cancer care. In the process, we question the applicability of a tightly coordinated 'team' concept, and suggest the concept of a 'care community' as a more achievable ideal for the way that cancer care is commonly delivered. We discuss the implications that this has for cancer communication education, and propose three principles to guide the development of educational interventions aimed at increasing patient-centeredness in cancer care delivery systems.
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Affiliation(s)
- Paul Haidet
- Office of Medical Education and the Department of Medicine, Pennsylvania State University College of Medicine, 500 University Drive (HU15), Hershey, PA 17033, USA.
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