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Vanderpool RC, Muro A. Building capacity for community outreach and engagement activities across the translational research continuum at NCI Cancer Centers. Cancer Causes Control 2024; 35:739-740. [PMID: 38180675 DOI: 10.1007/s10552-023-01831-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- Robin C Vanderpool
- Division of Cancer Control and Population Sciences, Behavioral Research Program, Health Communication and Informatics Research Branch, National Cancer Institute, 9609 Medical Center Drive, 3E610, Rockville, MD, 20850, USA.
| | - Abigail Muro
- Division of Cancer Control and Population Sciences, Behavioral Research Program, Health Communication and Informatics Research Branch, National Cancer Institute, 9609 Medical Center Drive, 3E610, Rockville, MD, 20850, USA
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Singh G, Morant L, Bedra M, Emel J, Harris K, Markan Y, de Borja C, Tong M, Downs P, Boutros C. Value of a multidisciplinary geriatric oncology committee on patient care in a community-based, academic cancer center. J Geriatr Oncol 2024; 15:101771. [PMID: 38615579 DOI: 10.1016/j.jgo.2024.101771] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/14/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION The heterogeneity in health and functional ability among older patients makes the management of cancer a unique challenge. The Geriatric Oncology Program at the University of Maryland Baltimore Washington Medical Center (BWMC) was created to optimize cancer management for older patients. This study aimed to assess the benefits of the implementation of such a program at a community-based academic cancer center. MATERIALS AND METHODS We analyzed patients aged ≥80 years presenting to the Geriatric Oncology Program between 2017 and 2022. A multidisciplinary team of specialists collectively reviewed each patient using geriatric-specific domains and stratified each patient into one of three management groups- Group 1: those deemed fit to receive standard oncologic care (SOC); Group 2: those recommended to receive optimization services prior to reassessment for SOC; and Group 3: those deemed to be best suited for supportive care and/or hospice care. RESULTS The study cohort consisted of 233 patients, of which 76 (32.6%) received SOC, 43 (18.5%) were optimized, and 114 (49.0%) received supportive care or hospice referral. Among the optimized patients, 69.8% were deemed fit for SOC upon re-evaluation following their respective optimization services. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) score was implemented in 2019 (n = 90). Patients receiving supportive/hospice care only had an average score of 5.8, while the averages for those in the optimization and SOC groups were 4.6 and 4.1, respectively (p ≤0.001). Patients receiving SOC had the longest average survival of 2.71 years compared to the optimization (2.30 years) and supportive care groups (0.93 years) (p ≤0.001). For all patients that underwent surgical interventions post-operatively, 23 patients (85%) were discharged home and four (15%) were discharged to a rehabilitation facility. DISCUSSION The present study demonstrates the profound impact that the complexities in health status and frailty among older individuals can have during cancer management. The Geriatric Oncology Program at BWMC maximized treatment outcomes for older adults through the provision of SOC therapies and optimization services, while also minimizing unnecessary interventions on an individual patient-centric level.
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Affiliation(s)
- Gurbani Singh
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States; University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201, United States
| | - Lena Morant
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - McKenzie Bedra
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - Jennifer Emel
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - Kelly Harris
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - Yudhishtra Markan
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - Christopher de Borja
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - Monica Tong
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - Patrice Downs
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States
| | - Cherif Boutros
- University of Maryland Baltimore Washington Medical Center, 301 Hospital Dr, Glen Burnie, MD 21061, United States; University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201, United States.
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Acramel A, Blondeel-Gomes S, Dupré M, Kayembe OT, Rochereau A, Escalup L, Desmaris R, Jourdan N, Cordary A, Vaflard P, Cottu P, Bellesoeur A. Advanced prescription of injectable anticancer drugs: Safety assessment in a European Comprehensive Cancer Centre using the risk matrix approach. Br J Clin Pharmacol 2024; 90:1333-1343. [PMID: 38403473 DOI: 10.1111/bcp.16020] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
AIMS The purpose of this work was to assess failures in the advanced prescription of parenteral anticancer agents in an adult day oncology care unit with more than 100 patients per day. METHODS An a priori descriptive analysis was carried out by using the risk matrix approach. After defining the scope in a multidisciplinary meeting, we determined at each step the failure modes (FMs), their effects (E) and their associated causes (C). A severity score (S) was assigned to all effects and a probability of occurrence (O) to all causes. These S and O indicators, were used to obtain a criticality index (CI) matrix. We assessed the risk control (RC) of each failure in order to define a residual criticality index (rCI) matrix. RESULTS During risk analysis, 14 FMs were detected, and 61 scenarios were identified considering all possible effects and causes. Nine situations (15%) were highlighted with the maximum CI, 18 (30%) with a medium CI, and 34 (55%) with a negligible CI. Nevertheless, among all these critical situations, only three (5%) had an rCI to process (i.e., missed dose adjustment, multiple prescriptions and abnormal biology data); the others required monitoring only. Clinicians' and pharmacists' knowledge of these critical situations enables them to manage the associated risks. CONCLUSIONS Advanced prescription of injectable anticancer drugs appears to be a safe practice for patients when combined with risk management. The major risks identified concerned missed dose adjustment, prescription duplication and lack of consideration for abnormal biology data.
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Affiliation(s)
- Alexandre Acramel
- Département de Pharmacie, Institut Curie, PSL Research University, Paris, France
- Université Paris Cité, CiTCoM, CNRS UMR 8038, Inserm U1268, Paris, France
| | - Sandy Blondeel-Gomes
- Département de Radiopharmacologie, Institut Curie, PSL Research University, Paris, France
| | - Mathilde Dupré
- Département de Pharmacie, Institut Curie, PSL Research University, Paris, France
| | | | - Aude Rochereau
- Département de Pharmacie, Institut Curie, PSL Research University, Paris, France
| | - Laurence Escalup
- Département de Pharmacie, Institut Curie, PSL Research University, Paris, France
| | - Romain Desmaris
- Département de Pharmacie, Institut Curie, PSL Research University, Paris, France
| | | | - Adeline Cordary
- Département de Qualité et Gestion des risques, Institut Curie, PSL Research University, Paris, France
| | - Pauline Vaflard
- Département d'Oncologie médicale, Institut Curie, PSL Research University, Paris, France
| | - Paul Cottu
- Département d'Oncologie médicale, Institut Curie, PSL Research University, Paris, France
- Université Paris Cité, Paris, France
| | - Audrey Bellesoeur
- Département de Radiopharmacologie, Institut Curie, PSL Research University, Paris, France
- Département d'Oncologie médicale, Institut Curie, PSL Research University, Paris, France
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Russell B, Hadi H, Moss CL, Green S, Haire A, Wylie H, Handford J, Monroy-Iglesias M, Dickinson H, Haire K, Van Hemelrijck M. The experience of surgical cancer patients during the COVID-19 pandemic at a large cancer centre in London. Support Care Cancer 2024; 32:321. [PMID: 38691178 PMCID: PMC11062958 DOI: 10.1007/s00520-024-08528-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/27/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND The COVID-19 pandemic has had an enormous impact on the experiences of patients across all health disciplines, especially those of cancer patients. The study aimed to understand the experiences of cancer patients who underwent surgery during the first two waves of the pandemic at Guy's Cancer Centre, which is a large tertiary cancer centre in London. METHODS A mixed-methods approach was adopted for this study. Firstly, a survey was co-designed by the research team and a patient study group. Patients who underwent surgery during the COVID-19 pandemic were invited to take part in this survey. Results were analysed descriptively. Three discussion groups were then conducted to focus on the main themes from the survey findings: communication, COVID-19 risk management and overall experience. These discussion groups were transcribed verbatim and underwent a thematic analysis using the NVivo software package. RESULTS Out of 1657 patients invited, a total of 250 (15%) participants took part in the survey with a mean age of 66 (SD 12.8) and 52% females. The sample was representative of a wide range of tumour sites and was reflective of those invited to take part. Overall, the experience of the cancer patients was positive. They felt that the safety protocols implemented at the hospital were effective. Communication was considered key, and patients were receptive to a change in the mode of communication from in-person to virtual. CONCLUSIONS Despite the immense challenges faced by our Cancer Centre, patients undergoing surgery during the first two waves of the COVID-19 pandemic had a generally positive experience with minimal disruptions to their planned surgery and ongoing care. Together with the COVID-19 safety precautions, effective communication between the clinical teams and the patients helped the overall patient experience during their surgical treatment.
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Affiliation(s)
- Beth Russell
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Science, King's College London, London, UK.
| | - Hajer Hadi
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Charlotte L Moss
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Saran Green
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Anna Haire
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Harriet Wylie
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Jasmine Handford
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | - Maria Monroy-Iglesias
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Science, King's College London, London, UK
| | | | - Kate Haire
- South-East London Cancer Alliance, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Science, King's College London, London, UK
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Nwozichi CU, Ramos MD, Ogunmuyiwa AO, Gigi MB. Dominant Worldviews, Institutional, and Contextual Factors Affecting Cancer Care: Evidence From an Institutional Ethnonursing Study in Nigeria. J Transcult Nurs 2024; 35:216-225. [PMID: 38351591 DOI: 10.1177/10436596241230998] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION Cancer remains a significant health burden in Nigeria and requires the efforts of all stakeholders to address it. Little is known about how the worldviews of Nigerian patients with cancer and other institutional factors affect cancer management in Nigeria. This paper draws evidence from an ethnonursing study conducted in a Nigerian cancer care setting. METHOD This study adopted a qualitative design using an ethnonursing approach. The study was conducted in one of the primary cancer treatment centers owned by the federal government of Nigeria. Data collection was conducted using participant observation, interviews, and field notes. Data collected were analyzed using NVivo 12 and presented as categories and sub-categories. RESULTS Analysis yielded two themes and seven sub-themes. The major themes included (1) dominant worldview and (2) institutional/contextual factors. Participants attributed life, living, and death as being controlled by a supreme being. Cancer care was constrained by unfavorable institutional factors such as lack of equipment, staffing, and intensified workload. DISCUSSION Cancer institutions should provide more cancer care infrastructure that will facilitate the work of nurses and other health care workers. There should be an enabling environment that would attract and retain nurses in the cancer wards. The hospital environment should be made conducive for the cancer care providers, patients with cancer, and their relatives.
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Haines E, Shelton RC, Foley K, Beidas RS, Dressler EV, Kittel CA, Chaiyachati KH, Fayanju OM, Birken SA, Blumenthal D, Rendle KA. Addressing social needs in oncology care: another research-to-practice gap. JNCI Cancer Spectr 2024; 8:pkae032. [PMID: 38676669 PMCID: PMC11104529 DOI: 10.1093/jncics/pkae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
Social determinants of health and unmet social needs are directly related to cancer outcomes, from diagnosis to survivorship. If identified, unmet social needs can be addressed in oncology care by changing care plans in collaboration with patients' preferences and accounting for clinical practice guidelines (eg, reducing the frequency of appointments, switching treatment modalities) and connecting patients to resources within healthcare organizations (eg, social work support, patient navigation) and with community organizations (eg, food banks, housing assistance programs). Screening for social needs is the first step to identifying those who need additional support and is increasingly recognized as a necessary component of high-quality cancer care delivery. Despite evidence about the relationship between social needs and cancer outcomes and the abundance of screening tools, the implementation of social needs screening remains a challenge, and little is known regarding the adoption, reach, and sustainability of social needs screening in routine clinical practice. We present data on the adoption and implementation of social needs screening at two large academic cancer centers and discuss three challenges associated with implementing evidence-based social needs screening in clinical practice: (1) identifying an optimal approach for administering social needs screening in oncology care, (2) adequately addressing identified unmet needs with resources and support, and (3) coordinating social needs screening between oncology and primary care.
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Affiliation(s)
- Emily Haines
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rachel C Shelton
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | - Kristie Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rinad S Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Carol A Kittel
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Krisda H Chaiyachati
- Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Oluwadamilola M Fayanju
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Philadelphia, PA, USA
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Daniel Blumenthal
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Katharine A Rendle
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Philadelphia, PA, USA
- Perelman School of Medicine, Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
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Ver Hoeve ES, Calhoun E, Hernandez M, High E, Armin JS, Ali-Akbarian L, Frithsen M, Andrews W, Hamann HA. Evaluating implementation of a community-focused patient navigation intervention at an NCI-designated cancer center using RE-AIM. BMC Health Serv Res 2024; 24:550. [PMID: 38685006 PMCID: PMC11059763 DOI: 10.1186/s12913-024-10919-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Patient navigation is an evidence-based intervention that reduces cancer health disparities by directly addressing the barriers to care for underserved patients with cancer. Variability in design and integration of patient navigation programs within cancer care settings has limited this intervention's utility. The implementation science evaluation framework, RE-AIM, allows quantitative and qualitative examination of effective implementation of patient navigation programs into cancer care settings. METHODS The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate implementation of a community-focused patient navigation intervention at an NCI-designated cancer center between June 2018 and October 2021. Using a 3-month longitudinal, non-comparative measurement period, univariate and bivariate analyses were conducted to examine associations between participant-level demographics and primary (i.e., barrier reduction) and secondary (i.e., patient-reported outcomes) effectiveness outcomes. Mixed methods analyses were used to examine adoption and delivery of the intervention into the cancer center setting. Process-level analyses were used to evaluate maintenance of the intervention. RESULTS Participants (n = 311) represented a largely underserved population, as defined by the National Cancer Institute, with the majority identifying as Hispanic/Latino, having a household income of $35,000 or less, and being enrolled in Medicaid. Participants were diagnosed with a variety of cancer types and most had advanced staged cancers. Pre-post-intervention analyses indicated significant reduction from pre-intervention assessments in the average number of reported barriers, F(1, 207) = 117.62, p < .001, as well as significant increases in patient-reported physical health, t(205) = - 6.004, p < .001, mental health, t(205) = - 3.810, p < .001, self-efficacy, t(205) = - 5.321, p < .001, and satisfaction with medical team communication, t(206) = - 2.03, p = .029. Referral patterns and qualitative data supported increased adoption and integration of the intervention into the target setting, and consistent intervention delivery metrics suggested high fidelity to intervention delivery over time. Process-level data outlined a successful transition from a grant-funded community-focused patient navigation intervention to an institution-funded program. CONCLUSIONS This study utilized the implementation science evaluation framework, RE-AIM, to evaluate implementation of a community-focused patient navigation program. Our analyses indicate successful implementation within a cancer care setting and provide a potential guide for other oncology settings who may be interested in implementing community-focused patient navigation programs.
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Affiliation(s)
| | | | | | | | | | | | - Michael Frithsen
- Banner Health, Tucson, AZ, USA
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Wendy Andrews
- Banner Health, Tucson, AZ, USA
- University of Arizona College of Medicine, Tucson, AZ, USA
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López AM, Rodríguez JE, Browning Hawes K, Marsden A, Ayer D, Ziegenfuss DH, Okuyemi K. Preparing historically underrepresented trainees for biomedical cancer research careers at Huntsman Cancer Institute/University of Utah Health. Med Educ Online 2021; 26:1929045. [PMID: 34024270 PMCID: PMC8158230 DOI: 10.1080/10872981.2021.1929045] [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: 02/27/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Abstract
Given the well-documented inequities in health care outcomes by race, ethnicity, and gender, many health career pipeline programs have focused on supporting the development of a diverse and inclusive workforce. The State of Utah, is vast, but sparsely populated outside the Salt Lake City metropolitan area. More than 96% of our nearly 85,000 square miles is designated rural (<100 people/square mile) or frontier (<7 people/square mile). The Salt Lake City area is home to the Hunsman Cancer Institute, the only NCI-designated Comprehensive Cancer Center in the region, also noted the limited diversity in the biomedical cancer research workforce. Our primary objective was to increase the number of underrepresented trainees who pursue higher education with the goal of a career in cancer research. PathMaker is a regional, competitive pipeline program that nurtures high school or undergraduate trainees from historically underrepresented backgrounds towards a career in cancer research. Our faculty and staff team collaboratively developed a cohort model curriculum that increased student awareness of research career options; provided academic and professional development, cultural and social support, evolutionary success strategies, active mentorship, and leadership skill development; and fostered an environment of continuous evaluation and improvement. Since pilot program initiation in May 2016, the PathMaker Research Program (PathMaker) has engaged a total of 44 underrepresented trainees in cancer research labs at Huntsman Cancer Institute, the majority still in college. Eleven trainees graduated college: five employed in STEM, one pursuing a PhD in STEM; two in medical school, and three are lost to follow-up. Alumni report high levels of satisfaction with PathMaker and will be followed and supported for academic success. PathMaker is a replicable model to increase diversity and inclusion in the biomedical cancer research workforce.
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Affiliation(s)
- Ana María López
- Professor and Vice Chair of Medical Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadephia, PA, USA
| | - José E Rodríguez
- Professor of Family Medicine and Associate Vice President for Health Equity Diversity and Inclusion, University of Utah Health, Salt Lake City, UT, USA
| | - Kathryn Browning Hawes
- Office of Health Equity, Diversity and Inclusion, University of Utah Health, Salt Lake City, UT, USA
| | - Anna Marsden
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Don Ayer
- Marriott Library, University of Utah, Salt Lake City, UT, USA
| | - Donna Harp Ziegenfuss
- Professor and Chair, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Kola Okuyemi
- Professor and Department Chair of Family & Preventive Medicine
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Carla Ida R, Maurizio L. Supportive care centers: definition of excellence. Curr Opin Oncol 2021; 33:267-272. [PMID: 33756516 DOI: 10.1097/cco.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current review is relevant because despite significant progress in oncology, a large proportion of patients with cancer still experience morbidity and symptoms, resulting from the cancer and/or its treatment. RECENT FINDINGS The main theme concerns the definition of excellence of Supportive Care centers based on the indications of the Multinational Association Supportive Care Cancer (MASCC) because there are no data in literature on this topic. SUMMARY Supportive care centers provide assistance to cancer patients suffering for anticancer treatments-related adverse effects. This leads to patient management with immediate evaluation and treatment of symptoms and therefore with improvement of quality of life and survival. In addition, there is less use of emergency room and hospitalizations with consequent savings of resources. According to MASCC evaluation criteria, some types of centers could be excellent in supportive care in cancer. Size, number of treated patients, or academic presence are not mandatory for the certification of excellence. However, centrality of patient and assessment of patient's needs, dedicated organizational models to evaluate and treat the adverse effects of anticancer treatments, dedicated activity and multidisciplinary staff, teaching programs, and adherence to guidelines are milestones for good clinical practices and consequently the centers that practice them represent the excellence in supportive care in cancer.
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Affiliation(s)
- Ripamonti Carla Ida
- Oncology-Supportive Care Unit, Department Medical Oncology & Haematology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano
| | - Lucchesi Maurizio
- Thoracic Oncology Service in Pneumology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Frelaut M, Vaflard P, Vuagnat P, Bozec L, Moreau P, Kriegel I, Vanjak D, Brisse H, Bouleuc C, Cottu P. [COVID-19 and patients with cancer: Experiment of a French comprehensive cancer center]. Bull Cancer 2021; 108:571-580. [PMID: 33896587 PMCID: PMC8030710 DOI: 10.1016/j.bulcan.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/25/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 01/08/2023]
Abstract
The emergence of the Coronavirus Disease 2019 (COVID-19) has caused profound upset in health systems around the world. As cancer patients seem to be at greater risk, the organization of oncological care had to be adapted. We first report the progress of the "first wave" of COVID-19 at the Institut Curie, a French comprehensive cancer center, by describing the measures implemented to limit the risk of transmission of COVID-19 while ensuring as much as possible the continuation of anticancer treatments. Then, we present the results of a prospective institutional database in which the characteristics and outcome of our patients with cancer and suffering from COVID-19 were collected. From March 13 to April 25, 2020, 141 patients followed at Institut Curie for cancer developed COVID-19, of which 26 (18%) died from it. The minimum incidence of COVID-19 in Institut Curie is estimated at 1.4% over this period. No risk factors for developing a severe form of COVID-19 related to cancer have been identified. Cancer patients do not appear to be at greater risk of developing COVID-19, nor of having a more severe form than the general population. With the current increase of COVID-19 cases, it seems essential to share the experience already acquired to minimize the impact of this crisis on the long-term outcome of patients followed for cancer.
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Affiliation(s)
- Maxime Frelaut
- Institut Curie, département d'oncologie médicale, 26, rue d'Ulm, 75005 Paris, France
| | - Pauline Vaflard
- Institut Curie, département d'oncologie médicale, 26, rue d'Ulm, 75005 Paris, France
| | - Perrine Vuagnat
- Institut Curie, département d'oncologie médicale, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Laurence Bozec
- Institut Curie, département d'oncologie médicale, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Pauline Moreau
- Institut Curie, service des consultations non programmées, 26, rue d'Ulm, 75005 Paris, France
| | - Irène Kriegel
- Institut Curie, département d'anesthésie, 26, rue d'Ulm, 75005 Paris, France
| | - Dominique Vanjak
- Institut Curie, service hygiène hospitalière, 26, rue d'Ulm, 75005 Paris, France
| | - Hervé Brisse
- Institut Curie, département de radiologie, 26, rue d'Ulm, 75005 Paris, France
| | - Carole Bouleuc
- Institut Curie, département de soins de support, 26, rue d'Ulm, 75005 Paris, France.
| | - Paul Cottu
- Institut Curie, département d'oncologie médicale, 26, rue d'Ulm, 75005 Paris, France
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Moriarty P, Chang J, Kayani B, Roberts L, Bourke N, Dann C, MacArthur E, Haddad FS. The Development of a Surgical Oncology Center During the COVID-19 Pandemic. J Patient Saf 2021; 17:81-86. [PMID: 33635842 DOI: 10.1097/pts.0000000000000821] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020. By mid-March, London had emerged as the epicenter in the United Kingdom, accounting for 45% of the COVID-19-related mortality. A cancer COVID-19-free "cold hub," through National Health Service partnership with independent institutions, was established to maintain a throughput of surgical oncology patients with an accessible triage system for oncologic specialties. The high population density, commuter volume, and rising COVID-19 incidence heightened the challenge of segregating a vulnerable population that was already at high risk for surgical morbidity and mortality.The aim of this review is to report the experience of developing a multicenter COVID-19-free cold hub with the aim of providing safe surgery for surgical oncology patients. We discuss the timeline, structure, and infection control policy and suggest practical points that may guide other health care systems.The surgical oncology hub treated 1542 patients between March 1 and July 1, 2020. There were no cases of COVID-19-related mortality in a 30-day follow-up. Key strategies for the restructuring of the cancer service included the following: (1) formation of an accessible referral pathway, (2) creation and structuring of cold hub hospitals, (3) development of protocols for infection control and preoperative testing, (4) rapid reorganization of services based on initial feedback, and (5) clear communication and leadership.It has been shown that a surgical oncology cold hub with an accessible referral system and an effective system of preoperative screening system can minimize COVID-19 transmission, morbidity, and mortality, in a region with heavy disease prevalence. This structure represents a safe, ethical, and viable system that can be replicated in other health care systems.
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Affiliation(s)
- Peter Moriarty
- From the University College London Hospitals NHS Foundation Trust, London, United Kingdom
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12
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Grossheim L, Ruff P, Ngoma T, Vanderpuye V, Mwango G, Ochieng P, Palmer D, Kouya F, Lasebikan N, Ntekim A, Ngoma M, Bih N, Malloum A, Elzawawy A, Kerr D, Ngwa W. Cancer and COVID-19 Experiences at African Cancer Centers: The Silver Lining. JCO Glob Oncol 2021; 7:410-415. [PMID: 33760639 PMCID: PMC8081519 DOI: 10.1200/go.20.00564] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The COVID-19 pandemic significantly disrupted cancer care in Africa, further exposing major health disparities. This paper compares and contrasts the experiences of 15 clinicians in six different African cancer centers to highlight the positive aspects (silver linings) in an otherwise negative situation. METHODS Data are from personal experience of the clinicians working at the six cancer centers blended with what is available in the literature. RESULTS The impact of COVID-19 on cancer care appeared to vary not only across the continent but also over cancer centers. Different factors such as clinic location, services offered, available resources, and level of restrictions imposed because of COVID-19 were associated with these variations. Collectively, delays in treatment and limited access to cancer care were commonly reported in the different regions. CONCLUSION There is a lack of data on cancer patients with COVID-19 and online COVID-19 and cancer registries for Africa. Analysis of the available data, however, suggests a higher mortality rate for cancer patients with COVID-19 compared with those without cancer. Positive or silver linings coming out of the pandemic include the adoption of hypofractionated radiation therapy and teleoncology to enhance access to care while protecting patients and staff members. Increasing collaborations using online technology with oncology health professionals across the world are also being seen as a silver lining, with valuable sharing of experiences and expertise to improve care, enhance learning, and reduce disparities. Advanced information and communication technologies are seen as vital for such collaborations and could avail efforts in dealing with the ongoing pandemic and potential future crises.
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Affiliation(s)
| | - Paul Ruff
- University of the Witwatersrand, Johannesburg, South Africa
| | - Twalib Ngoma
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Verna Vanderpuye
- National Center for Radiotherapy, Korlebu Teaching Hospital, Accra, Ghana
| | | | | | | | | | | | | | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Noella Bih
- Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | - David Kerr
- John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Wilfred Ngwa
- Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Cinar P, Bold R, Bosslet BA, Bota DA, Burgess D, Chew HK, Cohen JG, Elquza E, Gold KA, Kamiya E, Karlan BY, McKay RR, Patel SP, Ternavan K, Welborn J, Yamamoto M, Rugo HS. Planning for post-pandemic cancer care delivery: Recovery or opportunity for redesign? CA Cancer J Clin 2021; 71:34-46. [PMID: 32997807 PMCID: PMC7537198 DOI: 10.3322/caac.21644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 06/17/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/02/2023] Open
Abstract
The delivery of cancer care has never changed as rapidly and dramatically as we have seen with the coronavirus disease 2019 (COVID-19) pandemic. During the early phase of the pandemic, recommendations for the management of oncology patients issued by various professional societies and government agencies did not recognize the significant regional differences in the impact of the pandemic. California initially experienced lower than expected numbers of cases, and the health care system did not experience the same degree of the burden that had been the case in other parts of the country. In light of promising trends in COVID-19 infections and mortality in California, by late April 2020, discussions were initiated for a phased recovery of full-scale cancer services. However, by July 2020, a surge of cases was reported across the nation, including in California. In this review, the authors share the response and recovery planning experience of the University of California (UC) Cancer Consortium in an effort to provide guidance to oncology practices. The UC Cancer Consortium was established in 2017 to bring together 5 UC Comprehensive Cancer Centers: UC Davis Comprehensive Cancer Center, UC Los Angeles Jonsson Comprehensive Cancer Center, UC Irvine Chao Family Comprehensive Cancer Center, UC San Diego Moores Cancer Center, and the UC San Francisco Helen Diller Family Comprehensive Cancer Center. The interventions implemented in each of these cancer centers are highlighted, with a focus on opportunities for a redesign in care delivery models. The authors propose that their experiences gained during this pandemic will enhance pre-pandemic cancer care delivery.
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Affiliation(s)
- Pelin Cinar
- Division of Medical OncologyDepartment of MedicineUniversity of California San FranciscoSan FranciscoCalifornia
- University of California San Francisco Helen Diller Family Comprehensive Cancer CenterSan FranciscoCalifornia
| | - Richard Bold
- University of California Davis Comprehensive Cancer CenterSacramentoCalifornia
| | - Bryn A. Bosslet
- Division of Infectious DiseasesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCalifornia
| | - Daniela A. Bota
- University of California Irvine Chao Family Comprehensive Cancer CenterOrangeCalifornia
| | - Debra Burgess
- University of California Davis Comprehensive Cancer CenterSacramentoCalifornia
| | - Helen K. Chew
- University of California Davis Comprehensive Cancer CenterSacramentoCalifornia
| | - Joshua G. Cohen
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyUniversity of California Los AngelesLos AngelesCalifornia
- University of California Los Angeles Jonsson Comprehensive Cancer CenterLos AngelesCalifornia
| | - Emad Elquza
- University of California Irvine Chao Family Comprehensive Cancer CenterOrangeCalifornia
| | - Kathryn A. Gold
- University of California San Diego Moores Cancer CenterSan DiegoCalifornia
| | - Emi Kamiya
- University of California HealthLos AngelesCalifornia
| | - Beth Y. Karlan
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyUniversity of California Los AngelesLos AngelesCalifornia
- University of California Los Angeles Jonsson Comprehensive Cancer CenterLos AngelesCalifornia
| | - Rana R. McKay
- University of California San Diego Moores Cancer CenterSan DiegoCalifornia
| | - Sandip P. Patel
- University of California San Diego Moores Cancer CenterSan DiegoCalifornia
| | | | - Jeanna Welborn
- University of California Davis Comprehensive Cancer CenterSacramentoCalifornia
| | - Maki Yamamoto
- University of California Irvine Chao Family Comprehensive Cancer CenterOrangeCalifornia
| | - Hope S. Rugo
- Division of Medical OncologyDepartment of MedicineUniversity of California San FranciscoSan FranciscoCalifornia
- University of California San Francisco Helen Diller Family Comprehensive Cancer CenterSan FranciscoCalifornia
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Alom S, Chiu CM, Jha A, Lai SHD, Yau THL, Harky A. The Effects of COVID-19 on Cancer Care Provision: A Systematic Review. Cancer Control 2021; 28:1073274821997425. [PMID: 33631953 PMCID: PMC8482720 DOI: 10.1177/1073274821997425] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 01/06/2021] [Revised: 01/06/2021] [Accepted: 01/29/2021] [Indexed: 12/18/2022] Open
Abstract
This systematic review aims to gather primary data from cancer institutions that have implemented changes to cancer service provision amid the COVID-19 outbreak to inform future intervention and health care facility response strategies. A comprehensive literature search was done on Global Health Medline and EMBASE using pertinent key words and MeSH terms relating to COVID-19 and Cancer service provision. A total of 72 articles were selected for inclusion in this systematic review. Following the narrative synthesis that was conducted of the literature, 6 core themes that encompassed common cancer service intervention adopted by institutions were identified: (1) Testing and Tracking, (2) Outreach and Communication, (3) Protection, (4) Social Distancing (5) Treatment Management, (6) Service Restructuring. Since cancer patients are a high-risk population amid the COVID-19 pandemic, these areas of targeted intervention can be used to inform necessary actions in institutions facing similar risks, based on previous learning from numerous cancer centers globally.
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Affiliation(s)
- Samiha Alom
- School of Public Health, Imperial College London, London, UK
- Equal contribution
| | - Chun Ming Chiu
- Brighton and Sussex Medical School, University of Sussex, East Sussex, UK
- Equal contribution
| | - Ashwarya Jha
- School of Medical Sciences, University of Manchester, Manchester, UK
| | | | - Thomas Ho Lai Yau
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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15
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Rasschaert M, Vanclooster P, Depauw L, Mertens T, Roelant E, Coenen E, Anguille S, Janssens A, Van Dam P, Peeters M. Meeting the Challenges in Cancer Care Management During the SARS-Cov-2 Pandemic: A Retrospective Analysis. Cancer Control 2021; 28:10732748211045275. [PMID: 34623943 PMCID: PMC8504214 DOI: 10.1177/10732748211045275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has overwhelmed the capacity of healthcare systems worldwide. Cancer patients, in particular, are vulnerable and oncology departments drastically needed to modify their care systems and established new priorities. We evaluated the impact of SARS-CoV-2 on the activity of a single cancer center. METHODS We performed a retrospective analysis of (i) volumes of oncological activities (2020 vs 2019), (ii) patients' perception rate of the preventive measures, (iii) patients' SARS-CoV-2 infections, clinical signs thereof, and (iv) new diagnoses made during the SARS-CoV-2 pandemic. RESULTS As compared with a similar time frame in 2019, the overall activity in total numbers of outpatient chemotherapy administrations and specialist visits was not statistically different (P = .961 and P = .252), while inpatient admissions decreased for both medical oncology and thoracic oncology (18% (P = .0018) and 44% (P < .0001), respectively). Cancer diagnosis plummeted (-34%), but no stage shift could be demonstrated.Acceptance and adoption of hygienic measures was high, as measured by a targeted questionnaire (>85%). However, only 46.2% of responding patients regarded telemedicine, although widely deployed, as an efficient surrogate to a consultation.Thirty-three patients developed SARS-CoV-2, 27 were hospitalized, and 11 died within this time frame. These infected patients were younger, current smokers, and suffered more comorbidities. CONCLUSIONS This retrospective cohort analysis adds to the evidence that continuation of active cancer therapy and specialist visits is feasible and safe with the implementation of telemedicine. These data further confirm the impact of SARS-CoV-2 on cancer care management, cancer diagnosis, and impact of infection on cancer patients.
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Affiliation(s)
- Marika Rasschaert
- Department of Oncology, 60202Antwerp University Hospital Antwerp, Antwerp, Belgium
| | | | - Laura Depauw
- Department of Oncology, 60202Antwerp University Hospital Antwerp, Antwerp, Belgium
| | - Tim Mertens
- Department of Oncology, 60202Antwerp University Hospital Antwerp, Antwerp, Belgium
| | - Ella Roelant
- Clinical Trials Center (CTC), CRC Antwerp, 60202Antwerp University Hospital, Antwerp, Belgium
| | - Elke Coenen
- Department of Occupational Medicine, 60202Antwerp University Hospital, Antwerp, Belgium
| | - Sebastien Anguille
- Department of Hematology, 60202Antwerp University Hospital, Antwerp, Belgium
| | - Annelies Janssens
- Department of Thoracic Oncology, 60202Antwerp University Hospital, Antwerp, Belgium
| | - Peter Van Dam
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, 60202Antwerp University Hospital, Antwerp, Belgium
- Center for Oncology Research (CORE), 60202University of Antwerp (UA), Antwerp, Belgium
| | - Marc Peeters
- Department of Oncology, 60202Antwerp University Hospital Antwerp, Antwerp, Belgium
- Center for Oncology Research (CORE), 60202University of Antwerp (UA), Antwerp, Belgium
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Rambeau A, Renou M, Bisiaux F, Chaustier H, Joyaux C, Le Caer F, Fourel L, Solem-Laviec H, Poiree B, Corbinais S, Delorme C, Leloup-Morit V. A supportive care dedicated hospitalization ward in comprehensive cancer center. Support Care Cancer 2020; 28:5781-5785. [PMID: 32219570 DOI: 10.1007/s00520-020-05421-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/17/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Supportive care development has created new needs in patients' care pathway. In order to anticipate, evaluate, and take care of patients' needs, a supportive care dedicated hospitalization ward was created in late 2016 in our comprehensive cancer center, including 15 beds (11 for week care and 4 for day care). We aimed to assess the activity of this supportive care ward in 2018. METHODS Data were extracted from weekly activity reports of supportive care ward and retrospectively analyzed. Those reports are automatically generated from hospitalization scheduling software. RESULTS In week care ward, 627 stays were recorded. Occupancy rate was 88%. Mean stay duration was 3.01 days. Main indications for week stay were pain evaluation and management (47.4%) and nutritional management (31.7%). In day care ward, 1191 stays were registered. Turnover rate was 1.18 patients/bed/day. Main indications for day stay were pain management (41.6%) and comprehensive geriatric assessment in oncology (22.8%). CONCLUSION The 2018 supportive care ward evaluation showed its viability in comprehensive cancer center. The main activity was based on pain and nutritional management.
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Affiliation(s)
- Audrey Rambeau
- Supportive Care Hospitalization Ward, Center François Baclesse, Caen, France.
- Medical Oncology Department, Center François Baclesse, Caen, France.
| | - Marielle Renou
- Supportive Care Hospitalization Ward, Center François Baclesse, Caen, France
- Supportive Care And Transversal Activities Department, Center François Baclesse, Caen, France
| | - Frédérique Bisiaux
- Supportive Care Hospitalization Ward, Center François Baclesse, Caen, France
| | | | - Chloé Joyaux
- Supportive Care Hospitalization Ward, Center François Baclesse, Caen, France
- Supportive Care And Transversal Activities Department, Center François Baclesse, Caen, France
- Nutritional Management Team, Center François Baclesse, Caen, France
| | - Franck Le Caer
- Supportive Care And Transversal Activities Department, Center François Baclesse, Caen, France
- Pain Management Team, Center François Baclesse, Caen, France
| | - Lauriane Fourel
- Supportive Care And Transversal Activities Department, Center François Baclesse, Caen, France
- Pain Management Team, Center François Baclesse, Caen, France
| | - Heidi Solem-Laviec
- Supportive Care And Transversal Activities Department, Center François Baclesse, Caen, France
- Geriatric Oncology Team, Center François Baclesse, Caen, France
| | - Brigitte Poiree
- Supportive Care And Transversal Activities Department, Center François Baclesse, Caen, France
- Nutritional Management Team, Center François Baclesse, Caen, France
| | - Stéphane Corbinais
- Medical Oncology Department, Center François Baclesse, Caen, France
- Supportive Care And Transversal Activities Department, Center François Baclesse, Caen, France
- Nutritional Management Team, Center François Baclesse, Caen, France
| | - Claire Delorme
- Supportive Care And Transversal Activities Department, Center François Baclesse, Caen, France
| | - Virginie Leloup-Morit
- Supportive Care Hospitalization Ward, Center François Baclesse, Caen, France
- Supportive Care And Transversal Activities Department, Center François Baclesse, Caen, France
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Taskforce of the Hellenic Heart Failure Clinics Network. Distribution, infrastructure, and expertise of heart failure and cardio-oncology clinics in a developing network: temporal evolution and challenges during the coronavirus disease 2019 pandemic. ESC Heart Fail 2020; 7:3408-13. [PMID: 33284510 DOI: 10.1002/ehf2.12870] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/22/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022] Open
Abstract
The Hellenic Heart Failure Association has undertaken the initiative to develop a national network of heart failure clinics (HFCs) and cardio-oncology clinics (COCs). We conducted two questionnaire surveys among these clinics within 17 months and another during the coronavirus disease 2019 outbreak to assess adjustments of the developing network to the pandemic. Out of 68 HFCs comprising the network, 52 participated in the first survey and 55 in the second survey. The median number of patients assessed per week is 10. Changes in engaged personnel were encountered between the two surveys, along with increasing use of advanced echocardiographic techniques (23.1% in 2018 vs. 34.5% in 2020). Drawbacks were encountered, concerning magnetic resonance imaging and ergospirometry use (being available in 14.6% and 29% of HFCs, respectively), exercise rehabilitation programmes (applied only in 5.5%), and telemedicine applications (used in 16.4%). There are 13 COCs in the country with nine of them in the capital region; the median number of patients being assessed per week is 10. Platforms for virtual consultations and video calls are used in 38.5%. Coronavirus disease 2019 outbreak affected provision of HFC services dramatically as only 18.5% continued to function regularly, imposing hurdles that need to be addressed, at least temporarily, possibly by alternative methods of follow-up such as remote consultation. The function of COCs, in contrast, seemed to be much less affected during the pandemic (77% of them continued to follow up their patients). This staged, survey-based procedure may serve as a blueprint to help building national HFC/COC networks and provides the means to address changes during healthcare crises.
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18
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Kanesvaran R, Chia CS, Yap SP, Wang MLC, Tham CK, Lim ST, Hwang WYK, Kwek JW. Cancer Versus COVID-19: A Coordinated Disease Outbreak Response System (DORS) to Combat COVID-19 at the National Cancer Centre Singapore. Ann Acad Med Singap 2020; 49:807-809. [PMID: 33283845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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19
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Ng KYY, Zhou S, Tan SH, Ishak NDB, Goh ZZS, Chua ZY, Chia JMX, Chew EL, Shwe T, Mok JKY, Leong SS, Lo JSY, Ang ZLT, Leow JL, Lam CWJ, Kwek JW, Dent R, Tuan J, Lim ST, Hwang WYK, Griva K, Ngeow J. Understanding the Psychological Impact of COVID-19 Pandemic on Patients With Cancer, Their Caregivers, and Health Care Workers in Singapore. JCO Glob Oncol 2020; 6:1494-1509. [PMID: 33017179 PMCID: PMC7640379 DOI: 10.1200/go.20.00374] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has had a global impact, and Singapore has seen 33,000 confirmed cases. Patients with cancer, their caregivers, and health care workers (HCWs) need to balance the challenges associated with COVID-19 while ensuring that cancer care is not compromised. This study aimed to evaluate the psychological effect of COVID-19 on these groups and the prevalence of burnout among HCWs. METHODS A cross-sectional survey of patients, caregivers, and HCWs at the National Cancer Centre Singapore was performed over 17 days during the lockdown. The Generalized Anxiety Disorder-7 and Maslach Burnout Inventory were used to assess for anxiety and burnout, respectively. Self-reported fears related to COVID-19 were collected. RESULTS A total of 624 patients, 408 caregivers, and 421 HCWs participated in the study, with a response rate of 84%, 88%, and 92% respectively. Sixty-six percent of patients, 72.8% of caregivers, and 41.6% of HCWs reported a high level of fear from COVID-19. The top concern of patients was the wide community spread of COVID-19. Caregivers were primarily worried about patients dying alone. HCWs were most worried about the relatively mild symptoms of COVID-19. The prevalence of anxiety was 19.1%, 22.5%, and 14.0% for patients, caregivers, and HCWs, respectively. Patients who were nongraduates and married, and caregivers who were married were more anxious. The prevalence of burnout in HCWs was 43.5%, with more anxious and fearful HCWs reporting higher burnout rates. CONCLUSION Fears and anxiety related to COVID-19 are high. Burnout among HCWs is similar to rates reported prepandemic. An individualized approach to target the specific fears of each group will be crucial to maintain the well-being of these vulnerable groups and prevent burnout of HCWs.
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Affiliation(s)
| | - Siqin Zhou
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore
| | - Sze Huey Tan
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
| | | | | | - Zi Yang Chua
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jace Ming Xuan Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ee Ling Chew
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Than Shwe
- Division of Radiation Oncology, National Cancer Centre, Singapore
| | | | - Shen Si Leong
- Division of Medical Oncology, National Cancer Centre, Singapore
| | | | - Zoe Li Ting Ang
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Jo Lene Leow
- Department of Pharmacy, National Cancer Centre, Singapore
| | | | - Jin Wei Kwek
- Division of Oncological Imaging, National Cancer Centre, Singapore
| | - Rebecca Dent
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Jeffrey Tuan
- Division of Radiation Oncology, National Cancer Centre, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
| | - William Ying Khee Hwang
- Division of Medical Oncology, National Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Joanne Ngeow
- Division of Medical Oncology, National Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Abstract
Pituitary tumors are common and require complex and sophisticated procedures for both diagnosis and therapy. To maintain the highest standards of quality, it is proposed to manage patients in pituitary tumors centers of excellence (PTCOEs) with patient-centric organizations, with expert clinical endocrinologists and neurosurgeons forming the core. That core needs to be supported by experts from different disciplines such as neuroradiology, neuropathology, radiation oncology, neuro-ophthalmology, otorhinolaryngology, and trained nursing. To provide high-level medical care to patients with pituitary tumors, PTCOEs further pituitary science through research publication, presentation of results at meetings, and performing clinical trials.
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Affiliation(s)
- Stefano Frara
- Institute of Endocrinology, Università Vita-Salute San Raffaele, Via Olgettina Milano, 58, Milano, Milan 20132, Italy
| | - Gemma Rodriguez-Carnero
- Division of Endocrinology, Complejo Hospitalario Universitario de Santiago (USC/SERGAS), Instituto de Investigacion Sanitaria de Santiago (IDIS), Rúa da Choupana, S/N, Santiago de Compostela, A Coruña 15706, Spain
| | - Ana M Formenti
- Institute of Endocrinology, Università Vita-Salute San Raffaele, Via Olgettina Milano, 58, Milano, Milan 20132, Italy
| | - Miguel A Martinez-Olmos
- Division of Endocrinology, Complejo Hospitalario Universitario de Santiago (USC/SERGAS), Instituto de Investigacion Sanitaria de Santiago (IDIS), Rúa da Choupana, S/N, Santiago de Compostela, A Coruña 15706, Spain; CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Andrea Giustina
- Institute of Endocrinology, Università Vita-Salute San Raffaele, Via Olgettina Milano, 58, Milano, Milan 20132, Italy
| | - Felipe F Casanueva
- Division of Endocrinology, Complejo Hospitalario Universitario de Santiago (USC/SERGAS), Instituto de Investigacion Sanitaria de Santiago (IDIS), Rúa da Choupana, S/N, Santiago de Compostela, A Coruña 15706, Spain; CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.
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Jenssen BP, Leone F, Evers-Casey S, Beidas R, Schnoll R. Building Systems to Address Tobacco Use in Oncology: Early Benefits and Opportunities From the Cancer Center Cessation Initiative. J Natl Compr Canc Netw 2020; 17:638-643. [PMID: 31200354 DOI: 10.6004/jnccn.2019.7312] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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22
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The New Era in Lung Cancer Care. Oncology (Williston Park) 2020; 34:302-4. [PMID: 32785923 DOI: 10.46883/ONC.2020.3408.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ONCOLOGY recently sat down with Mark G. Kris, MD, of Memorial Sloan Kettering Cancer Center to discuss the recent trends in lung cancer treatment.
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Rais G, Amaoui B, Lahlou L, Ouazni M, Fares S. Spécificités de la réorganisation de la prise en charge des patients cancéreux au cours de la pandémie COVID-19 dans un centre régional d´oncologie au Maroc. Pan Afr Med J 2020; 35:114. [PMID: 33282069 PMCID: PMC7687472 DOI: 10.11604/pamj.supp.2020.35.23280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/17/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ghizlane Rais
- Medical Oncology Department, Regional Center of Oncology, Agadir, Morocco
| | - Bouchra Amaoui
- Radiotherapy Department Regional Center of Oncology, Agadir, Morocco
| | - Laila Lahlou
- Public Health Department, Faculty of Medicine and Pharmacy Agadir, University IBN Zohr Agadir
| | - Mohammed Ouazni
- Surgery Department, Faculty of Medicine and Pharmacy Agadir, University IBN Zohr Agadir
| | - Salma Fares
- Hematology Department, Faculty of Medicine and Pharmacy Agadir, University IBN Zohr Agadir
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Lee JJ, Chu E. The UPMC Hillman Cancer Center Approach to the Management of Colorectal Cancer During the COVID-19 Pandemic Era. Clin Colorectal Cancer 2020; 19:146-148. [PMID: 32811719 PMCID: PMC7347322 DOI: 10.1016/j.clcc.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 01/12/2023]
Affiliation(s)
- James J Lee
- Division of Hematology-Oncology, Department of Medicine, Cancer Therapeutics Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Edward Chu
- Division of Hematology-Oncology, Department of Medicine, Cancer Therapeutics Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Affiliation(s)
- Amer Harky
- Department of Cardio-thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
| | - Chun Ming Chiu
- Brighton and Sussex Medical School, University of Sussex, East Sussex, UK
| | - Thomas Ho Lai Yau
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Biganzoli L, Cardoso F, Beishon M, Cameron D, Cataliotti L, Coles CE, Delgado Bolton RC, Trill MD, Erdem S, Fjell M, Geiss R, Goossens M, Kuhl C, Marotti L, Naredi P, Oberst S, Palussière J, Ponti A, Rosselli Del Turco M, Rubio IT, Sapino A, Senkus-Konefka E, Skelin M, Sousa B, Saarto T, Costa A, Poortmans P. The requirements of a specialist breast centre. Breast 2020; 51:65-84. [PMID: 32217457 PMCID: PMC7375681 DOI: 10.1016/j.breast.2020.02.003] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022] Open
Abstract
This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Laura Biganzoli
- European Society of Breast Cancer Specialists (EUSOMA); Breast Centre, AUSL Toscana Centro, Prato, Italy.
| | - Fatima Cardoso
- European Society of Medical Oncology (ESMO); Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal
| | | | - David Cameron
- European Cancer Concord (ECC); University of Edinburgh Cancer Centre, IGMM, Western General Hospital, Edinburgh, UK
| | - Luigi Cataliotti
- European Society of Breast Cancer Specialists (EUSOMA), Senonetwork Italia and Breast Centres Certification, Florence, Italy
| | - Charlotte E Coles
- European Society for Radiotherapy and Oncology (ESTRO); University of Cambridge, Cambridge, UK
| | - Roberto C Delgado Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, Logroño, La Rioja, Spain
| | - Maria Die Trill
- International Psycho-Oncology Society (IPOS); ATRIUM: Psycho-Oncology & Clinical Psychology, Madrid, Spain
| | - Sema Erdem
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); Europa Donna, Milan, Italy
| | - Maria Fjell
- European Oncology Nursing Society (EONS); Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Romain Geiss
- International Society of Geriatric Oncology (SIOG); Medical Oncology, Hôpital René Huguenin - Institut Curie, St. Cloud, France
| | - Mathijs Goossens
- European Cancer League (ECL); Centre for Cancer Detection (CvKO), Brussels, Belgium
| | - Christiane Kuhl
- European Society of Radiology (ESR); Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - Lorenza Marotti
- European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy
| | - Peter Naredi
- European Cancer Organisation (ECCO); Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simon Oberst
- Organisation of European Cancer Institutes (OECI); Cancer Research UK Cambridge Centre, Cambridge, UK
| | - Jean Palussière
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Department of Imaging, Institut Bergonié, Bordeaux, France
| | - Antonio Ponti
- European Society of Breast Cancer Specialists (EUSOMA), Centre for Epidemiology and Prevention in Oncology (CPO) Piemonte, AOU Citta' Della Salute e Della Scienza, Turin, Italy
| | | | - Isabel T Rubio
- European Society of Surgical Oncology (ESSO); Breast Surgical Oncology, Clinica Universidad de Navarra Madrid, Spain
| | - Anna Sapino
- European Society of Pathology (ESP); Department of Medical Sciences, University of Turin, Turin, Italy; Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Elzbieta Senkus-Konefka
- European Organisation for Research and Treatment of Cancer (EORTC); Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Marko Skelin
- European Society of Oncology Pharmacy (ESOP); Pharmacy Department, General Hospital Sibenik, Sibenik, Croatia
| | - Berta Sousa
- European Society of Oncology Pharmacy (ESOP); Pharmacy Department, General Hospital Sibenik, Sibenik, Croatia
| | - Tiina Saarto
- Flims Alumni Club (FAC); Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal
| | | | - Philip Poortmans
- Iridium Kankernetwerk, University of Antwerp, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Wilrijk-Antwerp, Belgium
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Walker K. Prostate cancer in Scotland: an evolutionary journey. Br J Nurs 2020; 29:S4. [PMID: 32463751 DOI: 10.12968/bjon.2020.29.10.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Karen Walker
- Clinical Nurse Specialist, Edinburgh Cancer Centre
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Ramirez RA, Bren‐Mattison Y, Thiagarajan R, Boudreaux JP, Marsala AJ, Ryan P, Maluccio MA. A Neuroendocrine Tumor Specialty Center in New Orleans' (NOLANETS) Response to Patient Care During the COVID-19 Pandemic. Oncologist 2020; 25:548-551. [PMID: 32369669 PMCID: PMC7356714 DOI: 10.1634/theoncologist.2020-0279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/21/2020] [Indexed: 12/31/2022] Open
Abstract
This commentary outlines the steps taken by the New Orleans Louisiana Neuroendocrine Tumor Specialists to minimize the risk of patient exposure to SARS‐CoV‐2 but to continue to provide safe, high‐quality care during the COVID‐19 pandemic.
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Affiliation(s)
- Robert A. Ramirez
- Ochsner Medical CenterKennerLouisianaUSA
- Ochsner Clinical School, The University of Queensland School of MedicineNew OrleansLouisianaUSA
| | | | | | | | | | | | - Mary A. Maluccio
- Louisiana State University Health Sciences CenterNew OrleansLouisianaUSA
- Medical Director of New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS)KennerLouisianaUSA
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Lödel S, Ostgathe C, Heckel M, Oechsle K, Gahr S. Standard Operating Procedures (SOPs) for Palliative Care in German Comprehensive Cancer Centers - an evaluation of the implementation status. BMC Palliat Care 2020; 19:62. [PMID: 32359346 PMCID: PMC7196237 DOI: 10.1186/s12904-020-00565-6] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 04/22/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The working group for palliative medicine within the Comprehensive Cancer Center (CCC) network funded by the German Cancer Aid in Germany has developed and published 14 Standard Operating Procedures (SOPs) for palliative care in CCCs. This study analyzed to what extent these SOPs have been implemented in the clinical routine in the CCC network one year after their publication. METHODS An online-based survey on the implementation status, limitations in daily practice and further themes was conducted between April and July 2018. In total, 125 health professionals in specialized palliative care from all 16 CCC locations were invited to participate. The data were analyzed descriptively using SPSS. RESULTS The response rate was 52.8%. More than half of the respondents (57.6%) knew about the free availability of SOPs on the CCC network website. The extent to which each SOP was being used actively in practice by the survey respondents ranged from a low of 22.7% (for the "Fatigue" SOP) to a highest of 48.5% (for the "Palliative Sedation" and "Respiratory Distress" SOPs). The respondents became aware of the SOP through recommendations from colleagues, team meetings or from the head of the department. The SOPs "Respiratory distress of an adult palliative patient" and "Palliative sedation" were perceived as the most practically oriented and understandable. Barriers to use SOPs were mainly limited time resources and lack of knowledge of existence and availability. CONCLUSIONS In practice, better knowledge about the SOPs and at the same time increased use can be achieved through systematic training or discussion of SOPs in regular team meetings. There is a need to take measures to optimize the implementation in clinical practice.
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Affiliation(s)
- Sarah Lödel
- Department of Palliative Medicine, CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany.
| | - Christoph Ostgathe
- Department of Palliative Medicine, CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Maria Heckel
- Department of Palliative Medicine, CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Susanne Gahr
- Department of Palliative Medicine, CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
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31
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Acoba JD, Berenberg JL. University of Hawai'i Cancer Center Connection: University of Hawai'i Cancer Center: Collaboration Through Partnership with the National Cancer Institute. Hawaii J Health Soc Welf 2020; 79:171-173. [PMID: 32432224 PMCID: PMC7226314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Denys A, Guiu B, Chevallier P, Digklia A, de Kerviler E, de Baere T. Interventional oncology at the time of COVID-19 pandemic: Problems and solutions. Diagn Interv Imaging 2020; 101:347-353. [PMID: 32360351 PMCID: PMC7177103 DOI: 10.1016/j.diii.2020.04.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
COVID-19 pandemic modifies in-depth interventional oncology practice. Identification of aerosol-generating procedures is crucial for safety. Curative treatment of cancers should not be delayed during the COVID-19 pandemic. Solutions to overcome shortage in anesthesiology resources are described.
The COVID-19 pandemic has deeply impacted the activity of interventional oncology in hospitals and cancer centers. In this review based on official recommendations of different international societies, but also on local solutions found in different expert large-volume centers, we discuss the changes that need to be done for the organization, safety, and patient management in interventional oncology. A literature review of potential solutions in a context of scarce anesthesiologic resources, limited staff and limited access to hospital beds are proposed and discussed based on the literature data.
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MESH Headings
- Aerosols
- Age Factors
- Anesthesia, General
- Anesthesiology/statistics & numerical data
- Betacoronavirus
- Biopsy/adverse effects
- Biopsy/methods
- COVID-19
- COVID-19 Testing
- Cancer Care Facilities/organization & administration
- Carcinoma, Hepatocellular/therapy
- Carcinoma, Renal Cell/therapy
- Chemoembolization, Therapeutic/methods
- Clinical Laboratory Techniques/methods
- Colonic Neoplasms/pathology
- Coronavirus Infections/complications
- Coronavirus Infections/diagnosis
- Coronavirus Infections/epidemiology
- Coronavirus Infections/transmission
- Databases, Factual
- Health Personnel/statistics & numerical data
- Health Resources/organization & administration
- Health Resources/supply & distribution
- Hospital Bed Capacity/statistics & numerical data
- Hospitalization/statistics & numerical data
- Humans
- Hyperthermia, Induced/methods
- Kidney Neoplasms/therapy
- Liver Neoplasms/therapy
- Lung Neoplasms/secondary
- Lung Neoplasms/therapy
- Neoplasms/complications
- Neoplasms/therapy
- Palliative Care/methods
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/transmission
- SARS-CoV-2
- Triage
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Affiliation(s)
- A Denys
- Department of Radiology, CHUV UNIL, rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - B Guiu
- Department of Radiology, Hôpital Saint ELOI, CHU Montpellier, 34000 Montpellier, France
| | - P Chevallier
- Department of Radiology, Hôpital ARCHET 2, CHU Nice, 06000 Nice, France
| | - A Digklia
- Department of Oncology, CHUV UNIL, 1011 Lausanne, Switzerland
| | - E de Kerviler
- Department of Radiology, Assistance Publique-Hopitaux de Paris, Hôpital Saint-Louis, 75010 Paris, France; Université de Paris, 75006 Paris, France
| | - T de Baere
- Department of Interventional Radiology, Institut Gustave Roussy, 94800 Villejuif, France
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Sokolic R. The Sickle Cell Disease Multidisciplinary Clinic at the Lifespan Cancer Institute. R I Med J (2013) 2020; 103:25-27. [PMID: 32236157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Robert Sokolic
- Assistant Professor of Medicine, The Warren Alpert Medical School of Brown University; Lifespan Cancer Institute, Providence, RI
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Mobley EM, Swami U, Mott S, Ounda A, Milhem M, Monga V. A Retrospective Analysis of Clinical Trial Accrual of Patients Presented in a Multidisciplinary Tumor Board at a Tertiary Health Care Center and Associated Barriers. Oncol Res Treat 2020; 43:196-203. [PMID: 32222709 PMCID: PMC8188843 DOI: 10.1159/000506840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/26/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cancer clinical trial accruals have been historically low and are affected by several factors. Multidisciplinary Tumor Board Meetings (MTBM) are conducted regularly and immensely help to devise a comprehensive care plan including discussions about clinical trial availability and eligibility. OBJECTIVES To evaluate whether patient discussion at MTBM was associated with a higher consent rate for clinical trials at a single tertiary care center. METHODS Institutional electronic medical records (EMR) and clinical trials management system (OnCore) were queried to identify all new patient visits in oncology clinics, consents to clinical trials, and MTBM notes between January 1, 2011 and December 31, 2015. The association between MTBM discussion and subsequent clinical trial enrollment within 16 weeks of the new patient visit was evaluated using a χ2 test. RESULTS Between January 1, 2011 and December 31, 2015, 11,794 new patients were seen in oncology clinics, and 2,225 patients (18.9%) were discussed at MTBMs. MTBM discussion conferred a higher rate of subsequent clinical trial consent within 16 weeks following the patient's first consultation in an oncology clinic: 4.1% for those who were discussed at a MTBM compared to 2.8% for those not discussed (p < 0.01). CONCLUSIONS This study provides evidence that MTBMs may be effective in identifying patients eligible for available clinical trials by reviewing eligibility criteria during MTBM discussions. We recommend discussion of all new patients in MTBM to improve the quality of care provided to those with cancer and enhanced clinical trial accrual.
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Affiliation(s)
- Erin M Mobley
- Center for Young Adult Cancer Survivorship, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Umang Swami
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Sarah Mott
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, USA
| | - Agnes Ounda
- Healing Kidneys Institute, Shenandoah, Texas, USA
| | - Mohammed Milhem
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Varun Monga
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA,
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Chen ATC, Moniz CMV, Ribeiro-Júnior U, Diz MDPE, Salvajoli JV, Da Conceição Vasconcelos KGM, Auler-Júnior JOC, Cecconello I, Abdala E, Hoff PMG. How should health systems prepare for the evolving COVID-19 pandemic? Reflections from the perspective of a Tertiary Cancer Center. Clinics (Sao Paulo) 2020; 75:e1864. [PMID: 32294673 PMCID: PMC7134548 DOI: 10.6061/clinics/2020/e1864] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Andre Tsin Chih Chen
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital
das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,
BR
- *Corresponding author. E-mail:
| | - Camila Motta Venchiarutti Moniz
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital
das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,
BR
| | - Ulysses Ribeiro-Júnior
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital
das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,
BR
| | - Maria Del Pilar Estevez Diz
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital
das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,
BR
| | - João Victor Salvajoli
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital
das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,
BR
| | | | | | - Ivan Cecconello
- Disciplinas de Cirurgia do Aparelho Digestivo e
Coloproctologia, Hospital das Clinicas HCFMUSP, Faculdade Medicina, Universidade de Sao
Paulo, Sao Paulo, SP, BRChen ATC, Moniz CMV, Ribeiro-Júnior U, Diz MPE, Salvajoli
JV, Vasconcelos KGMC, et al. How should health systems prepare for the evolving COVID-19
pandemic? Reflections from the perspective of a Tertiary Cancer Center. Clinics.
2020;75:e1864
| | - Edson Abdala
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital
das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,
BR
| | - Paulo Marcelo Gehm Hoff
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital
das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,
BR
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Hui D, De La Rosa A, Chen J, Dibaj S, Guay MD, Heung Y, Liu D, Bruera E. State of palliative care services at US cancer centers: An updated national survey. Cancer 2020; 126:2013-2023. [PMID: 32049358 PMCID: PMC7160033 DOI: 10.1002/cncr.32738] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/15/2019] [Accepted: 12/29/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study examined the changes in outpatient palliative care services at US cancer centers over the past decade. METHODS Between April and August 2018, all National Cancer Institute (NCI)-designated cancer centers and a random sample of 1252 non-NCI-designated cancer centers were surveyed. Two surveys used previously in a 2009 national study were sent to each institution: a 22-question cancer center executive survey regarding palliative care infrastructure and attitudes toward palliative care and an 82-question palliative care program leader survey regarding detailed palliative care structures and processes. Survey findings from 2018 were compared with 2009 data from 101 cancer center executives and 96 palliative care program leaders. RESULTS The overall response rate was 69% (140 of 203) for the cancer center executive survey and 75% (123 of 164) for the palliative care program leader survey. Among NCI-designated cancer centers, a significant increase in outpatient palliative care clinics was observed between 2009 and 2018 (59% vs 95%; odds ratio, 12.3; 95% confidence interval, 3.2-48.2; P < .001) with no significant changes in inpatient consultation teams (92% vs 90%; P = .71), palliative care units (PCUs; 26% vs 40%; P = .17), or institution-operated hospices (31% vs 18%; P = .14). Among non-NCI-designated cancer centers, there was no significant increase in outpatient palliative care clinics (22% vs 40%; P = .07), inpatient consultation teams (56% vs 68%; P = .27), PCUs (20% vs 18%; P = .76), or institution-operated hospices (42% vs 23%; P = .05). The median interval from outpatient palliative care referral to death increased significantly, particularly for NCI-designated cancer centers (90 vs 180 days; P = 0.01). CONCLUSIONS Despite significant growth in outpatient palliative care clinics, there remain opportunities for improvement in the structures and processes of palliative care programs.
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Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Allison De La Rosa
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph Chen
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Seyedeh Dibaj
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marvin Delgado Guay
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yvonne Heung
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Wind A, Gonçalves FR, Marosi E, da Pieve L, Groza M, Asioli M, Albini M, van Harten W. Benchmarking Cancer Centers: From Care Pathways to Integrated Practice Units. J Natl Compr Canc Netw 2019; 16:1075-1083. [PMID: 30181419 DOI: 10.6004/jnccn.2018.7035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 04/18/2018] [Indexed: 11/17/2022]
Abstract
Background: Structuring cancer care into pathways can reduce variability in clinical practice and improve patient outcomes. International benchmarking can help centers with regard to development, implementation, and evaluation. A further step in the development of multidisciplinary care is to organize care in integrated practice units (IPUs), encompassing the whole pathway and relevant organizational aspects. However, research on this topic is limited. This article describes the development and results of a benchmark tool for cancer care pathways and explores IPU development in cancer centers. Methods: The benchmark tool was developed according to a 13-step benchmarking method and piloted in 7 European cancer centers. Centers provided data and site visits were performed to understand the context in which the cancer center operates and to clarify additional questions. Benchmark data were structured into pathway development and evaluation and assessed against key IPU features. Results: Benchmark results showed that most centers have formalized multidisciplinary pathways and that care teams differed in composition, and found almost 2-fold differences in mammography use efficiency. Suggestions for improvement included positioning pathways formally and structurally evaluating outcomes at a sufficiently high frequency. Based on the benchmark, 3 centers indicating that they had a breast cancer IPU were scored differently on implementation. Overall, we found that centers in Europe are in various stages of development of pathways and IPUs, ranging from an informal pathway structure to a full IPU-type of organization. Conclusions: A benchmark tool for care pathways was successfully developed and tested, and is available in an open format. Our tool allows for the assessment of pathway organization and can be used to assess the status of IPU development. Opportunities for improvement were identified regarding the organization of care pathways and the development toward IPUs. Three centers are in varying degrees of implementation and can be characterized as breast cancer IPUs. Organizing cancer care in an IPU could yield multiple performance improvements.
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Ogba N, Arwood NM, Bartlett NL, Bloom M, Brown P, Brown C, Budde EL, Carlson R, Farnia S, Fry TJ, Garber M, Gardner RA, Gurschick L, Kropf P, Reitan JJ, Sauter C, Shah B, Shpall EJ, Rosen ST. Chimeric Antigen Receptor T-Cell Therapy. J Natl Compr Canc Netw 2019; 16:1092-1106. [PMID: 30181421 DOI: 10.6004/jnccn.2018.0073] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 11/17/2022]
Abstract
Patients with relapsed or refractory (R/R) cancers have a poor prognosis and limited treatment options. The recent approval of 2 chimeric antigen receptor (CAR) autologous T-cell products for R/R B-cell acute lymphoblastic leukemia and non-Hodgkin's lymphoma treatment is setting the stage for what is possible in other diseases. However, there are important factors that must be considered, including patient selection, toxicity management, and costs associated with CAR T-cell therapy. To begin to address these issues, NCCN organized a task force consisting of a multidisciplinary panel of experts in oncology, cancer center administration, and health policy, which met for the first time in March 2018. This report describes the current state of CAR T-cell therapy and future strategies that should be considered as the application of this novel immunotherapy expands and evolves.
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MESH Headings
- Advisory Committees
- Cancer Care Facilities/organization & administration
- Drug Resistance, Neoplasm/immunology
- Health Policy
- Humans
- Immunotherapy, Adoptive/adverse effects
- Immunotherapy, Adoptive/methods
- Immunotherapy, Adoptive/trends
- Interdisciplinary Communication
- Medical Oncology/organization & administration
- Neoplasm Recurrence, Local/immunology
- Neoplasm Recurrence, Local/therapy
- Neoplasms/immunology
- Neoplasms/therapy
- Receptors, Chimeric Antigen/immunology
- Societies, Medical/organization & administration
- T-Lymphocytes/immunology
- T-Lymphocytes/transplantation
- Transplantation, Autologous/adverse effects
- Transplantation, Autologous/methods
- Transplantation, Autologous/trends
- United States
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Mori S, Navarrete-Dechent C, Petukhova TA, Lee EH, Rossi AM, Postow MA, Dunn LA, Roman BR, Yin VT, Coit DG, Hollmann TJ, Busam KJ, Nehal KS, Barker CA. Tumor Board Conferences for Multidisciplinary Skin Cancer Management: A Survey of US Cancer Centers. J Natl Compr Canc Netw 2019; 16:1209-1215. [PMID: 30323091 DOI: 10.6004/jnccn.2018.7044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/07/2018] [Indexed: 02/06/2023]
Abstract
Background: Tumor board conferences (TBCs) are used by oncologic specialists to review patient cases, exchange knowledge, and discuss options for cancer management. These multidisciplinary meetings are often a cornerstone of treatment at leading cancer centers and are required for accreditation by certain groups, such as the American College of Surgeons' Commission on Cancer. Little is known regarding skin cancer TBCs. The objective of this study was to characterize the structure, function, and impact of existing skin cancer TBCs in the United States. Methods: A cross-sectional online survey was administered to physician leaders of skin cancer TBCs at NCI-designated Comprehensive and Clinical Cancer Centers. Results: Of the 59 centers successfully contacted, 14 (24%) reported not having a conference where skin cancer cases were discussed, and 45 (76%) identified 53 physician leaders. A total of 38 physicians (72%) completed the survey. Half of the meeting leaders were medical and/or surgical oncologists, and dermatologists led one-third of meetings. TBCs had a moderate to significant impact on patient care according to 97% of respondents. All respondents indicated that the meetings enhanced communication among physicians and provided an opportunity for involved specialists and professionals to discuss cases. The most frequently cited barrier to organizing TBCs was determining a common available date and time for attendees (62%). The most common suggestion for improvement was to increase attendance, specialists, and/or motivation. Conclusions: Results showed overall consistency in meeting structure but variability in function, which may be a reflection of institutional resources and investment in the conference. Future directions include defining metrics to evaluate changes in diagnosis or management plan after tumor board discussion, attendance, clinical trial enrollment, and cost analysis. Results of this survey may aid other institutions striving to develop and refine skin cancer TBCs.
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Khater AI, Noaman MK, Hafiz MNA, Moneer MM, Elattar IA. Health-Related Quality of Life among Egyptian Female Breast Cancer Patients at the National Cancer Institute, Cairo University. Asian Pac J Cancer Prev 2019; 20:3113-3119. [PMID: 31653162 PMCID: PMC6982660 DOI: 10.31557/apjcp.2019.20.10.3113] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 10/03/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To measure the quality of life (QoL) of Egyptian females with breast cancer (BC) at the National Cancer Institute (NCI), Cairo University (CU) and its relations with the socio-demographic and clinical characteristics. METHODS A total of 200 female BC patients were recruited from the medical oncology outpatient clinic during a period from December 2015 to March 2018. The instrument of this study consisted of two parts: the first for Socio-demographic and clinicopathological characteristics, and the second was the Functional Assessment of Cancer Therapy-Breast for patients with Lymphedema (FACT-B+4) questionnaire. RESULTS The majority of the study participants were married, housewives, and without a family history of cancer (70.0%, 93.0%, and 63.0%, respectively). Most of them presented with breast mass, had IDC, grade II and disease stage III at diagnosis (89.0%, 84.5%, 85.6% and 56.8%, respectively) and had undergone modified radical mastectomy, received adjuvant chemotherapy, radiation, and hormonal therapy (62.0%, 83.8%, 73.5% and 60.5%, respectively). The median FACT-B score was 81 (range 35-133). The medians of subscales were: physical well-being 13 (range 0-28), social well-being 20 (range 0-28), emotional well-being 15 (range 2-24), and functional well-being 16 (range 2-28). The median score for breast subscale was 19 (range 2-32). Many factors affected the QoL scores, including age, marital status, occupation, smoking, residence, comorbidities, symptoms, grade, chemotherapy, radiation, and recurrence. CONCLUSION QoL of Egyptian females with BC was influenced by several factors like age, marital status, occupation, smoking, residence, comorbidities, symptoms, grade, chemotherapy, radiation, and recurrence.
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Affiliation(s)
| | | | | | - Manar M Moneer
- Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Egypt.
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41
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Printz C. Cancer centers issue call to action regarding the human papillomavirus vaccine. Cancer 2019; 124:4117. [PMID: 30475399 DOI: 10.1002/cncr.31805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Loudon J, Rozanec N, Clement A, Woo R, Grant A, Murray J, Wells W. Collaborating with the Community: Improving Patient Access to Palliative Radiation Therapy. Pract Radiat Oncol 2019; 10:1-7. [PMID: 31437605 DOI: 10.1016/j.prro.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/27/2019] [Accepted: 08/08/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Palliative radiation therapy (PRT) has an essential role in cancer symptom control but is underutilized in Ontario. This initiative aimed to implement an educational outreach intervention to improve knowledge of and access to PRT among interprofessional palliative health care teams across an Ontario Local Health Integration Network. METHODS AND MATERIALS A needs assessment was completed from June to September 2018 with interprofessional palliative health care teams. Participants completed a survey to identify perceived opportunities, barriers, and enablers to recommending or referring patients for PRT. Thematic analysis informed content of the educational outreach intervention and included how to access PRT, common indications, case studies, and side-effect management after completing PRT. The educational outreach intervention was completed from October 2018 to January 2019. Participants completed a survey, and results were analyzed using descriptive statistics. The number of patients who received PRT was determined by cross-referencing the regional database with the radiation oncology information system. RESULTS Although 22.9% of participants had previously recommended or referred patients, 96.2% of participants agreed or strongly agreed that they are likely to recommend or refer patients for PRT after the educational outreach intervention (n = 131). An increase was observed in the number of patients receiving PRT from the community during the intervention period. CONCLUSIONS The educational outreach intervention improved knowledge and the likelihood of interprofessional palliative health care teams providing access to PRT for patients in the community. More patients now receive PRT, conveying improved symptom control and quality of life.
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Affiliation(s)
- James Loudon
- Radiation Medicine Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario, Canada.
| | - Natalie Rozanec
- Radiation Medicine Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Ashley Clement
- Radiation Medicine Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Rachel Woo
- Radiation Medicine Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Anne Grant
- Hospice Palliative Care Teams for the Central Local Health Integration Network, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Judy Murray
- Hospice Palliative Care Teams for the Central Local Health Integration Network, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Woodrow Wells
- Radiation Medicine Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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Lavergne C, Edmunds L, Warden P. Utilizing Quality Improvement Methods to Examine the Radiation Therapy Pathway for Patients Requiring Palliative Radiation Therapy at a Community Cancer Center. J Med Imaging Radiat Sci 2019; 50:378-386. [PMID: 31307944 DOI: 10.1016/j.jmir.2019.05.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND At a community cancer center, during weekly quality improvement huddles, the radiation therapy team expressed stress and frustration with the pretreatment pathway for patients requiring palliative radiotherapy. As the department was meeting provincial targets with respect to wait times, it was unknown why the consensus around the department reflected discomfort and stress. METHODS Four radiation therapists formed a quality improvement project team, intent on utilizing a data-driven improvement cycle to investigate and address opportunities to improve the discomfort around this pretreatment pathway. After defining the process and identifying the customers (the health care providers operating in this pathway), the team conducted interviews with each person, transcribing answers verbatim, and grouping results by discipline. Utilizing the interview themes, each discipline identified one or two priorities to measure, as well as metrics to capture the magnitude and prevalence of these priorities. RESULTS Each discipline's priorities were measured and analyzed. The identified issues brought forward at the weekly quality improvement huddles were not as prevalent as expected. Minor changes were implemented for priority issues. CONCLUSION The team focused on the four principles of quality improvement: the patient, team, process, and data to address the expressed discomfort around this specific radiation therapy pathway. The results dispelled some of the myths among teams and provided solutions to areas where minor improvements were required. Utilizing the data, an evidence-informed timeline was validated, encouraging task deadlines to be more evenly distributed across the pathway. Plans to monitor this pathway are being established. The team was successful in contributing to a growing culture of continuous improvement at this community cancer center.
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Affiliation(s)
- Carrie Lavergne
- R.S.McLaughlin Durham Regional Cancer Centre, Lakeridge Health Oshawa, Oshawa, Ontario, Canada.
| | - Leslie Edmunds
- R.S.McLaughlin Durham Regional Cancer Centre, Lakeridge Health Oshawa, Oshawa, Ontario, Canada
| | - Pauline Warden
- R.S.McLaughlin Durham Regional Cancer Centre, Lakeridge Health Oshawa, Oshawa, Ontario, Canada
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Beasley M, Brown S, McNair H, Faivre-Finn C, Franks K, Murray L, van Herk M, Henry A. The advanced radiotherapy network (ART-NET) UK lung stereotactic ablative radiotherapy survey: national provision and a focus on image guidance. Br J Radiol 2019; 92:20180988. [PMID: 30924682 PMCID: PMC6592085 DOI: 10.1259/bjr.20180988] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/20/2019] [Accepted: 03/21/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Stereotactic ablative radiotherapy (SABR) has become the standard of care for suitable patients with peripherally located early stage non-small cell lung cancer. Lung SABR requires strict image-guided radiotherapy (IGRT) protocols to ensure its safe delivery. The aim of this survey was to provide an assessment of current lung SABR practice in the UK. METHODS An online semi-structured survey containing a maximum of 32 questions regarding lung SABR, focussing on treatment image verification processes was piloted, developed and disseminated to the radiotherapy managers of 62 National Health Service centres across the UK. RESULTS The survey had a 100% complete response from NHS centres. 36 centres (58%) currently deliver lung SABR, with half treating fewer than 50 patients per year. Six centres deliver SABR despite not being commissioned by the NHS to provide this service. There is wide variation in the use of IGRT. Eight different permutations of cone beam CT order within the workflow were reported. Almost half of lung centres (17/36, 47%) believe there is a need to update national image guidance associated with lung SABR, such as the use of 'day zero', mid treatment and post treatment cone beam CTs. CONCLUSION Our results demonstrate wide variation in IGRT for lung SABR. There is an opportunity to develop existing IGRT workflows and the optimal approach to image guidance. Further work is required to investigate lung SABR provision and potential barriers to its implementation. ADVANCES IN KNOWLEDGE This survey represents the most comprehensive and accurate assessment of lung SABR practice in the UK since the 2014 SABR consortium survey.
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Affiliation(s)
- Matthew Beasley
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Sean Brown
- The Christie Hospital, The Christie Hospital NHS Foundation Trust, Manchester, England
| | - Helen McNair
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, London, England
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Robinett HR, Guerrero RTL, Peterson JA, Ward DC, Palafox NA, Vogel CW. A Unique Partnership Between the University of Hawai'i Cancer Center and the University of Guam: Fifteen Years of Addressing Cancer Health Disparities in Pacific Islanders in Hawai'i and Guam. Hawaii J Med Public Health 2019; 78:205-207. [PMID: 31205817 PMCID: PMC6554546] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This manuscript describes the efforts in research, education, and outreach of a unique partnership between the University of Hawai'i Cancer Center and the University of Guam in addressing cancer health disparities faced by Pacific Islanders in Hawai'i, Guam, and other parts of Micronesia. Significant accomplishments of this 15-year collaboration in research, training Micronesian students, and impact on the local communities are highlighted.
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Affiliation(s)
- Hali R Robinett
- University of Hawai'i Cancer Center, Honolulu, HI (HRR, DCW, NAP, CWV)
| | | | | | - David C Ward
- University of Hawai'i Cancer Center, Honolulu, HI (HRR, DCW, NAP, CWV)
| | - Neal A Palafox
- University of Hawai'i Cancer Center, Honolulu, HI (HRR, DCW, NAP, CWV)
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Corbett V, Epstein AS, McCabe MS. Characteristics and Outcomes of Ethics Consultations on a Comprehensive Cancer Center's Gastrointestinal Medical Oncology Service. HEC Forum 2019; 30:379-387. [PMID: 30078063 DOI: 10.1007/s10730-018-9357-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The goal of this paper is to review and describe the characteristics and outcomes of ethics consultations on a gastrointestinal oncology service and to identify areas for systems improvement and staff education. This is a retrospective case series derived from a prospectively-maintained database (which includes categorization of the primary issues, contextual ethical issues, and other case characteristics) of the ethics consultation service at Memorial Sloan Kettering Cancer Center. The study analyzed all ethics consultations requested for patients on the gastrointestinal medical oncology service from September 2007 to January 2016. A total of 64 patients were identified. The most common primary ethical issue was the DNR order (39%), followed by medical futility (28%). The most common contextual issues were dispute/conflict between staff and family (48%), dispute/conflict intra-family (16%), and cultural/ethnic/religious issues (16%). The majority of ethical issues leading to consultation were resolved (84%); i.e., the patient, surrogate, and/or healthcare team followed the recommendation of the ethics consultant. 22% had a DNR order prior to the ethics consult and 69% had a DNR order after the consult. In this population of patients on a gastrointestinal oncology service, ethics consultations are most often called regarding patients with advanced cancers and the most common ethical conflicts arose between families and the health care team over goals of care at the end of life, specifically related to the DNR order and perceived futility of continued/escalation of treatment. Ethics consultations assisted with conflict resolution. Conflicts might be reduced with improved communication about prognosis and earlier end of life care planning.
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Affiliation(s)
| | | | - Mary S McCabe
- Memorial Sloan Kettering Cancer Center, New York, USA
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Temkin SM. On Vulnerability. Narrat Inq Bioeth 2019; 9:184-186. [PMID: 31956113 DOI: 10.1353/nib.2019.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Simon MA. Architecture Matters-Moving Beyond "Business as Usual": The Chicago Cancer Health Equity Collaborative. Prog Community Health Partnersh 2019; 13:1-4. [PMID: 31378726 PMCID: PMC6944977 DOI: 10.1353/cpr.2019.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shin J, Ko H, Kim JA, Song YM, An JS, Nam SJ, Lee J. Hospital cancer pain management by electronic health record-based automatic screening. Am J Manag Care 2018; 24:e338-e343. [PMID: 30452201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES A cancer pain clinic (CPC) service is a thorough, comprehensive consultation service for patients with uncontrolled cancer pain. The aim of this study was to determine the success of a new CPC service with enrollment via electronic health record-based automatic screening at 1 cancer center in Korea. STUDY DESIGN A case-control study and a satisfaction survey. METHODS The intervention group (n = 158) was enrolled in the CPC service, whereas the control group (n = 158), which was matched using propensity scores, did not participate in the service. The pain scores of participants were compared using an independent t test. Thirty-nine patients and 20 physicians completed a self-administered survey on instructions for pain-relief medications, effective usage of long-acting and short-acting opioids, perceptions of or barriers to CPC services, knowledge of opioid use, and overall satisfaction. RESULTS Although the baseline pain score of the intervention group was significantly higher than that of the control group (P = .013), the difference in the decrease of pain between the groups was significant at days 1 (P = .001) and 2 (P = .039). Although the difference in pain scores disappeared on day 3, total pain score was significantly lower in the intervention group than in the control group (P = .012). When comparing pain relief events (<4 points on a 0-10 numeric rating scale that measured pain daily), the intervention group experienced more relief events than did controls (P = .017). Patients were satisfied with their physicians giving clear instructions and considering their opinions about pain-relief medications. The oncology residents expressed satisfaction with the management of patients with opioid-naïve or intractable pain. CONCLUSIONS The new CPC service seems to provide effective pain relief and users seem to be highly satisfied with it. These results support the importance of an integrated and specialized approach to cancer-related pain management.
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Affiliation(s)
| | | | | | | | | | | | - Jungkwon Lee
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Korea 06351.
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Thomas SM, Malvar J, Tran H, Shows J, Freyer DR. A prospective comparison of cancer clinical trial availability and enrollment among adolescents/young adults treated at an adult cancer hospital or affiliated children's hospital. Cancer 2018; 124:4064-4071. [PMID: 30291804 PMCID: PMC6234084 DOI: 10.1002/cncr.31727] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/23/2018] [Accepted: 05/27/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Low cancer clinical trial (CCT) enrollment may contribute to survival disparities affecting adolescents and young adults (AYAs) (ages 15-39 years). The objective of this study was to evaluate whether differences in CCT availability related to treatment site could explain the low CCT enrollment. METHODS This prospective, observational cohort study was conducted at an academic children's hospital and its affiliated but geographically separated adult cancer hospital within a National Cancer Institute-designated Comprehensive Cancer Center. For consecutive, newly diagnosed AYA patients, it was determined whether an appropriate CCT existed nationally, was available at the treatment site, and was used for enrollment. Proportions of AYAs in these categories were compared between sites using the chi-square test. RESULTS One hundred fifty-two consecutive AYA patients were included from the children's hospital (n = 68; ages 15-20 years) and the adult cancer hospital (n = 84; ages 18-39 years). Although there was no difference in CCT existence for individual AYA patients by site (children's hospital [36 of 68 patients; 52.9%] vs adult cancer hospital [45 of 84 patients; 53.6%]; P = .938), CCT availability was significantly lower at the adult cancer hospital (14 of 84 patients [16.7%] vs 30 of 68 [44.1%] at the children's hospital; P < .001). The proportion of AYAs enrolled was low at both sites (8 of 68 patients [11.8%] vs 6 of 84 patients [7.1%], respectively; P = .327). Fewer existing CCTs were available at the adult cancer hospital (4 of 27 patients [14.8%] vs 8 of 14 patients [57.1%], respectively), and those were directed toward solid tumors and new agents. CONCLUSIONS Efforts to improve low CCT enrollment among AYAs should be differentiated by treatment site. In the adult setting, these efforts should be aimed at improving CCT availability by overcoming site-level barriers to opening existing CCTs.
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Affiliation(s)
- Stefanie M. Thomas
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jemily Malvar
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
| | - Henry Tran
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jared Shows
- Department of Pathology, Long Beach Memorial/Miller Children’s Hospital, Long Beach, California
| | - David R. Freyer
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Medicine and the USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
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