Showing papers in "Journal of Oncology Practice in 2015"
TL;DR: Financial burden is prevalent among cancer survivors and is related to patients' health-related quality of life and future studies should consider interventions to improve patient education and engagement with regard to financial burden.
Abstract: Purpose: The impact of financial burden among patients with cancer has not yet been measured in a way that accounts for inter-relationships between quality of life, perceived quality of care, disease status, and sociodemographic characteristics. Patients and Methods: In a national, prospective, observational, population- and health care systems‐based cohort study, patients with colorectal or lung cancer were enrolled from 2003 to 2006 within 3 months of diagnosis. For this analysis, surviving patients who were either disease free or had advanced disease were resurveyed a median 7.3 years from diagnosis. Structural equation modeling was used to investigate relationships between financial burden, quality of life, perceived quality of care, and sociodemographic characteristics. Results: Among 1,000 participants enrolled from five geographic regions, five integrated health care systems, or 15 Veterans Administration Hospitals, 89% (n 889) were cancer free, and11%(n111)hadadvancedcancer.Overall,48%(n482) reported difficulties living on their household income, and 41% (n 396) believed their health care to be “excellent.” High financial burden was associated with lower household income (adjusted odds ratio [OR] 0.61 per $20k per year, P .001) and younger age (adjusted OR 0.63 per 10 years; P .001). High financial burden was also associated with poorer quality of life (adjusted beta0.06 per burden category; P .001). Better quality of life was associated with fewer perceptions of poorer quality of care (adjusted OR 0.85 per 0.10 EuroQol units; P .001). Conclusion: Financial burden is prevalent among cancer survivors and is related to patients’ health-related quality of life. Future studies should consider interventions to improve patient education and engagement with regard to financial burden.
208 citations
TL;DR: There is substantial variation in survivorship care models and specific research questions need to be addressed by the survivorship community to better understand the advantages and limitations of survivorship models.
Abstract: There is substantial variation in survivorship care models. The authors conclude that the optimal nature, timing, intensity, format, and outcomes of survivorship care models are uncertain and require further research.
152 citations
TL;DR: A systematic review of literature published between 2009 and 2014 did not see convincing evidence that MDTs affect patient survival or cost of care, or studies of how or which MDT processes and structures were associated with success.
Abstract: The authors did not see evidence that multidisciplinary teams (MDTs) affect patient survival or cost of care, or studies of how or which MDT processes and structures were associated with success.
135 citations
TL;DR: Most hematologic oncologists view palliative care as end-of-life care, whereas solid tumor oncologist more often view p terminally ill patients with complex cases as a subspecialty that could assist with complex patient cases.
Abstract: Most hematologic oncologists view palliative care as end-of-life care, whereas solid tumor oncologists more often view palliative care as a subspecialty for comanaging patients with complex cases.
123 citations
TL;DR: Efforts to reduce unexpected hospitalizations and employment disruptions by providing more comprehensive supportive care for pediatric patients with cancer could help ease families' financial burden.
Abstract: Efforts to reduce unexpected hospitalizations and employment disruptions by providing more comprehensive supportive care for pediatric patients with cancer could help ease families' financial burden.
104 citations
TL;DR: An ad hoc panel is established to conduct a formal review of the pan-Canadian guideline on screening, assessment, and psychosocial-supportive care interventions for adults with cancer who are identified as experiencing symptoms of depression and/or anxiety.
Abstract: Introduction Because of growing numbers of cancer survivors, the American Society of Clinical Oncology ASCO has taken steps to address the call by the Institute of Medicine for the “use of systematically developed evidence-based clinical practice guidelines, assessment tools, and screening instruments to help identify and manage late effects of cancer and its treatment.” To that end, ASCO established an ad hoc panel to conduct a formal review of the “PanCanadian Practice Guideline on Screening, Assessment and Care of Psychosocial Distress (Depression, Anxiety) in Adults With Cancer.” ASCO has a policy and set of procedures for adapting clinical practice guidelines developed by other organizations. The pan-Canadian guideline addresses the optimum screening, assessment, and psychosocial-supportive care interventions for adults with cancer who are identified as experiencing symptoms of depression and/or anxiety. The ASCO ad hoc panel
103 citations
TL;DR: Although ibrutinib and idelalisib are profound treatment advances, they will dramatically increase individual out-of-pocket and societal costs of caring for patients with CLL and may undermine the potential promise of these agents by limiting access and reducing adherence.
Abstract: Although ibrutinib and idelalisib are profound treatment advances, they will dramatically increase individual out-of-pocket and societal costs of caring for patients with CLL.
100 citations
TL;DR: An episode-based model of oncology care that incorporates elements from several successful model tests is designed, hoped that this model will demonstrate how oncologists care in the US can transform into a high value, high quality system.
Abstract: Centers for Medicare and Medicaid Services have designed an episode-based model of oncology care that incorporates elements from several successful model tests. It is hoped that this model will demonstrate how oncology care in the United States can be transformed into a high-value, high-quality system.
93 citations
TL;DR: The overall rate of documentation of discussion of FP is low, and results show disparities among specific groups, although greater numbers of discussions may be occurring.
Abstract: The authors conclude that the overall rate of documentation is low and results show disparities among specific groups. While greater numbers of discussions may be occurring, there is need to create interventions to improve documentation.
86 citations
TL;DR: The case helps demonstrate the differences between groups and teams and can help move groups toward becoming teams who deliver better care by identifying and managing goals, roles, and interdependent care tasks.
Abstract: This article discusses the care process among three groups (primary care, radiology, and surgery) aiding a 57-year-old woman during her screening mammography and diagnosis of breast cancer. This is the first in a series of articles exploring principles and topics relevant to teams guiding clinicians involved in cancer care. The challenges demonstrated in this case illustrate how clinicians work within and between groups to deliver this first phase of cancer care. The case helps demonstrate the differences between groups and teams. Focusing on the patient and the overall process of care coordination can help move groups toward becoming teams who deliver better care by identifying and managing goals, roles, and interdependent care tasks. Care providers and researchers can use the case to consider their own work and essential aspects of teamwork needed to improve care, patient outcomes, and the evidence that supports each.
71 citations
TL;DR: This CAP/IASLC/AMP guideline on molecular testing for the selection of patients with lung cancer for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors is endorsed.
Abstract: Purpose The College of American Pathologists (CAP), the International Society for the Study of Lung Cancer (IASLC), and the Association of Molecular Pathologists (AMP) guideline on molecular testing for the selection of patients with lung cancer for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors was considered for endorsement. Methods American Society of Clinical Oncology (ASCO) staff reviewed the CAP/IASLC/AMP guideline for developmental rigor; an ASCO ad hoc review panel of experts reviewed the guideline content. Results The ASCO panel concurred that the recommendations are clear, thorough, and based on the most relevant scientific evidence in this content area and present options that will be acceptable to patients. The CAP/IASLC/AMP guideline comprises 37 recommendations (evidence grade A or B), expert consensus opinions, or suggestions that address the following five principal questions: (1) When should molecular testing be performed? (2) How should EGFR testing be performed? (3) How should ALK testing be performed? (4) Should other genes be routinely tested in lung adenocarcinoma? (5) How should molecular testing be implemented and operationalized? Conclusion The ASCO review panel endorses the CAP/IASLC/AMP guideline. This guideline represents an important advance toward standardization of EGFR and ALK testing practices and is of major clinical relevance in advancing the care of patients with lung cancer. In the Discussion section, the ASCO review panel highlights three evolving areas: advances in ALK testing methodology, considerations for selecting appropriate populations for molecular testing, and emergence of other targetable molecular alterations. J Clin Oncol 32. © 2014 by American Society of Clinical Oncology
TL;DR: Patients with mRCC treated with tyrosine kinase inhibitors in real-world clinical practice are sicker than those enrolled onto pivotal clinical trials, and more than one third are trial ineligible.
Abstract: Patients with mRCC treated with tyrosine kinase inhibitors in real-world clinical practice are sicker than those enrolled onto pivotal clinical trials, and more than one third are trial ineligible.
TL;DR: Improvements in perceived knowledge and quality of survivorship care after receipt of a comprehensive SCP are demonstrated and those closer to diagnosis reported greater satisfaction with and use of the materials.
Abstract: This study demonstrates improvements in perceived knowledge and quality of survivorship care after receipt of a comprehensive survivorship care plan.
TL;DR: In an era of rising co-pays, patients with cancer want cost-of-treatment discussions, and these conversations do not lead to negative feelings in the majority of patients.
Abstract: As one solution to reducing costs and medical bank- ruptcies, experts have suggested that patients and physicians should discuss the cost of care up front. Whether these discus- sions are possible in an oncology setting and what their effects on the doctor-patient relationship are is not known. Methods: We used the National Comprehensive Cancer Network (NCCN) Guidelines and the eviti Advisor platform to show patients with metastatic breast, lung, or colorectal cancer the costs associated with their chemotherapy and/ or targeted therapy options during an oncology consulta- tion. We measured provider attitudes and assessed patient satisfaction when consultations included discussion of costs. Results: We approached 107 patients; 96 (90%) enrolled onto the study, three (3%) asked if they could be interviewed at a later date, and eight (7%) did not want to participate. Onlyfive of 18 oncologists (28%) felt comfortable discussing costs, and only one of 18 (6%) regularly askedpatientsaboutfinancialdifficulties.Themajorityofpatients(80%) wanted cost information, and 84% reported that these conversations wouldbeevenmoreimportantiftheirco-paysweretoincrease.Intotal, 72% of patients responded that no health care professional has ever discussed costs with them. The majority of patients (80%) had no negative feelings about hearing cost information. Conclusion: In an era of rising co-pays, patients with cancer want cost-of-treatment discussions, and these conversations do not lead to negative feelings in the majority of patients. Additional training to pre- pare clinicians for how to discuss costs with their patients is needed.
TL;DR: Multidisciplinary molecular tumor boards may help to optimize the management of patients with advanced, heavily pretreated breast cancer who have undergone genomic testing, and here report the experience with breast cancer.
Abstract: Multidisciplinary molecular tumor boards may help optimize the management of patients with advanced, heavily pretreated breast cancer who have undergone genomic testing.
TL;DR: Among patients receiving myelosuppressive chemotherapy for metastatic cancer in US clinical practice, FN is a frequent complication, associated with significant morbidity, mortality, and economic costs, and should be given careful consideration in the treatment of this population.
Abstract: Among patients receiving myelosuppressive chemotherapy for metastatic cancer in US clinical practice, febrile neutropenia is a frequent complication associated with morbidity, mortality, and economic costs.
TL;DR: The tool seems to be a valid method for identifying patients with cancer with complex PC needs who would benefit from a PC consult, and reliability testing, external validation, and demonstration of the utility of the tool as a decision aid all await confirmation.
Abstract: The authors conclude an 11-item screening tool seems to be a valid method for identifying patients with cancer who have complex PC needs and could benefit from a PC consult.
TL;DR: The cancer list was developed in partnership with the Canadian Society of Surgical Oncology, Canadian Association of Medical Oncologists, andCanadian Association of Radiation oncology to empower patients with cancer and physicians to assist in a targeted conversation about the appropriateness and quality of individual patient care.
Abstract: Using knowledge translation and exchange efforts, this list should empower patients with cancer and physicians to participate in a targeted conversation about the appropriateness and quality of individual patient care.
TL;DR: Provider-level factors are associated with delivery of nonstandard cancer treatment to HIV-infected patients and policy change, provider education, and multidisciplinary collaboration are needed to improve access to cancer treatment.
Abstract: Provider-level factors are associated with delivery of nonstandard cancer treatment to HIV-infected patients. Policy change, provider education, and multidisciplinary collaboration are needed to improve access to cancer treatment.
TL;DR: Among patients with lung or colorectal cancer, frequent physician tumor board engagement was associated with patient clinical trial participation and higher rates of curative-intent surgery for stage I to II NSCLC but not with overall survival.
Abstract: Among patients with lung or colorectal cancer, frequent physician tumor board engagement was associated with patient clinical trial participation and higher rates of curative-intent surgery for stage I to II NSCLC but not with overall survival.
TL;DR: ER + Hs are common among patients with EBC receiving chemotherapy and significantly higher than among controls, and represents a potential opportunity for quality improvement.
Abstract: The authors conclude that emergency room visits and hospitalization are common among patients with early breast cancer receiving chemotherapy and significantly higher than among controls.
TL;DR: There is significant variation in end-of-life quality indicators across regions in four provinces in Canada, and methods-deriving empiric benchmarks and funnel plots-regions can determine their relative performance with greater context that facilitates priority setting and resource deployment.
Abstract: There is significant variation in end-of-life quality indicators across regions in four provinces in Canada. Applying this study's methods can support quality improvement by decreasing variation and striving for a target.
TL;DR: Analysis using a willingness-to-pay threshold of $50,000 per quality-adjusted life-year suggests that the benefits of TMZ fall on the edge of acceptable therapies, and larger out-of-pocket costs may influence the choice of chemotherapeutic agents, which should be evaluated prospectively.
Abstract: With increased chemotherapy use for malignant glioma, the paradigm for treatment and associated out-of-pocket and total medical costs continue to evolve.
TL;DR: It was concluded that new, innovative trial designs and the realities of limited funding would require the adoption of effective and efficient recruiting strategies, specialized training, and stakeholder engagement.
Abstract: Racial and ethnic diversity has historically been difficult to achieve in National Cancer Institute-sponsored clinical trials, even while as many as 80% of those trials have faced difficulty in meeting overall recruitment targets. In an attempt to address these issues, NRG Oncology recently convened a comprehensive workshop titled "Clinical Trials Enrollment: Challenges and Opportunities." Discussants at the workshop included representatives of the three legacy groups of the NRG (ie, Gynecologic Oncology Group, National Surgical Adjuvant Breast and Bowel Program, and Radiation Therapy Oncology Group), a minority-based community clinical oncology program, a large integrated health care system, the leadership of the National Cancer Institute, and a large patient advocacy group. This article summarizes the concepts discussed at the workshop, which included: needs assessments, infrastructural support, training of investigators and research staff, specific clinical trial recruitment strategies (both system and community based), and development and mentoring of young investigators. Many new, more specific tactics, including use of diverse cancer care settings, direct-to-consumer communication, and the need for centralized information technology such as the use of software to match trials to special populations, are presented. It was concluded that new, innovative trial designs and the realities of limited funding would require the adoption of effective and efficient recruiting strategies, specialized training, and stakeholder engagement. US clinical research programs must generate and embrace new ideas and pilot test novel recruitment strategies if they are to maintain their historic role as world leaders in cancer care innovation and delivery.
TL;DR: It was found that only 10% of older patients with cancer who self-reported a recent fall had appropriate medical record documentation, suggesting a need to increase awareness of falls prevalence and consequences among oncology providers in order to provide timely interventions to reduce the risks associated with falls.
Abstract: The authors found that only 10% of older patients with cancer who self-reported a recent fall had appropriate medical record documentation.
TL;DR: The ED FNP is a significant quality initiative with sustainable interventions, and was able to demonstrate value by decreasing TTA compared to both historical and DA controls in cancer patients presenting to the emergency department.
Abstract: The Emergency Department (ED) Febrile Neutropenia Pathway quality initiative demonstrated value by decreasing time to antibiotic administration in patients with cancer presenting to the ED compared with historical and direct admissions controls.
TL;DR: This VTB program positively affected the process of care for patients with HCC by improving the quality and timeliness of the MDE process, while avoiding the burden arising from travel needs.
Abstract: A VTB program positively affected the process of care for patients with HCC by improving the quality and timeliness of the multidisciplinary evaluation process.
TL;DR: The goal of PCORnet is to create a community of research that includes patients, clinicians, and health care delivery systems to improve the nation's ability to conduct comparative-effectiveness research.
Abstract: The goal of PCORnet is to create a community of research that includes patients, clinicians, and health care delivery systems to improve the nation's ability to conduct comparative-effectiveness research.
TL;DR: Analysis of qualitative data showed that all participants needed to create buy-in among key cancer center staff, including oncologists, to decide how to conduct screening in their institution in a way that complied with the standard.
Abstract: Several months before the compliance deadline, fewer than half of applicant institutions had begun distress screening. Adding implementation strategies to mandated quality care standards may reduce uncertainty on how to comply.