Acute Cancer Care Research Articles

A Hybrid Model of Acute Cancer Care from a Hospital-based Acute Care Clinic and the Emergency Department: A Descriptive Study

Emergency department (ED) visits by patients with cancer are increasing. New care delivery models are emerging to address the demand for acute care for patients with cancer. A Cancer Hospital and the affiliated ED implemented a novel care model in January 2016 whereby cancer patients are able to contact a nursing hotline, and based on their symptoms are triaged to the ED or to the Cancer Hospital’s Acute Care Clinic (ACC) for further evaluation.

Cancer survivorship care at the time of the COVID-19 pandemic.

Cancer survivorship care at the time of the COVID-19 pandemic.

Efficiency in health services based on professionals consensus quality indicators

ABSTRACT This study aims to determine the predictive factors of technical efficiency of Organization for Economic Co-operation and Development (OECD) countries according to Health Care Quality Indicators (HCQI) and health status measures. The technical efficiency of OECD countries was analyzed by using data envelopment analysis and different model specifications from 1 to 13. Data was obtained from HCQI project statistics and OECD reports for the years between 2008 and 2011. The technical efficiency of OECD countries according to acute care, primary care, cancer care, cardiovascular diseases, and diabetes and health status measures was determined. The different model specification results indicate that the first model, which includes HCQI, such as primary care, acute care, cancer care, and cardiovascular diseases, as input variables and life expectancy and maternal mortality as output variables have the highest technical efficiency score (79%). The most influential variable that predicts the technical efficiency of OECD countries according to HCQI and health status measures is case fatality in adults within 30 days after admission for acute myocardial infarction (AMI). This study highlights the need to improve diagnostic and treatment technologies of acute care to reduce hospital mortality following AMI to develop quality of health care in developed countries.

Impact of COVID-19 pandemic on health system & Sustainable Development Goal 3.

Impact of COVID-19 pandemic on health system & Sustainable Development Goal 3.

Ambulatory management in low risk neutropenic sepsis – A plea for integrated acute cancer care

Neutropenic Sepsis (NS) is a well recognised treatment complication, typically occurring 7-10 days following cancer cytotoxic chemotherapy. Colleagues in acute medicine will be only too familiar with the scenario of cancer patients that present with fever in the absence of localising signs and symptoms and with a very low yield from microbiological cultures. The incidence and mortality of NS are poorly defined and historically, management guidelines have often been developed in relative isolation from the broader subject of infection and sepsis care. Despite the lack of a clear and pragmatic definition, NICE guidance CG151 (2012) identified suspected NS as a medical emergency requiring prompt empirical broad spectrum antibiotics.

Thai Oncology Nurses' Perceptions of Patient Participation in Acute Cancer Care

PurposePatient participation in care is considered a core component of high-quality nursing care and medical treatment. In the context of cancer care in Thailand, we know very little about the way patient participation in care is perceived and enacted. The aim of this study was to explore Thai oncology nurses' perceptions and understandings of patient participation in their own care during hospitalization. MethodsA qualitative descriptive research approach using focus groups was applied. Two focus group interviews (N = 16) were conducted with registered nurses who provide care in oncology units of one tertiary care university hospital in Bangkok, Thailand. The transcribed interviews were analyzed using qualitative content analysis. ResultsIn this study, nurses were aware of the value of patient participation during hospitalization but acknowledged that current processes to involve patients in their care were not as effective as they could be. Facilitating participation is seen as a means of supporting patients to make decisions independently that are in line with their treatment plans, in particular, decisions related to self-care and illness-related symptoms. This raises the potential for conflict when patients make choices that are contrary to recommendations. Barriers to facilitating participation identified were high clinician workloads and lack of time, and ambiguity of existing guidelines for supporting lifestyle decisions. ConclusionFacilitating patient participation is complex in acute cancer care. Patient participation is recognized by nurses as a positive way of promoting independence in patients. However, balancing patient autonomy with nurses' perceived professional responsibilities is challenging in practice.

A qualitative exploration of the experiences, needs, and roles of caregivers during and after cancer treatment: "That's what I say. I'm a relative survivor".

The transition out of acute cancer treatment has been identified as a time of stress and uncertainty for cancer survivors, but little is known about how caregivers fare during this period. In this paper, we discuss caregiving work up to and including transition from initial care and the needs of caregivers during transition and beyond. We held four focus groups with breast, prostate, and colorectal cancer survivors who had completed treatment with intent to cure and two with caregivers for the same population. Participants were affiliated with either an urban academic or rural community cancer center. The discussions focused on cancer-related experiences and needs during the transition out of acute cancer care. Focus groups included 47 people: 28 survivors and 19 caregivers. Three key caregiving themes identified the significance of support for the patient in the clinic, support for the patient in the home, and for caregiver self-care. Discussions revealed aspects of caregiving that created difficulties for the caregiver themselves or between the caregiver and the cancer survivor. Caregiver experiences and needs may warrant explicit attention as survivors and caregivers are adjusting to a "new normal" that is no longer centered on getting through treatment. Patients and informal caregivers are often conceptualized as a "unit of care"; consideration of the needs of both is important for the provision of appropriate and effective health services.

Using QR codes to enable quick access to information in acute cancer care.

Quick access to toxicity management information ensures timely access to steroids/immunosuppressive treatment for cancer patients experiencing immune-related adverse events, thus reducing length of hospital stays or avoiding hospital admission entirely. This article discusses a project to add a QR (quick response) code to a patient-held immunotherapy alert card. As QR code generation is free and the immunotherapy clinical management algorithms were already publicly available through the trust's clinical network website, the costs of integrating a QR code into the alert card, after printing, were low, while the potential benefits are numerous. Patient-held alert cards are widely used for patients receiving anti-cancer treatment, and this established standard of care has been modified to enable rapid access of information through the incorporation of a QR code.

No Ifs, No Butts: Compliance with Smoking Cessation in Secondary Care Guidance (NICE PH48) by Providers of Cancer Therapies (Radiotherapy and Chemotherapy) in the UK.

Background: Legislation preventing smoking in public places was introduced in England in July 2007. Since then, smoke-free policies have been extended to the majority of hospitals including those providing cancer therapies. Whilst studies have been conducted on the impact and effectiveness of hospital smoke-free policy in the UK and other countries, there have not been any studies with a focus on cancer care providers. Cancer patients are a priority group for smoking cessation and support and this study aimed to examine implementation of the National Institute Clinical Excellence (NICE) guidance (PH48) in acute cancer care trusts in the UK. Methods: Participants were recruited from UK radiotherapy and chemotherapy departments (total 80 sites, 65 organisations) and asked to complete a 15 min online questionnaire exploring the implementation of NICE guidance at their hospital site. Results: Considerable variability in implementation of the NICE guidance was observed. A total of 79.1% trusts were smoke-free in theory; however, only 18.6% were described as smoke-free in practice. Areas of improvement were identified in information and support for patients and staff including in Nicotine Replacement Therapy (NRT) provision, staff training and clarity on e-cigarette policies. Conclusions: While some trusts have effective smoke-free policies and provide valuable cessation support services for patients, improvements are required to ensure that all sites fully adopt the NICE guidance.

Learning in Online Continuing Professional Development: An Institutionalist View on the Personal Learning Environment

The nature of institutions is an important question for the Personal Learning Environment (PLE). Whilst the PLE has tended to focus on what is considered to be “non-institutional” technology like social software, most online tools today have a corporate/institutional foundation. How should educators position themselves with learners who have to negotiate different institutional and discursive contexts – whether within corporate social software, formal education, work or the family? Drawing on previous work focusing on how learners maintain personal coherence in organising learning between different contexts, institutional theory is used to revise the model of the learner as a ‘viable system’, which focuses on the dynamics of transactions that learners make with different institutional entities. Data from an online Continuing Professional Development (CPD) course in acute cancer care is analysed to show how learner transactions indicate constraints bearing upon learners both from their professional context and from their formal educational study. The pattern of learner engagement suggests that the interaction of constraints creates the conditions to motivate in-depth contribution to the course forums. This finding leads us to suggest a rethink of pedagogy within the PLE, and a broader consideration of institutional and other constraints in educational dynamics.

Effective Transitional Therapy for Adolescent and Young Adult Patients With Cancer: An Integrative Literature Review.

The adolescent and young adult (AYA) cancer community has demonstrated a need for psychosocial help transitioning from acute cancer care to survivorship while navigating appropriate developmental challenges. The purpose of this integrative literature review is to examine the transition of AYAs from life as patients with cancer to life as cancer survivors and to evaluate the most effective, therapeutic ways to make this transition. This integrative literature review focused on articles published from 2008-2015 using PubMed, CINAHL®, and PsycINFO. Key search terms were cancer, [adaptation, psychological], adolesc*, and young adult. Outcomes were evaluated using the Adaptation Model of Nursing. Twenty-two studies met the inclusion criteria, but only four empirically examined interventions. Eighteen studies demonstrated AYAs' unmet needs and suggested important therapeutic components. The four empirically examined interventions were dynamic group therapy, online cognitive-behavioral therapy, an online cancer forum, and an educational cancer retreat. Eighteen therapeutic themes were identified as integral to a complete and healthy transition. Five of these themes seemed to be of particular importance.

Challenges and Advances in Pain Management for the Cancer Patient

The field of cancer pain management is rapidly changing to parallel the advances in pain medicine. Improved perioperative care has brought about a change in pain management to a proactive state rather than our historical reactive position. While pain specialists will aim to optimize management, more frequently anesthesiologists and perioperative physicians will implement strategies in pain prevention, treat the difficult pain patient early, and be faced with newer and more complicated interventions. We will review common challenges and areas of advancement in the realm of acute cancer care.

Health care professionals' perspectives of the experiences of family caregivers during in-patient cancer care.

Being a family member of a patient who is being treated in an acute care setting for cancer often involves a number of challenges. Our study describes Norwegian cancer care health professionals' perceptions of family members who served as family caregivers (FCs) and their need for support during the in-hospital cancer treatment of their ill family member. Focus group discussions were conducted with a multidisciplinary team of 24 experienced social workers, physicians, and nurses who were closely involved in the patients' in-hospital cancer treatment and care. Drawing on qualitative hermeneutic analysis, four main themes describe health professionals' perceptions of FCs during the patient's in-hospital cancer care: an asset and additional burden, infinitely strong and struggling with helplessness, being an outsider in the center of care, and being in different temporalities. We conclude that it is a challenge for health care professionals to support the family and create room for FC's needs in acute cancer care. System changes are needed in health care, so that the patient/FC dyad is viewed as a unit of care in a dual process of caregiving, which would enable FCs to be given space and inclusion in care, with their own needs simultaneously considered alongside those of the patient.

Delivering care to oncology patients in the community: an innovative integrated approach.

A community oncology nursing programme was developed in Ireland between the hospital and community health services for patients receiving systemic cancer therapy, in response to a service need. A robust evaluation of the pilot programme was undertaken, which found that defined clinical procedures traditionally undertaken in hospitals were safely undertaken in the patient's home with no adverse effects. There was a dramatic decrease in hospital attendances for these defined clinical procedures, and hospital capacity was consequently freed up. Patients valued having aspects of their care delivered at home and reported that it improved their quality of life, including reduced hospital visits and travel time. Community nurses expanded their scope of practice and became partners with oncology day-ward nurses in caring for these patients. Community nurses developed the competence and confidence to safely deliver cancer care in the community. This initiative shows that defined elements of acute cancer care can be safely delivered in the community so long as the training and support are provided. The findings and recommendations of the evaluation resulted in university accreditation and approval for national roll-out of the programme. Integration of services between primary and secondary care is a key priority. This innovative programme is a good example of shared integrated care that benefits both patients and health-care providers.

Timely access to specialist medical oncology services closer to home for rural patients: experience from the Townsville Teleoncology Model.

Prior to 2009, the teleoncology model of the Townsville Cancer Centre (TCC) did not achieve its aims of equal waiting times for rural and urban patients and the provision of reliable, local acute cancer care. From 2007-2009, 60 new patients from Mt Isa travelled to TCC for their first consultation and their first dose of chemotherapy. Six of these patients required inter-hospital transfers and eight required urgent flights to attend outpatient clinics. Only 50% these rural patients (n = 30) were reviewed within one week of their referral, compared with 90% of Townsville patients. A descriptive study. TCC provides teleoncology services to 21 rural towns; the largest is Mt Isa, Qld. Specialist review of 90% of urgent cases within 24 hours, and 90% of non-urgent cases within one week of referral via videoconferencing. A 50% reduction in inpatient inter-hospital transfers from Mt Isa to Townsville. Employment of a half-time medical officer and a half-time cancer care coordinator, and implementation of new policies. Between 2009 and 2011, TCC provided cancer care to 70 new patients from Mt Isa. Of these new patients, 93% (65/70) were seen within one week of referral. All 17 patients requiring urgent reviews were seen within 24 hours of referral and managed locally thus eliminating the need for inpatient inter-hospital transfers. Provision of timely acute cancer care closer to home requires an increase in the rural case complexity and human resources.

Sleep Disruption in Breast Cancer Patients and Survivors

Sleep disruption is prevalent in patients and survivors of breast cancer. Most patients undergoing chemotherapy will experience transient sleep disruption, and nearly 60% will have chronic sleep problems. Numerous factors contribute to sleep disruption in women diagnosed with breast cancer. Sleep disruption is a consequence of several biological alterations, including circadian disruption and immune and metabolic deregulations. These systems also play significant roles in the control and progression of breast cancer. Sleep disruption is associated with many side effects and psychiatric and medical comorbidities. This article discusses the relationship between stress and posttraumatic stress disorder, depression and fatigue, and how sleep disturbance might be the cause or consequence of these disorders. Current evidence for management of sleep disturbance in breast cancer and high chronic use of hypnotic medication in this population is also discussed. Finally, the differences in management of sleep disturbance during acute cancer care and during the survivorship phase are discussed. More research is needed on accurate and timely assessment of sleep disturbance associated with breast cancer, and additional tailored approaches for the management of sleep problems in breast cancer should be developed.

Working out of the ‘tool box’: An exploratory study with complementary therapists in acute cancer care

AimsThe aim of this research was to explore and capture complementary therapists' experiences of and preparation for working with patients in an acute cancer care setting. MethodSemi structured interviews with therapists (n = 18) in an acute cancer hospital in the North West of England. The interviews were transcribed and analysed using thematic coding. ResultsKey themes identified included; the need for a ‘tool box’ of skills that develop beyond those taught in initial training, building confidence when adapting these new skills in practice, helping patients to become empowered, the need to support carers, research evidence and resources issues, and the role of supervision. ConclusionThis study was limited by being set in a single acute cancer site. Therapists valued having a ‘tool box’ but needed confidence and support to navigate the challenges of clinical practice.

Trialling a patient-led cancer care website in an acute cancer care setting

Health ICT is rapidly gaining popularity among policy makers and health consumers. Specific platforms for use in cancer care are missing. Aim: The aim of this pilot study was to: 1) test the feasibility, functionality and usability of a patient-led cancer care web platform: CanCare, in a sample of people undergoing cancer treatment and 2) ascertain if CanCare could enhance communication between patients, family, friends and health professionals. Methods: Cancer patients receiving chemotherapy were invited to participate. Data were collected via semi-structured interviews, online surveys and a website usage program. Results: Nine patients with four different types of cancer completed the study. All saw the potential of the website but many found it too complex to use, particularly when unwell post treatment. Many were frustrated by the lack of integration with existing hospital systems and the need to enter relevant data manually. The cancer-specific information tab rated highly and was used extensively. The website used alone did not promote interactions between family and/or health professionals. Conclusion: A patient-led cancer care website has the potential to help patients manage their cancer care but needs to be intuitive to use, integrated into hospital systems and requires significant family/carer and health professional engagement.

Review: Trialling a patient-led cancer care website in an acute cancer care setting

Review: Trialling a patient-led cancer care website in an acute cancer care setting

An innovative approach to post-treatment cancer care: The After Cancer Treatment Transition Clinic (ACTT).

e19522 Background: Improvements in early detection and cancer therapy have led to better survival rates. Integration of cancer survivorship initiatives as part of cancer care is gaining momentum. However, post cancer treatment follow up care may not be best met in acute cancer clinics. Visits to a large urban cancer centre in Canada have increased by 30% in the past 5 years. These increased volumes have lead to prolongation of patient wait times and increased stress for health care providers. This cancer centre is undergoing a transformative change that focuses on improving the patient cancer care experience. Methods: The development of the ACTT clinic has been a partnered initiative between two academic healthcare centres: an urban cancer centre and a community ambulatory hospital with a focus in chronic disease management. It is being managed by an advanced practice nurse and a GP Oncologist. The ACTT clinic delivers high quality, safe specialized physician and advanced nursing patient care, with engagement of patients/families, oncologists and primary care. The target population is patients who have completed cancer therapy, are well and are at moderate to low risk for cancer recurrence. The initial phase of the project involved transitioning patients with Testes, Melanoma, Breast and Colorectal cancers. Each cancer site group identifies the appropriate processes for clinic functioning at the ACTT, and if required, for appropriate linkages back to acute cancer care and primary care. Results: Over 1,000 patients have been transitioned to ACTT since April 2010 with 10-20 additional patients referred weekly. Essential components of the model include: standard surveillance protocols for recurrence or secondary cancers, management of long term and late effects of cancer treatment, monitoring for distress and health promotion. Standard reporting includes patient assessment and a defined plan of care communicated to their oncologist and primary care. Patient experience evaluation of the program is ongoing. Conclusions: The ACTT clinic initiative has been successful in developing a novel clinic model and has successfully transitioned over 1,000 patients from an acute care cancer clinic.