Adult Oncology Setting Research Articles

Vaccination attitudes and practices of physicians and nurses in adult oncology settings

Vaccination attitudes and practices of physicians and nurses in adult oncology settings

Acute lymphoblastic leukemia in young adults: which up-front treatment?.

Significant improvements have occurred for adolescent and young adult (AYA) B-cell acute lymphoblastic leukemia (B-ALL) patients following the widespread adoption of "pediatric-inspired" treatment regimens for AYA patients cared for in adult oncology settings. However, for AYA patients, aged 15 to 39, an outcomes gap remains in B-ALL, necessitating the incorporation of novel therapies into up-front treatment regimens. As a result, clinical trial enrollment remains the current standard of care for AYA B-ALL across disease subtypes when available and accessible. Currently, several up-front trials are looking to incorporate the use of inotuzumab, blinatumomab, and chimeric antigen receptor T-cell therapy into existing chemotherapy backbones for AYA patients, as well as tyrosine kinase inhibitors for both Philadelphia-positive (Ph+) and Ph-like B-ALL. In addition to ongoing attempts to improve up-front treatments by incorporating immunotherapy and targeted approaches, the increased use of next generation sequencing for measurable residual disease evaluation has led to superior risk-stratification and a decreased need to pursue consolidative hematopoietic stem cell transplantation during the first complete remission for many patients.

Outcomes of a National Training Curriculum to Advance Generalist Level Palliative Care.

Background: The adoption of palliative care as an integral component of health care has led to the need for generalist level providers, especially important in serious illnesses such as cancer. Objectives: The goals of this National Cancer Institute-funded training program were to (1) identify the eight domains of quality palliative care applied to oncology practice, (2) demonstrate skills for oncology advanced practice registered nurses (APRNs) in the domains of palliative care, and (3) develop goals for implementing the skills training in practice through process improvement, staff education, and clinical care. Design: The training program led by the End of Life Nursing Education Consortium (ELNEC) project included oncology APRNs in a three-day training course with one-year follow-up for ongoing support and to assess impact. Settings: Five training courses included 430 APRNs from 46 U.S states including both pediatric and adult oncology settings. The project included 25% minority participants. Measurement: Measures included participant goal implementation, course evaluations, and surveys to assess implementation and palliative care practices (precourse, 6 and 12 months postcourse). Results: The ELNEC oncology APRN training course resulted in changes in practice across domains, improved perceived effectiveness in clinical practice, and valuable insight regarding the challenges in generalist level palliative care implementation. Conclusion: The ELNEC oncology APRN course serves as a model for the palliative care field to advance generalist level practice. Future training efforts can build on this project to reach more oncology professionals and those in other areas of serious illness care.

Establishing nursing-sensitive quality indicators for pediatric oncology: An international mixed methods Delphi study.

Nursing-sensitive indicators (NSIs) measure factors influencing nursing care quality and patient outcomes. Established NSIs reflect general and select specialty nursing practices. However, a core set of NSIs for international pediatric oncology nursing practice does not currently exist. Without valid and reliable quality indicators, the impact of nursing care on children and adolescents with cancer cannot be effectively measured and improved. The purpose of this study was to develop a preliminary core set of NSIs for international pediatric oncology nursing that would be important, actionable, and feasible to measure across varied resource settings and countries. A multiphase sequential mixed methods research design, intersected with a classical Delphi method, was utilized. Through purposive snowball sampling, 122 expert pediatric oncology nurses from 43 countries participated. Round One: Panelists identified five potential NSIs and constructs. Open-ended responses were coded and categorized through descriptive content analysis and integrated into the next round. Round Two: Panelists selected their top 10 NSIs and constructs and ranked them by importance to patient care quality. Mean importance scores were calculated through reverse scoring; the top 10 NSIs and constructs were integrated into the next round. Round Three: Panelists ranked the top 10 NSIs and constructs by order of importance for this particular population, then rated each NSI/Construct for actionability and feasibility of measurement by Likert-scale. Rounds Two and Three were analyzed using descriptive statistics. Mixed methods meta-inferences were derived from the integration of Rounds One and Three findings. Eighty-five (70%) panelists from 38 countries completed all Delphi survey rounds. The preliminary core set of NSIs and constructs identified by the expert panel, and ranked in order of importance, were as follows: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. All NSIs and constructs were rated as actionable; all but palliative/end of life care were rated as feasible to measure. Each of the 10 NSIs and constructs were nominated in Round One by at least one expert panelist from low- and middle-income and high-income countries, and at least one panelist from the Americas. Preliminary core NSIs and constructs provide insight into common attributes of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement. NSIs have the potential to drive quality improvement, guide comparison with other institutions, promote knowledge-sharing, and advance pediatric oncology nursing outcomes around the world. These NSIs and constructs may also be relevant to other pediatric and adult oncology settings.

A Multicomponent Telehealth Intervention to Improve Oncofertility Care Delivery Among Young Cancer Patients: A Pilot Study.

Purpose: Oncofertility care for pediatric, adolescent, and young adult cancer patients remains under-implemented across adult and pediatric oncology settings. We pilot tested an electronic health record (EHR)-enabled multicomponent oncofertility intervention (including screening, referral, and fertility consult) in an adult academic oncology program and systematically assessed intervention fit to pediatric and community oncology programs. Methods: Using surveys (n = 33), audits (n = 143), and interviews (n = 21) guided by implementation science frameworks, we pilot tested the EHR-enabled intervention for oncofertility care in young cancer patients at an adult oncology program and evaluated implementation outcomes. We interviewed health care providers from seven regional oncology and fertility programs about intervention fit to their clinical contexts. Results: We recruited 33 health care providers from an adult oncology setting and 15 health care providers from seven additional oncology and fertility settings. At the adult oncology setting, the intervention was found to be appropriate, acceptable, and feasible and improved the screening of fertility needs (from 30% pre- to 51% post-intervention); yet, some patients did not receive appropriate referrals to fertility consults. Providers across all settings suggested content and context modifications, such as adding options to the intervention or allowing the screening component to pop up at a second visit, to improve and adapt the intervention to better fit their clinical care contexts. Conclusions: We found that the EHR-enabled intervention increased the rate of goal-concordant oncofertility care delivery at an adult oncology program. We also identified facilitators, barriers, and needed adaptations to the intervention required for implementation and scaling-up across diverse oncology settings.

Covid-19 and beyond: Broadening horizons about social media use in oncology. A survey study with healthcare professionals caring for youth with cancer

ObjectivesThe study aimed to explore the attitudes of Swiss healthcare professionals toward the use of social media in adolescent and young adult oncology, and to examine whether the ongoing social restrictions due to COVID-19 might have altered these attitudes. MethodsThis research was a survey study. The subjects were healthcare providers working in pediatric or adult oncology settings in Switzerland. 62 providers completed the survey. We performed descriptive and inferential statistical analyses. ResultsWhile considered useful for various professional aspects (professional life 62.1%, educational purposes 72.7%, networking 83.3%, patient engagement 57.6%, clinical trial recruitment 51.5%), only a small proportion of participants actually used social media for professional reasons weekly (32.8%). Just over half considered themselves skillful in using these platforms (56.1%). Regression analysis revealed that self-assessed skillfulness with social media, the Covid-19 impact on attitudes, and the oncology setting, significantly predicted assessment of the usefulness of social media. Although, in answers to open items, institutional guidelines were deemed crucial to improve social media use, many respondents seemed unaware of their existence (50.8%). Only a minority reported an impact of Covid-19 on their attitudes towards the professional implementation of social media (25.0%). ConclusionThe global health crisis creates important challenges for young patients with cancer and their healthcare providers. In times of social restrictions, social media may be a promising tools to facilitate health information provision, connectivity, and patient care. Virtual mentorship and targeted social media training interventions might be a good way to improve familiarity with using social media and to increase awareness about existing ethical guidelines for their use.

Implementing an evidence-based structured education and management program in an inpatient adult oncology setting to improve patients' pain control.

Cancer-related pain is prevalent across the cancer trajectory, and is probably one of the most feared of all cancer symptoms for patients and their families. Although there were guidelines and framework regarding the management of cancer pain, pain control among patients remain suboptimal. This best practice implementation project aimed to improve patients' perception on cancer pain management and pain control through implementing structured patient and family education and patient information leaflet (PIL) on managing cancer pain. The current implementation project conducted in an adult oncology inpatient unit utilized the JBI Practical Application of Clinical Evidence System and Getting Research into Practice module for promoting evidence-based health care. A comparison between the preimplementation and postimplementation findings showed significant improvements for both audit criteria outcomes. The percentage of patients receiving verbal education rose from 0 to 69%, whereas the percentage of patients receiving PIL increased 0-100%. Patient compliance to analgesic regime increased from 0 to 100%. There was a significant improvement in patients' pain levels ( P < 0.001), with majority rate having none-mild pain post intervention. A structured educational program on cancer-related pain improved patients' knowledge on cancer-related pain management and pain control. Despite the remarkable increase in the compliance rate, further interventions may still be required to achieve 100% compliance. Continuous audits will be held to guide follow-up interventions to ensure compliance and sustention of the project.

The Use of Inhibitors of Tyrosine Kinase in Paediatric Haemato-Oncology-When and Why?

The fundamental pathophysiology of malignancies is dysregulation of the signalling pathways. Protein tyrosine kinases (PTKs) are among the enzymes which, if mutated, play a critical role in carcinogenesis. The best-studied rearrangement, which enhances PTK activity and causes atypical proliferation, is BCR-ABL1. Abnormal expression of PTKs has proven to play a significant role in the development of various malignancies, such as chronic myelogenous leukaemia, brain tumours, neuroblastoma, and gastrointestinal stromal tumours. The use of tyrosine kinase inhibitors (TKIs) is an outstanding example of successful target therapy. TKIs have been effectively applied in the adult oncology setting, but there is a need to establish TKIs’ importance in paediatric patients. Many years of research have allowed a significant improvement in the outcome of childhood cancers. However, there are still groups of patients who have a poor prognosis, where the intensification of chemotherapy could even cause death. TKIs are designed to target specific PTKs, which lead to the limitation of severe adverse effects and increase overall survival. These advances will hopefully allow new therapeutic approaches in paediatric haemato-oncology to emerge. In this review, we present an analysis of the current data on tyrosine kinase inhibitors in childhood cancers.

Covid-19, The Perfect Time to Broaden our Horizons About Social Media Use in Oncology?

"Objective: The study aims to explore the attitudes of Swiss healthcare professionals towards the use of social media in adolescent and young adult oncology and to examine whether the ongoing social restrictions due COVID-19 might have altered these attitudes. Methods: This study was cross-sectional in design. The subjects were healthcare providers working in pediatric or adult oncology settings in Switzerland. We performed descriptive and inferential statistical analyses. Results: While considered useful, only a small minority of participants actually used social media for professional reasons and considered themselves skillful in using these platforms. Although institutional guidelines were deemed crucial to improve social media use, many respondents seemed unaware of their existence. Only a minority reported an impact of Covid-19 on their attitudes towards the professional implementation of social media. Conclusion: The global health crisis creates important challenges for young patients with cancer and their healthcare providers. In times of social restrictions, social media may be promising tools to facilitate health information provision, connectivity and patient care. Virtual mentorship and target social media training interventions might be the best way to improve familiarity with social media and with ethical guidelines for their use. "

To be or not to be in the social media arena? The perspective of healthcare providers working within adolescent and young adult oncology in Switzerland.

Given that social media is quickly penetrating clinical practice, it is essential to explore how these technologies can be used to improve patient-centered care. This is particularly important for healthcare professionals caring for adolescents and young adults (AYA), amid whom the use of social media is nearly universal and whose medical and psychosocial needs are often underestimated by the pediatric or adult oncology settings in which they are treated. To examine the perspectives of various medical professionals on the emerging role of social media in AYA oncology. Three focus groups were performed with Swiss healthcare professionals involved in the care of AYA patients with cancer. The focus groups were analyzed using thematic coding. Healthcare professionals caring for AYA cancer patients in Switzerland are reluctant to step into the social media sphere because they find it difficult to navigate professional boundaries in an unfamiliar space where different contexts collapse. Nurses and younger healthcare professionals who tend to have a more intimate relationship with AYA, often lack virtual mentorship to know how to maintain online professionalism. Adolescents and young adults cancer-related social media presence was unknown to our participants which resulted in missed occasions to inform, educate and care for this often underserved population of cancer patients. More practical guidance is needed to help healthcare professionals with how to integrate social media into clinical practice. Setting up fruitful collaborations between medical institutions and existing AYA support groups online might be the best way forward.

Guideline concordant care for prevention of acute chemotherapy-induced nausea and vomiting in children, adolescents, and young adults.

Prescribing guideline-recommended anti-emetics is an effective strategy to prevent CINV. However, the rate of guideline-concordant care is not well-understood. The purpose of this study was to describe the proportion of pediatric, adolescent, and young adult patients receiving HEC or MEC who received guideline-concordant antiemetic prophylaxis for acute CINV and to identify potential predictors of guideline-concordant antiemetic prophylaxis. Using electronic health record data from 2016 through 2018, a retrospective single-institution cohort study was conducted to investigate how often patients less than 26years of age receiving moderately or highly emetogenic chemotherapy receive guideline-concordant prophylaxis for acute CINV. Guideline-concordant care was defined according to guidelines from the Pediatric Oncology Group of Ontario for patients < 18years and the American Society of Clinical Oncology for those ≥ 18years. Independent variables included: sex, age, insurance status, race, ethnicity, cancer type, chemotherapy regimen, clinical setting, chemotherapy emetogenicity, and patient location. Predictors of receiving guideline-concordant care were determined using multiple logistic regression. Of 180 eligible patients, 65 (36.1%) received guideline-concordant care. In multivariable analysis, being treated in adult oncology setting (aOR 14.3, CI95 5.3-38.6), with a cisplatin-based regimen (aOR 3.5, CI951.4-9.0), solid tumor diagnosis (aOR 2.2, CI95 1.0-4.8), and commercial insurance (aOR 2.4, CI95 1.1-5.2) were associated with significantly higher likelihood of receiving guideline-concordant care. Multi-level factors were associated with receiving guideline concordant care for prevention of CINV in children, adolescents, and young adults receiving emetogenic chemotherapy. These findings can inform current efforts to optimize implementation strategies for supportive care guidelines.

Adherence to clinical practice guidelines for the prevention of acute chemotherapy-induced nausea and vomiting in children, adolescents, and young adults with cancer receiving their first cycle of highly emetogenic chemotherapy.

19 Background: Prescribing guideline-recommended anti-emetics for the prevention of chemotherapy-induced nausea and vomiting (CINV) is an effective strategy to prevent a common treatment-related adverse effect in children, adolescents and young adults (AYAs) with cancer that impacts quality of life. The rate of guideline-concordant care (GCC) is not well-understood. Methods: Using electronic health record data Columbia University Irving Medical Center from a 3-year period, we conducted a retrospective single-institution cohort study to investigate how often children and AYAs (age 26 or less) receive GCC to prevent CINV prior to the first administration of highly-emetogenic chemotherapy. We defined GCC from the Pediatric Oncology Group of Ontario guideline for patients &lt; 18 years and the American Society of Clinical Oncology guideline for those ≥ 18 years. Independent variables included: sex, age, insurance status, race, ethnicity, cancer type, chemotherapy regimen, clinical setting (adult or pediatric oncology), and patient location (inpatient or outpatient). Predictors of GCC were determined using multiple logistic regression. Results: Of 91 included patients, 39 (43%) received GCC. Those treated in adult oncology setting (OR 7.5, 95% CI: 2.7–20.7), receiving cisplatin-based chemotherapy (OR 3.5, CI: 1.4–8.5), or with commercial insurance (OR 2.7, CI: 1.1–6.3) were more likely to receive GCC. In multivariable analysis, patients treated in adult oncology had 6.4 higher odds (CI: 2.1–19.1, p&lt;.001) and those receiving cisplatin 4.6 higher odds (1.6–13, p&lt;.01) of GCC. Conclusions: Clinical setting and chemotherapy regimen independently predicted GCC for prevention of CINV in children and AYAs receiving highly-emetogenic chemotherapy. These findings can inform current efforts to optimize implementation strategies for supportive care guidelines by focusing on specific provider- and patient-level factors.

Exploring the Effect of Exercise Physiology Intervention Among Adolescent and Young Adults Diagnosed With Cancer

Background: Exercise in the adult oncology setting has proven to be an effective intervention in improving patients' physical condition and mental health and reducing treatment side effects; however, its role in the adolescent and young adult (AYA) population is less well understood. This study aimed to explore the effects of an exercise physiology (EP) intervention on the functional capacity of AYA diagnosed with malignancy. Methods: A prospective, single-institution cohort study was conducted of all AYA patients who were referred to the EP service and participated in baseline and postintervention assessment. Patients were provided with an individualized exercise program aimed at improving functional capacity as measured by the Six-Minute Walk Test, maximum push-ups, arm curls, and Sit-to-Stand Test, and a hand-held dynamometer was used to measure limb strength. Results: Fifty-one patients were included in the analysis, with predominant histological subgroups being sarcoma (37%) and lymphoma (26%). Thirty-seven percent of patients completed the program while on treatment and 63% were posttreatment. For those on treatment, there were significant improvement between baseline and postintervention strength assessments in sit-to-stand, push-ups, and arm curls, with robust effect sizes (Cohen's d R) ranging from small (d R = −0.02, U 3 = 49%) to large (d R = 1.05, U 3 = 85%). For posttreatment AYA, there were differences between all baseline and postintervention functional and strength assessments, with effect sizes ranging from small (d R = 0.30, U 3 = 61.8%) to large (d R = 1.29, U 3 = 90.1%). Conclusion: An individualized exercise intervention had a positive effect on AYA cancer patients' physical performance both while undergoing treatment and posttreatment. Future randomized controlled trials are required to validate these findings.

Bare Below the Elbows: Perception of Patients and Providers on the Impact on Patient Care in an Adult Oncology Setting

Bare Below the Elbows: Perception of Patients and Providers on the Impact on Patient Care in an Adult Oncology Setting

A qualitative exploration of oncology nurses’ family assessment practices in Denmark and Australia

The nurses' ability to provide supportive care to the patient and the family is influenced by their family assessment skills, which provide them with understanding of the family needs and strengths. When a patient is diagnosed with cancer, it is the family who provides the long-term support for the patient, and nurses need to understand the family needs in order to provide holistic care. The objective of the present study is to understand the factors that influence nurses' family assessment practices in adult oncology setting in Denmark and Australia. An interpretive qualitative study was conducted guided by the family systems theory. Focus groups were completed with 62 nurses working in adult oncology areas in Denmark and Australia. A thematic analysis and a computer-generated concept mapping were completed to identify themes within the data. Overall, the nurses valued family as part of the patient care and worked to understand the family concerns. However, the family assessment process was unstructured and did not enable holistic family support. Nurses from both countries discussed that experience and ability to engage with the family influenced the nurse's role in family assessment. This study identified that nurses value family as part of patient care, however struggle to assess and support families during oncology care. There is a need for a structured assessment approach and education on family assessment, which could be used across the two countries and possibly internationally.

Understanding family assessment in the Australian context; what are adult oncology nursing practices?

It is widely recognised, that the caregiver role creates a physical and emotional strain on family members during health adversity. Therefore, family assessment is considered a crucial step in determining appropriate support and guidance required for both patient and family within the oncology setting. Despite this, little is known about the family assessment practices of oncology nurses in the Australian setting. This qualitative study investigated nurses’ family assessment practices in adult oncology settings using an interpretive approach. Focus groups [N = 20] were conducted with registered nurses [N = 56] across day, ward and radiation oncology areas in three Australian metropolitan hospitals. Results identified that family assessment was completed informally and varied relative to nurses’ education, experience, views about family assessment and characteristics of the workplace environment. Most nurses considered family assessment important; however, opinions differed with regard to nurses’ role in family assessment. The findings provide an understanding around nurses’ knowledge about family assessment and how they engaged with the family. Some nurses identified that a structured assessment approach may provide greater knowledge and understanding of family needs; therefore improve outcomes for patients and families. It is widely recognised, that the caregiver role creates a physical and emotional strain on family members during health adversity. Therefore, family assessment is considered a crucial step in determining appropriate support and guidance required for both patient and family within the oncology setting. Despite this, little is known about the family assessment practices of oncology nurses in the Australian setting. This qualitative study investigated nurses’ family assessment practices in adult oncology settings using an interpretive approach. Focus groups [N = 20] were conducted with registered nurses [N = 56] across day, ward and radiation oncology areas in three Australian metropolitan hospitals. Results identified that family assessment was completed informally and varied relative to nurses’ education, experience, views about family assessment and characteristics of the workplace environment. Most nurses considered family assessment important; however, opinions differed with regard to nurses’ role in family assessment. The findings provide an understanding around nurses’ knowledge about family assessment and how they engaged with the family. Some nurses identified that a structured assessment approach may provide greater knowledge and understanding of family needs; therefore improve outcomes for patients and families.

Utility of 3-dimensional echocardiography, global longitudinal strain, and exercise stress echocardiography to detect cardiac dysfunction in breast cancer patients treated with doxorubicin-containing adjuvant therapy

Conventional resting left ventricular ejection fraction (LVEF) assessments have limitations for detecting doxorubicin (DOX)-related cardiac dysfunction. Novel resting echocardiographic parameters, including 3-dimensional echocardiography (3DE) and global longitudinal strain (GLS), have potential for early identification of chemotherapy-related myocardial injury. Exercise "stress" is an established method to uncover impairments in cardiac function but has received limited attention in the adult oncology setting. We evaluated the utility of an integrated approach using 3DE, GLS, and exercise stress echocardiography for detecting subclinical cardiac dysfunction in early breast cancer patients treated with DOX-containing chemotherapy. Fifty-seven asymptomatic women with early breast cancer (mean 26 ± 22 months post-chemotherapy) and 20 sex-matched controls were studied. Resting left ventricular (LV) function was assessed by LVEF using 2-dimensional echocardiography (2DE) and 3DE and by GLS using 2-dimensional speckle-tracking echocardiography (2D-STE). After resting assessments, subjects completed cardiopulmonary exercise testing with stress 2DE. Resting LVEF was lower in patients than controls by 3DE (55 ± 4 vs. 59 ± 5 %; p = 0.005) but not 2DE (56 ± 4 vs. 58 ± 3 %; p = 0.169). 10 of 51 (20 %) patients had GLS greater than or equal to -17 %, which was below the calculated lower limit of normal (control mean 2SD); this patient subgroup had a mean 20 % impairment in GLS (-16.1 ± 0.9 vs. -20.1 ± 1.5 %; p < 0.001), despite similar LVEF by 2DE and 3DE compared to controls (p > 0.05). Cardiopulmonary function (VO2peak) was 20 % lower in patients than controls (p < 0.001). Exercise stress 2DE assessments of stroke volume (61 ± 11 vs. 69 ± 15 ml; p = 0.018) and cardiac index (2.3 ± 0.9 vs. 3.1 ± 0.8 l min(-1) m(-2) mean increase; p = 0.003) were lower in patients than controls. Post-exercise increase in cardiac index predicted VO2peak (r = 0.429, p = 0.001). Resting 3DE, GLS, and exercise stress 2DE detect subclinical cardiac dysfunction not apparent with resting 2DE in post-DOX breast cancer patients.

Impact of dose rounding of cancer therapy on cost avoidance: a pilot study

BACKGROUND: A significant and progressive cost rising in medical oncology due to the incorporation of novel and highly expensive drugs into clinical practice have been seen in the past ten years. Dose rounding is an option might be used in oncology settings to avoid extra cost. The purpose of this project is to determine the theoretical cost saving related to a dose rounding process for biological and chemotherapy agents in adult oncology settings and to determine the opinion of oncologists about dose rounding.MATERIALS AND METHODS: Data was obtained prospectively during April 2011. All chemotherapy and targeted therapy orders prescribed in adult oncology outpatient clinics as well as in-patient wards have been collected. We considered rounding to an amount within 15% for targeted therapy and 10% for cytotoxic drugs. Chemotherapy dosing was calculated according to body surface area. Prescriptions that include cancer therapy in doses that might be rounded according to study criteria were identified.RESULTS: Two hundred and thirty three orders of chemotherapy and targeted therapy were processed by Adult Oncology Satellite Pharmacy during the period of data collection. Forty percent of the collected prescriptions fulfilled the criteria. The potential cost savings from dose rounding per year was $192,800. Data was extrapolated from the determined monthly cost savings. The highest cost saving was for breast cancer orders $80,820 (42%), followed by colorectal cancer $47,965 (25%), while in non-Hodgkin's lymphoma cost savings was $ 45,107 (23%) and for other types of cancer that include non small cell lung cancer, prostate and ovarian cancer, in addition to head and neck cost savings was $18,867 (10%).CONCLUSIONS: Our experience confirms the significant cost savings of cancer therapy by applying dose rounding to chemotherapy and biologic drugs prescriptions. While clinical impact of the suggested percentage needs to be evaluated.

Adolescent and Young Adult Oncology

Adolescent and young adult (AYA) oncology is caught between the pediatric and adult oncology settings and, therefore, poorly defined. Unfortunately, progress in overall survival for this age cohort has been stagnant while children and older adults have seen significant improvements. Reasons for the lack of progress are multifactorial, with biologic and psychosocial explanations. The current article will detail the unique features of AYA patients with cancer in terms of outcomes, psychosocial issues, and recommendations. Literature pertaining to AYA patients with cancer from 2006-2012 was reviewed. Findings suggested that recognizing AYAs as a subspecialty that requires holistic, multidisciplinary care may improve outcomes. Nurses at all levels are adept at providing holistic care and are, therefore, excellent potential advocates for a specialized care delivery model that AYAs with cancer deserve.

Cancer Survivorship Care for Adult Survivors of Childhood Cancer: An Adult Based Model Facilitating Multi-Disciplinary Long-Term Follow-Up Care, Education and Research

As the number of adult survivors of childhood cancers continues to grow, the challenges of long-term follow-up (LTFU) care escalate. When adult survivors of childhood cancer are followed in a pediatric oncology setting their care can be fragmented, leading to barriers for both providers and patients. To address the need for continued LTFU care as survivors age out of the pediatric medicine arena, the STAR (Survivors Taking Action & Responsibility) Program was established in June of 2001 within an adult oncology setting at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. The 11-year old program currently has over 320 survivors enrolled (ages 19-60, all diagnosed at 21 years of age or younger). The program’s three main foci are (1) comprehensive, long-term followup clinical care, (2) patient/family education and (3) research. The STAR team includes a general internal medicine physician, a clinical health psychologist, and an advanced practice nurse with expertise in childhood cancer and late effects from cancer therapy. The program facilitates referrals to specialty care as appropriate. Patient-oriented events allow opportunities for networking, outreach and education to assist patients in becoming autonomous in their comprehensive care and survivorship. The purpose of this article is to share our experiences with the implementation of this program, offer information on how to build a similar model in institutions caring for childhood cancer patients and adult survivors of childhood cancer.