Practice In Cancer Care Research Articles

Impact de la pandémie de COVID-19 sur les prises en charge pour cancer du sein et gynécologique

IntroductionDurant la pandémie de COVID-19, les mesures de confinement et les recommandations des sociétés savantes de cancérologie ont pu impacter le recours aux soins des patients.MéthodesCette étude rétrospective unicentrique comparaît le nombre et les caractéristiques des patientes reçues pour une première consultation pour une tumeur du sein ou gynécologique entre la période du confinement et une période contrôle, ainsi que les délais de prise en charge et les traitements proposés.RésultatsDurant le confinement, 91 patientes ont été vues pour une demande de prise en charge, contre 159 durant la période contrôle, soit une baisse de 43,5 %. Les patientes étaient plus âgées (62,9 contre 60,9 ans), sans que cette différence soit significative (p = 0,339). Le stade tumoral n’était pas modifié. En sénologie, le délai entre la biopsie et la première consultation a été allongé de 5,5 jours (différence non significative). Parmi les 51 patientes ayant une indication opératoire durant le confinement, 16 (31,4 %) ont été reportées après la levée du confinement. Malgré tout, le délai entre la consultation et le début des traitements n’a pas été impacté. Nous n’avons pas non plus mis en évidence de modification statistiquement significative des pratiques.DiscussionAu plus fort de la pandémie, les bénéfices et les risques du traitement du cancer ont dû être évalués en permanence, face au risque d’exposition au SARS-CoV-2. L’évaluation des pratiques en oncologie est essentielle pour comprendre le réel impact de cette pandémie, et se préparer à d’éventuelles crises futures.

The Paradoxical Effects of COVID-19 on Cancer Care: Current Context and Potential Lasting Impacts.

Coronavirus disease 2019 (COVID-19) has fundamentally disrupted the practice of oncology, shifting care onto virtual platforms, rearranging the logistics and economics of running a successful clinical practice and research, and in some contexts, redefining what treatments patients with cancer should and can receive. Since the start of the pandemic in early 2020, there has been considerable emphasis placed on the implications for patients with cancer in terms of their vulnerability to the virus and potential exposure in healthcare settings. But little emphasis has been placed on the significant, and potentially enduring, consequences of COVID-19 for how cancer care is delivered. In this article, we outline the importance of a focus on the effects of COVID-19 for oncology practice during and potentially after the pandemic, focusing on key shifts that are already evident, including: the pivot to online consultations, shifts in access to clinical trial and definitions of "essential care," the changing economics of practice, and the potential legacy effects of rapidly implemented changes in cancer care. COVID-19 is reshaping oncology practice, clinical trials, and delivery of cancer care broadly, and these changes might endure well beyond the short- to mid-term of the active pandemic. Therefore, shifts in practice brought about by the pandemic must be accompanied by improved training and awareness, enhanced infrastructure, and evidence-based support if they are to harness the positives and offset the potential negative consequences of the impacts of COVID-19 on cancer care.

A scoping review characterizing "Choosing Wisely®" recommendations for breast cancer management.

Choosing Wisely (CW)® was created by the American Board of Internal Medicine (ABIM) to promote patient-physician conversations about unnecessary medical interventions. Similarly, other countries created their own panels of experts called "CW® campaigns" which review recommendations submitted by that country's oncology societies. We performed a scoping review to consolidate CW® recommendations from different groups with respect to breast cancer care. A systematic search of Medline and Embase was designed by an information specialist for publications presenting CW® recommendations for breast cancer care practices from 2011-2020. We also reviewed the websites of all CW® campaigns and reference sections of each CW® recommendation. Two reviewers independently screened studies for inclusion and performed data extraction. Findings were summarized narratively. Review of ABIM CW® recommendations showed 19 breast cancer-related recommendations pertaining to; screening (n = 4), radiological staging (n = 2), treatment (n = 10), surveillance (n = 2), and miscellaneous (genetic testing; n = 1). Of 22 countries with CW® campaigns, 10 published recommendations for breast cancer. Over half (57%) of recommendations were supported by more than one country. No recommendations were refuted between campaigns. Two campaigns developed 3 novel recommendations on new topics, including chemotherapy in ductal carcinoma in situ (Italy) and comparison of screening imaging modalities (Portugal). CW® recommendations focus on reducing overutilization of investigations and treatments. There was a high rate of consensus between different CW® campaigns. As health care systems globally move attention to reduce low-value care, further studies are required to address adherence to these current recommendations and develop new recommendations.

Academics as leaders in the cancer artificial intelligence revolution.

The successful translation of artificial intelligence (AI) applications into clinical cancer care practice requires guidance by academic cancer researchers and providers who are well poised to step into leadership roles. In this commentary, the authors describe the landscape of the deep learning-based AI innovation boom in cancer research. For progress in applied AI research to continue, 4 essential components must be present: algorithms, data, computational resources, and domain-specific expertise. Each of these components is available to researchers and providers in academic settings; in particular, cancer care domain-specific expertise in academia is superb. Three common pitfalls for deep learning research also are detailed along with a discussion of how the academic oncology research environment is well suited to guard against these challenges. In this rapidly developing field, there are few established standards, and oncology researchers and providers must educate themselves about emerging AI technology to avoid common pitfalls and ensure responsible use.

Hand Hygiene Compliance at a Canadian provincial cancer centre – the complementary roles of nurse auditor-driven and patient auditor-driven audit processes and impact upon practice in ambulatory cancer care

We examined the patterns of hand hygiene compliance (HHC) among health care providers (HCP) as observed by trained nurse and patient auditors over time in an ambulatory care Canadian provincial cancer agency. Nurse and volunteer patient auditors completed separate standardized forms documenting hand-cleansing opportunities during clinic visits. HHC rates were compared over time by HCP group and by specialty teams. Observations from 10 calendar quarters were analyzed from April 2015 to September 2019. Nurse audit HHC rates ranged from 84% to 96%, encompassing 7,213 opportunities with no significant time-dependent trends by linear regression (R2 = 2.3E-005, P = .9895). The patient audit HHC rates ranged from 57% to 82%, encompassing 23,402 opportunities, were lower overall compared to the nurse audit (73.6% vs 89.2%, respectively, P < .0001), but displayed an increasing trend (R2 = 0.5374, P = .0159) over the same 10 time periods. The relative risk ratio for the differences decreased over time (R2 = .5101, P = .0203). Patients acknowledged the importance of HHC and the audit process, but were reticent to remind HCP to comply. The nurse audit measuring HCP HHC before entering and after exiting patient examination rooms showed persistently high compliance over time whereas the patient-driven audit measuring HHC within the examination room increased over time suggesting a training effect upon practice. These measures appeared complementary.

Evaluation of a novel strategy to implement exercise evidence into clinical practice in breast cancer care: protocol for the NEXT-BRCA randomised controlled trial

IntroductionThe burden of breast cancer in Canada is steadily growing. More women are surviving breast cancer, yet, survivors live with side effects for years after treatments have ended. The benefits...

Gaps in patient-centered follow-up cancer care: a cross sectional study

Objective There are published guidelines on the care that should be provided to cancer patients upon finishing treatment (i.e. follow-up care). Gaps in care may arise where patients’ reported experiences of care do not align with guideline recommendations. The aim of this study was to explore whether oncology patients report gaps in patient-centered follow-up care. Methods This study was a cross-sectional survey of adult cancer patients receiving follow-up care within four outpatient oncology clinics. Patients were approached in clinic waiting rooms and asked to complete an electronic survey. The survey examined patients’ self-report of receiving six aspects of follow-up care. Results A total of 239 participants completed the survey (study consent rate = 83%). Only 49% of participants received all six items of care. Patients reported high rates of being told who to contact if they have any questions or concerns (95%); who to contact if signs or symptoms occur (91%); and what to expect in their follow-up care (90%). A lower proportion of patients indicated they were informed about the role of their GP after treatment has finished (79%); what symptoms or signs might suggest the cancer had returned (74%); or were given a written care plan (71%). Conclusions: The study highlights that there is a gap between some aspects of optimal patient-centered care, and the actual care received by patients. Health care providers and researchers should consider how to improve follow-up care experiences to ensure best practice cancer care delivery during this important stage in cancer survivorship.

1774P The study of physical and mental distress among cancer patients during the COVID-19 epidemic

In December 2019, an outbreak of respiratory infection in humans caused by a novel coronavirus was detected. It is characterized by rapid human-to-human transmission leading to a pandemic spread. Cancer care practice paradigms have drastically changed during this time and, consequently, cancer patients may exhibit psychological difficulties. The purpose of this study is to assess the intensity of physical and mental distress among cancer patients during this pandemic.

Contextualizing the Cultural Factors Associated With Cancer Care in Nigeria: An Ethnonursing Study.

Introduction: Culture and care are two important phenomena of particular concern to transcultural nursing. Cancer care is generally affected by certain cultural factors that influence how cancer patients experience diseases and seek and utilize care services. This study aimed to explore the cultural factors that affect cancer care in a Nigerian cancer care institution. Method: This study adopted an ethnonursing method involving participant observation and individual interviews. The study was conducted in the oncology unit of University College Hospital, Nigeria. Seven nurses and six patients were key participants, while four physicians, three ward assistants, and six patients' relatives constituted the general participants. Result: Two themes and five patterns were identified. Participants described how the interplay of several cultural factors influenced or inhibited cancer care. Findings revealed significant influence of kinship, family, and social structure as well as the roles played by cultural beliefs, values, and practices in cancer care in Nigeria. Discussion: Cultural factors need to be considered broadly for the efforts toward prevention, early diagnosis, and treatment of cancer to be effective in Nigeria.

Implementation of lung cancer multidisciplinary teams: a review of evidence-practice gaps.

Multidisciplinary care (MDC) is considered best practice in lung cancer care. Health care services have made significant investments in MDC through the establishment of multidisciplinary team (MDT) meetings. This investment is likely to be sustained in future. It is imperative that MDT meetings are efficient, effective, and sufficiently nimble to introduce new innovations to enable best practice. In this article, we consider the ‘evidence-practice gaps’ in the implementation of lung cancer MDC. These gaps were derived from the recurrent limitations outlined in existing studies and reviews. We address the contributions that implementation science and quality improvement can make to bridge these gaps by increasing translation and improving the uptake of innovations by teams.

"I'm Not From Another Planet": The Alienating Cancer Care Experiences of Trans and Gender-Diverse People.

There is little research that addresses the needs of trans and gender diverse people with cancer. Emerging evidence shows unique concerns, particularly in relation to gendered cancers such as breast and gynecological. The aim of this study was to explore the intersubjective experiences in cancer care of trans and gender-diverse people to inform a microethical approach to improving care for this community. Qualitative interviews (n = 12) were conducted with trans and gender-diverse people who had a diagnosis of cancer. Analysis was phenomenologically inspired and used Braun and Clarke's inductive thematic methods. The intersubjective experiences revealed that interactions were often characterized by a sense of alienation and invisibility. Six intertwined themes demonstrate the emergence of these feelings for the participants, these included Gender Stereotypes and Assumptions, Negation of Identity, Dismissed Concerns, Invisibility in the System, Alienation in Waiting Rooms and Support Groups, and Uniquely Gendered Bodies and Interactions. Conversely, 1 theme showed how participants could be made to feel connected and recognized-Affirming Experiences. The unique experiences of trans and gender-diverse people in cancer care shed light on the effect of gender biases and barriers to empathic care. Findings provide professionals with insights that can enhance their clinical practice through informing the ways they provide care to people with diverse genders. Cancer care nurses should be reflecting on their own assumptions related to gender and engaging their patients in genuinely empathic communication.

Democratizing Access to Best Practice Cancer Care in Low-Resource Settings: Project ECHO

PURPOSE The aim of this study was to understand how telementoring and training through the ECHO model can build the cancer workforce and bring best practice cancer care to low-resource settings. METHODS The ECHO Institute launched a 5-year project to expand the use of the ECHO model to improve the capacity of local providers to bring cancer prevention, diagnostic, treatment, and survivorship knowledge to rural and underserved populations. The ECHO model leverages technology, telementoring, and case-based learning to connect rural populations to specialty cancer care, improve access to evidence-based therapies and practices, and provide state-of-the-art training and mentorship to build the cancer workforce, particularly in underserved regions. Through the ECHO model, local providers are paired with experts and doctors at National Cancer Institute–designated Comprehensive Cancer Care Centers and academic medical centers for ongoing training, technical assistance, and mentorship. Although originally developed to bring best practice care for hepatitis C to rural communities, the ECHO model is now being used to treat 70 conditions or topics globally. RESULTS Since 2016, the ECHO model has been replicated by 73 partner hubs in 13 countries that are operating 130 cancer programs focused on diverse cancer prevention and treatment topics, including increasing clinical trial enrollment, cancer control and best practices, cervical cancer prevention and treatment, tobacco cessation, and more. To date, 21 peer-reviewed publications have documented the ECHO model’s efficacy in improving the use of best practices in cancer care and expanding access to care in low-resource settings. CONCLUSION Use of the ECHO model to train and mentor local providers is building the cancer workforce and increasing capacity to address critical topics in cancer screening, diagnosis, care, and survivorship. The ECHO Institute is successfully strengthening the cancer health system and accelerating the transmission of best practice cancer care from cancer centers to health care workers in underserved communities.

Leveraging Patient Reported Outcomes Measurement via the Electronic Health Record to Connect Patients with Cancer to Smoking Cessation Treatment.

Tobacco use negatively impacts cancer treatment outcomes, yet too few providers actively support their patients in quitting. Barriers to consistently addressing tobacco use and referring to treatment include time constraints and lack of knowledge surrounding treatment options. Patient Reported Outcomes (PRO) measurement is best practice in cancer care and has potential to help address these barriers to tobacco cessation treatment. This descriptive program evaluation study reports preliminary results following implementation of a novel automated PRO tobacco use screener and referral system via the electronic health record (EHR) patient portal (MyChart) that was developed and implemented as a part of a population-based tobacco treatment program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Between 25 June 2019 and 6 April 2020, 4589 unique patients completed the screener and 164 (3.6%) unique patients screened positive for recent (past month) cigarette smoking. All patients who screened positive were automatically referred to a smoking cessation treatment program integrated within the Lurie Cancer Center, and 71 (49.7%) patients engaged in treatment, as defined by completing at least one behavioral counseling session. Preliminary results indicate that the PRO/MyChart system may improve smoker identification and increase offering of treatment and, despite the “cold call” following a positive screen, may result in a treatment engagement rate that is higher than rates of treatment engagement previously documented in oncology settings. Longer term evaluation with formal statistical testing is needed before drawing conclusions regarding effectiveness, but PRO measurement via the EHR patient portal may serve a potentially important role in a multi-component approach to reaching and engaging cancer patients in comprehensive tobacco cessation treatment.

Promoting Evidence-Based Practices for Breast Cancer Care Through Web-Based Collaborative Learning

PURPOSE The objective of the Project ECHO (Extension for Community Healthcare Outcomes) for Knowledge Summaries for Comprehensive Breast Cancer Control (KSBC) was to strengthen the capacity to plan and implement evidence-based, resource-appropriate breast cancer control programs using virtual case-based learning within a global network of experts and peers. METHODS The KSBC ECHO was a collaboration between the US National Cancer Institute Center for Global Health, Women’s Empowerment Cancer Advocacy Network, and Breast Health Global Initiative in alignment with the Breast Cancer Initiative 2.5 campaign to reduce disparities in breast cancer outcomes. Using the ECHO model, we developed a 6-month Web-based program to support the development of locally relevant, resource-appropriate cancer control programs through mentorship and use of KSBCs. The course was advertised via existing networks, conferences, and social media. Breast cancer control project teams from around the world applied and were accepted to participate in the KSBC ECHO. Fourteen biweekly ECHO sessions were held via Zoom and included case presentations, didactic presentations, and discussion. Projects spanned the care continuum and sessions addressed preplanning, assessing need/barriers, setting objectives/priorities, and implementing/evaluating. Baseline and end point surveys were used to evaluate the ECHO program. Participants identified a mentor, completed worksheets, and presented on the project status. RESULTS Fifteen project teams from 11 countries—64 participants: advocates, clinicians, policymakers, and researchers—were enrolled. Twenty-eight participants (57%) completed the baseline and end point surveys. Analysis of the data using a paired t-test indicates that the knowledge increase was statistically significant: The average knowledge gain was 0.76 ± 0.89 (95% CI, 0.44 to 1.08; P &lt; .0001). Additional feedback on the Web-based collaborative learning model will be presented. CONCLUSION The ECHO model encouraged interaction between policymakers, clinicians, advocates, and technical experts while using evidence-based tools to develop locally relevant, resource-appropriate implementation strategies and policy recommendations.

Oral and Subcutaneous Anticancer Therapy Training Course for Non-physician Healthcare Professionals: a Survey Evaluating the Relevance of its Content and its Implications in the Practice of Cancer Care.

The creation of antitumor agents with an oral or subcutaneous route of administration has had important positive implications in the development of drugs to treat cancers, but issues such as false drug intake, uncontrolled side effects, and limited supervision may jeopardize the ability of these agents to improve treatment. A potential solution is the recruitment of non-physician healthcare professionals (i.e., nurses and physician assistants) and a special training course for them that focuses on the improvement of patient compliance. We developed and implemented three special professional training modules for non-physician healthcare professionals, which focus on the pharmacological aspects and side effects of oral and subcutaneous antitumor medications in regard to management strategies and communication issues that these non-physician healthcare professionals should address. Subsequently, we administered a questionnaire survey evaluating the course content and the implementation of the course in practice to the training participants to collect data for its implementation. Of 165 questionnaires that were administered, 44 (27%) were answered. The participants rated the course as being highly useful for their daily work. The participants reported a significant improvement in their professional expertise from the course. They emphasized the importance of medical topics and practical content to be included in the course delivery. The course encouraged 75% of the responders to start independent consultations with cancer patients that focused on questions of medication adherence for oral and subcutaneous antitumor medications, as well as the management of their side effects. Based on our results, at least a portion of the non-physician healthcare workforce is highly interested in engaging in active and autonomous co-supervision of patients who are treated with oral and subcutaneous antitumor medications. In addition to the theoretical basics of the treatment modalities, educational courses on oral and subcutaneous antitumor medications for non-physician healthcare professionals should focus on practical training and topics relevant to patient care.

Promoting evidence-based practices for breast cancer care through web-based collaborative learning

The Knowledge Summaries for Comprehensive Breast Cancer Control (KSBCs) are a series of 14 publications aligned with World Health Organization guidance on evidence-based breast cancer control and accepted frameworks for action. To study utilization of the KSBCs in the development of locally relevant breast cancer control policies and programs in limited resource settings, the National Cancer Institute Center for Global Health, the University of Washington and the Fred Hutchinson Cancer Research Center developed the Project ECHO® for KSBCs (KSBC ECHO). Project ECHO is an online model which employs case-based learning, while promoting multi-directional learning and network-building. The program was evaluated using a pre-post study design to assess if this online collaborative learning platform can be an effective model for dissemination and utilization of the KSBCs to inform breast cancer control programs and policy advocacy in limited resource settings.A total of 28 KSBC ECHO participants (57 %) responded to the baseline and endpoint program evaluation surveys. Across all 28 respondents, analysis of the data indicates that knowledge increase was statistically significant overall: average knowledge gain was 0.77, 95 % CI [0.44–1.08] and p value < 0.0001. A majority of responding team leads reported that the core ECHO components (case/didactic presentations, discussion) contributed to a great extent to strengthening their project proposal/goals.Program evaluation survey responses indicate that utilization of this online platform provided an opportunity for individual knowledge gain, multi-directional information exchange, network-building, and strengthening of the proposed breast cancer control projects based in limited resource settings.

Coronavirus Disease 2019 (COVID-19): Radiology Department Financial Impact and Planning for Post-COVID Recovery.

Coronavirus Disease 2019 (COVID-19): Radiology Department Financial Impact and Planning for Post-COVID Recovery.

PCN218 AVOIDABLE WASTE IN ONCOLOGY CARE DELIVERY: PERCEPTIONS OF US HEMATOLOGISTS/ONCOLOGISTS

Almost a third of US healthcare expenditure has been attributed to waste from unnecessary process and inappropriate care. The Choosing Wisely® (CW) campaign initiated in 2012, assumes that educating providers about low value interventions will reduce waste. We sought to assess drivers of waste in oncology, awareness of CW and of the low value interventions it identifies in cancer patient management, among community hematologists/ oncologists (cH/O). A live meeting in November 2019 convened a representative sample of US cH/O. Participants attended a discussion entitled “From Choosing Wisely to Value-Based Care” and responded to questions via an audience response system. Of 54 cH/O, 43% had not heard of CW with only 24% reporting that CW programs are making a favorable impact. cH/O reported high prevalence of clinical practices that CW advises against: Multi-fraction radiation for skeletal metastases (60%), whole breast radiation post-lumpectomy (54%), overuse of imaging for staging (69%) and of biomarkers during post-treatment surveillance (59%). The primary drivers of cost within US healthcare system by participant ranking: administrative complexity (47%), overtreatment (44%) and drug pricing failure (41%). The most cited areas of resource overuse were inappropriate oncologic treatment (71%), imaging for staging (44%) and supportive care therapies (35%). The primary drivers of overuse were defensive medicine: fear of missing something (34%) and litigation (33%). The most underutilized resources were survivorship (56%), end of life care (56%) and molecular testing at diagnosis (36%). Nearly half (45%) of physician practices did not have protocols in place to minimize low-value practices. Several years after its initiation, there is limited awareness and adoption of CW and its recommendations among cH/O. Given its limited impact on clinical practice, research is needed to understand what interventions may be more effective in decreasing low value interventions and driving evidence-based practices in cancer care.

Cancer patients and research during COVID-19 pandemic: A systematic review of current evidence.

The novel coronavirus, also known as SARS-Cov-2 or COVID-19 has become a worldwide threat and the major healthcare concern of the year 2020. Cancer research was directly affected by the emerging of this disease. According to some Chinese studies, cancer patients are more vulnerable to COVID-19 complications. This observation led many oncologists to change their daily practice in cancer care, without solid evidence and recommendations. Moreover, the COVID-19 manifestations as well as its diagnosis are particular in this special population. In this review paper we expose the challenges of cancer management in the era of SARS-CoV-2, the epidemiological, clinical, pathological and radiological characteristics of the disease in cancer patients and its outcomes on this population. Finally, we focus on strategies that are followed in cancer management with review of national and international guidelines.

Impact of nationwide enhanced implementation of best practices in pancreatic cancer care (PACAP-1): a multicenter stepped-wedge cluster randomized controlled trial

BackgroundPancreatic cancer has a very poor prognosis. Best practices for the use of chemotherapy, enzyme replacement therapy, and biliary drainage have been identified but their implementation in daily clinical practice is often suboptimal. We hypothesized that a nationwide program to enhance implementation of these best practices in pancreatic cancer care would improve survival and quality of life.Methods/designPACAP-1 is a nationwide multicenter stepped-wedge cluster randomized controlled superiority trial. In a per-center stepwise and randomized manner, best practices in pancreatic cancer care regarding the use of (neo)adjuvant and palliative chemotherapy, pancreatic enzyme replacement therapy, and metal biliary stents are implemented in all 17 Dutch pancreatic centers and their regional referral networks during a 6-week initiation period. Per pancreatic center, one multidisciplinary team functions as reference for the other centers in the network. Key best practices were identified from the literature, 3 years of data from existing nationwide registries within the Dutch Pancreatic Cancer Project (PACAP), and national expert meetings. The best practices follow the Dutch guideline on pancreatic cancer and the current state of the literature, and can be executed within daily clinical practice. The implementation process includes monitoring, return visits, and provider feedback in combination with education and reminders. Patient outcomes and compliance are monitored within the PACAP registries. Primary outcome is 1-year overall survival (for all disease stages). Secondary outcomes include quality of life, 3- and 5-year overall survival, and guideline compliance. An improvement of 10% in 1-year overall survival is considered clinically relevant. A 25-month study duration was chosen, which provides 80% statistical power for a mortality reduction of 10.0% in the 17 pancreatic cancer centers, with a required sample size of 2142 patients, corresponding to a 6.6% mortality reduction and 4769 patients nationwide.DiscussionThe PACAP-1 trial is designed to evaluate whether a nationwide program for enhanced implementation of best practices in pancreatic cancer care can improve 1-year overall survival and quality of life.Trial registrationClinicalTrials.gov, NCT03513705. Trial opened for accrual on 22th May 2018.