Care Cancer Center Research Articles

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Outcomes From a Tertiary Cancer Care Center in India

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Outcomes From a Tertiary Cancer Care Center in India

Acute myeloid leukemia in the next-generation sequencing era : Real-world data from an Austrian tertiary cancer care center.

Next-generation sequencing (NGS) has recently entered routine acute myeloid leukemia (AML) diagnostics. It is paramount for AML risk stratification and identification of molecular therapeutic targets. Most NGS feasibility and results data are derived from controlled clinical intervention trials (CCIT). We aimed to validate these data in areal-world setting. This study retrospectively analyzed 447 AML patients treated at an Austrian tertiary cancer care center. A total of 284 out of the 447 cases were treated between 2013-2023 when NGS was locally available for the clinical routine. The NGS was successfully performed from bone marrow biopsies and aspirates, with processing times decreasing from 22days in 2013/2014 to 10days in 2022. Molecular therapeutic target(s) were identified by NGS in 107/284 (38%) cases and enabled risk stratification in 10 cases where conventional karyotyping failed. Concerning molecular landscape, TET2 (27%), FLT3 (25%), DNMT3A (23%), and NPM1 (23%) were most frequently mutated. Comparing older and younger patients (cut-off 70years) showed enrichment in older people for mutations affecting DNA methylation (72% vs.45%; P < 0.001) and the spliceosome (28% vs. 11%; P = 0.006) and more cellular signaling mutations in younger patients (61% vs. 46%; P = 0.022). Treatment outcomes corroborated asignificant survival benefit in the recent NGS era and patients treated with novel/molecularly targeted drugs. Ultimately, biospecimens of these patients are stored within aleukemia biobank, generating avaluable tool for translational science. Our study validates data from CCIT and supports their relevance for treatment decisions in areal-world setting. Moreover, they demonstrate the feasibility and benefits of NGS within aroutine clinical setting.

Socioeconomic Factors' Impact on Survivorship in Patients with Cervical Cancer: A Study from the Tertiary Cancer Center in Muzaffarpur, North Bihar, India

ObjectiveTo ascertain the survivorship among cervical cancer patients and the factors responsible for early death. In India, cervical cancer ranks second among cancer-related deaths among women. Estimating the survivability rate of patients with cervical cancer who come to our tertiary cancer care center was imperative, as was figuring out.What was causing the greater death rate.MethodThe present study is a retrospective audit of cervical cancer registered at our hospital-based cancer registry from 2021 till date.ResultThe three-year survival rate among women with late-stage cervical cancer was 45%, while 100% of women with early-stage care were alive at the end of three years. The survival rate was also poor among women belonging to middle and low socioeconomic status and illiterate women.ConclusionAmong women who have cervical cancer, those with early-stage cancer, who are literate and those who belong to above middle socioeconomic status have higher survivorship than their counterparts.

Self protective health care in childhood cancer survivors from the perspective of survivors, parents, and professionals: a qualitative study

IntroductionChildhood cancer survivors experience many health problems that they must protect themselves from their destructive physical and psychological effects. Understanding experiences of children about self-protective care will help health care providers manage long-term care plans. Therefore, this study was conducted with the aim of exploring self-protection care in childhood cancer survivors.MethodsThis is a phenomenological study that was conducted in the clinics and cancer care centers of Urmia and Khoy in Iran. 27 participants were selected by purposive sampling until data saturation. The data was collected using a semi-structured and in-depth face to face interview. Content analysis approach used for data analysis and MAXQUDA 10 software used for data management.ResultsData analysis led to the emergence of “self-protection health care” as a main category, two categories “maintaining physical health” and “keeping a strong mindset” and 9 sub-categories including “abstain activities that may cause harm”, “refusing contact with others for possible infection”, “monitoring symptoms and side-effects of cancer coming back”, “avoiding unhealthy diet”, “knowing about cancer from similar others”, “keep away negative thoughts and emotions”, “drawing on spiritual resources”, “creating a bridge to life again” and “being healthy for the sake of one’s family”.ConclusionAccording to the results of this study, self-protection is one of the most important cares for childhood cancer survivors. Over time, the influence of the clinical team and parents on children’s health care diminishes. Therefore, they should promote their health and well-being behaviors and use a variety of protective approaches to self-care.

A retrospective audit of audiology encounters in patients undergoing Cisplatin treatment at a large Australian tertiary cancer care centre.

To identify the number and timing of audiology encounters for adult oncology patients in a tertiary care setting in Australia. A retrospective case review was completed for 149 patients who received Cisplatin chemotherapy (CT) at a large, publicly funded tertiary hospital in Brisbane, Queensland, Australia between 1st January and 31st December 2019. Patient data was extracted from the Queensland Oncology Repository (QOR) provided by Cancer Alliance Queensland (CAQ). The number of audiology encounters was low overall with a median of 0 and interquartile range (IQR) of 0-1. Of the entire patient cohort, there was a mean of 1.2 encounters with 56% of patients not engaging with audiology. Where audiology did occur, encounters were most likely before or early in the CT treatment period. This study has demonstrated engagement with audiology services for patients undergoing CT treatment was limited with the few audiology engagements occurring before or early in the CT treatment period. Further research is needed to identify the barriers and facilitators to accessing audiological ototoxic monitoring (OtoM) during chemotherapy treatment in hospitals in Australia. Early identification of ototoxic hearing loss offers the opportunity to minimise further exposure to the ototoxic agent, minimise functional and communication impacts for the patient and provide early opportunity for discussion, education and counselling with patients, carers and their treating team. This, in turn, is expected to improve health related quality of life.

Integrating Biomarker Testing into EHR Systems: Implications for the Laboratory Based on Findings from a Multistakeholder Summit

Abstract Introduction/Objective Guideline-driven tumor biomarker testing remains standard of care for precision oncology due to the increasing number of treatment decisions that can be made based on tumor-specific alterations. However, most electronic health record (EHR) systems lack bidirectional interfaces with labs that enable computerized order entry and tumor biomarker testing results. Without these integrations, cancer centers may experience delays in test ordering and resulting, manual data entry errors, and operational inefficiencies that impact patient care and survival outcomes. Methods/Case Report To explore how cancer centers, hospitals, oncology practices, and labs integrate EHRs to streamline cancer biomarker testing processes, the Association of Cancer Care Centers (ACCC), in partnership with LUNGevity, convened a multistakeholder summit on Oct. 4, 2023. The summit brought together clinicians, pathologists, genetic counselors, and administrators to discuss practical solutions to issues surrounding interoperability, clinical workflows, and access to clinical data. Results (if a Case Study enter NA) Key findings from the summit include: -EHR-integrated orders and results save time, reduce errors, and streamline clinical workflow. These electronic interfaces enable clear communication between multidisciplinary teams system-wide and ensure that required patient information is readily available at the time of therapy planning. -Standardized workflows that define test ordering, tracking, and resulting protocols for in-house and send-out testing offer important downstream benefits. Staff should clearly understand how specimens are handled for in-house and send-out testing. -Integrations should be planned and built based on the EHR/laboratory information systems (LIS) in place can incorporate solutions to integrate with reference labs using HL7 standards and/or add-on modules to enable discrete genomic data elements. Conclusion Clinicians, pathologists, and administrators should prioritize EHR/LIS integrations to enable more effective cancer biomarker test ordering and resulting. These pre/post-analytic processes have significant implications for patient care. Findings from this summit can enable cancer programs and labs to evaluate current processes, work collaboratively to build integrations, and streamline biomarker testing workflows to enhance the quality and efficiency of delivering precision oncology.

Short-Course TNT Improves Rectal Tumor Downstaging in a Retrospective Study of the US Rectal Cancer Consortium.

The RAPIDO trial showed promising rates of pathologic complete response (pCR) after neoadjuvant short-course radiation with consolidation chemotherapy (total neoadjuvant therapy [SC TNT]) for rectal cancer. Only single-center reviews comparing tumor downstaging between SC TNT and long-course chemoradiation (LCRT) have been published in the United States. We reviewed our multi-institutional experience with both. The US Rectal Cancer Consortium database (2007-2018) including data from six high-volume rectal cancer care centers was reviewed. Patients with nonmetastatic, rectal adenocarcinoma who had neoadjuvant LCRT alone or SC TNT before excision or definitive nonoperative management were included. The primary outcome was the rate of complete response (CR), including pCR or durable (12 month) clinical complete response. Of 857 included patients, 175 (20%) received SC TNT and 682 (80%) received LCRT. The LCRT group had more low tumors (51.8% vs. 37.1%, p < 0.0001) and more clinically node-negative disease (31.8% vs. 22.3%, p < 0.0001). The CR rate was higher after SC TNT (34.1% vs. 20.3%, p = 0.0001). SC TNT was a predictor of CR (OR: 2.52, CI: 1.68-3.78). SC TNT patients completing 5-6 months of consolidation chemotherapy had a CR rate of 42.9%. There was no difference in 3-year PFS. SC TNT increases CR rate when compared to LCRT. For patients seeking nonoperative options or fewer radiation treatments, SC TRT should be preferred over LCRT alone.

Dose-adjusted direct oral anticoagulants (DOACs) in patients with acute leukemia: experience of a tertiary cancer care center.

Dose-adjusted direct oral anticoagulants (DOACs) in patients with acute leukemia: experience of a tertiary cancer care center.

Differences in survival of patients with multiple myeloma in rural versus metropolitan regions: Analysis of population data of an Australian local health district.

The objective of this study is to determine if there are differences in outcome for patients diagnosed with multiple myeloma in a rural setting compared to a metropolitan setting and which factors influence these outcomes. Retrospective cohort study. Illawarra Shoalhaven Local Health District. A total of 391 patients diagnosed with multiple myeloma between 2000 and 2022. Treatment and survival outcomes of these patients. Patients being treated in a rural cancer care centre had lower overall survival compared to those treated at a metropolitan cancer care centre (median OS = 44.4 months vs. 80.2 months, p = 0.002), despite access to similar treatments by the same group of haematologists. There was a significantly higher rate of upfront autologous transplantation (38% vs. 20%, p = 0.001) and higher rate of inclusion in clinical trials (16% vs. 7%, p = 0.021) in patients treated at a metropolitan cancer care centre compared to the rural cancer care centre. Multiple myeloma patients treated at a rural centre had shorter survival compared to patients treated at a metropolitan centre, and this may be related to lower rates of autologous transplantation and inclusion in clinical trials.

PDOC-12 PEDIATRIC BRAIN TUMOR INCIDENCE, AND TREATMENT MODALITY AT KILIMANJARO CHRISTIAN MEDICAL CENTER

Abstract INTRODUCTION Pediatric brain tumors (PBT) a significant health concern, they are the primary cause of cancer-related deaths among children. PBTs in Low- and Middle-Income Countries are diagnosed late due to insufficient resources. This abstract describes Pediatric Brain tumor incidence and treatment modalities at Kilimanjaro Christian Medical Center (KCMC) Cancer Care Center (CCC), Moshi, Tanzania from December 2016 to March 2024. METHOD Data on pediatric patients treated at the CCC between Dec. 2016 and March 2024, were analyzed. Inclusion criteria were a primary brain tumor and patients aged 0-19 at the time of diagnosis. All patients were previously diagnosed by computer tomography/ magnetic resonance imaging. Variables retrospectively collected from patient’s medical records were: demographic characteristics (age, gender, Place of residence, and insurance status), previous history of malignant diseases, incidence date, and treatment modality. RESULTS Total of 748 cases of pedeatric cancer were diagnosed at CCC. Of all the pediatric cancers diagnosed, brain cancer accounted for 22(2.9%). Out of these cases of brain cancer, 63.6% were males and 36.4% were females.Majority of them came within the Kilimanjaro region. 41% were palliated while 59% had a curative intent at the time of diagnosis, 22.7% died between December 2016 to March 2024.Embryonal tumors were (40.9%) with a breakdown that includes 6 Medulloblastoma and 3 cases of Craniopharyngioma (teratoid/rhabdoid), gliomas (36.4%) with sub-types such as Ependymoma, Anaplastic Astrocytoma, Pilocytic Astrocytoma, Pineocytoma, Stem glioma, and Tectal glioma, unspecified cases (13.6%), and Pineoblastoma were (9.1%). Surgery was used in 40.9% of cases, radiotherapy in 31.8%, and chemotherapy in 72.7%. Chemoradiotherapy was used in 31.8% of cases. 13.6% of cases utilized a combined approach, including chemotherapy, radiotherapy, and surgery. CONCLUSION PBT incidence at KCMC is 2.9%, improving access to screening, accurate diagnosis and treatment modalities are essential in identifying and managing PBT in our setting.

COVID-19 pandemic impact on gynecologic cancer treatment pathways in a Finnish tertiary center.

COVID-19 and new guidelines during the pandemic affected the gynecologic cancer treatment pathways, resulting in recorded delays and modifications in the treatment protocols. The aim of this study was to determine the impact of the COVID-19 pandemic in one of the major gynecologic cancer care centers in Finland, Tampere University Hospital. Our retrospective register study included 909 patients that were new gynecologic cancer cases (uterine, cervical, vulvar, vaginal, or ovarian) referred to the Tampere University Hospital Gynecologic Oncology Outpatient Clinic between March 17th, 2018, and March 15th, 2022. The patients were divided into two separate groups depending on their time of referral: time before COVID (March 17th, 2018, to March 15th, 2020), and during COVID (March 16th, 2020, to March 15th, 2022). These groups were compared in terms of patient characteristics, different cancer types and stages, symptoms, and treatment methods. During the COVID-19 pandemic, patients generally suffered from cancer symptoms longer (p < 0.003) and were more likely to be overweight (p = 0.035). The improved multidisciplinary team meeting gave the patients a faster route to their first intervention during COVID (p < 0.05). An insignificant shift toward nonsurgical first interventions and non-curative intent was seen during COVID, but the multidisciplinary team treatment plans were mostly implemented accordingly on both eras. No decrease was seen in the number of new gynecologic cancer cases, and the one-year overall survival remained the same in both groups. Overall, the COVID-19 pandemic did not significantly alter treatment pathways in gynecologic cancer care at Tampere University Hospital. The number of new patients and given treatments remained relatively stable. During COVID, access from referral to cancer treatment was significantly accelerated, which is likely confounded by changes to the multidisciplinary team protocol made in early 2021.

Empowering survivors, elevating care: The vital role of oncology primary care clinics.

362 Background: Due to increasing numbers of cancer survivors, there is a greater focus on the longitudinal management of treatment-related comorbidities. Cancer survivors have increased risk of cardiovascular (CV) disease, CV-related mortality, and second primary cancers (SPCs). Primary care providers (PCPs) are responsible for most of the care of long-term survivors, however, many report uncertainty around long-term effects and survivorship guidelines. While fostering strong primary care-oncology relationships is one approach to support those impacted by cancer, the development of oncology primary care clinics enhances patient outcomes and ensures patients receive comprehensive survivorship care. Despite this, few tertiary cancer care centers offer such clinics. Methods: In 2021, the University of Cincinnati Cancer Center established an oncology primary care clinic. Patients are eligible if they have a current or prior cancer diagnosis or cancer hereditary syndrome (CHS). The clinic is comprised of two-family medicine physicians, one with survivorship experience, and one fellowship-trained in palliative and hospice medicine. Clinical team members include an RN with oncology experience, medical assistants, a clinical service specialist, two oncology clinical pharmacists, and an oncology social worker. A clinical registry was developed to longitudinally measure patient outcomes. Electronic medical records of patients (n=683) seen between 1/2021 and 1/2024 were extracted and entered in REDCap. Data was summarized using SAS. Results: The mean age was 56 years (range 20-93), and 12% received a diagnosis in the pediatric/adolescent/young adult age range (0-39 years). The most common types included breast (23%),hematologic cancers (15%), and CHS (16%). Notably 43% of patients are on active treatment and 53% completed or are on maintenance treatment. Over 61% struggle with obesity, while 45% report being a current or former smoker. Comorbidities were common with 79% of patients having at least one CV diagnosis. Of 57% patients eligible for cardiomyopathy screening, 78% received recommended echocardiograms. Many patients received their recommended screenings including breast (79%), colon (43%), cervical (56%), prostate (46%), and lung (55%). Patients were referred to a variety of supportive services including physical therapy (42%), cancer exercise (18%) and psychiatry (14%). Conclusions: This model of care is a viable option for connecting cancer survivors with PCPs knowledgeable about survivorship care. CV-related comorbidities were common, and their management is a critical need during and after cancer. Survivors have increased risk of SPCs, and while the number of patients up to date on recommended cancer screenings is low, screenings are on the rise with ongoing efforts. Patient registries enable objective measurement of outcomes and can inform future research and care.

Assessing workforce trends and needs for oncology financial advocacy programs.

25 Background: Financial advocates (also known as navigators/counselors) are an increasingly important role on the multidisciplinary team to improve equitable access to care by assessing and addressing risks of financial distress for people with cancer and their families. The Association of Cancer Care Centers (ACCC) recently published consensus-driven guidelines for delivering financial advocacy (FA) services, but the field still lacks standard definition of roles, responsibilities, metrics, and benchmarks. ACCC’s Financial Advocacy Network Census survey provides an opportunity to monitor FA workforce trends over time. Methods: ACCC worked with an expert multidisciplinary committee to guide development of a Census survey. It was distributed electronically via Qualtrics to a subset of ACCC members (clinical and non-clinical staff involved in delivering FA services) in May-June 2023. Exploratory analysis was performed on 2023 Census data and results were compared to 2019-2020 Census data. Results: 95 respondents representing 70 unique cancer centers participated in the 2023 Census, compared respondents from 153 unique in 2019-20. Sample size varied between the two time points due to length of recruitment time. Most respondents were financial advocates (36% in 2023 vs 53% in 2019-20), followed by administrators (34% 3%), and nurses/nurse navigators (14% vs 21reported that their cancer center did not have any dedicated financial advocates (4% vs 10%). There was a decrease in the percentage of respondents reporting that their current level of FA staffing was sufficient to meet patient demand (13% vs 30%). A smaller proportion of respondents indicated that their cancer center did not track any FA metrics (17% vs 23%). More respondents reported receiving formal FA training (77% vs 30%). Conclusions: Despite variability in sample size across the Census time points, the trends are clear. There is growth in FA staffing since 2019, but patient demand for FA services appears to have outpaced workforce growth. There appears to be increased tracking of the impact of FA services, which can be used to support the business case for additional staff. Cancer centers can use ACCC’s FA Services Guidelines and corresponding assessment tool to measure how their current level of service delivery aligns with expert guidelines and specific standards for program metrics and training. Engagement in formal FA training has increased substantially, but an opportunity remains to reach more staff that support FA services to provide training (eg ACCC’s Financial Advocacy Network Boot Camp).

Leveraging a geographic information system (GIS) to identify lung cancer care disparities and opportunities in rural Appalachia.

78 Background: The Rural Appalachian Lung Cancer Screening Initiative is led by the Association of Cancer Care Centers (ACCC) and patient advocacy partners. Recognized by the White House Cancer Moonshot, this initiative seeks to improve lung cancer screening rates by partnering with health systems in rural Appalachia to develop and implement interventions. An 11-county region bordering West Virginia, Virginia, and Kentucky has significantly higher mortality and lung cancer incidence rates than the national rates of 35.0 and 54.0 per 100,000 people, respectively (Table 1). This region was identified as the focus area for the initiative with participation from health systems in Pike County, KY, and Buchanan County, VA. Methods: To understand availability of local resources, ACCC developed an interactive GIS tool that identifies screening and referral locations as well as essential services in the region. Lung cancer screening sites, oncology services, mammography locations, critical access hospitals, NCI-designated cancer centers, federally qualified health centers (FQHCs) and look-alikes, rural health clinics, and primary care/general health services were identified from publicly available data and data requested from state departments of health. Facilities were contacted to verify services when unclear. STATA 18 was used to combine and clean data for upload to Google MyMaps, creating an interactive map. Results: Of the 11 counties, all contain at least 1 FQHC or primary care site. However, 5 of the counties do not have lung cancer screening sites and 7 of the counties do not have oncology service sites (Table). The closest NCI-designated cancer centers to the participating sites are over 140 miles away. Conclusions: While there is a notable presence of primary care, access to lung cancer screening and oncology care is limited. Sites can utilize this map to inform development of interventions by considering potential geographical challenges, identifying referral sites, outreach opportunities, and partners to facilitate lung cancer screening and education. Further, these methods are replicable, and can be used to inform current access to care and improve equitable delivery of lung cancer screening in regions across the U.S. Distribution of lung cancer mortality, incidence, and infrastructure within initiative focus region. Region Mortality*(per 100,000) Incidence*(per 100,000) # Lung Cancer Screening Sites # Oncology Services Sites KY (1 county) 70 109.3 2 2 VA (6 counties) 45.0 – 61.4 42.9 – 68.6 4 3 WV (4 counties) 57.6 – 74.8 100.4 – 111.5 1 0 *Lung &amp; Bronchus, 2016-2020 age-adjusted death rates (KY, VA, WV) and incidence rates (KY, WV). Lung &amp; Bronchus, 2015-2019 age-adjusted incidence rate (VA). Source: statecancerprofiles.cancer.gov.

Development of a tool to assess financial advocacy service delivery.

21 Background: In 2023, the Association of Cancer Care Centers (ACCC) Financial Advocacy Network published Financial Advocacy Services Guidelines developed through an expert-led, consensus-driven process (1). The Guidelines provide a framework for equitable delivery of financial advocacy (FA) services to address patients’ financial concerns. The Guidelines cover 3 domains: financial advocacy services and functions, program management functions, and partner engagement functions. ACCC adapted the Guidelines into a Financial Advocacy Services Assessment Tool to help cancer care organizations assess and improve service delivery and to advance research of organization-level FA practices across the U.S. Methods: ACCC convened an expert task force to guide this work. ACCC conducted a scan of implementation science literature and health care organizational assessments to inform the development of a rating system for each of the 43 guidelines. Four service delivery levels were identified, and a score was assigned to each level (Table). The tool was programmed in Qualtrics to provide a total score and average score per guideline for each FA domain and sub-domain. The task force added unscored questions about organizational demographics, barriers, and readiness to enable aggregate research and sub-group analysis. ACCC invited members of the Financial Advocacy Network to participate in a pilot via email invitation and provided opportunities for open-ended feedback. Results: 20 cancer centers participated in the pilot between March-May 2024. 15% were academic institutions and 85% were community-based programs (18% of which are directly affiliated with an academic institution). Respondents reported the tool was easy to use and informative for quality improvement efforts. See Table 1 for total scores for initial pilot. Conclusions: Pilot results reflect that all participating cancer centers are already engaged in some level of FA services. Broader dissemination and analysis is ongoing. The assessment provides centers with a practical resource to assess alignment to guidelines and identify opportunities for quality improvement. Regular review of aggregate results will help ACCC provide benchmarks for areas of service delivery, identify barriers to implementation, and monitor trends in FA staffing. 1. Kajdic Hodzic R, Liang MI, et al. Developing consensus-based oncology financial advocacy services guidelines. JCO Oncol Pract. 2023;19(suppl 11):38. Levels of FA service delivery and pilot total scores. Level Description % of pilot cancer centers Level 1 Not performing financial advocacy services. 0% Level 2 Making progress with financial advocacy services, but it is done informally or inconsistently. 35% Level 3 Performing financial advocacy services consistently in at least one key area of the organization. 60% Level 4 Reliably performing financial advocacy services across all key areas of the organization. 5%

Urgent palliative care: An effective intervention to improve end-of-life experience and outcomes for patients with advanced cancer.

203 Background: Early integration of palliative care services for advanced oncology patients has a well-documented benefit on quality-of-life measures including symptom management, quality-of-death measures, cost-effectiveness, care-giver burden, and patient satisfaction metrics. However many barriers exist, including delayed referrals and negative perceptions of hospice/palliative care by patients and families. Furthermore, wait times from referral to visit can vary from weeks to months. For patients with late-stage disease, rapidly advancing disease or symptoms, this delay can lead to unnecessary acute care utilization, impoverished quality-of-life, and discordant end-of-life care. Methods: The CU Cancer Center CARE clinic provides advanced symptom management and urgent care services to oncology patients, often seeing patients with high symptom burden and advanced disease. A recent unpublished case-based analysis demonstrated that patients seen in CARE clinic 4 times or more in a month have a high risk of inpatient mortality within 3 months. In response, the CARE clinic created an urgent palliative care program wherein patients have the ability to see a palliative care provider within 1 week of referral who could provide ongoing advanced symptom management/medication titration and facilitate conversations around goal-concordant care in late-stage illness. A 1-year feasibility pilot took place from 2022-2023. Referrals required patients to meet the following criteria: 1) Not already being seen by an ambulatory palliative care professional; and 2) any of the following: prognosis of weeks without an end-of-life care plan; symptoms likely to require hospitalization if not addressed within a week; or seen in CARE clinic 4 or more times in the last month From 09/2022-08/2023, 55 patients were seen. Outcomes were followed for 3 months following final CARE clinic visit and were compared to patients who had received palliative care referrals from the CARE clinic in the preceding year (9/2021-9/2022). Results: In-hospital deaths, hospital days in the last 30 days of life, and palliative care/hospice involvement were all positively affected in our initial pilot. Notably, in-hospital deaths were reduced by 50%. There was also a 14% increase in deaths with hospice care in the pilot group compared to the control group. Conclusions: Data from this feasibility pilot suggest that urgent palliative care can improve key metrics in oncology quality-of-care, and improve cost effectiveness. Further delineation of the outcomes compared in a rigorously controlled population will further define the relative clinical benefit and fiscal implications of such interventions. Urgent palliative care outcomes. Historical Control (2021-2022) Pilot (2022-2023) N 44 55 Hospitalizations 101 52 Deaths 30 (68%) 40 (72%) Deaths in the Hospital 8 (18%) 5 (9%) Deaths With Hospice Care 21 (47%) 34 (61%)

Surgical Technique and Implementation of Total Minimally Invasive (Laparo-Thoracoscopic) Ivor Lewis Esophagectomy for Cancer.

Esophagectomy represents a major oncological operation due to the surgical involvement of both the abdominal and thoracic cavities. The minimally invasive technique has been developed to minimize the operative impact on patients undergoing esophageal resections, often presenting with nutritional deterioration and poor functional reserves. The present article provides an illustrative description of the total minimally invasive (laparo-thoracoscopic) Ivor Lewis esophagectomy for cancer integrated with complementary components of perioperative clinical management. This standardized surgical technique of two-field esophagectomy (i.e., laparoscopy and thoracoscopy) was depicted based on the experience of a tertiary center for esophageal cancer care with more than 1500 cases operated on, and in accordance with the SUPER reporting guidelines. The accomplishment of the following descriptive and illustrative content allowed the development of remarks on the strengths and possible flaws of this specific procedure, providing a measurable opportunity to absorb technical details of the most widespread surgical resection for esophageal cancer worldwide.

Myeloid sarcoma: A 7-year retrospective study from a tertiary cancer care center, illustrating the clinical, morphological, and immunohistochemical features

Myeloid sarcoma: A 7-year retrospective study from a tertiary cancer care center, illustrating the clinical, morphological, and immunohistochemical features

Efficacy and Safety of Acupuncture and Related Techniques in the Management of Oncological Children and Adolescent Patients: A Systematic Review.

Background/Objectives: Oncology acupuncture is emerging as a complementary treatment in pediatric cancer care centers. It is valued for its potential to manage symptoms associated with cancer and treatment toxicities without increasing polypharmacy. The aim of this review is to evaluate the efficacy and safety of acupuncture and related techniques in alleviating symptoms of cancer treatment in pediatric oncology patients. Methods: A comprehensive search was conducted across nine databases, including PubMed, Cochrane Library, and CNKI, up to June 2023. Inclusion criteria focused on randomized and quasi-randomized controlled trials involving pediatric oncology patients undergoing needle acupuncture or related techniques. Study selection and data extraction were independently performed by pairs of authors. Results were analyzed narratively, and meta-analysis was performed when possible. Results: Results suggest that acupuncture may help manage symptoms such as nausea and vomiting in pediatric oncology patients. However, the quality of evidence was generally low, and further research is required to substantiate these findings. Conclusions: Acupuncture shows promising results as a complementary treatment for reducing nausea and vomiting in pediatric oncology. However, current evidence is insufficient to draw conclusions for other outcomes, such as the number of vomiting episodes, reduction in antiemetic medication use, or fatigue. High-quality, rigorously designed studies are necessary to better understand the clinical relevance and safety of acupuncture in this vulnerable population.

A Qualitative Study on the Impact and Feasibility of a Simulation-Based Program for Shared Decision-Making in Non-Small Cell Lung Cancer Care.

In the pursuit of improved clinical outcomes and patient experience in health care, shared decision-making (SDM) stands as a pivotal concept garnering increasing attention, but SDM utilization varies widely, often leading to confusion regarding team members' roles. This study explores knowledge, skills, and attitudes of oncology clinicians engaged in a pioneering educational initiative at a comprehensive cancer care center, aimed at enhancing frontline SDM capabilities. Utilizing a prospective cohort qualitative approach, the team conducted interviews with 6 clinicians in a multidisciplinary oncology program who were engaged in an SDM continuing education program. In the program, participants were immersed in experiential learning activities including standardized didactic sessions and simulation-based SDM case role-play activities. Thematic analysis of interview data revealed 5 major categories: 1) perceptions of SDM; 2) training; 3) patient-centered care; 4) challenges and constraints; and 5) leadership buy-in. Participants perceived benefits, including adopting a better approach to integrate SDM into their practice, heightened engagement, emphasizing team collaboration, and embracing a patient-centric care model. This study underscores the transformative impact of education and training on enhancing SDM capabilities among oncology clinicians and is not intended for generalizability. By promoting a basic understanding and application of SDM principles, practicing clinicians can be better empowered to improve health care outcomes and experience. Our findings contribute to the broader endeavor of embedding practical SDM principles within clinical practice, thereby fostering a more patient-centered and effective health care environment.