Chemotherapy In Outpatient Setting Research Articles

The influence of visual objects and music on anxiety levels of breast cancer patients scheduled to experience chemotherapy for the first time: a prospective randomized clinical study.

To investigate the influence of music together with visual objects as an ambiance in the waiting room on anxiety levels of breast cancer patients scheduled to receive chemotherapy in outpatient setting for the first time. Breast cancer patients planned to receive adjuvant or neoadjuvant chemotherapy for the first time between November 1, 2020, and July 31, 2021, were included. Two designs, including a standard waiting room (StWR) and an intervention waiting room (IWR) that was created by adding music and visual objects to the standard room, were constructed. These 2 designs were repeated sequentially in monthly periods, and a total of 104 patients with 52 in each group were randomized. The State Trait Anxiety Inventory (STAI) and Hospital Anxiety and Depression Scale (HADs) were used for assessments. Results of the patients in StWR and IWR groups were compared. Both HADs anxiety and STAI-state anxiety scale scores were lower in patients who waited in IWR compared to those who waited in StWR (p = 0.041, p = 0.012, respectively). In patients in the IWR group, mean heart rate was lower by 7.6bpm (p = 0.009). No difference was found between the groups with regard to HADs depression score and STAI-trait anxiety score (p = 0.305, p = 0.535, respectively). For all patients, HADs anxiety scale (r = 0.400, p = < 0.001) and STAI-state anxiety scale (r = 0.475, p = < 0.001) scores increased as the waiting time increased. The present study is the first to investigate the influence of adding music together with visual objects to the standard ambiance of the chemotherapy waiting room on anxiety levels of breast cancer patients. We propose that introduction of paintings, artificial plants, and music to the ambiance of the waiting room has a significantly positive effect on alleviating anxiety levels of cancer patients waiting for chemotherapy.

Natural language processing (NLP) and machine learning (ML) model for predicting CMS OP-35 categories among patients receiving chemotherapy.

e13591 Background: The Hospital Outpatient Quality Reporting Program is a pay-for-quality data reporting program implemented by the Centers for Medicare &amp; Medicaid Services (CMS). Hospitals collect data on various measures of the quality of care provided in outpatient settings for the CMS. One such measure is OP-35, where data about patients who received chemotherapy in outpatient settings are collected. Such quality measures help hospitals assess their performance and allow patients to compare the quality of care among different hospitals in that region. Currently, the process to label data for OP-35 categories is manual. This study aims to develop a model using NLP and ML to predict the ten OP-35 complication categories and automate the process. Methods: Data from 1000 adult cancer patients who received chemotherapy at a comprehensive cancer center in the South Florida region between Sept and Oct 2019 were extracted to train the ML models. Text from the Chief Complaint field was manually labeled into ten binary categories: anemia, nausea, dehydration, neutropenia, diarrhea, emesis, pneumonia, fever, sepsis, and pain. The data were divided into a training set (80%) and a test set (20%). After initial pre-processing of the text, term frequency–inverse document frequency (TF-IDF) feature extraction method with a vocabulary size of 10,000 was applied. Various models (stochastic gradient descent, support vector classification [SVC], and binary relevance, etc.) were trained to predict multiple labels. These models were evaluated using Jaccard score, accuracy, F1 score, and Hamming loss. Additionally, two deep learning approaches: a single dense output layer and multiple dense output layer models, were also used for comparison. Python version 3.8 was utilized for the analysis. Results: The best performing model was SVC, with a Jaccard score of 85.13 and 90% accuracy. In the first deep learning approach, a single dense output layer was used with multiple neurons where each neuron represented only one label. In the second approach, a separate dense layer for each label was created with one neuron. The model with a single output layer produced an accuracy score of 32%, and the model with multiple output layer had an accuracy score of 31%. Both deep learning models with single and multiple output layers did not perform well compared to SVC. Conclusions: Our study shows an early indication regarding the feasibility of modern ML techniques in predicting multiple label categories or outcomes. As a potential clinical decision support system, this model could replace manual data entry, minimize human error, and decrease resources for data collection. In the next stage, healthcare providers will validate this model by manually checking the predicted labels. In the final stage, model will be deployed in real-time to predict OP-35 categories automatically.

Improvement of Dysgeusia by Polaprezinc, a Zinc-L-carnosine, in Outpatients Receiving Cancer Chemotherapy.

Dysgeusia is one of the adverse events frequently affecting patients undergoing cancer chemotherapy. Dysgeusia-induced anorexia could decrease patient's quality of life. The present study was designed to determine whether the zinc-containing compound polaprezinc improves chemotherapy-induced dysgeusia. The incidence of grade 2 dysgeusia was assessed in 634 patients receiving cancer chemotherapy in outpatient settings during January 2013 and June 2017. Polaprezinc was administered to patients showing grade 2 dysgeusia and the effect was compared with that in patients subjected to follow-up observation. Grade 2 dysgeusia appeared in 80 patients (12.6%), in whom pancreatic cancer and treatment with fluoropyrimidines were significant risks for dysgeusia. Polaprezinc, when administered to patients with grade 2 dysgeusia, significantly shortened the duration of dysgeusia compared with that in the follow-up observation group. Subgroup analysis indicated that polaprezinc was less effective in patients with pancreatic cancer, those receiving gemcitabine, or those whose age was 65 year-old and over. Chemotherapy-induced dysgeusia occurred with high frequency in patients with pancreatic cancer or in those receiving fluoropyrimidines. Polaprezinc was highly effective in improving the symptom of dysgeusia, except for patients with pancreatic cancer, those receiving gemcitabine and the elderly.

Venous thromboembolism incidence in radiation oncology: Retrospective trial.

e18289 Background: Venous thromboembolism (VTE) prevention in oncology patients during external beam radiation therapy (RT) in outpatient setting is the challenging question. We performed analysis of our own data. The aim of study is the clear assessment of VTE incidence in these patients Methods: In retrospective analysis 5134 patients' medical records were included (2612 with RT and 2522 with chemotherapy). Inclusion criteria were: RT in outpatient setting and chemotherapy in outpatient setting. Exclusion criteria: combined radiochemotherapy, hospitalzation, central venous catheter, palliative treatment. 487 patients were selected for the final analysis and stratified in 3 groups: group I (n = 165) 3D-conformal RT for brain tumors or brain metastasis; group II (n = 158) RT for body tumors (abdominal, retroabdominal, pelvic, chest, breast); group III (n = 164) was control –brain and body tumors on chemotherapy. Mean fraction numbers were 25 (11 - 32), mean total dose – 52 Gy (22 - 66). VTE assessment based on clinical data, ultrasound examination (US) and chest CT. Statistical analysis was performed by OpenEpi, Version 3 software pack. Results: Deep vein thrombosis (DVT) was detected in 10 cases (6.06%) in group I, 4 cases in group II and 4 case in control group. VTE patients has a different tumors (astrocytomas, brain trunk tumors, skull basis cancer, rectal cancer, breast cancer). 3 patients were available for long-term outcomes assessment (12 months after radiation therapy). During 1-year period we haven’t detected thrombosis recurrence. One patient on 11th follow-up month was exposed with repeated course of RT without any complications. The difference between VTE incidence for group I and group III characterized by statistical significance (p = 0.018). Risk difference for these groups was 5% (p &lt; 0.05). Conclusions: Based on study results we suggest that external beam radiation therapy is potentially an independent risk factor for VTE development even in outpatient settings. High degree of clinical suspicion and aggressive diagnostic work-up in case of suspicion is necessary. In our opinion low molecular weight heparins prevention should be considered at least during active radiation therapy.

'Shadowing' as a management strategy for chemotherapy outpatient primary support persons.

Despite growing numbers of patients with cancer receiving chemotherapy in outpatient settings and the corresponding increase in care demands on family and close friends, little is known about the experiences of those informal carers supporting people with cancer during their chemotherapy trajectories. Using an interpretivist theoretical framework, this study explored the experiences of primary support persons of chemotherapy outpatients through in-depth interviews with 17 participants nominated as their primary support persons by people receiving chemotherapy at a large tertiary hospital in Australia. The study demonstrates that primary support persons of chemotherapy outpatients face distinct challenges, being at the frontline of treatment and managing side effects with minimal support at home. This role involves sensitive provision of complex medical and social care in circumstances that profoundly challenge the everyday worlds of both patient and carer. From the moment of diagnosis, informal carers in this context face the 'double whammy' of needing to 'manage' the cancer diagnosis experience as well as the chemotherapy trajectory experience. This study points to the significant level of responsibility that primary support persons take on, and the extent to which patients and clinicians rely on their support and management skills. It also points, however, to the lack of recognition they receive for assuming this role, and their sense of frustration in the face of this invisibility. The conceptualisation of the informal carer role as a 'shadowing' role explicitly represents the protective, vigilant, but almost invisible, support role described by the participants in this study.

Medication errors on oral chemotherapy in children with acute lymphoblastic leukemia in a developing country.

Medication errors occur universally. Inappropriate administration of chemotherapy drugs can have adverse effects in cancer patients. Our objective was to assess the rate and type of medication errors in children with acute lymphoblastic leukemia (ALL) receiving oral chemotherapy in outpatient setting. Prescription and administration of oral chemotherapy drugs in children with ALL were evaluated prospectively to determine rate and type of medication errors. Errors were defined as prescription (physician) level or administration (patient) level errors. Two hundred eighty-nine drugs were prescribed to 121 patients. Medication errors occurred in 36 (12.5%) prescriptions; 21(7.3%) were administration errors, 13 (4.5%) were prescribing errors, and two errors occurred at both levels. Mercaptopurine (6-MP) was significantly associated with higher rates of errors (Odds ratio [OR] = 2.1, 95% CI [confidence interval] 1-4.1) whereas lapses were less with dexamethasone (OR = 0.25, 95% CI 0.09-0.67). As a result of medication errors 28 (23.1%) patients received inappropriate doses. Twenty five (21%) patients received sub-optimal doses whereas three got higher doses of chemotherapy. On univariate analysis, socioeconomic status, education status of the caregiver, 6-MP and methotrexate were significantly associated with errors (P ≤ 0.05). On multivariate analysis, ≤ primary school education of the caregiver and prescription of methotrexate were independent predictors of errors. Medication errors affected nearly one fourth of the children receiving oral chemotherapy. Future studies are needed to look at effective interventions to avoid chemotherapy associated errors especially amongst the lower strata of society.

O3–032 - Analysis of the Incidence About Consultation At Emergency Room in Outpatients Receiving Cancer Treatment

Background: In recent years, chemotherapy in outpatient setting plays an important role in the treatment of malignancy. We therefore assessed the incidence and characteristics of consultation at emergency room in cancer patients undergoing chemotherapy at our clinic. Methods: We reviewed electronic medical records of the patients consulted our emergency room between October 2011 and September 2012. Results: Cumulative total number of patients consulting the our emergency room was 120 (86 males / 34 females). Median age was 66 years [range 37-90]. The kind of cancer were NSCLC in 49 cases, SCLC in 22 cases, colorectal cancer in 8 cases, biliary tract cancer in 8 cases, and pancreatic cancer in 8 cases. The most common reason for consultation was gastrointestinal symptoms (28 patients), including anorexia (18 patients), diarrhea (5 patients), constipation(5 patients) followed by febrile events (16 patients),CNS symptoms (14 patients). The treatment regimen was gemcitabine, amrubicin, docetaxel, pemetracate, and erlotinib in 10,9,8,8 and 7 patients, respectively. 65 patients (54%) of them were hospitalized. Conclusions: In order to reduce emergency room visits, it is important to control gastrointestinal and infectious toxicities.

The Effects of Pain Management Education on Knowledge, Concern, and Attitude about Pain Management in Cancer Patients Receiving Chemotherapy in Outpatient Settings

Purpose: The purpose of this study was to identify the effects of pain management education on knowledge, concern, and attitude about pain management for cancer patients receiving chemotherapy in outpatient settings. Methods: This study used a nonequivalent control group pre-post test design. Data collection was conducted from June to September 2012. The participants of this study were 56 patients (Experimental group; 28, Control group; 28) at one University Hospital in D city. The data were analysed with a SPSS/ WIN program. Results: There was a significant difference on knowledge about pain management (t= 2.139, p= .037), but there were no difference on concern (t= -1.355, p= .181) and attitude (F= 3.276, p= .076) about pain management between experimental group and control group. Conclusion: The pain management education had positive effects on knowledge about pain management for cancer patients receiving chemotherapy in outpatient settings. Therefore, to validate the effectiveness of pain management education, customized program and further research should be considered focusing on demographic and disease-specific characteristics.

Unplanned presentations to emergency departments due to chemotherapy induced complications: Opportunities for improving service delivery

Summary Aim To understand the key characteristics of emergency department (ED) presentations among newly diagnosed cancer patients undergoing chemotherapy in outpatient settings. Methods A retrospective audit of 443 randomly selected newly diagnosed cancer patients who received chemotherapy through day oncology and presented to an ED in 2007. Data were collected from the Victorian Emergency Minimum Dataset and medical record review. Descriptive statistics, chi-square, t -tests and logistic regression, were used to analyse the data. Results There were slightly more males than females (53.0% and 47.0%, respectively); the mean age was 61 years ( SD = 12; range 22—89 years). The main cancer diagnoses were lymphoma/leukaemia (17.5%); breast (14.7%); lung (11.3%); and gallbladder, liver, or pancreas (5.3%). Febrile neutropenia (15%) was the most common ED discharge diagnosis and it was also the diagnosis (82.8%) most likely to result in a hospital admission. Diarrhoea/constipation (52.9%) were the ED diagnoses least likely to result in hospital admission. Conclusions Strategies to reduce preventable presentations would not only benefit patients but reduce additional health care costs associated with chemotherapy treatment. A specialist liaison or coordinating role within health services, providing continuity of care, during the course of patients' chemotherapy treatment, has the potential to reduce unplanned presentations to EDs, improve service delivery and reduce health care costs.

Port central venous catheters–associated bloodstream infection during outpatient-based chemotherapy

Central venous catheters (CVCs) are commonly used for the administration of intravenous chemotherapy in outpatient setting. Nevertheless, outbreaks of catheter-associated bloodstream infections had been reported from oncology centers. We describe a large outbreak of CVCs-associated Klebsiella oxytoca bloodstream infection, occurring in an oncology chemotherapy outpatient unit of northern Greece between October 2006 and May 2007. The outbreak involved approximately 10% of the patients with CVCs who were receiving home-based chemotherapy, and it represents the second larger outbreak of CVCs-associated BSIs due to Klebsiella oxytoca in oncology outpatient centers. We retrospectively analyzed the chain of investigations and prophylactic/diagnostic measures taken to eradicate the infection: (1) patients' chart audit, (2) estimation of the infection among asymptomatic patients, (3) implementation of the level of awareness of medical and paramedical personnel, (4) collection of samples from environment, medications and infusion materials, (5) critical appraisal of chemotherapeutical schemes and (6) cooperation with peripheral institutions. The isolation of Klebsiella oxytoca in a chemotherapy solution (infusional 5-FU in dextrose 5% solution within a 48h pump) from a peripheral General Hospital and the prompt transmission of the data to the chemotherapy center played a key role for the management of the infection cluster. This is the first report that evidenced the detection of Klebsiella oxytoca within a chemotherapeutical preparation. Data transmission from peripheral hospitals to the central institution resulted in an important feedback that allowed a better estimation of the infection cluster and more tailored actions for the eradication of the infection.

Palliative care needs of cancer outpatients receiving chemotherapy: an audit of a clinical screening project

Although more and more cancer patients are receiving chemotherapy in outpatient settings in their advanced stage and could have a broad range of palliative care needs, referral to the specialized palliative care service is often delayed. The primary aim of this study is to explore the usefulness of a combined intervention for cancer patients in identifying patients with under-recognized palliative care needs and referring them to the specialized palliative care service. The intervention consisted of (1) introducing the specialized palliative care service when starting chemotherapy, (2) using screening tools, and (3) providing on-demand specialized palliative care service. All cancer patients newly starting chemotherapy with primary tumor sites of the lung, gastrointestine, pancreas, bile duct, breast, ovary, and uterus were included. As routine practice, at the first instruction about chemotherapy, pharmacists provided information about the role of the specialized palliative care service using a pamphlet and handed out screening questionnaires. Screening questionnaires were distributed at every hospital visit. Treating physicians and/or nurses checked the questionnaire before examining the patients. The patients were referred to the palliative care team, if (1) the patients voluntarily wished for the specialized palliative care service or (2) the treating physicians clinically determined that, on the basis of the screening results, the patients had physical or psychological needs appropriate for referral to the specialized palliative care service. The screening questionnaire included an open-ended question about their greatest concerns, the severity of 11 physical symptoms, overall quality-of-life, the distress thermometer, help for information about the treatment and decision-making, economic problems, nutrition, daily activities, and wish for help from the specialized palliative care service. Of 211 patients who newly started chemotherapy, 5 patients refused to complete the questionnaire (compliance rate, 98%). We obtained 1,000 questionnaires from 206 patients. The percentages of missing values ranged from 2.7% to 7.0%. Of 206 patients, 38 (18%) were referred to the palliative care team due to newly recognized problems, in addition to 10 patients with problems well-recognized by primary physicians. The total percentage of patients receiving specialized palliative care service was thus 23% of all patients. Frequently identified problems were oral problems (20%), insomnia (20%), help with information and decision-making (16%), psychological distress defined as the distress thermometer (14%), severe fatigue (9.0%), and severe appetite loss (8.8%). As a whole, problems were identified in half of all questionnaires. The combined intervention of introducing the specialized palliative care service, using screening tools and providing on-demand specialized palliative care service, was feasible as part of the routine clinical practice for all cancer patients starting chemotherapy. It might be useful in identifying patients with under-recognized palliative care needs and referring them to the specialized palliative care service at the appropriate time.