Comprehensive Oncology Care Research Articles

Role of Sodium-Glucose Co-Transporter-2 Inhibitor During Anthracycline Use: An Updated Review.

The coalescence of anthracycline-induced cardiotoxicity and the evolving role of sodium-glucose co-transporter-2 (SGLT-2) inhibitors in oncology and cardiology has prompted a comprehensive review of their mechanisms, clinical implications, and future directions. Anthracyclines, potent chemotherapeutic agents, have been integral in cancer treatment, yet their potential for cardiac harm necessitates careful monitoring and management. We explore the multifactorial nature of anthracycline-induced cardiotoxicity, encompassing diverse patient populations, cumulative doses, and interplay with other treatments. While advancements in imaging and biomarker assessments aid in early detection, the lack of standardized criteria poses challenges. The emergent role of SGLT-2 inhibitors, initially developed for diabetes management, presents a novel avenue for cardioprotection. Beyond glycemic control, these inhibitors exhibit pleiotropic effects, including enhanced diuresis, anti-inflammatory actions, and modulation of energy sources. Consequently, SGLT-2 inhibitors are being investigated for their potential to mitigate cardiotoxic effects, promising an innovative approach in cardio-oncology. Despite these advancements, limitations in data interpretation and patient-specific considerations persist. The future of anthracycline-induced cardiotoxicity research lies in predictive biomarkers, precision medicine, multidisciplinary collaboration, and tailored treatment regimens. By navigating these challenges and harnessing emerging strategies, we aim to optimize cancer treatment efficacy while safeguarding cardiovascular health, ultimately paving the way for a new era of personalized and comprehensive oncologic care.

ASCO Patient-Centered Cancer Care Certification (APC4) pilot: Assessing and improving care delivery gaps.

67 Background: APC4 is a comprehensive oncology care delivery certification built on oncology medical home (OMH) standards developed by ASCO and COA. APC4 consists of 7 domains supported by 39 specific standards, including the chemotherapy safety domain, which incorporates the existing ASCO QOPI Certification Program. To test the standards and assess the feasibility of a vigorous certification process, ASCO embarked on a two-year pilot with twelve oncology practices. All twelve practices achieved certification, although each practice had to address gaps. We present the results of the gap assessment as determined by both onsite survey and practice self-assessment. Methods: The APC4 process involves an onsite survey, followed by cycles of monitored improvement. Certification is awarded after a practice has satisfactorily met all standards. We report here on the 17 care delivery standards not included in QCP. Onsite survey teams consisting of qualified oncology professionals evaluated practice performance against the standards. The final scoring was reviewed and agreed upon by a governance committee. In the final phase of the pilot, practices were surveyed to determine which standards required practices to adopt new procedures or to improve existing care processes to meet certification requirements. Results: At the initial site survey none of the twelve practices met 100% of the 17 standards. Combining the experience of all 12 practices – 68% of the care delivery standards were met (# total standards met by 12 practices / 17 standards X 12 practices) (range 47-82%). Following recalibration of care through implementing new or modified processes of care all 17 standards were met resulting in certification. For example, 85-95% of the practices had to implement new or improve existing processes to meet advanced care planning & goals of care standards; and 90% to deal with the health equity standard (notably 5 of the 12 practices developed completely new equity initiatives). Conclusions: The APC4 pilot was deemed to be feasible and is now being expanded. The presented pilot data suggest that even among oncology practices experienced in the implementation of therapy administration safety (10/12 were already QOPI certified) and practice transformation (11/12 participated in OCM) there is significant room for improvement to meet the standards of APC4 certification. The pilot also demonstrated that practices could identify and rectify gaps through a continued quality improvement focus. [Table: see text]

ASCO's Leadership Development Program: Focusing on the Next Generation of Leaders in Asia Pacific.

The demand for high-quality and more comprehensive oncology care will continue to rise globally. Effective leadership is particularly important. The evolving endeavor of ASCO to reach out globally has covered the development of the next-generation leaders from Asia Pacific. Through the Leadership Development Program, the untapped talent of the region and the future leaders in oncology will gain the knowledge and skill sets, which prepares them to navigate the complex dynamics of oncology health care. The region is the largest and the most populous with more than 60% of the world's population. It has 50% of cancer cases and is estimated to account for 58% of cancer deaths worldwide. The demand for high-quality and more comprehensive oncology care will continue to rise in the years to come. This growth will intensify the need for capable leaders. Leadership styles and behaviors are different. These are shaped within the context of cultural and philosophical views and beliefs. The pan-Asian interdisciplinary group of young leaders are expected to gain knowledge and skillsets through the Leadership Development Program. They will learn to work on strategic projects within a team and gain knowledge about advocacy. Communication and presentation skills and conflict management are also important components of the program. Through learning culturally relevant skills, participants can effectively collaborate with others, build relationships, and lead within their own institutions and societies and within ASCO. Institutions and organizations need to have a deeper and more sustained focus on leadership development. Successfully addressing the challenges on leadership development in Asia Pacific is important.

Integration of Patient-Reported Outcome Measures in the Electronic Health Record: The Veterans Affairs Experience.

There are growing efforts to integrate patient-reported outcome (PRO) data into electronic health records (EHRs) to bring together disparate sources of patient information and improve medical care. PRO measures can be used to assess cancer symptom presence and severity. Integrating PRO tools in EHRs can alert providers to address symptoms, which is an essential component of comprehensive oncology care. We modified a PRO used to measure cancer and end-of-life symptoms, the Edmonton Symptom Assessment System to create the Veteran Symptom Assessment System (VSAS). VSAS was implemented as an integrated PRO as part of the Veterans Administration EHR system and was used at hematology-oncology clinics in Veteran Administration (VA) medical centers in the Southeast. From 2013 to 2014, VSAS was introduced, underwent usability testing and modifications, and was finally implemented in the EHR. Between 2015 and 2019, VSAS was administered 43,883 times in 9,058 patients. Eighty-nine percent of Veterans were male, 11% were female, 52% identified as non-Hispanic White, and 43% identified as African American. Fatigue, shortness of breath with exertion, and pain were most frequently reported initially (68%, 48%, and 45%, respectively) and were most frequently rated as severe (27%, 16%, and 17%, respectively). In patients diagnosed with stage IV cancer, higher symptom burden was significantly associated with shorter overall survival. The majority of Veterans with longitudinal measurements experienced improvement in symptoms, most frequently in severe symptoms. To our knowledge, this is the first large-scale implementation of a PRO system, integrated in the VA EHR, in ambulatory patients with cancer and blood disorders. The integration of VSAS within the VA EHR is a significant demonstration and a necessary requirement for current and future systemic initiatives in cancer symptom management.

Palliative care training: a national study of internal medicine residency program directors in the United Arab Emirates

BackgroundInternal medicine residents are responsible for providing much of the direct care for palliative and terminally ill patients in teaching hospitals in the United Arab Emirates (UAE). To date, little systematic information is available on the prevalence of palliative care (PC) programs or faculty in UAE academic hospitals, or on the nature of PC education in internal medicine residency programs in the country.MethodsSemi-structured interviews were conducted with program directors of all 7 internal medicine residency programs in the UAE. Qualitative content analysis was conducted to identify recurring themes.ResultsAll program directors agreed that PC knowledge and skills are an essential component of training for internal medicine residents, but have had variable success in implementing the components. Three themes emerged, namely lack of structured PC training, perceptions of resident preparedness, and barriers to implementing a PC curriculum.ConclusionInternal medicine residency programs in the UAE currently lack structured, mandatory PC curricula and have limited opportunities for formal teaching and assessment of PC knowledge and skills. The planned development of comprehensive oncology and palliative care centers and ongoing curricular reform in teaching hospitals in the country will provide important opportunities to train a cadre of competent health professionals to provide high quality palliative and end-of-life care to UAE patients and their families.

Robot-assisted neck dissection

The neck dissection is an integral component of comprehensive oncologic care for patients with head and neck cancer. Modern robotic surgical platforms are being utilized within otolaryngology for a growing number of indications, including, robot-assisted neck dissections. The proposed benefits of robot-assisted include improved cosmesis and reductions in post-operative lymphedema. Early data suggests that oncologic control following robot-assisted neck dissection is comparable to the gold-standard, open technique. Here we present review of the surgical techniques involved in a robot-assisted neck dissection as well as a review of perioperative care.

Point of care tobacco treatment sustains during COVID-19, a global pandemic

BackgroundTobacco cessation treatment for cancer patients is essential to providing comprehensive oncologic care. We have implemented a point of care tobacco treatment care model enabled by electronic health record (EHR) modifications in a comprehensive cancer center. Data are needed on the sustainability of both reach of treatment and effectiveness over time, including the COVID-19 pandemic. MethodsUsing EHR data from the pre-implementation (P: 5 months) and post-implementation periods (6 month-blocks, T1-T5 for a total of 30 months), we compared two primary outcomes: 1) reach of treatment among those smoking and 2) effectiveness assessed by smoking cessation among those smoking in the subsequent 6 month period. We analyzed the data using generalized estimation equation regression models. ResultsWith the point of care tobacco treatment care model, reach of treatment increased from pre to post T5 (3.2 % vs. 48.4 %, RR 15.50, 95 % CI 10.56–22.74, p < 0.0001). Reach of treatment in all post periods (T1-T5 including the COVID-19 pandemic time) remained significantly higher than the pre period. Effectiveness, defined by smoking cessation among those smoking, increased from pre to post T2 before the pandemic (12.4 % vs. 21.4 %, RR 1.57, 95 % CI 1.31–1.87, p < 0.0001). However, effectiveness, while higher in later post periods (T3, T4), was no longer significantly increased compared with the pre period. ConclusionA point of care EHR-enabled tobacco treatment care model demonstrates sustained reach up to 30 months following implementation, even during the COVID-19 pandemic and changes in healthcare prioritization. Effectiveness was sustained for 12 months, but did not sustain through the subsequent 12 months.

A call to action: unified clinical practice guidelines for oncofertility care.

By 2030, WHO estimates that 1.4 million reproductive-aged women will be diagnosed with cancer annually. Fortunately, cancer is no longer considered an incurable disease in many cases. From 2008-2014, 85% of women under the age of 45 years diagnosed with cancer survived. This increase in survival rate has shifted attention from focusing exclusively on preserving life to focusing on preserving quality of life after treatment. One aspect of this is preserving the ability to have a biological family. Oncofertility, the field that bridges oncology and reproductive endocrinology with the goal of preserving fertility, offers these patients hope. Though it is clear that ASCO and ASRM recognize the importance of fertility preservation as an aspect of comprehensive oncology care, there are not yet unified guidelines for oncologists and fertility specialists for treating oncofertility patients. First, we identify the need for reproductive counseling prior to cancer treatment, as many patients report that their fertility preservation concerns are not addressed adequately. We then delineate multi-modal fertility preservation options that are available and appropriate for different patients with corresponding outcomes using different treatments. We discuss the unique challenges and considerations, including ethical dilemmas, for delivering timely and comprehensive care specifically for oncofertility patients. Finally, we address the multidisciplinary team that includes oncologists, reproductive endocrinologists, surgeons as well as their staff, nurses, genetic counselors, mental health professionals, and more. Since oncofertility patient care requires the coordination of both physician teams, one set of unified guidelines will greatly improve quality of care.

Palliative care referral patterns of adolescent and young adult patients at a comprehensive cancer center.

63 Background: Adolescent and young adults (AYA) diagnosed with cancer have distinct physical, developmental and psychosocial needs that are often unmet during oncology treatment. Such needs are further intensified for AYA patients with an advanced cancer diagnosis. Palliative Care (PC), specialized care for patients and families with serious illness, can address these needs throughout the disease trajectory including symptom management, supportive communication, and advance care planning. The incorporation of PC remains suboptimal despite evidence that palliative services can improve quality of life. In an effort to identify strategies to advance access to PC for the AYA population at our institution, the referral pattern to PC was studied. Methods: A retrospective chart review was performed to identify referral patterns to PC in the AYA population (ages 18-39) from July 2017 through June 2019 at a National Cancer Institute designated comprehensive cancer center. Descriptive statistics were utilized to summarize referral patterns and trends. Results: In the past 2 years, 1,894 AYA patients established oncology care at our institution. The most common AYA cancer diagnoses included hematologic 20.8% (n=944), thyroid 10.8% (n=490), brain 9.9% (n=451) and breast 9.1% (n=414). There were 311 (16%) referrals placed to PC, mostly in the inpatient setting (81.4%). Less than half (43%) of the inpatient referrals had a post-discharge follow-up appointment in the PC clinic. Multiple disease-specific service lines were represented including leukemia (40%), colorectal (14.5%), sarcoma (9%) and breast (9%). Quarterly volumetric trends remained static over the 2 years (average number of referrals: 54/quarter). The average age at cancer diagnosis in the AYA population was 30 years and 32.7 years (range 19-39) at time of PC referral. This was consistent with the average length of time from initial diagnosis to PC referral of 2.8 years. Conclusions: Comprehensive oncology care in the AYA population should include PC. Yet, involvement of PC in the AYA population during oncologic treatment was limited. Future research will investigate optimal models of integrative PC to address the unique needs of AYA cancer.

Experiences with Menses and Menstrual Suppression of Young Women with a History of Cancer.

Background: Adolescent and young adult (AYA) women undergoing multiagent chemotherapy are at risk for heavy menstrual bleeding (HMB). There is a paucity of data on the experiences with menses of AYA women with cancer, their risk for HMB, and how they perceive menstrual suppression. Objective: This study aimed to (1) describe the attitudes and experiences of AYA women with a history of cancer regarding their menses and menstrual suppression and to (2) investigate facilitators and barriers to improve this aspect of oncologic care. Design/Methods: AYA women with a history of cancer completed individual semistructured interviews regarding their experiences, attitudes, and preferences around menstrual health. Two independent reviewers conducted a thematic analysis of transcribed interviews to elicit major themes. Results: We interviewed 20 young women with a history of cancer (mean age 19.9 years) who were treated with chemotherapy within the past 5 years. Themes included the following: (1) negative feelings and worry about menstrual bleeding; (2) positive attitudes toward menstrual suppression; (3) misconceptions about menstrual health; and (4) desire for tailored discussions about menstrual suppression. Conclusions: AYA women with a cancer history elucidate clear opinions regarding menstruation during chemotherapy, and many hold misconceptions regarding menses and menstrual suppression. Enhanced patient-provider communication and patient educational resources around menstrual health and menstrual suppression are needed to improve comprehensive oncologic care during chemotherapy.

Identification of pharmacogenetic markers in cancer supportive care.

109 Background: Precision medicine has become increasingly critical in cancer supportive care, with implications for treatment selection, medication dosing, and side effect prediction. The presence of clinically actionable germline variants brought the hope that accurate prediction of drug efficacy and toxicity would be in the future. This will greatly improve the comprehensive oncology care, where supportive care treatment options can be subjective and personalized. Methods: The changes in drug effect and toxicity caused by genetic variations were characterized in 4,287 patients submitted for clinical pharmacogenetics testing using a gene panel including key pharmacokinetic and pharmacodynamic genes. For each patient, the need to select an alternate medication and adjust medication dose was determined for the treatment of pain (CYP2D6, CYP1A2, OPRM1), nausea/vomiting (CYP2D6), antifungal prophylaxis (CYP2C19), and depression (CYP2D6, CYP2C19). It is recognized that there are many other factors playing in the variations of the response and toxicity to these classes of medications. Results: Of the 4,287 patients, 964 (22%) would have a recommendation to choose alternatives of oxycodone, codeine, or tramadol therapy and 3,394 patients (79%) for a non-standard dosage. A change in certain antiemetics such as ondansetron would be suggested for 171 patients (4%). If voriconazole antifungal prophylaxis was clinical required, 1,228 (29%) would need a dose increase, while 133 (3%) should be switched to a different regimen. 2,727 patients (64%) should avoid or adjust dosage on some of the commonly used agents for depression due to reduced efficacy or heightened risk of toxicity. Conclusions: Pharmacogenetics markers associated with reduced drug efficacy and higher rate of ADRs were commonly observed for medications used in cancer supportive care. Identification of these markers would help clinicians achieve optimal treatment outcome with manageable time and cost. This provides great opportunities to apply precision medicine principles to patient management.

A Prospective, Interventional Study Evaluating the Use of a Prompt to Improve Compliance with Documentation of a Plan of Care for Pain in Patients with Bone Metastases Seen for Palliative Radiation Therapy

Management of cancer-related pain is an essential component of comprehensive oncologic care. Undertreated pain results in adverse clinical outcomes, undue suffering, and decreased quality of life. Furthermore, there are significant disparities in pain management, with racial/ethnic minorities and underserved populations at higher risk for undertreated cancer related pain. We studied whether the use of a simple electronic medical record (EMR) prompt could increase compliance with documentation of pain interventions in patients seen for palliative radiotherapy for bone metastases. A prospective, interventional study was approved by the Resident and Fellow Quality Improvement Incentive Program at our institution. Evaluable patients were seen in consultation for palliative radiation therapy for bone metastases. Resident physicians were asked to imbed a prompt in their consultation note, including pain scale (0/10) and plan of care for pain management. The primary endpoint was compliance rate of documenting a plan of care for >50% of audited patient encounters. The protocol aligned with Merit-based Incentive Payment System (MIPS) quality measures as defined by the Centers for Medicare Services. Quarterly EMR review was performed, with charts selected at random for auditing. Prior to initiation of the QI protocol, a pain intervention was documented in just 17.2% of patients. In the first 6 months following institution of the QI protocol, a plan of care for pain was documented in 65.5% of patients. The analgesic regimen was assessed or modified in 35% of consultations, urgent radiation therapy undertaken in 26%, communication with primary provider or oncologist in 10%, and referral to the Palliative Care service in just 4%. After institution of this protocol for patients being evaluated for palliative radiotherapy for bone metastases, substantially more patients had documentation of a plan of care for pain in accordance with MIPS quality guidelines. In addition to offering palliative radiation therapy, analgesics regimens were adjusted, referrals to palliative care were offered, and pain control was discussed with the referring provider. Ongoing efforts in our department are aimed at improving pain management and integrating radiation therapy with specialized palliative care providers.

A physical assessment tool to evaluate functional status compared to ECOG scores in cancer outpatients.

135 Background: Individuals with cancer may experience loss of function, disability and fatigue. There is interest in team-based functional and physical assessment as part of a comprehensive oncology care plan. The Bellarmine Norton Assessment Tool (BNAT) was developed to provide an objective physical assessment tool for interprofessional use. The purpose of this study was to evaluate the BNAT and correlate its outcomes with ECOG scores across groups diagnosed with pancreatic (P), breast (B) and lung (L) cancers. Methods: The BNAT was developed by the Bellarmine University Physical Therapy Program utilizing validated physical assessment tests. It consists of 1 subjective question about physical activity frequency followed by 4 objective tests: 2-Minute Step Test (2MST), 30 Sec Sit-to-Stand, Timed Arm Curl (TAC) and Timed Up and Go. The ECOG was administered by attending oncologists during the same visit as BNAT testing. 18 participants were identified 6 in each of the diagnosis groups from a recruitment cohort of 57. The avg. age for P was 68.8±9 yrs 4♀,2♂; B 71.5±15.8 yrs 6♀; L 65.0±12.4 yrs 3♀,3♂. Results: The combined mean ± SD ECOG score was 1.2±1.0 (range 0-3) while the combined BNAT score was 15.4±6.5 (range 7-29). Mean BNAT score by diagnosis: P 16.6±7.4; B 13.0±5.5; &amp; L 18.3±5.7. Spearman correlation analysis of BNAT and ECOG scores revealed a significant (p = 0.0001) negative correlation of agreement (r = -0.79). Both B and L cancers had significant (p &lt; 0.05) correlation of agreement (B r = -0.71 &amp; L r = -0.88). TAC correlation to ECOG was strongest in L group (r = -0.86), but 2MST was strongest for P group (r = -0.62). There was a reciprocal relationship of slopes between TAC and 2MST based on diagnosis. L steepest slope in TAC (-6.2 with deviation from 0, p = 0.014) while P had steepest slope with 2MST (-13.1). Slope for B group consistently fell between the 2 other diagnoses. Conclusions: There was a strong linear relationship of BNAT, TAC &amp; 2MST to ECOG scores across the 3 cohorts of diagnoses. The BNAT subcomponents have varying degrees of contribution to the total that can be attributed to diagnosis-related functional deficits, thus giving providers information to determine appropriate care.

Disparities in genetics assessment for women with ovarian cancer: Can we do better?

ObjectiveWe sought to characterize referral patterns for genetic counseling for women with ovarian cancer and hypothesized that differences in referral and testing rates are shaped by socioeconomic factors. MethodsPatients were identified by pathology reports from August 2012 to January 2016 containing the words “serous” or “ovarian.” Patient information was obtained via electronic medical record. Primary outcomes were placement of a genetics referral and completion of counseling. A secondary outcome was completion of genetic testing. ResultsWe identified 246 women with a diagnosis of ovarian cancer. Ten were previously counseled and excluded. 53% of patients were referred for counseling with mean time from diagnosis to counseling of 4.6months. Age and family history were not associated with referral, however rates differed by race with 61% of Caucasian and 40%, 38% and 33% of Asian, Latina and Black women, respectively, referred (p=0.035). Overall, 36% of patients diagnosed underwent counseling, and 33% were tested. English language (p<0.0001), high-grade serous histology (p=<0.0001) and private or Medicare insurance (p<0.0001) were significantly associated with referral. ConclusionWe have not yet reached the Society of Gynecologic Oncology recommendation for referral to genetics. Women of color and those with public insurance have lower referral rates. This disparity in care impacts cancer treatment options and prevents appropriate screening for other hereditary malignancies. To provide comprehensive oncology care, including genetic assessment, we recommend focusing on these barriers including improving outreach and interpreter services.

Developing a survivorship specific curriculum for an advanced practice provider fellowship.

14 Background: Holistic oncology care combines cancer treatment with supportive care to meet the physical and psychosocial needs of the cancer survivor. Advanced Practice Providers (APPs) are prepared to deliver high-quality, comprehensive oncology care and are vital to survivorship care as the number of cancer survivors continues to rise. At a Midwest Comprehensive Cancer Center (CCC), an APP oncology-specific fellowship is an innovative year-long postgraduate clinical training program. For the first time, a 2 week rotation through this CCC’s survivorship department will be piloted to provide the fellow with a basic immersion into survivorship care. Methods: APP oncology fellowship graduates completed an open ended survey. They were asked to reflect on their experiences during the fellowship and provide feedback on how to improve course content, and resources that are essential to the delivery of survivorship care. APPs within the survivorship department and the APP fellowship lead educator were asked what objectives they thought were important to be met. Results: APPs fellowship graduates desired to learn more about the philosophy of survivorship care, latent and long term side effect management, creation and delivery of a treatment summary and survivorship care plan (TS/SCP), and specific strategies for executing a meaningful survivorship care visit. Networking with oncology providers was also important. Survivorship department APPs and the fellowship lead thought it was important to know how to do a holistic and supportive care assessment, create a TS/SCP, interpret and manage a distress screening tool and make appropriate supportive care referrals. Conclusions: Cancer survivorship is an integral part of holistic oncology care. As the number of cancer survivors continues to increase, so does the need for supportive care services throughout the cancer continuum. Feedback from those surveyed was used to help develop a survivorship specific curriculum for APP oncology fellows. Educating future APPs in the principles of survivorship care and available supportive care services will result in expert clinicians in survivorship care, and improve overall well-being and quality of life of cancer survivors.

Effects of community-embedded care management model on patients, providers, and payors.

44 Background: Comprehensive oncology care management is commonly built on expert clinical support and coordinated services, but lacks a community focus during critical phases of the cancer journey. However, a community-embedded approach extends past practice walls by incorporating local resources and identifying barriers to care in-between office visits. The cycle of care management adheres to the following objectives: Improve health outcomes; Engage the patient, their family and healthcare team; Advance payor efficiency and cost savings; Support the treatment plan in the community. Methods: Stratification Technology Platform &amp; Levels of Care: A risk-based process is implemented through proprietary stratification software, which combines all data points of the healthcare system. A three-step risk acuity score is calculated for each patient based on claims data, diagnoses and disabilities to assure care is tailored to meet individual needs. Patients are then designated to care programs in accordance to their various risk levels. This allows for personalized care plans and staff workflows. Care Teams: Teams of a care coordinator, registered nurse and social worker provide consistent healthcare navigation, monitor patients’ treatment adherence and improve health outcomes. They act as a safety net for patients and their families at all times. Results: 31% decrease in ER visits; 51% decrease in hospital admissions; Hospice conversion at 8x national average; Improved side effects management; ROI of 3:1. Conclusions: Through community-embedded oncology care management, patients not only receive the proper level of care, but also show various improved health outcomes. Providers and patients see decreased emergency room visits, shorter hospital stays and improved quality of life, while payers experience tremendous cost savings due to smarter spending and utilization management. Practices continue to recognize community-embedded care management as a transformative standard of treatment that is central to positive health outcomes. However, there is always more to learn and improve upon, so constant evaluations of quality metrics are essential to provide the very best to patients, providors and payers.

Cancer Prevention and Detection: Application Across the Cancer Trajectory

Oncology nurses have many opportunities to implement cancer prevention and early detection recommendations across the cancer trajectory. Understanding the principles that guide the recommendations is important to providing comprehensive oncology care; many readily available resources can assist oncology nurses with this education. Guidelines for the prevention and early detection of malignancy are based on a comprehensive cancer risk assessment that includes past medical history, lifestyle factors, family history, and, in some cases, genetic testing. .

Symptom Burden: Experiences of Puerto Rican Men With Prostate Cancer Prior to External Beam Radiation Therapy.

Prostate cancer is the most frequently diagnosed cancer in men in Puerto Rico, and external beam radiation therapy (EBRT) is a popular treatment. Although symptom management is a clinical priority of comprehensive oncology care, symptom assessment at the time of primary or adjuvant EBRT has received limited attention. This article examines the prevalence and severity of symptoms experienced by 54 Puerto Rican men prior to EBRT. Participants completed a demographic form and the MD Anderson Symptom Inventory. Descriptive statistics were generated. Most participants had received hormonal treatment, and about a third had received no treatment prior to EBRT. About a third of those who received hormonal treatment reported experiencing side effects before EBRT, and disturbed sleep, numbness and tingling, fatigue, and dry mouth were the most severe. Puerto Rican men with prostate cancer who receive hormonal treatment are at increased risk for experiencing symptom burden prior to EBRT. Greater need for symptom surveillance, treatment, and control may be needed among this population.

How well are cancer centers addressing supportive oncology needs?

96 Background: The IOM 2013 report recommends comprehensive supportive oncology care from diagnosis through survivorship to end of life. The Coleman Foundation supported a baseline assessment of supportive oncology care using key COC, ASCO-QOPI and NQF measures. Methods: Data extracted from medical records at 6 Chicago cancer centers in 2014 (n = 843 patients), including stage I-III (n = 391) and stage IV solid tumor or refractory hematologic malignancy (n = 452). Results: Fifty-four percent of patients had discussions on understanding of illness, 24% were informed of prognosis timeframe, and 5% had a documented healthcare power of attorney. Only 6% of stage IV patients received distress screening within 2 weeks of diagnosis and 15% of Stage IV patients had referrals to palliative care. Among patients with Stage I-III cancer, 38% had a supportive oncology screening, and 2% received treatment summaries and a SCPs. Conclusions: There are still large gaps in important supportive care processes based on IOM 2013 recommendations, COC, and ASCO QOPI measures. Future steps include implementing supportive care processes that address gaps across the 6 cancer centers. [Table: see text]

Existential distress among caregivers of patients with brain tumors: a review of the literature.

Attention to existential needs is a component of comprehensive oncologic care, and understanding these needs among informal caregivers of patients with brain tumors is necessary to provide them with comprehensive psychosocial care. The purpose of this systematic review was to synthesize the literature on existential distress experienced by these informal caregivers to inform the development of psychotherapeutic interventions for this population. A systematic review was conducted using electronic medical databases. Studies that examined any element of existential distress among informal caregivers of patients with brain tumors were included. A final sample of 35 articles was reviewed. Six existential themes emerged: identity; isolation; responsibility and guilt; death anxiety; deriving meaning and personal growth; and spirituality and religion. The unique existential experience of parenting a patient with a brain tumor also emerged. Existential distress in all areas was identified as experienced early in the cancer trajectory and as a critical, unmet need. Existential distress is well documented among informal caregivers of patients with brain tumors and is a significant driving force of burden. Awareness and acknowledgement of this distress, as well as interventions to ameliorate this suffering, are needed. More candid communication between health care providers and caregivers about brain tumor prognosis and caregivers' existential distress may improve their psychosocial outcomes.