Hospitalized Oncology Patients Research Articles

Concreteness in Finitude

I am a social worker and the author of this poetry which is based on my professional practice with hospitalized oncology patients. Poetry is a therapeutic resource which can and should be used to m...

Significance of a clinical pharmacist-led comprehensive medication management program for hospitalized oncology patients.

Background The use of highly toxic drugs in cancer treatment and supportive care medications exposes patients to an increased number of drug-related problems (DRPs). Clinical pharmacists contribute to the optimal use of medications by intervening in identified drug-related problems. Objective To evaluate the relevance of a comprehensive medication management service in oncology patients. Setting Marmara University Teaching and Research Hospital Medical Oncology Ward, Istanbul, Turkey. Methods This prospective study was carried out between December 2015 and April 2016 with adult patients with confirmed malignancy. Comprehensive medication management was performed by the clinical pharmacist throughout the patient's hospital stay. The medication-related data as well as data regarding demographic and general health status of the patients were reviewed for the presence of drug-related problems. The identified problems, interventions and acceptance rate by physicians were recorded with the help of the Pharmaceutical Care Network Europe V6.0 (PCNE) classification. Main outcome measures Number and causes of drug-related problems, nature and acceptance rate of clinical pharmacist interventions and rate of problems solved. Results The study included 137 patients. The mean (SD) age of the patients was 58 (14.6) years. A total of 481 drug-related problems were recorded. The most frequent drug-related problems were 'adverse drug events [including drug interactions]' (n = 376), 'untreated indications' (n = 59) and 'unnecessary drug treatment' (n = 25). Inappropriate combination of drugs was the cause of 73.2% of the total problems. Interventions were made to stop administration of a suitable drug if the combination with another drug was contraindicated while prescribers were mostly informed about major drug interactions. The prescribers approved 93% of the total intervention proposals. The majority (90.9%) of the identified problems were totally solved. Conclusion Integration of clinical pharmacy services through a comprehensive medication management program in oncology will help to reduce the number of drug-related problems.

QTc Prolongation and Risk of Torsades de Pointes in Hospitalized Pediatric Oncology Patients

To evaluate the prevalence of torsades de pointes and to identify risk factors associated with QTc prolongation of ≥500milliseconds in hospitalized pediatric oncology patients. A QTc prolongation of ≥500milliseconds is associated with higher mortality in hospitalized adults but has not been demonstrated in pediatrics. A single-center, retrospective review of all hospitalized oncology patients ≤21years of age was performed from 2014 to 2016. Patients with long/short QT syndrome or a QRS interval of ≥120ms were excluded. Rapid response events were reviewed to determine the prevalence of torsades. In patients with ECGs for review, data were compared between patients with a QTc of <500 and≥500ms via logistic regression. There were 1934 hospitalized patients included. Rapid response events occurred in 90 patients (4.7%) with 2 torsades events (0.1%). There were 1412 electrocardiograms performed in 287 unique patients (10.6±6.3years of age; 43% female). The mean QTc was 448±31ms; 25 patients (8.7%) had ≥1 ECG with a QTc of ≥500ms. The prevalence of torsades was greater in patients with a QTc of ≥500ms (8% vs 0%; P<.01). In multivariate analysis, factors associated with a QTc of ≥500ms included female sex, (OR 2.95) and ≥2 QT-prolonging medications (OR, 2.95). The prevalence of torsades in hospitalized pediatric oncology patients was low (0.1%), although the risk was significantly greater in patients with a QTc of ≥500ms. Routine monitoring of electrocardiograms and electrolytes is essential in patients with risk factors predisposing to QTc prolongation.

Low advance directive completion rates in hospitalized oncology patients: Room for improvement.

1 Background: Advance care planning (ACP), which includes advance directive (AD) completion, ensures that patients receive care that is consistent with their beliefs and preferences. ACP is particularly important to patients with cancer as they have high rates of hospitalization and mortality. However, AD completion rates for oncology patients have been reported to be as low as 10%. We sought to evaluate barriers and improve AD completion rates in hospitalized oncology patients in our institution. Methods: 63 patients with cancer admitted to our inpatient oncology unit were surveyed. A multi-disciplinary team, consisting of resident physicians and social workers, was constituted to educate patients and provide assistance with AD completion. Barriers to AD completion were identified and AD completion and filing rates on patients’ discharge were calculated. Results: Most patients were female (66.6%) with mean age of 63.8 years. Majority of patients had stage IV cancer (71.4%) and were receiving palliative treatment (80.9%). Only 9.5% (6/63) of the patients had completed AD on file. However, 92% of the patients had previously heard about AD. After intervention, the AD filing rate improved to 41.2% (26/63). Some of the patient-reported barriers were needing more time to discuss with family (28.5%), wanting to file in clinic (23.8%), too sick to make decision (6.3%) and did not think they needed it (4.7%). Conclusions: AD completion rate in hospitalized oncology patients in our institute was lower than anticipated. We identified the barriers and improved the AD filing rate, however there is room for further improvement. While AD discussion and filing should ideally be done in clinic, hospitalization is an opportunity that should not be missed to educate and assist completion of AD. [Table: see text]

A physician-led team approach to improve advance directive completion rates in an inpatient oncology unit.

e18271 Background: Advance care planning (ACP) ensures that patients receive care which is consistent with their beliefs and preferences. Advance directive (AD) completion is an important part of this process, but there is much room for improvement as the AD completion rates in oncology patients have been reported to be as low as 10%. We sought to improve the AD completion rates in the inpatient oncology unit in our institution by undertaking an 8-week quality improvement project. Methods: Using a Plan-Do-Study-Act (PDSA) methodology, a multidisciplinary team lead by residents was created to review the process. 2 cycles of PDSA were conducted over a period of 8 weeks. Electronic medical record (EMR) was reviewed each morning, new patients admitted to oncology unit were identified, and those without AD on file were educated by a designated resident about the importance of completing AD. Based on the patients’ willingness, the case manager was alerted with daily communication to follow-up, provide more information and assistance to file the AD. The AD completion rates were tracked daily and communicated to the team through an e-mail. Results: Only 8.3% of hospitalized oncology patients had completed AD prior to our intervention. PDSA cycle 1 resulted in improving the AD completion rates to 28.9%. Barriers were identified after cycle 1 and were overcome by clarifying the role of each team member, addressing inconsistencies in AD filing, uploading into EMR and making the scanned AD easily accessible. After implementation of the above measures, PDSA cycle 2 resulted in improving the AD completion rates to 40.9%. Conclusions: Designating a person to take lead of a multi-disciplinary team, addressing the inconsistencies in the process and keeping a daily track through EMR can lead to an improvement in AD completion rates. Sustainability of this projects remains to be tested. However, there is a room for further improvement.

Patient, Nurse, and Organizational Factors That Influence Evidence-Based Fall Prevention for Hospitalized Oncology Patients: An Exploratory Study.

Hospital falls remain common despite decades of studies and guidelines to reduce their rate. Research evidence alone is insufficient, and integration of patient values and preferences, clinician expertise and experiences, and organizational culture is needed to ensure sustainable practice changes. Little is known about the best strategies for integrating these constructs to sustain effective fall prevention programs. Guided by the Comprehensive Framework for Implementation Research (CFIR), this study aimed to identify patient, nursing staff, and organizational-level factors that influence effective and sustainable fall prevention strategies with the goal of identifying variables amenable to targeted interventions. A descriptive research design engaged four oncology units in a Midwestern academic medical center and included patients (N=39) and nursing staff (N=70). Questionnaire data were collected from patients with interview assistance, and nursing staff completed a demographic form and two standardized instruments adapted for the study. Data were analyzed using descriptive statistics and narrative summaries. Findings indicated two-thirds of patients did not see themselves at risk for falling, despite nearly half having a fall history. Nursing staff indicated knowledge gaps related to specific known risks and interventions, and confidence in fall prevention management was lowest for team communication about patient risks and engaging patients and families in preventing falls. Engagement of patients in fall risk assessment and management, clear and routine communication among team members, and creating a culture of true engagement with appropriate leadership and resources can potentially improve the sustainability of successful fall prevention programs. The CFIR can guide the planning of fall prevention and other evidence-based practice changes to become hardwired and sustainable over time even with the ongoing introduction of new initiatives.

Mortality outcomes in hospitalized oncology patients after rapid response team activation

Mortality outcomes in hospitalized oncology patients after rapid response team activation

Integrating mental health professionals into the care team to better recognize and manage delirium in hospitalized oncology patients.

83 Background: Delirium is a common neuropsychiatric condition associated with increased morbidity and mortality, length of hospitalization, and distress. The prevalence of delirium in cancer ranges from 10% to 30% in hospitalized patients and up to 85% in terminally ill cancer patients. Rates of delirium on Cleveland Clinic’s inpatient oncology units were lower than expected. Our goal was to integrate mental health professionals into the care team to assist with better recognition and management of delirium. Methods: Education was developed for a range of caregivers, including physicians, nurses, and advanced practice providers. It was facilitated by a psychiatrist, psychologist, and clinical social workers, and included proper identification of both hyper- and hypoactive delirium through use of the Brief Confusion Assessment Method (bCAM) and use of a delirium order set to treat and manage patients identified as positive for delirium. An important component of this education included a proper assessment and comparison of patients’ current mental status compared to their true baseline prior to hospitalization. Additional integration directly into the care team included participation of the psychiatrist, psychologist, and clinical social workers into each team’s multidisciplinary rounds to facilitate discussions around delirium and its appropriate management, and separate targeted rounding which included one-to-one education with front-line caregivers. Results: During the first year of integration, substantial improvements were noted. The percentage of patients identified as positive for delirium through bCAM screening increased from 3.4% to 15.8% after 12 months, and utilization of the delirium order set increased from 11.1% to 58.3%. Additionally, the average nursing unit length of stay (LOS) for delirium-positive patients decreased by more than 2 days compared to baseline. Conclusions: Integration of mental health providers into the care team to assist with recognizing and managing patients with delirium and to provide direct education to front-line caregivers has helped to rapidly improve delirium identification and management for oncology inpatients.

Addressing advance directive completion rates on an inpatient oncology unit.

147 Background: Advanced directives (ADs), particularly heath care power of attorney (HC-POA), are not always obtained or documented for patients with cancer. Hospitalized cancer patients may become too ill to complete them, making treatment decisions difficult. Understanding patients’ end-of-life preferences and providing care congruent with their values is fundamental to quality care. Completing ADs is an important aspect of this process. However, AD rates for oncology patients are typically under 40%. Our team sought to measure and increase our oncology inpatient AD rates. Methods: An interdisciplinary group including oncology and palliative medicine physicians, nurses, social workers, care managers and quality leaders convened to address ADs on our inpatient oncology services as a quality improvement project. We completed a current state analysis, evaluated areas of wasted or redundant workflow and performed a root cause analysis, identifying 4 countermeasures: 1) educating patients and staff re the value of completing HC-POAs, 2) clarifying the role of each team member, 3) implementing a discussion script for HC-POA conversations and 4) tracking and reviewing HC-POA completion in daily multidisciplinary rounds. AD completion rate by discharge was collected weekly through the 12-week project (325 discharges) then monthly for 6 months (709 discharges.) Results: Our baseline HC-POA rate was 30% for hospitalized oncology patients. Completion increased to 39% with education, role clarification and use of a discussion script. When daily tracking was initiated with the entire care team, including medical oncology staff, fellow and residents, the AD rate increased as high as 65%. This model was implemented as a best practice and has been sustained with AD completion rates of 45-60% in the subsequent 6 months. Conclusions: Our interventions successfully and sustainably increased HC-POA completion rate by engaging the entire interdisciplinary oncology team around the need for HC-POA documentation. We standardized team communication about ADs into daily workflow in interdisciplinary rounds. This increased the comfort level of the entire team and normalized discussion of HC-POAs, contributing to increased AD completion.

Medical Adhesive-Related Skin Injury Prevalence at the Peripherally Inserted Central Catheter Insertion Site: A Cross-sectional, Multiple-Center Study.

We examined prevalence and associated risk factors of medical adhesive-related skin injury (MARSI) at the peripherally inserted central catheter (PICC) insertion site in hospitalized oncology patients in Guangxi, China. A cross-sectional, multiple-center epidemiological study. The sample comprised 697 adult inpatients at 4 tertiary hospitals (3 general hospitals and 1 oncology hospital). The facilities are located in the western China. Trained nurses examined and assessed all subjects' skin exposed to medical adhesive during PICC maintenance process followed by recording the morphological features of the skin lesions, complaints of the patients, and information of catheter maintenance. Data related to patient demographics, PICC insertion information, disease, and laboratory parameters were collected through the electronic medical record. The prevalence of MARSI was calculated statistically and risk factors were examined using a logistic regression model. A total of 697 patients (mean age, 48.86 years; range, 18-89 years) were enrolled. The prevalence of MARSI was 19.7% (137/697), including mechanical skin injury 5.0% (35/697), contact dermatitis 14.8% (103/697), folliculitis 1.0% (7/697), and moisture-associated skin damage 1.3% (9/697). There were significant differences in presence of MARSI and age, diagnoses, body mass index, smoking history, indwelling time of PICC, types of dressing, types of antiseptic, a history of MARSI, and skin allergies (P < .05). Multivariate analysis identified 50 years or older (odds ratio [OR], 2.202; 95% confidence interval [CI], 1.222-3.968; P = .009), a history of MARSI (OR, 14.834; 95% CI, 6.534-33.680; P = .000) as independent risk factors for MARSI. Additionally, type of transparent film dressing used was a risk factor for MARSI (OR, 3.292; 95% CI, 1.092-9.923; P = .034). The prevalence of MARSI is significant in hospitalized oncology patients in China. Our study provided new knowledge for the epidemiology of MARSI and identified high-risk population, which will guide clinical nursing practice and ensure patient safety.

Differences in distress severity among oncology patients treated by a consultation–liaison service. A five-year survey in Germany

Background and objectivesCancer diagnosis commonly causes distress. There are associations between distress levels and clinical and psychosocial variables, but they are not necessarily dependent on cancer type. We assessed whether distress in hospitalised oncology patients treated by a consultation–liaison service (CLS) varied with oncological diagnosis or sociodemographic, clinical and care variables. MethodsA naturalistic, retrospective survey of all cancer patients (N=2864) treated by a CLS over a five-year period (2012–2016). Data were collected using standardised documents. Differences were analysed using bivariate regression. Multivariate linear regression and logistic regression respectively were used to assess associations between distress as a continuous (0–10) or dichotomous variable (0–4 vs. 5–10) and clinical and care variables. ResultsBivariate tests showed that the following characteristics were associated with higher distress levels: female (68.5%); foreign (7.9%); psychiatric comorbidity (18.9%); electively referral (23.6%); two or more interventions (20.7%); psychotherapeutic (35.3%) or psychopharmacological (5.4%) interventions; post-discharge treatment recommendation (23.3%). Level of functioning (Eastern Cooperative Oncology Group Scale-ECOG), number of contacts and cumulative treatment time were positively associated with distress, unlike age. Patients with gynaecological, lung, otorhinolaryngological and brain cancers had higher distress levels. Multivariate linear regression largely confirmed the bivariate results. Logistic regression demonstrated that a dichotomous distress variable did not differentiate between cancer types. ConclusionsDistress is less strongly related to cancer type than other clinical factors, e.g. psychiatric comorbidity, autonomy. Highly distressed patients should receive more intensive CLS care, irrespective of specific diagnosis. The positive association between elective referral and distress indicates that the CLS referral process works well.

A quality improvement initiative to reduce low-value red blood cell transfusions in hospitalized oncology patients.

116 Background: Red blood cell (RBC) transfusions are costly, a limited resource, and pose serious medical risk. While most disciplines now transfuse sparingly, hospitalized oncology patients at our institution are often transfused liberally. We conducted a QI initiative to reduce practice variation by adopting a standardized restrictive transfusion strategy. Methods: We performed a retrospective analysis of the total number of pre-transfusion hemoglobin-adjusted RBC transfusions from 02/2015 to 08/2015. Patients with severe gastrointestinal bleeding and acute coronary syndrome were excluded. Extensive feedback from providers was solicited and a comprehensive review of the evidence was performed to understand the process driving existing practices. This information and a root cause analysis were presented to key members of Oncology leadership to gain consensus on a RBC transfusion algorithm. The final algorithm recommended transfusing to a Hg goal of 8 g/dL if the platelet count was ≤ 50K; otherwise the Hg goal was 7 g/dL. We defined low-value RBC transfusions as a transfusion occurring outside the parameters of this algorithm. A multifaceted educational campaign comprising in-person meetings and web-based postings was launched to target ward nurses, advanced practitioners, residents, and attending physicians. RBC transfusions were then tracked to monitor adherence to the algorithm. Results: Analysis of the current process using QI methods found that RBC transfusion practices are most influenced by uncertainty of best practice and variation in attending preference. After the implementation of a RBC transfusion algorithm, the overall number of low-value RBC transfusions decreased from 29.6% to 19.7% (p &lt; 0.001). This reduction was most marked in patients with platelet counts &gt; 50K where there was a reduction from 78.7% to 55.6% (p &lt; 0.001). A 9.9% overall reduction corresponds to roughly 520 fewer RBC transfusions per year, which suggests an annual estimated cost savings of $520,000. Conclusions: By using a standardized QI framework, we were able to successfully decrease variation in practice that results in low-value RBC transfusions in hospitalized oncology patients.

Novel tool utilized as a trigger for advance care planning in hospitalized oncology patients.

22 Background: Study Purpose: reduce inpatient oncology readmissions; determine if there is a need to standardize trigger for Advance Care Planning in the inpatient oncology population. Methods: Investigational Quality Improvement Study January-June 2014. Retrospective chart review of oncology readmissions on the BMC Hematology and Oncology service during a 6 month period, January-June 2013 (N = 68). Data abstracted included: demographics (age, race/ethnicity, primary language, education, marital status, ECOG); type and stage of cancer; type of consults (palliative, spiritual, social services, integrative, PT/OT, hospice, visiting nurse). Developed a Severity of Illness Scale for use in the oncology inpatient patients at BMC. Results: Mortality rate within 1 year of discharge: 32.8% (non-elective readmissions) 19/58; mean days to death from readmission discharge: 65 days (range 0-252); 84.2% of those who died had metastatic cancer in index admission; only 37% ever had a palliative care consult placed (all on readmit); only 17% had a documented EOL discussion on index admission; 38.5% of patients had lung CA (22% of all non-elective readmissions). Conclusions: (1) There is a need to standardize triggers to goals of care discussions and access to Palliative Care in the Hematology/Oncology Inpatient Population at this Institution. (2) Readmissions may be reduced with better Advance Care Planning. (3) There is a communication gap amongst interdisciplinary teams in regards to Advance Care Planning at this institution. Currently IRB Approval for use of novel severity of illness scale on a maximum 450 patient sample (current N = 300) at daily rounds administered in all inpatients admitted to the Hematology/Oncology Service January 4, 2016-June 30, 2016. Preliminary data shows 25-30% of study sample scoring in for Advance Care Planning with a score of greater than or equal to 4 on novel tool (BMC Cancer Care Severity Of Illness Tool).

Assessment of Adverse Drug Reaction Due to Cancer Chemotherapy in a Teaching Oncology Hospital in Isfahan, Central of Iran.

Adverse Drug Reactions (ADRs) are common in hospitalized oncology patients. The kinds of ADRs experienced by cancer patients are varied. Therefore, the identification of appropriate manner in order to prevent ADRs may improve patient outcome. The present study evaluated the incidence, frequency and common types of adverse drug reactions among hospitalized oncology patients. Patients hospitalized at a university oncology center (children and adult) during the calendar year 2012 were randomly selected. Data were collected by reviewing of medical records. The outcome measures included the incidence of observed ADRs and ADR-related admissions and achieving strategies to prevent the emergence of chemotherapy side effects. ADRs frequently occurred in the age group less than 20 years (22%). Prevalence of leukemia (27%), colon cancer (16.5%) and breast cancer (14%) was higher in our region. Most ADRs were recorded in patients receiving cisplatin (44%), doxorubicin (24%) and 5-fluouracil (20%) as chemotherapy. The most frequently observed ADRs were nauseavomiting, neutropenia and constipation in both pediatric and adult population. This study shows that ADRs occur more frequently in the pediatric group compared to adults. Therefore, optimum use of preventative strategy program may contribute to reducing the incidence and severity of ADRs especially in this group.

Survey of Provider Transfusion Practices for Oncology Patients in an Academic Medical Center.

Hospitalized oncology patients receive care from a variety of professionals, each of whom plays a role in decisions related to blood transfusions. We sought to examine differences in transfusion practices based on professional role, years of experience, and patient clinical scenario. We surveyed general medicine residents, hospitalists, and oncologists caring for inpatients at a large academic medical center between August 2013 and June 2014. Respondents reported transfusion practices in three different patient scenarios: a generally healthy patient, a patient with solid tumor malignancy, and a patient with hematologic malignancy. We also assessed rationale for transfusion practices. Bivariate comparisons of respondent characteristics and transfusion threshold were conducted using the Fisher exact test. Multivariate logistic regression was performed to assess the relative relations among professional role, years in practice, clinical scenario, and transfusion threshold <7 g/dL. Of 158 physicians surveyed, 97 responded (61.4%). In bivariate analyses, fewer oncologists than residents or hospitalists used a threshold of <7 g/dL, but the result was significant for only one of three scenarios. The multivariate odds of transfusing at a threshold <7 g/dL were significantly higher among nononcologists (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.03-4.28). Residents and practitioners in practice for <4 years also were more likely to use a threshold <7 g/dL (OR 1.82, 95% CI 0.99-3.33). Providers were less likely to use a restrictive threshold when an underlying malignancy was present (solid tumor OR 0.31, 95% CI 0.15-0.64; hematologic malignancy OR 0.34, 95% CI 0.16-0.70). Transfusion thresholds differed based on professional role, years in practice, and patient scenario. Further research is needed to determine the optimal transfusion threshold for oncology patients.

Improving Patient-Centered Care: A Cross-Sectional Survey of Prior Use and Interest in Complementary and Integrative Health Approaches Among Hospitalized Oncology Patients.

To describe cancer inpatients' prior-year use of complementary and integrative health (CIH) therapies and interest in receiving CIH therapies while in the hospital. Observational, cross-sectional survey of prior-year use of 12 different CIH approaches and interest in receiving any of 7 CIH services in the hospital. Surgical oncology ward of an academic medical center. 166 hospitalized oncology patients, with an average age of 54 years. The most commonly used CIH approach was vitamins/nutritional supplements (67%), followed by use of a special diet (42%) and manual therapies (39%). More than 40% of patients expressed interest in each of the therapies if it was offered during their hospital stay, and 95% of patients were interested in at least one. More than 75% expressed interest in nutritional counseling and in massage. CIH use and interest varied somewhat by demographic and clinical characteristics. Rates of CIH use among patients with cancer were high, as were their preferences to have these services available in the inpatient setting. Hospitals have the opportunity to provide patient-centered care by developing capacity to provide inpatient CIH services.

1464P - The Difference in the Serum Levels of BDNF, IL-6, IL-8, IL-10 and EGF in Oncology Patients Divided According to the Presence of Symptoms of Depression

ABSTRACT Objective To assess the differences in the serum levels of Brain-derived neurotrophic factor (BDNF), interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 10 (IL-10) and epidermal growth factor (EGF) in oncology patients with symptoms of depression and in oncology patients without symptoms of depression. Methods We administered the following self – report questionnaires to the hospitalized oncology patients (n = 32): Zunǵs Self-Rating Depression Scale (ZSDS) and Symptom Check List Psychiatric Rating Scale (SCL 90). We also collected blood samples from these patients for the detection of the following factors: BDNF, IL-6, IL-8, IL-10 and EGF. The procedures had been fully explained to all patients and written informed consent had been obtained. The patients were divided into two groups according to the scores in ZSDS: a group with the presence of symptoms of depression (n = 20) and a group without the symptoms of depression (n = 12). The differences in the levels of BDNF, interleukins and EGF between the groups were statistically assessed by Wilcoxon rank-sum test. Results Oncology patients with the symptoms of depression showed significantly lower levels of BDNF (medians 1452.3 vs 3229.0 pg/ml, p = 0.014). There were no significant differences in the levels of IL-6, IL-8, IL-10 and EGF between the groups. Conclusion This result supports the hypothesis of diminished neuroplasticity in oncology patients with the symptoms of depression as measured by the serum levels of BDNF. This study was supported by research project MSM 0021620819. Disclosure All authors have declared no conflicts of interest.

Does Exercise Reduce Cancer-Related Fatigue in Hospitalised Oncology Patients? A Systematic Review

The primary aim was to find out if exercise reduces cancer-related fatigue in hospitalised oncology patients. Controlled trials of fatigue outcomes after exercise in hospitalised oncology patients were obtained by searching electronic databases. Two reviewers completed data extraction and quality assessment independently. Standardised mean differences and 95% confidence intervals (CI) were determined and a meta-analysis completed. Five relevant trials evaluated 269 hospitalised oncology patients. Meta-analysis of fatigue had an overall standardised mean difference of –0.27 (95% CI –0.62 to 0.08, p = 0.13) in favour of exercise. Evidence from a single trial supported the use of exercise in increasing muscle strength, and there were no significant between-group differences in psychological status and aerobic capacity. Though inconclusive, the findings demonstrate positive trends of reduced cancer-related fatigue in hospitalised oncology patients who exercise. Future adequately powered trials are required to provide evidence to confirm these positive effects.

An outbreak of Burkholderia cenocepacia bacteremia in immunocompromised oncology patients

Burkholderia cepacia is a common environmental bacterium that is resistant to disinfectants, and therefore is often encountered as a hospital-acquired pathogen. We describe an outbreak of B. cenocepacia bacteremia among hospitalized oncology patients. A matched case-control study and an extensive environmental investigation were conducted. Species were identified by RFLP of the amplified recA gene. DNA was fingerprinted by pulsed-field gel electrophoresis (PFGE). Between November 2005 and September 2006, B. cenocepacia bacteremia developed in 17 patients with underlying malignancy of whom 14 had tunneled central venous catheters. All patients had fever and chills which subsided following removal of the central catheter and administration of ceftazidime. Extensive epidemiological investigation could not find a common source for the outbreak. Patients were hospitalized in three different buildings with different health care personnel. Medications were prepared in different sites by different personnel. A multivariate analysis demonstrated that the independent risk factors for developing nosocomial B. cenocepacia bacteremia were hospitalization at the center for long-term support (OR 28.8; 95% CI 1.83-453.4) and reduced use of antibiotics during the last month (OR 0.07; 95% CI 0.01-0.40). All isolates had identical antimicrobial susceptibility; PFGE indicated that a complex of closely related strains was involved in the outbreak. All isolates were identified as B. cenocepacia, known to infect cystic fibrosis patients. Strict infection control measures terminated the outbreak. B. cenocepacia is an emerging nosocomial pathogen among oncology patients.

Effect of an Audit and Feedback Intervention on Hospitalized Oncology Patients' Perception of Nurse Practitioner Care

Although patient satisfaction has been used traditionally as a measure of excellence, research has suggested that the perception of being well cared for is likely a more promising indicator of quality than satisfaction alone. Expectations, physical environment, communication, participation and involvement, technical competence, and the influence of healthcare organizations are factors that may impair patients' ability to distinguish nursing care from their overall healthcare experience. This study evaluated the effect of a nurse practitioner audit and feedback intervention on hospitalized patients' perception of care.