Oncology Population Research Articles

Screening for Psychosocial Distress: A Brief Review with Implications for Oncology Nursing

Purpose: Psychosocial care is an integral component of caring for individuals living with cancer. The identification of psychosocial distress has been acknowledged as a hallmark of quality cancer care, and screening for distress standards has been established in several countries. The purpose of this brief review is to highlight recent developments in screening for distress in oncology populations; to provide insight into significant trends in research and implementation; and to explore implications for oncology nursing practice. Methods: This paper reports a brief review of the literature from March 2021 to July 2024 on the topic of screening for distress in oncology. The literature was accessed through PubMed and reviewed by two authors. Trends in the topics presented were identified independently and then discussed to achieve consensus. Results: The search within the designated period produced 47 publications by authors in North America, Australasia, and Europe. Topic trends included the design and adaptation of tools for special populations, the use of technology, descriptions of programs, identification of benefits, challenges, and overcoming barriers to screening for distress. Conclusions: Screening for distress is endorsed as part of the provision of quality oncology care. Nurses have an important role in screening individuals at risk for developing psychosocial problems and acting to reduce the associated morbidity. By continuing to be informed and educated about the emerging developments in screening for distress, nurses can understand and overcome barriers to implementation.

Comprehensive assessment in uro-oncologic geriatric patients: interdisciplinary management to improve survival.

Urological cancers represent 13.1% of cancer cases in the world, with a mean age of diagnosis of 67years, making it a geriatric disease. The lack of participation and evaluation of treatments by the geriatric oncologic population has made their mortality rate higher than that of other oncologic population groups, urologic cancers being no exception. The comprehensive management of older people with urological cancers is a bet that is presented to improve the quality of life and survival of this group. Managing elements such as nutritional, physical, cognitive, psychosocial, and sexual status improves the chances of adherence and treatment, contributing significantly to improving the quality of life. The integrated management of the geriatric oncology population has brought positive effects on quality of life, enhancing levels of depression and anxiety and also allowing the classification of oncology patients based on other criteria in addition to their chronologic age, contributing to the management of specialized treatments that have allowed the implementation of more specific interventions with better results.

Implementing Mental Health Screening for Adolescent Hematology and Oncology Patients: A Quality Improvement Initiative.

Purpose: Adolescents and young adults (AYA) with chronic illnesses experience an increase in mental health concerns. A mental health screening (MHS) process for hematology and oncology patients was implemented in a single institution. The quality improvement project was conducted to integrate a MHS process, educate providers about the importance of mental health in this patient population, and evaluate the process. Methods: The COM-B (capability, opportunity, motivation-behavior) model for behavior change was used to inform strategic planning and Plan-Do-Study-Act (PDSA) methodologies for process improvement. Retrospective chart reviews and surveys were conducted to determine missed screening rates and providers' perceptions, knowledge, attitudes, and skills of the MHS process. Results: Of 334 eligible patient encounters, the missed screening rate was 15.0%, the overall error rate of completing the screening was 3.8%, the error rate of completing the suicide or self-harm indicator was 2.6%, and the missed medical social worker touch point was 4.8%. Conclusion: The rising rates of mental health concerns in AYA hematology and oncology patients call for streamlined MHS processes to improve the identification of patients who may need intervention and services. Processes should be tailored to workflows and available resources. Future PDSA cycles will include providing dedicated nursing education and determining the cost needed to meet the rising mental health needs of the AYA hematology and oncology population.

Decreasing adverse events from concurrent Vinca-alkaloid and azole antifungals in a pediatric oncology population: Patient safety improvement process.

297 Background: Azole-antifungals like posaconazole and voriconazole have a documented significant risk of adverse drug events (ADE) when concomitantly administered with vinca-alkaloid chemotherapy (vincristine, vinblastine, vinorelbine) due to inhibition of vinca clearance. Potential ADE’s include paralytic ileus, severe, potentially permanent neuropathies, cranial nerve dysfunction, seizures, etc. Aim: Assess a standardized process to hold azole-antifungal around vinca-alkaloid drug administration to decrease the risk of adverse events associated with this drug-drug interaction in pediatric oncology patients. Intervention: Azole-antifungals (fluconazole*, voriconazole, posaconazole, itraconazole) will be held the day before, day of, and day after the vinca-alkaloid administration (with flexibility given provider discretion*) in the outpatient and inpatient setting at a single site. Methods: Development of a Standard Operating Procedure (SOP), informational technology (IT) processes such as Best Practice Advisory (BPA), nursing orders, Vinca Time-Out order and standard nursing note template for telephone encounter to remind patient/parents. Retrospective data was assessed in three 6-12 month phases, Pre-SOP (Phase 0), Post- SOP and Pre-IT support (Phase 1), and Full implementation (Phase 2). Study Outcomes: 1.Hold the azole-antifungal in 100% of encounters where vinca-alkaloid is due. 2. Decrease number of adverse events by 10%. 3. Maintain adequate fungal prophylaxis (or treatment) with a 0% incidence of breakthrough fungal infections. Results: Average number of concomitant azole/vinca administrations for each Phase was 39. A 97% improvement was seen in the number of vinca administrations dose reduced or held from 28 (Phase 0) to 1 (Phase 2). A 66% improvement in SOP compliance was observed (19 % in Phase 0, and 85% in Phase 2). Significant adverse effects were decreased by 33-50% between Phase 0, and Phase 1 and 2, respectively. Three patients in Phase 2 experienced fungal infection breakthrough; all had documented compliance issues prior to the study period. Conclusions: Implementation of the SOP and IT processes helped achieve a process to hold azole antifungals and led to significant decrease in the need to dose reduce or hold vinca-alkaloids thereby allowing less chemotherapy interruption/dose adjustments. Further modification of the SOP may be developed to exclude those patients on anti-fungal therapy for an active fungal infection.

Perioperative interventions to enhance surgical outcomes for older adults with cancer: A systematic review.

219 Background: Older adults with cancer have unique needs, particularly in the perioperative setting, which likely influence surgical outcomes in the geriatric oncology population. Little work has sought to describe available literature investigating perioperative interventions to enhance surgical outcomes for these individuals. Our systematic review sought to describe the literature on perioperative interventions in older adults with cancer undergoing surgery. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search using the Ovid MEDLINE, CINAHL, and Embase databases, searching for literature published from 1/2010-10/2023 (search terms used relevant terminology for geriatric oncology in the perioperative setting). We included randomized controlled trials (RCT) focusing on patient-centered interventions that enrolled adults >60 years old with cancer, excluding studies with pharmacologic, procedural, and radiographic interventions. Results: We included 11 RCTs with 2,177 patients. Patients’ age ranged from 60-95, and median number of patients per study was 147 (range: 44-690). Most studies included patients with colorectal cancer (81.8% [9/11]), all involving non-emergent elective surgeries. Half the studies (54.5% [6/11]) evaluated exercise interventions, and the remaining assessed geriatric assessment-guided interventions (27.2% [3/11]), nutrition optimization (9.1% [1/11]), and patient empowerment (9.1% [1/11]). Primary outcomes were as follows: postoperative complications, quality of life, feasibility of exercise programs, delirium incidence, inspiratory muscle endurance, hospital length of stay, and consistency of nutritional management. All studies had postoperative complications as a primary or secondary outcome. In studies with exercise-based interventions, all but one (83.3% [5/6]) found reduction in postoperative complications, and one showed improvement in quality of life (16.7% [1/6]). Studies focusing on geriatric assessment did not achieve significant differences in outcomes. We found implementation challenges that influenced several studies, including high drop-out rates and intervention fidelity. Conclusions: In this review, we found 11 studies focused on perioperative interventions in older adults with cancer undergoing surgery. Notably, interventions involved exercise, geriatric assessment-guided care, nutrition optimization, and patient empowerment. RCTs to date seem to primarily focus on exercise interventions and geriatric assessment-guided strategies. Although most studies met their primary endpoint, we found heterogeneity in intervention modality and outcome assessment, thus demonstrating a need for ongoing work to address the unique needs of the geriatric oncology population.

Toxicity of Cancer Immunotherapies in Older Patients: Does Age Make a Difference?

The use of immunotherapy agents especially immune checkpoint inhibitors is growing, and toxicities known as immune-related adverse events affecting any organ system may develop as a consequence of the treatment. With an ageing population, a considerable number of patients who will receive these therapies will be older adults. However, older patients who have highly heterogenous clinical characteristics, age-related changes in the immune system, a higher prevalence of comorbidities and frailty have been poorly represented in clinical trials, leaving gaps in understanding the safety of immune checkpoint inhibitor agents in this subgroup. Therefore, the safety of immune checkpoint inhibitors is a primary point of consideration when treating older patients with cancer. The available evidence is conflicting, but it generally suggests that the incidence of immune-related adverse events is not necessarily higher in older patients, but it may have a different profile. It is important to also note that the management of immune-related adverse events can be a challenge in these patients, owing to the risks associated with the use of corticosteroids and a reduced physiological reserve. A comprehensive characterisation of immune ageing, potential biomarkers to predict immune-related adverse events, the use of measures for frailty, enrolling older patients with cancer to clinical trials and analysis of real-world data are necessary to improve the evidence-based decision making for immune checkpoint inhibitor treatment in a geriatric oncology population.

Adverse drug reactions and drug-related problems with supportive care medications among the oncological population

AimThe current study emphasizes the impact of adverse drug reactions (ADRs) and Drug-Related Problems (DRPs) caused by supportive care medications administered with chemotherapy.MethodThis is a longitudinal observational study carried out at the Ramaiah Medical College Hospital in Bengaluru, Karnataka, India, at the Department of Oncology. The data was recorded using a specifically created data collecting form. Based on the PCNE (Pharmaceutical Care Network Europe), DRPs are identified. The WHO probability scale, Modified Hartwig and Siegel for ADR severity assessment, Naranjo's algorithm for causality assessment, Rawlins and Thompson for predictability assessment, and Modified Shumock and Thornton for preventability assessment were all utilized. The OncPal guideline was considered in terms of the precision of supportive care medications regarding the reduction of ADRs in cancer patients.ResultWe enrolled 302 patients,166 (55%) female and 136 (45%) male (SD 14.378) (mean 49.97), patients with one comorbidity 59(19.6%) and multimorbidity (two or more) 45(14.9%), the DRPs identified were found to be 153 (50.6%); only P2 (safeties of drug therapy PCNE) were considered in this study. ADRs which are identified 175(57.9%) contributed/caused by the supportive care medications. WHO probability scale: 97 (32.1%) possible and 60 (19.9%) unlikely; Naranjo’s algorithm: 97 (32.1%) unlikely and 69 (22.8%) possible; ADR severity assessment scale (Modified Hartwig and Siegel): 95 (31.5%) mild and 63 (20.9%) moderates; Rawlins and Thompson for determining predictability of an ADR: 33 (10.9%) predictable and 137 (45.5%) non-predictable; and Modified Shumock and Thornton for determining preventability of an ADR: 81 (26.8%) probably preventable and 90 (29.8%) non-preventable. The statistical comparison through preforming t-test and measuring Chi-Square between group with ADRs and without ADRs shows in some variables, significantly (Alcohol consumption status, P = .019) and Easter Cooperative Oncology Group (ECOG) performance status P < 0.001.ConclusionComprehensive assessment of supportive medications in cancer patients would enhance the patient management and therapeutic outcome. The potential adverse drug reactions (ADRs) caused by supportive care medications can contribute to longer hospital stays and interact with the systemic anti-cancer treatment. The health care professionals should be informed to monitor the patients clinically administered with supportive medications.

Implementation of Virtual Yoga Shared Medical Appointment (VYSMA) Pilot at an Academic Medical Center Within a Mixed-Diagnosis Oncology Population.

Yoga is highly sought after by people seeking oncology care, endorsed by clinical practice guidelines, and supported by leading cancer organizations, yet barriers related to access, time, cost, and availability of quality providers remain. Shared medical appointments (SMA), a group healthcare model where patients with similar medical conditions participate in a collective appointment with healthcare providers, are associated with increased access to quality care, patient satisfaction, and clinician satisfaction. We piloted a unique insurance-covered virtual yoga SMA series to assess feasibility and acceptability in a mixed-diagnosis population. In this prospective cohort pilot, a trauma-informed Hanna Somatic Yoga instructor and an integrative medicine physician co-led yoga SMAs via live web-based conferencing. SMA content included conscious self-regulation through mind-body practices including breathing, movement, visualization, meditation, chanting, and guided relaxation. Qualitative and quantitative data were gathered to assess satisfaction with the 88 sessions offered over 33 months. Sixty-nine participants with diverse demographics attended a total of 500 visits. Class attendance ranged from 2-11 participants (mean 6 participants). Participants attended a mean of 7 sessions (range 1-63 sessions), with 63% attending > 1 session. Participants' diagnoses/symptoms included cancer (77%), anxiety/depression (38%), and pain (38%). Preseries, participants reported pain, weakness, neuropathy, lymphedema, insomnia, and fatigue. Postseries survey results suggested improvements in anxiety/fear, pain, fatigue, poor sleep, neuropathy, brain fog, isolation, weakness, inflexibility, and poor balance. Postseries, participants also reported incorporating mindfulness, breathing techniques, somatic skills, weight training, and yoga into their daily routines, with 91% reporting that their goals had been met. Participants appreciated remote delivery, learning new skills, community, and the instructors. This virtual yoga SMA series in a diverse population with mixed diagnoses was feasible, acceptable to participants, and showed promising positive impact. A larger randomized controlled trial with longer follow-up is recommended.

Data-driven education improves patient blood management: A pilot study

Abstract Introduction: We sought to increase the use of a restrictive transfusion protocol through clinician education and a standard approach to Patient Blood Management (PBM) in our gynecologic oncology service. Optimal PBM requires the consistent application of evidence-based, restrictive transfusion guidelines, however the use of restrictive transfusion is understudied in surgical oncology populations. We hypothesized that provider specific education that includes data derived from their own clinical practice would result in improved compliance current evidence-based transfusion guidelines. Methods: We created an educational activity that described evidence-based restrictive transfusion guidelines followed by data showing providers their own clinical transfusion practice where compliance with restrictive guidelines was poor. After the education, a plan to improve compliance was developed and put into place. Comparison of transfusion practices and complication/morbidity rates before and after the education was performed. Results: During the 18 months post-education the number of RBC units transfused decreased from 316 152, a 57% reduction and monthly transfusion events were reduced by 42% from 12 to 7 per month. The percent of transfusions with a pretransfusion hemoglobin less than 7 g/dL increased from 40% to 56%. The percent of transfusions with a hemoglobin less than 8 g/dL increased to 90%. Finally, the use of single unit transfusions increased from 49 to 85%, a major contributor to the reduction in units transfused. Conclusion: We created a service-specific educational intervention that improved compliance with evidence-based restrictive transfusion practice. This intervention improved provider compliance with lower transfusion thresholds and increased the use of single-unit transfusions.

Sulfamethoxazole-Trimethoprim Prophylaxis in Pediatric Oncology Patients With Glucose-6-Phosphate Dehydrogenase Deficiency.

We sought to determine whether Pneumocystis jirovecii pneumonia prophylaxis with sulfamethoxazole-trimethoprim (SMX-TMP) is associated with an increased frequency of acute hemolytic anemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency versus non-G6PD-deficient controls in a pediatric oncology population. There was no statistically significant difference in change in hemoglobin or transfusion requirements after starting SMX-TMP between groups. These findings suggest no increased risk of acute hemolytic anemia with SMX-TMP administered at prophylaxis doses in patients with G6PD deficiency.

Anxiety and depression are common in surgical oncology patients: Results of a prospective cohort study

BackgroundThe oncology patient population is vulnerable to elevated levels of anxiety and depression. These states of psychological distress have been associated with negative effects on treatment course and outcomes, but reported prevalence rates are varied. The General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) questionnaires are screening tools that can be utilized to assess the levels of anxiety and depression, respectively. MethodsThis prospective, surgeon-blinded study assessed the preoperative prevalence of anxiety and depression in patients with abdominal malignancies who underwent curative-intent resection. Postoperative outcomes and survival were assessed. ResultsOverall, 218 patients were enrolled and included in the final analysis. Patients were stratified into groups by severity of anxiety and depression. 67 (31 %) patients reported at least mild anxiety as defined by GAD-7 score of 5 +, and 74 (34 %) patients reported at least mild depression, as defined by PHQ-9 score of 5 +. Functional status as defined by Eastern Cooperative Oncology Group scores was associated with anxiety (P = 0.003) and depression (P = 0.024). Depression was associated with race and ethnicity (P = 0.014) and marital status (P = 0.021), with Hispanic/Latino and unpartnered patients reporting higher rates of depression. ConclusionAnxiety and depression are common in the surgical oncology population, affecting a third of the patient population in this prospective study. In addition to a thorough social assessment, the GAD-7 and PHQ-9 questionnaires can be utilized preoperatively to identify patients with psychological distress. SynopsisAnxiety and depression were assessed preoperatively in patients with abdominal malignancies who underwent curative-intent resection. These states of psychological distress were highly prevalent, affecting a third of the population, and significantly associated with certain vulnerable groups.

Muscle matters: Prognostic implications of malnutrition and muscle health parameters in patients with cancer. A secondary analysis of a randomised trial

BackgroundLow muscle mass and malnutrition are independently associated with an increased risk of adverse outcomes in patients with cancer. However, it is not yet clear which parameter is most indicative of these risks. This study investigates the prognostic significance of different parameters reflecting malnutrition and muscle health in a well-characterised oncology population at nutritional risk. MethodsThis preplanned secondary analysis included patients with cancer from a Swiss-wide, randomised-controlled nutritional trial. We investigated associations among malnutrition markers (i.e., malnutrition diagnosis based on modified Global Leadership Initiative on Malnutrition (GLIM) criteria, albumin concentration) and muscle health markers (i.e., hand grip strength, computed tomography (CT)-based muscle mass and radiodensity) with 180-day all-cause mortality (primary outcome). ResultsWe included 269 patients with a main admission diagnosis of cancer and available CT scans. In a mutually adjusted model, four parameters contributed to risk assessment including modified malnutrition diagnosis (GLIM) (HR 1.78 (95%CI 1.17 to 2.69), p = 0.007, AUC 0.58), low albumin concentration (HR 1.58 (95%CI 1.08 to 2.31), p = 0.019, AUC 0.62), low handgrip strength (HR 2.05 (95%CI 1.43 to 2.93), p = 0.001, AUC 0.62) and low muscle radiodensity (HR 1.39 (95%CI 0.90 to 2.16), p = 0.139, AUC 0.63). Combining these parameters resulted in a model with high prognostic power regarding 180-day mortality (overall AUC 0.71). ConclusionsIn this study of inpatients with cancer at nutritional risk, several malnutrition and muscle health parameters emerged as independent prognostic indicators for mortality. The use of these parameters may improve risk stratification and guide nutritional interventions in this vulnerable population. Trial registrationClinicalTrials.gov, number NCT02517476.

Validation and Adaptation of the Spanish Version of Cancer Survivors’ Unmet Needs survey (CaSUN-MX) for Use in the Mexican Adult Oncology Population

Introduction. Cancer survivorship in Mexico is a research topic that is still in its infancy. No specific studies have been found on the needs of this population, meaning that there are no validated scales in the Mexican population measuring the needs of cancer survivors. Objective. To validate and adapt the Cancer Survivors’ Unmet Needs survey, Spanish version (CaSUN-Mx) for use in the Mexican adult oncology population. Method. One hundred and eighty participants answered the questionnaire (CaSUN-S). For the analysis, the study was divided into three phases: content validity, construct validity, and internal consistency analysis. Results. The final version of the adapted questionnaire (CaSUN-Mx) has 34 items and one open question. It was divided into five factors with a total Cronbach’s Alpha of .95 and a value of over .85, in all the subscales (psychological care, comprehensive and collaborative care, practical and information needs, and those associated with effects. Discussion and conclusion. The CaSUN-Mx questionnaire has content validity because it has been adequately linguistically and culturally adapted, and construct validity because of its factorial structure, and reliability, making it suitable for use in the Mexican adult oncology population.

Remote organ cancer adversely alters renal function and induces kidney injury, inflammation, and fibrosis.

Approximately 30% of cancer patients experience kidney complications, which hinder optimal cancer management, imposing a burden on patients' quality of life and the healthcare system. The etiology of kidney complications in cancer patients is often attributed to nephrotoxic oncological therapies. However, the direct impact of cancer on kidney health is underestimated, as most nephrotoxic oncological therapies have been studied in animal models that do not have cancer. Our previous study demonstrated that advanced lung cancer adversely alters kidney physiology and function, and exacerbates chemotherapy-induced nephrotoxicity, indicating lung cancer-kidney crosstalk. This study examines whether this phenomenon is specific to the employed cancer model. Female and male mice of various strains were injected with different cell lines representing human and mouse lung cancer, breast cancer, and melanoma, and their kidney tissues were analyzed for toxicity and fibrosis. The impact of cancer on the kidney varied by cancer type. Breast cancer and specific subtypes of lung cancer, including KRAS- and EGFR-mutant cancer, pathologically altered kidney physiology and function in a manner dependent on the metastatic potential of the cell line. This was independent of mouse strain, sex, and cancer cell line origin. Moreover, tumor DNA was not detected in the renal tissue, excluding metastases to the kidney as a causative factor for the observed pathological alterations. Lewis lung carcinoma and B16 melanoma did not cause nephrotoxicity, regardless of the tumor size. Our results confirm cancer-kidney crosstalk in specific cancer types and highlight gaps in understanding the risk of renal complications in cancer patients. In the era of precision medicine, further research is essential to identify at-risk oncology populations, enabling early detection and management of renal complications.

Suprascapular nerve peripheral nerve stimulation for pediatric cancer pain: a case series.

Aim: Despite the growing evidence supporting the use of peripheral nerve stimulation (PNS) for cancer pain in adults, it is underutilized in the pediatric oncology population. Method: We describe the use of temporary, percutaneous PNS for pain management in pediatric patients suffering from cancer related pain. Results: Two adolescent patients underwent an ultrasound-guided suprascapular nerve PNS placement utilizing the percutaneous 60-day therapy system. Both patients reported approximately 60% pain relief during the therapy, as well as up to 90days post lead removal. Conclusion: PNS may play a crucial role in the pediatric oncology population. Further studies are warranted to investigate the efficacy and safety of PNS for various cancer-related pain conditions in pediatric populations.

The association between malnutrition risk and revised Edmonton Symptom Assessment System (ESAS-r) scores in an adult outpatient oncology population: a cross-sectional study

BackgroundCancer-associated malnutrition is associated with worse symptom severity, functional status, quality of life, and overall survival. Malnutrition in cancer patients is often under-recognized and undertreated, emphasizing the need for standardized pathways for nutritional management in this population. The objectives of this study were to (1) investigate the relationship between malnutrition risk and self-reported symptom severity scores in an adult oncology outpatient population and (2) to identify whether a secondary screening tool for malnutrition risk (abPG-SGA) should be recommended for patients with a specific ESAS-r cut-off score or group of ESAS-r cut-off scores.MethodsA single-institution retrospective cross-sectional study was conducted. Malnutrition risk was measured using the Abridged Patient-Generated Subjective Global Assessment (abPG-SGA). Cancer symptom severity was measured using the Revised Edmonton Symptom Assessment System (ESAS-r). In accordance with standard institutional practice, patients completed both tools at first consult at the cancer centre. Adult patients who completed the ESAS-r and abPG-SGA on the same day between February 2017 and January 2020 were included. Spearman’s correlation, Mann Whitney U tests, receiver operating characteristic curves, and binary logistic regression models were used for statistical analyses.Results2071 oncology outpatients met inclusion criteria (mean age 65.7), of which 33.6% were identified to be at risk for malnutrition. For all ESAS-r parameters (pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and wellbeing), patients at risk for malnutrition had significantly higher scores (P < 0.001). All ESAS-r parameters were positively correlated with abPG-SGA score (P < 0.01). The ESAS-r parameters that best predicted malnutrition risk status were total ESAS-r score, lack of appetite, tiredness, and wellbeing (area under the curve = 0.824, 0.812, 0.764, 0.761 respectively). Lack of appetite score ≥ 1 demonstrated a sensitivity of 77.4% and specificity of 77.0%. Combining lack of appetite score ≥ 1 with total ESAS score > 14 yielded a sensitivity of 87.9% and specificity of 62.8%.ConclusionMalnutrition risk as measured by the abPG-SGA and symptom severity scores as measured by the ESAS-r are positively and significantly correlated. Given the widespread use of the ESAS-r in cancer care, utilizing specific ESAS-r cut-offs to trigger malnutrition screening could be a viable way to identify cancer patients at risk for malnutrition.

P-378 Relation between AMH serum levels and recovered mature oocytes in infertile, healthy, and oncological patients

Abstract Study question Does AMH serum levels correlate with the recovered mature oocytes in similar way among infertile, healthy, and oncological patients? Summary answer AMH serum levels correlated well with the number of mature oocytes in infertile, healthy, and oncological patients What is known already AMH is a protein produced by granulosa cells from pre-antral follicles and uses as biomarker of ovarian reserve. The aim of ovarian stimulation in the IVF setting or fertility preservation is obtaining metaphase II oocytes. The value of serum AMH to predict the number of mature oocytes has not been study in a comparative way among infertile patients vs. healthy and oncological population Study design, size, duration Retrospective study of the AMH serum levels and number of recovered mature oocytes in oocyte vitrification cycles from April 2017 to June 2023. We included 78 patients with cancer, 119 healthy patients and 668 infertile patients undergoing oocyte vitrification for fertility preservation or as accumulation of oocytes strategy Participants/materials, setting, methods This single centre study included Infertile patients ≤ 42 with gynaecological pathology (endometriosis, polycystic ovarian syndrome, low ovarian reserve, and/or tubal factor), any type of cancer and healthy women demanding social fertility preservation. We excluded IVF healthy patients (normal patients with exclusively male factor). AMH serum level was measured before ovarian stimulation. We analysed the probability of obtain ≥ 8 mature oocytes considering as normal AMH (1.2 ng/mL). Ethical approval was obtained for this stud Main results and the role of chance IVF patients were older and had higher body mass index than the other two groups. AMH serum level (ng/mL) was similar among groups; in IVF patients (1.88 [1.67-2.09]); oncological patients (2.25 [1.85-2.65]), and healthy women (2.5 [2.2-2.8]). (p= 0.064). Ovarian stimulation was longer and more FSH units were employed in IVF patients. Oestradiol level at the oocyte maturation triggering was lower in oncological patients. The number of MII oocytes was significantly lower in IVF patients (6.1 [5.9-6.4]) compared with oncological and healthy patients (9.2[8.0-10.5]; 9.9 [9.0-10.8], respectively). AMH level correlated well with the number of recovered mature oocytes and similar among groups. The Odds Ratio to recover ≥ 8 mature oocytes considering as normal AMH (1.2 ng/mL) showed a probability 8.3 times higher in healthy patients, but only 0.3 times in IVF patients and 0.5 times in oncological patients. A OR: 9.1 was observed for obtain ≥ 8 mature oocytes between normal vs low AMH. The area under the curve in the ROC curve for AMH was 0.7191 Limitations, reasons for caution This study had limitations in the sample size and differences in ovarian stimulation protocol as oncological patients in hormone-dependent cancer received letrozole while conventional ovarian stimulation with FSH was performed in IVF and healthy patients. IVF patients’ group was heterogeneous in the aetiology of infertility Wider implications of the findings This study remarks the use of AMH in different conditions: infertility, oncological, and healthy status. Although no differences were found in correlation with the number of mature oocytes, the probability to obtain ≥ 8 mature oocytes with normal AMH was higher in healthy women compared with infertile patients Trial registration number 2306-VGO-128-EM

Clinical practice review: outpatient palliative care for the geriatric chronic kidney disease population.

With a growing geriatric population in the United States, there is an increased need for healthcare resources and collaborative care for serious illnesses. Patients with chronic illnesses including chronic kidney disease (CKD) often experience severe symptoms and face complex decisions, many of which develop or occur in the outpatient setting. Though many of these symptoms overlap between different chronic illnesses, the CKD population remains largely untapped in terms of access to said resources; until recently, the focus in palliative care has been largely in the oncologic population. Older patients with CKD may benefit from additional tools and resources provided from collaborative care models specifically involving palliative care, especially as this population is high risk for experiencing lack of support. In this review, we use case vignettes to discuss the key concepts and roles of outpatient palliative care and how they can be integrated into the nephrology care of older patients with advanced kidney disease. These highlighted concepts include shared decision-making, selective deprescribing and symptom management, psychosocial support, and advance care planning. We also review different outpatient models for integrative palliative care, and the roles and resources of the palliative multidisciplinary team within these models and how these models can potentially be implemented in the care of CKD patients.

Empowering Patient Hand Hygiene and Reducing Infection in the Oncology Population

Background: Significant focus has been placed on healthcare worker hand hygiene, but little attention is has been assigned to the role of patient hand hygiene (HH) in reducing hospital acquired infections. Therefore, in this quality improvement study, we examined the impact of providing patients with hand hygiene products around mealtime on increasing patient HH adherence and on reducing acquisition of nosocomial antibiotic resistant organisms. Methods: Patients on two inpatient leukemia units at a tertiary oncologic center were provided with a single use pre-packaged alcohol wipe on their meal trays prior to every meal (three times daily). Additionally, an information card explaining to patients how and when to use the alcohol wipe was provided on the meal trays three times a week. Both the wipe and instructions were designed with input from patient representatives at the hospital. Two oncologic control units were selected where no specific intervention for patient hand hygiene was conducted. Patient hand hygiene adherence on the control and intervention units were measured through once monthly patient interviews conducted after meals where patients were asked to recall whether they washed their hands prior to eating (using any product). Vancomycin Resistant Enterococcus (VRE) incidence was compared on the intervention and control units during the 7 months prior and 7 months following initiating the intervention. Results: During the seven-month intervention period, more than 15 000 wipes were dispensed to patients on the intervention units. Through interview, 91% of 87 patients on the intervention units reported cleaning their hands before eating a meal using any cleaning product compared to 72% of 68 patients on the control units (X2 = 9.32, p = 0.002). Furthermore, on the intervention units, 30 (38%) patients endorsed using the provided hand hygiene product. During intervention period, the combined incidence rate of VRE the intervention units was 1.85 case/1000 patient-days compared to 5.35 cases/1000 patient-days during the 7 months prior to intervention (t = 3.24, p=0.007)(Figure 1). Conclusions: This patient-centered quality improvement intervention increased patient hand hygiene and potentially reduced VRE incidence in a vulnerable oncologic population. This practical intervention that incorporated the patient perspective provided accessible hand hygiene products with simple instruction and reminders required minimal participation of unit staff. Further application of the intervention in non-oncologic populations is needed to further establish the relationship between patient hand hygiene and the acquisition of nosocomial infections.

Is there still a place for serum galactomannan in the diagnosis of invasive aspergillosis in children at high risk and under antifungal prophylaxis?

The performance of serum galactomannan (GM) for the diagnosis of invasive aspergillosis (IA) has been studied mainly in adults. Paediatric data are scarce and based on small and heterogeneous cohorts. To evaluate the performance of serum GM for the diagnosis of IA in a paediatric oncologic population at high risk of IA and to clarify the impact of antifungal prophylaxis on this test. We performed a retrospective study from January 2014 to December 2020 in the paediatric oncologic haematologic department of the University Hospital of Bordeaux. The diagnosis of IA was made using the recommendations of the EORTC and the MSGERC. Among the 329 periods at high risk of IA in 222 patients, the prevalence of IA was 1.8% (3 proven and 3 probable IA). In the total population, the sensitivity, and the positive predictive value (PPV) were respectively 50% and 17.6%. Under antifungal prophylaxis, the sensitivity and PPV dropped, respectively, to 33.3% and 14.3%. In this group, the post-test probability of IA was 2% for a negative serum GM and only 14%. In this large cohort of children at high risk of IA, the incidence of IA is low and the diagnostic performance of GM is poor, especially in the case of mould-active prophylaxis. Screening should be targeted rather than systematic and should be reserved for patients at highest risk for IA without mould-active prophylaxis. Combination with other tests such as Aspergillus PCR would increase the accuracy of GM in screening setting.