Oncology Ward Research Articles

Breast cancer patient experiences in the Botswana health system: Is it time for patient navigators?

BackgroundNew models of care are required to support women with breast cancer due to rising incidence and mortality in sub-Saharan Africa (SSA). This study gives voice to the experiences of advanced-stage breast cancer patients in the Botswana healthcare system, to guide improved service provision and the potential utility of patient navigator (PN) programs. Methodsfocus group discussions (FGD) were conducted with advanced-stage breast cancer patients recruited from the oncology ward of the public Princess Marina Hospital located in Gaborone, Botswana. ResultsFGDs included 7 female breast cancer patients and their 7 caregivers (2 male and 5 females). Findings fell into the following themes: experiences with cancer diagnosis, experiences with treatment, roles of caregivers, information needs, views on cancer resources, and attitudes towards cancer research. The study identified several barriers across the cascade of care for breast cancer patients in the Botswana health system. These correspond to challenges with timely diagnosis and comprehensive management and highlight community level barriers to achieving the targets of the WHO Global Breast Cancer initiative (GBCI). ConclusionThe study findings suggest PN programs have the potential to bridge barriers identified in the Botswana healthcare system by improving communication, meeting information needs, providing emotional or practical support, and by addressing logistical barriers to cancer diagnosis and treatment in Botswana.

Clinical impact and cost-saving analysis of a comprehensive pharmaceutical care intervention in older patients with cancer.

Hospital admission and discharge are at high risk of drug-related problems (DRPs) in older patients with cancer. This study aimed to assess the clinical and economic impact of a comprehensive pharmaceutical care intervention (RECAP) to optimize drug therapy in patients with cancer ≥75 years admitted to oncology or geriatric wards. RECAP intervention was defined as follows: at admission and discharge, hospital pharmacists conducted comprehensive medication reconciliation and review, identified relevant DRPs and provided optimization recommendations to prescribers; at discharge, pharmacists also provided patient education and shared information with primary care providers. The impact of the intervention was assessed by the rate of implementation of recommendations by the prescribers and the evolution of polypharmacy rate; a peer review of the clinical significance of DRPs was performed by an expert panel of geriatric oncologists and pharmacists. A cost saving analysis compared cost avoided through resolution of DRPs to cost of pharmacist's time. From January 2019 and August 2020, 201 patients were included (median age 80 [75-97] years), 68.7% with solid tumors. DRPs requiring optimization were identified in 70.9% of patients at admission (mean 1.7 DRP/patient) and 47.7% at discharge (0.9 DRP/patient). Most pharmacist recommendations (70.8%) were followed by prescribers, allowing the correction of 1.2 DRP/patient at admission and 0.7 DRP/patient at discharge. Half of resolved DRPs were rated as clinically significant. However, polypharmacy rate was not reduced at discharge. Cost comparison showed $7.2 avoided for $1 invested, with an estimated total net benefit of $354,822 (mean $1766 per patient). The RECAP model significantly reduces DRPs in hospitalized older patients with cancer. The model was cost saving, confirming the value of implementing it in routine practice.

Association between adult attachment style, communication patterns and caregiver burden in parents of children with solid tumors: A cross-sectional study

PurposeThe primary purpose of this cross-sectional study was to delve into the connections among adult attachment styles, communication patterns, and caregiver burden within the sample of parents caring for children diagnosed with solid tumors. MethodsA sample of 456 parents responsible for the care of children with solid tumors was conveniently recruited from a pediatric oncology ward at a tertiary hospital from September 2021 to September 2022. The data collection process included a questionnaire on general information, the Caregiver Burden Inventory, the Adult Attachment Questionnaire Short Form, and the Communication Pattern Questionnaire. ResultsThe findings demonstrated a strong and positive connection between caregiver burden and attachment avoidance, whereas no considerable association was observed for attachment anxiety. Attachment avoidance exhibited a positive link with communication patterns and caregiver burden, and a noteworthy inverse correlation with attachment anxiety. Additionally, communication patterns were uncovered as a mediator in the association between attachment avoidance and caregiver burden. ConclusionsThis study underscores the role of communication patterns as mediators between attachment avoidance and caregiver burden among parents of children with solid tumors. These outcomes emphasize the significance of considering attachment styles and communication patterns when comprehending caregiver burden, and can guide the development of targeted interventions to provide support for parents within this challenging context.

Nurses' Adherence to the Portuguese Standard to Prevent Catheter-Associated Urinary Tract Infections (CAUTIs): An Observational Study.

Urinary tract infections are among the most prevalent types of healthcare-associated infections (HAIs) in hospitals and nursing homes, and they are primarily a result of unnecessary catheter usage and inadequate care. In Portugal, epidemiological data indicate that catheter-associated urinary tract infections (CAUTIs) remain widespread in clinical settings, resulting in increased morbidity and mortality rates among vulnerable populations. This study aimed to assess urinary catheter use in an oncology ward in Portugal and to evaluate nurses' adherence to the government-endorsed standards for preventing CAUTIs. An observational study was conducted over a four-month period with daily assessments of nurses' practices during urinary catheter insertion and maintenance using a government-endorsed auditing tool. Data were collected through on-site observations and nurses' feedback. The findings revealed a urinary catheter utilization rate of 17.99%. However, there was a lack of complete adherence to government-endorsed standards among oncology nurses (0%). These results indicate that current practices lack evidence-based standardization. Therefore, there is a need to develop and implement quality improvement initiatives to enhance patient safety and experiences.

Histopathological Study and Clinical Correlation of Glial Tumors at a Tertiary Care Hospital of Karachi

Objective: To observe the spectrum of glial tumors in a resource-limited tertiary care setup of Karachi according to the modified WHO central nervous system tumor classification.Study Design:A retrospective analysis.Place and Duration of Study: The study was conducted at the Oncology Ward of Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan from August 2020 to January 2021.Methods: The study was done to record data of patients diagnosed with glioma, which were registered during 2017 - 2019. Patients were classified according to recent WHO brain tumor classification. Data analysis as performed by SPSS version 26.0.Results: A total of 115 glioma cases were included. The most common presenting age group was in the 4th decade of their life. Oligodendroglioma was the most common histological type 61 (53.5%). The most common presenting symptom was a headache in 46 (40%). The location of the tumor was temporoparietal lobe in 51/115 (44.3%). Immunohistochemical studies showed a significant association with histological subtypes (p-value: 0.002). Conclusion: Oligodendroglioma was found to be the most common histological type. Immunohistochemical marker GFAP expression was positive for the majority of diagnosed cases, where 1p19q / codeletion was observed specifically in oligodendrogliomas.
 How to cite this: Khan J, Bhatt IA, Jaffar N, Haider G, Zaman A, Shabbir SM Histopathological Study and Clinical Correlation of Glial Tumors: Tertiary Care Setting in Karachi. Life and Science. 2023; 4(4): 481-486. doi: http://doi.org/10.37185/LnS.1.1.337

The Relationship Between Safe Nursing Care and Professional Commitment of Nurses in Iranian Educational-Therapeutic Hospitals

Background: Safe nursing care and professional commitment are known as two important components influencing the nursing service quality. Objectives: The present study aimed to assess the relationship between safe nursing care and nurses’ professional commitment. Methods: In the present cross-sectional correlational research, 263 nurses were selected from the intensive care unit/cardiac care unit (ICU/CCU), internal, surgery, pediatrics, gynecology and obstetrics, oncology, burn, orthopedics, infectious, and neurology wards of educational-therapeutic hospitals affiliated with Qazvin University of Medical Sciences by quota sampling method between May 2022 and September 2022. Data collection was performed using the nurses’ professional commitment scale (NPCS) and the assessment of safe nursing care (ASNC) questionnaire. Nurses were selected using a convenience sampling method. The collected data were analyzed using descriptive and inferential statistical tests (t-test, Pearson’s correlation, and one-way analysis of variance (ANOVA)) by SPSS software version 16. Results: The mean scores of nurses’ professional commitment and safe nursing care were 86.16 ± 4.92 and 134.57 ± 16.15, respectively. Pearson’s correlation test showed a significant relationship between nurses’ professional commitment and safe nursing care (r = 0.345, P ≤ 0.001). Also, the test results indicated that the level of nurses’ professional commitment varied among individuals with different employment types (P = 0.008). Conclusions: According to this study, safe nursing care and nurses’ professional commitment are two important components influencing each other. Therefore, these results have important implications for policymakers and healthcare systems involved in promoting the level of safe nursing care and nurses’ professional commitment.

Evaluation of electronic patient–reported outcome assessment in inpatient cancer care: a feasibility study

PurposePatient-reported outcome (PRO) measures are increasingly important in evaluating medical care. The increased integration of technology within the healthcare systems allows for collection of PROs electronically. The objectives of this study were to Ashley et al. J Med Internet Res (2013) implement an electronic assessment of PROs in inpatient cancer care and test its feasibility for patients and Dawson et al. BMJ (2010) determine the equivalence of the paper and electronic assessment.MethodsWe analyzed two arms from a study that was originally designed to be an interventional, three-arm, and multicenter inpatient trial. A self-administered questionnaire based on validated PRO-measures was applied and completed at admission, 1 week after, and at discharge. For this analysis — focusing on feasibility of the electronic assessment — the following groups will be considered: Group A (intervention arm) received a tablet version, while group B (control arm) completed the questionnaire on paper. A feasibility questionnaire, that was adapted from Ashley et al. J Med Internet Res (2013), was administered to group A.ResultsWe analyzed 103 patients that were recruited in oncology wards. ePRO was feasible to most patients, with 84% preferring the electronic over paper-based assessment. The feasibility questionnaire contained questions that were answered on a scale ranging from “1” (illustrating non achievement) to “5” (illustrating achieving goal). The majority (mean 4.24, SD .99) reported no difficulties handling the electronic tool and found it relatively easy finding time for filling out the questionnaire (mean 4.15, SD 1.05). There were no significant differences between the paper and the electronic assessment regarding the PROs.ConclusionResults indicate that electronic PRO assessment in inpatient cancer care is feasible.

Thirty-day mortality in hospitalised patients with lung cancer: incidence and predictors

ObjectivesPatients with lung cancer experience high rates of hospitalisation, mainly due to the high risk of complications that emerge during the natural history of the disease. We designed a retrospective,...

Development of a Novel Massage Therapy Outcome Measure for Children and Young Adults Receiving Hematopoietic Cell Transplant.

Children receiving hematopoietic stem cell transplantation (HCT) often experience an unfortunate sequalae of negative effects including pain, deconditioning, and anxiety. Massage therapy (MT) has demonstrated effective non-pharmacological management of fatigue, pain, and anxiety in patients undergoing cancer treatment. Existing studies have been limited by the lack of available MT-specific outcome measures to track responses to interventions. This study aimed to describe the creation of a novel MT-specific outcome measure to be utilized in the pediatric acute-care setting and establish construct validity for this measure to assess clinical effectiveness of MT interventions. An oncology ward at a large pediatric tertiary medical center in the United States. A total of 58 children and young adults undergoing HCT. Retrospective Cohort Study. A panel of massage therapists created a novel outcome measure, OMPREP, for use in MT sessions and performed a literature review to ensure face validity of the tool. This outcome measure was administered to patients and data were collected retrospectively to assess construct validity. A total of 1,333 MT sessions were completed (80.7% completion rate) with the novel OMPREP outcome measure utilized on 100% of visits. Mean engagement (p<.001), response (p<.001), and pain (p<.001) scores were all significantly greater at evaluation and discharge compared to the lowest observed scores post-HCT. The novel MT-specific outcome measure, OMPREP, was feasible and demonstrated construct validity when implemented in a pediatric acute-care setting by massage therapists. This new tool may offer a quantitative measure of MT-interventions and assist in tracking patient outcomes.

Knowledge, Attitudes and Nursing Stress Related to Life-Sustaining Treatment among Oncology Nurses.

This study investigated knowledge, attitudes, and nursing stress related to life-sustaining treatment among oncology nurses. A descriptive study design was used. Data were collected through a survey from April 1 to May 31, 2022. The participants were 132 nurses working in the oncology ward of a tertiary hospital in Seoul. Data were analyzed using the SPSS 25.0 program with descriptive statics, the independent t-test, analysis of variance, and Pearson correlation coefficients. The average scores for knowledge, attitudes, and nursing stress related to life-sustaining treatment were 14.42, 3.29, and 3.96, respectively. Significant differences in knowledge about life-sustaining treatment were observed based on clinical experience (P=0.029) and education about life-sustaining treatment (P=0.044). Attitudes toward life-sustaining treatment varied significantly with education about life-sustaining treatment (P=0.014), while stress levels differed significantly across working units (P=0.004). A positive correlation was found between the dilemma of extending or stopping life-sustaining treatment (a subdomain of nursing stress) and attitudes toward life-sustaining treatment (r=0.260, P=0.003). There was no significant correlation between the nursing stress experienced by oncology nurses and their knowledge and attitudes toward life-sustaining treatment. However, a more positive experience with life-sustaining treatment education was associated with higher stress levels related to the dilemma of extending or stopping life-sustaining treatment. Therefore, it is crucial to develop strategies to manage this dilemma and reduce stress in the field.

Knowledge, Attitude and Practice of Hand Hygiene among Healthcare Workers Caring for Children with Leukaemia in the Paediatric Oncology Ward of King Saud Medical City, Saudi Arabia.

Hands are the most common vehicle of pathogen transmission in a healthcare setting. Therefore, hand hygiene is the leading method of reducing healthcare-associated infections. This study aimed to determine the knowledge, attitude and practice (KAP) of hand hygiene and predictors for poor hand hygiene practice among healthcare workers who care for children with leukaemia in the paediatric oncology ward of King Saud Medical City (KSMC) in Saudi Arabia. One hundred and ninety medical doctors and nurses, who were registered with the Saudi Commission for Health Specialities, were selected to participate in this cross-sectional study using a simple sampling technique. Their KAP of hand hygiene was assessed using a self-structured questionnaire and the collected data was analysed using IBM® SPSS® version 26.0. Of the 190 healthcare workers, 74.7% were nurses and 25.3% were medical doctors. Among the participants, 53.7% (102) had good knowledge of hand hygiene, 51.6% (98) had positive attitudes towards hand hygiene and 55.8% (106) practised satisfactory hand hygiene. Bachelor education level (adjusted OR = 2.736; 95% CI = 1.101, 6.799; P = 0.030), postgraduate education level (adjusted OR = 6.256; 95% CI = 2.171, 18.028; P = 0.001), poor knowledge (adjusted OR =2.575; 95% CI = 1.263, 5.246; P = 0.009) and negative attitude (adjusted OR = 4.702; 95% CI = 1.263, 5.246; P < 0.001) were the significant predictor variables of unsatisfactory hand hygiene practice among healthcare workers. The performance of hand hygiene among healthcare workers is still far less than optimal, particularly in settings like oncology units. Effective programmes are needed to increase their awareness of hand hygiene KAP, while strict guidelines are needed to reduce nosocomial infections.

Effects of the Wrist Band Acupressure Technique on the Severity of Nausea among Patients Receiving Highly Versus Moderately Emetogenic Chemotherapy

Background: Chemotherapy is an important therapeutic option for patients with cancers, but it is also associated with a number of adverse effects that can affect practically every body system. The most frequent side effects of chemotherapy are gastrointestinal in nature, such as nausea and vomiting. The pericardium 6 (P6) is one of the most important points used in acupressure techniques for treating nausea and vomiting.&#x0D; Aim: This study aims to examine the effects of wrist band acupressure technique on the severity of nausea among patients receiving highly or moderately emetogenic chemotherapy.&#x0D; Methods &amp; materials: A quasi-experimental design was conducted at the Imam Al-Hussein Center for Oncology and Hematology and the oncology wards of the Imam Al-Hassan Al-Mujtaba teaching hospital, which is located in Kerbala Holy City. Forty-seven patients with cancer undergoing chemotherapy were divided into two groups: 22 patients were assigned in the intervention group and 25 in the control group. Patients in the intervention group were followed to perform acupressure techniques, while in the control group only received routine conventional care.&#x0D; Results: Before applying the interventional approach, the intervention group's overall mean score for nausea was 52.3±10.9; it was 39.8 ±14.5 after implementing the intervention. There is a statistically significant difference in the severity of nausea between the two groups after implementing the interventional protocol at a p-value of 0.000. Moreover, there are no significant differences between the severity of nausea after using wrist band acupressure and the type of chemotherapy (p-value 0.6).&#x0D; Conclusion: Using wrist band acupressure as a noninvasive technique can be effective in reducing the severity of nausea among patients receiving highly or moderately emetogenic chemotherapy.&#x0D;

The Effect of Educational Support Program on the Amount of Caregiver Burden on the Parents of Children with Cancer Admitted to the Oncology Ward of Besat Hospital in Sanandaj, 2021

The Effect of Educational Support Program on the Amount of Caregiver Burden on the Parents of Children with Cancer Admitted to the Oncology Ward of Besat Hospital in Sanandaj, 2021

Assessing the Self-efficacy and Risk Perception of COVID-19 Among Cancer Patients Admitted to a Hospital in Ardabil-Iran

Background: Cancer patients have defects in their immune systems due to chemotherapy and corticosteroid therapy and are at risk of viral diseases. Objectives: This study aimed to evaluate the risk perception and self-efficacy related to COVID-19 among cancer patients in Ardabil, Iran. Methods: This cross-sectional study was conducted on 200 cancer patients hospitalized in the oncology department of Ardabil Imam Khomeini Hospital in the summer of 2020, who were selected by simple random sampling. After obtaining informed consent, data was gathered using a questionnaire based on the extended parallel process model (EPPM) consisting of seven subscales, including perceived sensitivity, perceived severity, response efficacy, self-efficacy, intention, fear, and defensive motivation. The data were analyzed using linear regression by SPSS 18 and Stata 8. Results: Mean age of 200 cancer patients in this study was 52.35 ± 6.30 years. Among the constructs of EPPM, perceived susceptibility (coefficient = 0.23, P-value &lt; 0.001) and perceived severity (coefficient = 0.160, P-value = 0.026) were significant predictors of self-efficacy, while response efficacy, intention, fear, and defensive motivation were not significant. In the regression model, R squared (R2) and adjusted R squared (adj-R2) were 0.182 and 0.180, respectively. Conclusions: This study demonstrated that perceived susceptibility and severity had significant roles in predicting self-efficacy. Therefore, it is proposed that according to the conditions of the cancer patients, health providers in oncology wards should provide the necessary information to enhance the risk perception regarding COVID-19 and promote self-efficacy to observe health protocols.

Positive Implications of Experiencing Grief for Health Professionals in Iran: A Qualitative Study

Background: As an unavoidable experience in oncology departments, grief following a patient’s death, coupled with work difficulties, can affect health professionals’ individual and work performance. Objectives: The present research was conducted to explain the positive consequences following the experience of grief for oncology nurses. Methods: In 2021, the present qualitative study utilized content analysis and interviewed 20 nurses working in the oncology wards of hospitals affiliated with universities of medical sciences in Iran. Purposive sampling was performed, and data were collected through unstructured interviews until reaching data saturation. The data collected were analyzed in MAXQDA10 based on conventional content analysis. Results: The main concepts were categorized into three themes and seven subthemes. The themes included “promoting and practicing religious beliefs,” “feeling rewarded after experiencing grief,” and “promoting ethical virtues.” Conclusions: According to the present findings, the nurses identified having profound religious and spiritual beliefs, promoting ethical virtues, and using positive experiences associated with grief over patient deaths as the positive implications of experiencing grief. These results can be employed to design interventions for preventing burnout in nurses and assisting them in providing high-quality care. Strengthening the positive implications of experiencing grief is one way to prevent the negative effects of grief on health professionals. Recommendations include implementing educational programs to improve these outcomes.

Characteristics of the clinical pharmacist interventions at the National Center for Cancer Care and Research Hospital in Qatar.

Drug-related problems (DRPs) affect the health outcomes of patients during hospitalization. We sought to analyze the clinical pharmacist-documented interventions among hospitalized patients in the cancer hospital in Qatar. A retrospective analysis of electronically reported clinical pharmacist interventions of patients admitted to cancer units at Hamad Medical Corporation, Qatar was conducted. Extracted data was based on an overall 3-month follow-up period; March 1-31, 2018, July 15-August 15, 2018 and January 1-31, 2019. Categorical variables were expressed as frequencies and percentages, while continuous variables were expressed as mean ± standard deviation (SD). A total of 281 cancer patients with 1354 interventions were included. The average age of the study participants was 47 years (SD ± 17.36). The majority of the study population was females (n = 154, 54.80%). The prevailing pharmacist intervention was the addition of a drug therapy (n = 305, 22.53%), followed by medication discontinuation (n = 288, 21.27%) and the addition of a prophylactic agent (n = 174, 12.85%). This pattern was similar across all subgroups (i.e., gender, age, ward), except for the urgent care unit, where an increase in medication dose was the third highest frequently identified intervention (n = 3, 0.22%). The two medication groups associated with the majority of interventions were the anti-infective and fluid/electrolyte agents. Most of the interventions documented were in the oncology ward (73.19%), while the urgent care unit had the least documented interventions (1.62%). Our analysis showed that clinical pharmacists can effectively identify and prevent DRPs among hospitalized cancer patients.

Exploring different stakeholders’ perspectives on ward rounds in paediatric oncology: a qualitative study

Rational/Aims and ObjectivesWard rounds are a core routine for interprofessional communication and clinical care planning: Health care professionals and patients meet regularly and it encourages patients to actively participate. In paediatric oncology, the long treatment process, the serious diagnosis, and involvement of both patients and their parents in shared-decision-making require specific ward round skills. Despite its high value for patient-centred care, a universal definition of ward round is lacking. Little is known about attitudes and expectations of different participants towards a ‘good’ ward round. This study aims to capture experiences and expectations of different stakeholders to better understand ward round needs in paediatric oncology and serve as a basis to improve future ward rounds.MethodSemi-structured interviews were conducted with patients, parents, nurses and medical doctors of a paediatric oncology ward until theoretical saturation (13 interviews). A standardised qualitative analysis using the phenomenological framework defined by Colaizzi was used to identify important aspects in the interviews.ResultsThree major themes were identified in the interviews: [1] Structure and Organisation; [2] Communication; [3] Education. Further analysis revealed 23 categories and elucidated several opportunities and unmet needs recognized by stakeholders: Ward round functions in comforting families in stressful situations, and relationship building. Interviewees expressed their concerns about missing structures. Families pleaded for smaller ward round teams and layperson language. Health care professionals underscored the lack of ward round training. Paediatric patients stated that ward round scared them without proper explanation. All interviewees emphasized the need for professionalization of the ward round in the setting of paediatric oncology.ConclusionThis study gives important insights into ward round functions and organisational requirements. It addresses special challenges for ward round participants in paediatric oncology, such as consideration of the emotional aspect of cancer treatment or the limits of shared decision making. Furthermore, this study underscores the great significance of ward rounds in paediatric oncology, with an emphasis on communication and relationship-building. Although performed universally, ward rounds are poorly explored or evaluated. This structured analysis synthesizes important expectations of different WR stakeholders, revealing opportunities of improvement and stressing the need for guidelines, training, and preparation.

Effectiveness of Meaning-Centered Coaching on the Job of Oncology Nurses on Spiritual Care Competences: A Participatory Action Research Approach.

Nurses' competences in providing spiritual care can increase quality of care for and quality of life of patients with cancer and job satisfaction but are often suboptimal. Training to improve this mostly takes place off-site, although implementation in daily care practice is key. The aims of this study were to implement a meaning-centered coaching on the job intervention and to measure its effects on oncology nurses' spiritual care competences and job satisfaction, and factors influencing this. A participatory action research approach was adopted. Mixed methods were used to assess intervention effects in which nurses of an oncology ward in a Dutch academic hospital participated. Spiritual care competences and job satisfaction were quantitatively measured and complemented with content analysis of qualitative data. Thirty nurses participated. A significant increase in spiritual care competences was found, particularly regarding communication, personal support, and professionalization. More self-reported awareness of personal experiences in caring for patients, and an increase in mutual communication and involvement around meaning-centered care provision as a team were found. Mediating factors were related to nurses' attitudes, support structures, and professional relations. No significant impact was found on job satisfaction. Meaning-centered coaching on the job increased oncology nurses' spiritual care competences. Nurses developed a more exploratory attitude in their communication with patients-instead of acting based on their own assumptions about what is of meaning. Attention to and improving spiritual care competences should be integrated into existing work structures, and terminology used should match existing understandings and sentiments.

Closing the cancer care gap with a patient-reported nutrition screening: A retrospective analysis of a quality improvement project on an oncology ward (CCC study)

Early identification of patients at risk for malnutrition followed by individualized nutrition interventions is a central step to the provision of appropriate nutrition care. However, a health care professional (HCP)-based nutrition screening is not always consistently integrated into routine care. Patient-reported (PR) nutrition screening could thus potentially alleviate the burden on the HCPs and contribute to a greater number of patients who are identified and treated for malnutrition. In 2021 a Quality Improvement Project (QIP) at our out-patient oncology clinic was undertaken to implement the change from a HCP-based nutrition screening to a PR-screening. This was followed by a retrospective analysis in which the primary outcome measure was the rate of nutrition consultations initiated for patients undergoing cancer therapy. In total n=1657 patient data sets derived from comparable time periods before and after the QIP were analyzed and compared. Both groups had a comparable mean age and gender distribution. The most common diagnosis in both groups was gastrointestinal tumors. The change in routine care from a HCP-based nutrition screening to a PR-screening led to a significant increase in nutrition consultation rates (RD=19%; p<0.001; 95% CI 14.4%-23.5%) and screening rates (RD =30.5%; p <0.001; 95% CI 26.2%-34.7%). The change to PR-screening potentially facilitates an increase in nutrition screening rates. This in turn leads to an increased rate of patients identified at risk for malnutrition and thus referrals for nutrition consultations. Our findings indicate that a PR nutrition screening tool could play a role in closing the care gap and contribute to reducing rates of malnutrition among this population where screening is not consistently integrated into routine care.

#3154 MALIGNANT HYPERCALCEMIA IN A CASE OF SMALL BOWEL GASTROINTESTINAL STROMAL TUMOUR

Abstract Background and Aims Malignant hypercalcemia is the most common cause of hypercalcemia, occurring in 30% of cancer patients and rendering a poor prognosis. Most cases have a humoral cause, the majority mediated by parathyroid hormone related peptide (PTHrP), rarely by 1,25-dihydroxyvitamin D3 (1,25(OH)2D) and very rarely by parathyroid hormone (PTH) ectopic production; other cases are due to local osteolysis. In the literature, there are only 5 reported cases of hypercalcemia associated to gastrointestinal stromal tumour (GIST), only 2 of them due to 1,25(OH)2D overproduction. Method Case report. Results Sixty-two years-old male with small bowel GIST diagnosed in 2014, subjected to enterectomy and on tyrosine kinase inhibitor (TKI) since 2017. TKI was changed from imatinib to sunitinib 25mg since August 2020 to the present date due to disease progression with liver metastasis. In March 2022, a PET scan showed no bone or soft tissue metastasis and there was a finding of right ureteral lithiasis with asymptomatic mild pyelocaliceal dilation. The patient had also subclinical hypothyroidism and several episodes of acute kidney injury (AKI) associated with hypercalcemia and hyperphosphatemia managed in outpatient clinic. He did not take any other medication besides the TKI. In April 2022, symptoms of disequilibrium, confusion, asthenia, and anorexia drove the patient to the Oncology Department. At physical examination the patient had an ECOG 3, was disoriented, cachectic and dehydrated, with no other noticeable findings. Blood lab tests showed a serum creatinine (sCr) of 2,86 mg/dL (baseline 1,10 mg/dL, estimated glomerular filtration rate of 72 mL/min/1,73 m2), a corrected serum total calcium (sCa) of 16,6 mg/dL and a normal serum phosphate of 4,0 mg/dL. The patient was admitted in the oncology ward with the collaboration of the nephrology department and was started on fluid therapy with 3000–4000cc NaCl 0,9%/day for a target urinary output of 75–200 mL/h. Hypercalcemia work-up showed low PTH of 8,8 pg/dL (reference range: 12–65 pg/dL). Measurement of PTHrP and 1,25(OH)2D were requested but took longer. After 3 days, despite the improvement of both sCr (2,23 mg/dL) and sCa (13,6 mg/dL), zoledronic acid was started. Results revealed an increased 1,25(OH)2D of 309 pg/dL (reference range: 10,9-79,3 pg/dL) and negative PTHrP. At the 6th day, a clear improvement of analytical (sCr 1,60 mg/dL; sCa 11,9 mg/dL) and clinical status, so the patient was discharged. The diagnosis was GIST 1,25(OH)2D overproduction causing malignant hypercalcemia and prednisolone on 20mg id was started. In June 2022, the patient had tumour progression, presenting lethargic, disoriented, and dehydrated; blood lab results showed AKI (sCr 1,97 mg/dL) and worsening hypercalcemia (sCa 14,7 mg/dL). He was admitted for fluid therapy and bisphosphonates but, even though there was a recovery of the hypercalcemia and renal function, the patient's clinical status got worse and he had a fatal outcome in the following days. Conclusion Malignant hypercalcemia caused by GIST 1,25(OH)2D overproduction is a rare condition. The work-up of an oncological patient with ureteral lithiasis and recurrent hypercalcemia should prompt us to a more in-depth investigation.