Outpatient Cancer Center Research Articles

Evaluating Nutrition Services in Outpatient Cancer Centers in New Mexico – A Pilot Study Protocol

ObjectivesNationally, 50% of all cancer patients experience malnutrition upon diagnosis or during the course of treatment. When registered dietitian nutritionists (RDNs) are involved in oncology treatment, outcomes improve, with a reduction in financial burden for the patient and health delivery system. Despite the high prevalence of outpatient treatment utilization (up to 90% of cancer patients), RDN understaffing is common in outpatient cancer treatment settings. The goal of this pilot project is to characterize and understand factors at the organizational level (e.g., policies and practices) and provider level (e.g., knowledge, attitudes, practices and needs) that affect implementation of nutrition standards of practice at outpatient oncology clinics in New Mexico (NM). Characterizing current nutrition resources in distinct regions across the state is crucial to the development of effective interventions to improve access to RDN nutrition care across NM. MethodsWe will conduct a comprehensive, 7-domain, nutrition-focused environmental scan of ∼15 treatment centers and surrounding areas. Data collected will include clinic catchment area information; patient and area census demographics; clinic screening and referral policies; clinic technical, financial, and personnel resources; and community nutrition resources. We will then conduct ∼50 semi-structured interviews of stakeholders, including administrators and medical and RDN providers, at ∼10 of these treatment facilities to contextualize the results of the environmental scan. Qualitative interviews will explore facilitators and barriers to provision of guideline concordant nutrition care. We will perform a case study analysis (both within-case and cross-case) of sites and examine the identified resources and gaps to care in each region and will note differences across settings (e.g., urban vs. rural centers). ResultsN/A. ConclusionsThis innovative, mixed-methods study will provide a context-driven inventory of nutrition processes, services, and resources at outpatient cancer treatment clinics in NM. These data will inform a tailored intervention to improve access to nutrition care for ambulatory oncology patients throughout NM. Funding SourcesAmerican Cancer Society Institutional Research Grant; NCI Cancer Center Support Grant.

Screened social risk factors & screening acceptability among oncology patients in Philadelphia.

12125 Background: This pilot study describes the cancer-specific social risk factors (SRFs) of oncology patients on active treatment and the acceptability of using SRF screening to inform care and bolster support during cancer treatment. Methods: This is an ongoing cross-sectional survey of adult cancer patients on active treatment at two outpatient cancer centers in the University of Pennsylvania Health System. Since October 2019, 176 patients have completed our two-part, 19-item social risk screening tool (44% response rate; 49% age > 65yo; 45% female; 35% non-white). Survey questions were adapted from other social screening measures (e.g., AHC-HRSN tool, PRAPARE), then pre-tested and modified for our cancer-specific population. Part 1 of our tool covers 12 SRFs in four core domains: technology (e.g., internet accessibility challenges), environmental (e.g., housing instability), emotional (e.g., social isolation), and financial (e.g., ongoing financial toxicity). In part 2, seven acceptability questions cover patients’ perceived appropriateness of and comfort with screening, expectations of clinical staff to act on identified SRFs, prior SRF assistance received, interest in receiving SRF assistance (i.e., a proxy for patients’ most pressing unmet social needs), willingness to add SRF data to electronic health records (EHR), and comfort sharing findings with other clinicians (e.g., oncologists, primary care physicians, nurses). Results: We identified an average of 2.48 SRFs per patient. The five most commonly reported SRFs were ongoing financial toxicity (57%), internet accessibility challenges (46%), social isolation (40%), housing instability (34%), and insufficient internet for telemedicine (29%). The majority of patients thought that SRF screening was appropriate (56%) and many felt comfortable being screened (63%). Half of patients expected cancer center staff to connect them to social resources (50%), fewer wanted staff to just be aware of their SRFs (43%), and a minority did not want staff to know about their SRFs (7%). Many patients had received prior SRF assistance (49%) or were interested in receiving future help (51%). Most patients felt discomfort toward listing SRF results in their EHR (63%) and some felt uncomfortable giving other clinicians access to this data (38%). Conclusions: Our study shows that oncology patients contend with SRFs while undergoing treatment and find SRF screening acceptable. These findings support clinical implementation of a cancer-specific social screening tool into routine cancer care, but also bring attention to privacy preferences and limited acceptability of EHR documentation of SRFs. Cancer centers adopting this approach may gain insights into where interventions or resources could be targeted to meaningfully address SRFs, potentially improving clinical outcomes for vulnerable populations.

Clinical treatment pathways utilization in an outpatient academic cancer center.

e18673 Background: Clinical treatment pathway (CTP) tools have been incorporated into oncology practices to help standardize treatment, reduce care variation in cancer patients, and move towards value-based care. CTP tools incorporate the latest guidelines and are developed through multidisciplinary committees. Treatment decisions are prioritized by efficacy, toxicity, and cost to improve quality and value. This is especially important in cancer care which is associated with high drug costs. However, use and implementation of CTP tools has been met with mixed reviews and published data from academic medical centers are limited. Methods: Outpatient treatment decisions for patients across different cancer types, including colorectal, gastroesophageal, and breast cancers from July 2018 to March 2020 at an urban NCI-designated cancer center were evaluated. Every treatment decision was evaluated in relation to physician utilization of CTP tools. Treatment decisions were categorized as choosing a CTP recommended option ( pathways dependent), not choosing a CTP recommended option ( pathways independent), or not using the CTP tool at all ( non-pathways). Descriptive statistics and significance testing were used to explore CTP utilization over time, physician years in practice, cancer type, and cancer stage. Multinomial and binary logistic regression models were used to evaluate associated factors with CTP utilization. Results: During the study period, 1,007 treatment decisions were identified. Of these, 76% were pathways dependent, 13% were pathways independent, and 11% were non-pathways. CTP utilization was statistically significant in association with cancer type, cancer stage, physician years in practice, and year of encounter. In multinomial logistic regression models, physicians with more years in practice were more likely to be pathways independent and non-pathways than pathways dependent. Physicians treating colorectal or gastroesophageal cancer were more likely to be pathways independent [OR 3.27; 95% CI: 1.98-5.42 and OR 2.25; 95% CI: 1.12-4.49, respectively] or non-pathways [OR 2.98; 95% CI: 1.65-5.37 and OR 3.21; 95% CI: 1.58-6.54, respectively] than pathways dependent compared to physicians treating breast cancer. Treatment decisions for patients with either stage 2 and stage 4 cancers were more likely to be pathways independent than stage 1 cancers [OR 4.13; 95% CI: 1.44-11.84 and OR 4.37; 95% CI: 1.27-15.04, respectively]. Conclusions: This study found that a large proportion of treatment decisions for patients across different cancer types were made utilizing CTP tools, but utilization varies according to cancer type, stage, and physician years in practice. Further research is needed to better understand the physician decision making process and implementation of CTP tools to drive improvement in design, education, and training.

Patient reported sexual concerns in routine cancer care.

12128 Background: Sexual health is an important component of overall well-being and can be adversely impacted by chemotherapy, surgery, radiation, in addition to the psychological effects of cancer treatments. Sexual health is challenging to discuss and may be overlooked or avoided during cancer care. Methods: Patients presenting for consultation in an outpatient multisite cancer center completed electronic distress screening (EDS) between January 2017 and December 2020. The EDS contains 42 questions; demographic information, cancer symptoms and side effects, and psychosocial factors. The EDS is completed by patients before a clinical encounter for early symptom identification and intervention. We conducted a retrospective data analysis of sexual health concerns (>5; scale 0-10) and evaluated patient characteristics and clinically relevant distress (>4; NCCN Distress Tool), depression risk (>3; PhQ2), and anxiety risk (>3; GAD2). Our primary aim was to identify the prevalence of sexual health concerns. The secondary aim was to examine the relationship between sexual health and emotional well-being. Results: 57,375 EDS screens were completed. 13,950 patients (24%) reported sexual concerns or lack of interest in sex (>5) within the last 2 weeks. The frequency of these concerns at specific clinics ranged from 12% to 48%, with the highest rates at Palliative care (39%) and Psycho-Oncology (48%) clinics. Genitourinary (30%), Gynecologic (27%) and Gastroenterology (26%) reported the highest frequency of sexual concerns from cancer site specific clinics. Males reported a higher rate of sexual problems compared to females (30% vs 21%, p < 0.001), but a lower rate of relationship concern distress (12% vs 13%, p < 0.05). Patients with a risk for depression (n = 9,126) or anxiety (n = 10,809) had higher rates of self-reported sexual concerns than those with a negative screen (44% vs 21% depression, p < 0.001; 40% vs 21% anxiety, p < 0.001). Conclusions: Sexual health is a concern for approximately one-quarter of patients presenting for cancer care. Sexual health concerns were prevalent across cancer sites. Patients with positive screens for anxiety and/or depression have nearly double the rates of reported sexual health concerns. Sexual health is a current unmet need that impacts cancer patients and warrants attention.

Patient factors associated with time to medication receipt of oral anti-cancer drugs.

1519 Background: The past decade has seen a dramatic increase in the number of Food and Drug Administration approvals of oral anti-cancer drugs (OACDs). Most OACD prescriptions require coordination between providers, payers, specialty pharmacists, and financial assistance organizations, which can delay drug receipt. We evaluated median time to OACD receipt (TTR) from initial OACD prescription submission and assessed clinical and process-related factors associated with TTR. Methods: We prospectively collected data on all new OACD prescriptions for adult oncology patients at a large, urban outpatient cancer center from 1/1/2018 to 12/31/2019. We collected patient demographic, medical, and insurance data; prescription submission and delivery dates; and interactions with payers and financial assistance groups. TTR was defined as the number of days from OACD initial prescription to patient receipt of the drug. We estimated the median TTR across all patients and used multivariable logistic regression to identify factors associated with TTR above the median. Results: The cohort included 1080 patients who were prescribed 1269 new OACDs. Of these prescriptions, 84% (N=1069) were received, and 71% (N=896) required prior authorization. The median patient age was 66, 44% identified as Non-Hispanic White (White), 25% of patients had commercial insurance, 16% had Medicaid alone, and 58% had Medicare alone or in combination with another plan. The median TTR per patient was 7 days (IQR 0 – 142; 25% ≥ 14 days and 5% ≥ 30 days). In unadjusted analyses, insurance and race/ethnicity were associated with TTR. Compared with patients covered by Medicaid, those with Medicare and supplemental insurance (a partial, not free-standing plan) had nearly 2.5 times the odds of TTR >7 days controlling for other factors. Race/ethnicity showed a trend toward longer TTR with Non-Hispanic Black (Black) patients having a longer TTR compared to White patients, controlling for other factors. We did not observe statistically significant effects of either comorbidity or prior authorization requirement on TTR. Conclusions: Though the majority of oncology patients prescribed OACDs receive the drug, 71% of prescriptions required prior authorization and a quarter of patients waited at least two weeks. Disparities in TTR are primarily driven by financial factors, specifically insurance type.[Table: see text]

The association between perceived patient-centered care and symptoms experienced by patients undergoing anti-cancer treatment.

PurposeCancer patients undergoing active anti-cancer treatment experience multiple symptoms concurrently. Over the years, studies to improve patients’ physical and psychological discomfort by focusing on patients’ needs and preferences have reported promising outcomes. This study aims to explore perceived patient-centered care and its association to symptoms experienced by cancer patients undergoing active anti-cancer treatment.MethodsA cross-sectional study was conducted at an outpatient cancer center between August 2018 and July 2019 among adult cancer patients receiving chemotherapy and biological therapy. Participants were asked by their oncology nurse to complete a self-administered questionnaire which included the three subscales (physical, psychological, and global distress) of the Memorial Symptoms Assessment Scale as well as the perceived patient-centered care questionnaire. To examine the association between participants’ perceived patient-centered care and each of the symptoms scale scores, three hierarchical (block-wise) linear regression models were performed.ResultsOf the 125 participants, 57 (45.6%) were diagnosed with breast cancer and were treated with chemotherapy either alone (n = 62, 49.6%), with radiotherapy (n = 4, 3.2%), or with biological therapy (n = 45, 36.0%). Hierarchical regression models found that perceived patient-centered care contributed to 11.3%, β = − .351 (p < 0.001); 8.9%, β = − .311 (p < 0.001); and 10.3% β = −.336 (p < 0.001) of the variance of the global distress index, physical symptoms, and psychological symptoms, respectively.ConclusionsThis study shows the importance of perceived patient-centered care in alleviating physical and psychological symptoms and overall distress in cancer patients undergoing active anti-cancer therapy. Our findings call for oncology teams to adopt and implement patient-centered care as part of their routine work.

Shifting psychosocial oncology care to telepsychology during the COVID-19 pandemic

Background The novel coronavirus (COVID-19) rapidly shifted psychosocial services to telepsychology, including psychosocial oncology (PSO) practices. PSO providers work with patients undergoing treatment, experiencing treatment delays and/or immuno-suppression in the context of a global pandemic. There is evidence to support the acceptability of telepsychology among cancer patients and an emerging need for data to inform the design and provision of telepsychology PSO care during the pandemic and beyond. Research Objectives This study examined engagement in telepsychology PSO care at an outpatient community cancer center. Methods The current study analyzed practice data from a PSO department from March 2020 through September 2020. The sample included 354 patients (91 established; 263 newly referred). Descriptive, correlational, and comparative analyses were conducted. Results Among established patients, 93% continued with telepsychology PSO care after the pandemic and 94% completed at least one telepsychology appointment. Among newly referred patients, 50.6% scheduled a telepsychology appointment, consistent with the scheduling rate for the proceeding calendar year (50%). Across patients scheduling telepsychology PSO appointments (N = 194), 68 initially engaged in phone-based services with 20 converting to video, for a total of 127 (76.5%) patients utilizing video-based PSO services. Common reasons for phone-based services included ‘patient preference’ (N = 14), ‘lack of access’ (N = 9), and ‘technology barriers’ (N = 8). During this timeframe, 18% had at least one no-show, which is significantly less than the preceding year (23%). Phone-based patients were significantly older (p =.007). A greater proportion of males engaged in phone-based services compared to females (p = .006). Conclusions Telepsychology PSO engages new and existing patients during the COVID-19 pandemic. There may be an increased demand for services and increased utilization in the context of the pandemic and the availability of telepsychology. There are disparities and access issues that should be considered and addressed.

Feasibility of Safe Opioid Prescribing in Outpatient Palliative Care: A Quality Improvement Project

BackgroundNo guidelines for safe opioid prescribing in palliative care exist, which contributes to limited monitoring of opioid misuse in palliative care. MeasuresFeasibility of a safe opioid prescribing standard operating protocol (SOP) was determined by assessing the percentage of patients in an outpatient cancer center who completed each component of a five-component SOP. InterventionA five-component SOP included: risk stratification for misuse, consent form, prescription drug monitoring program review, urine drug testing, and Naloxone for high-risk individuals. OutcomesAfter one year, compliance rates on four of the of the five-component SOP were greater or equal to 93%. Naloxone co-prescription for high-risk patients never reached over 78%, largely due to clinical decision not to co-prescribe if transition to hospice was imminent. Conclusions/Lessons LearnedSafe opioid prescribing measures are feasible in outpatient palliative care and can facilitate identification of individuals at risk for opioid misuse and prompt early interventions for misuse.

SARS-CoV-2 nosocomial infection: Real-world results of environmental surface testing from a large tertiary cancer center.

BACKGROUNDDespite consensus guidelines, concern about severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission has dissuaded patients with cancer from seeking medical care. Studies have shown that contaminated surfaces may contain viable virus for up to 72 hours in laboratory settings. The purpose of this study was to investigate contamination of SARS‐CoV‐2 on commonly used environmental surfaces in a tertiary cancer care center.METHODSThis study evaluated the incidence of SARS‐CoV‐2 viral RNA in high‐touch outpatient and inpatient cancer center spaces. Surfaces were tested over a 2‐week period after patient or staff exposure but before scheduled disinfection services according to the World Health Organization protocols for coronavirus disease 2019 (COVID‐19) surface sampling. Samples were analyzed via reverse transcriptase–polymerase chain reaction for the presence of SARS‐CoV‐2 RNA.RESULTSTwo hundred four environmental samples were obtained from inpatient and outpatient oncology clinics and infusion suites, and they were categorized as 1) public areas, 2) staff areas, or 3) medical equipment. One hundred thirty surfaces from 2 outpatient hematology and oncology clinics and 36 surfaces from an inpatient leukemia/lymphoma/chimeric antigen receptor T‐cell unit were examined, and all 166 samples were negative for SARS‐CoV‐2. One of 38 samples (2.6%) from COVID‐19+ inpatient units was positive. Altogether, the positive test rate for SARS‐CoV‐2 RNA across all surfaces was 0.5% (1 of 204).CONCLUSIONSThis prospective, systematic quality assurance investigation of real‐world environmental surfaces, performed in inpatient and outpatient hematology/oncology units, revealed overall negligible detection of SARS‐CoV‐2 RNA when strict mitigation strategies against COVID‐19 transmission were instituted.LAY SUMMARY The potential risks of nosocomial infection with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) have deterred patients with cancer from seeking timely care despite consensus guidelines.This study has found negligible rates of environmental contamination with SARS‐CoV‐2 across a multitude of commonly used surfaces in outpatient and inpatient hematology/oncology settings with adherence to strict infection control protocols.

Monitoring Rates of Malnutrition Risk in Outpatient Cancer Centers Utilizing the Malnutrition Screening Tool Embedded into the Electronic Health Record

BackgroundThe risk of malnutrition in patients with cancer is well documented. However, screening to identify patients at risk in ambulatory cancer centers is not standardized nor uniform. The 2-question Malnutrition Screening Tool (MST) is validated in the ambulatory oncology setting and endorsed by the Academy of Nutrition and Dietetics. ObjectiveTo test the feasibility of operationalizing and standardizing malnutrition risk assessment across 2 large ambulatory cancer centers by embedding the MST into the electronic health record (EHR) with the goal of identifying and quantifying the prevalence of malnutrition risk in outpatient settings. DesignA Quality Assurance Performance Improvement project was conducted to evaluate malnutrition screening practices by leveraging the EHR. Work standards were developed, implemented, and evaluated to assess the feasibility of utilizing de-identified MST data, entered as discrete variables in an EHR flowsheet, to track monthly MST completion rates and to identify and quantify patients being treated for cancer scoring at risk for impaired nutritional status. Participants/settingData from 2 large adult ambulatory community cancer centers in the upper Midwest were collected between April 2017 and December 2018. ResultsOver a 20-month period, the average monthly MST completion rate was 74%. Of those with completed MST screens, the average percentage of patients identified at nutritional risk (MST score ≥2) was 5% in medical oncology and 12% in radiation oncology. ConclusionIt is feasible to (1) integrate and standardize data collection of the MST into existing EHR flowsheets and (2) identify and quantify patients at risk for malnutrition on a consistent basis.

Prevalence and Survival Impact of Self-Reported Symptom and Psychological Distress Among Patients With Multiple Myeloma

BackgroundAdvances in the management of multiple myeloma (MM) have extended survival and reduced painful skeletal-related events. As MM is evolving toward a chronic disease, we sought to determine the prevalence of self-reported symptom burden and psychological distress, and to determine the association of distress with survival. MethodsThe CPASS-7 patient-reported outcome instrument was administered to a convenience sample of MM patients at 7 outpatient cancer centers. ResultsA total of 239 patients completed the CPASS-7 between September 2015 and October 2016%; 57% of respondents were male, and median age was 67 years. Forty-eight percent were concerned that they could not do the things they wanted to do, with 33% reporting decreased performance status. Financial toxicity concerns were self-reported by 44%, with family burdens noted in 24%. Although depression was reported by only 15%, 41% noted lack of pleasure. Pain was a concern in 36%. With a median follow-up of 316 days since CPASS-7 completion, 13% of patients had died. A high total distress score was noted in 57 (24%) and trended toward an association with a decreased survival rate compared to the 182 patients (76%) with a low total distress score (P = .066). The 6-month survival rates for patients with high and low distress scores were 86% and 96%, respectively, and 12-month survival rates were 76% and 87%, respectively. ConclusionDespite dramatic improvements in survival among patients with MM, symptom, financial, and psychosocial concerns continue to be major patient concerns. As MM becomes a chronic disease, additional attention to addressing these issues is required.

Association Between Preoperative Patient-Reported Symptoms and Postoperative Outcomes in Rectal Cancer Patients: A Retrospective Cohort Study

BackgroundRectal cancer patients undergoing preoperative radiotherapy experience a significant symptom burden. However, it is unknown whether symptoms during radiotherapy may portend adverse postoperative outcomes and healthcare utilization. MethodsA retrospective cohort study was performed of rectal cancer patients undergoing neoadjuvant radiotherapy and proctectomy in Ontario from 2007 to 2014. The primary outcome was a complicated postoperative course–a dichotomous variable created as a composite of postoperative mortality, major morbidity, or hospital readmission. Patient-reported Edmonton Symptom Assessment System (ESAS) scores, collected routinely at outpatient provincial cancer center visits, were linked to administrative healthcare databases. The receiver-operating characteristic analysis was used to compare ESAS scoring approaches and to stratify patients into low versus high symptom score groups. Multivariable regression models were constructed to evaluate associations between preoperative symptom scores and postoperative outcomes. Results1455 rectal cancer patients underwent sequential radiotherapy and proctectomy during the study period and recorded symptom assessments. Patients with high preoperative symptom scores were significantly more likely to experience a complicated postoperative course (OR 1.55, 95% CI 1.23-1.95). High preoperative ESAS scores were also associated with the secondary outcomes of emergency department visits (OR 1.34, 95% CI 1.08-1.66) and longer length of stay (IRR 1.23, 95% CI 1.04-1.45). ConclusionsRectal cancer patients reporting elevated symptom scores during neoadjuvant radiotherapy have increased odds of experiencing a complicated postoperative course. Preoperative patient-reported outcome screening may be a useful tool to identify at-risk patients and to efficiently direct perioperative supportive care.

Improving Code Response Time through Strategic Positioning of Nursing House Supervisors: Results of a Nurse-Led Intervention

Background: In many settings, the nursing house supervisors (NHS) are a critical part of the entity’s code response team. To date, much of the research on code response has focused on improving response times through staff-focused interventions such as simulation training. However, use of data to determine where to physically place NHS in the building to optimize code response times has received little attention, especially in an outpatient oncology setting. Purpose: To test whether using data on code frequency/location to strategically position NHS could reduce mean code response times in large (450,000-ft2) outpatient cancer center. Methods: Data on code volume, type, distance and estimated response time before and after strategic repositioning was collected by staff over a 238-day period occurring between September, 2019 and April, 2020. Results: Over an eight-month period, NHS staff responded to 64 codes. Prior to repositioning, 77.3% of codes required NHS to travel to a different building and through at least one floor and/or departments to arrive at the code. After strategic repositioning, mean code response times at our center fell from 3.4±0.7 min, on average, to 1.5 ± 0.6 min (p < .000). Improvements in code response times and distance travelled were observed regardless of code type, time of day, or individual NHS responding to the code. Conclusions: Results suggest that a data-driven strategy for determining where to place NHS in the building based on code frequency and location may be a useful way for oncology centers to improve code response times.

Pharmacist review of high-risk haematology outpatients to improve appropriateness of antifungal prophylaxis.

Background Patients with haematological malignancies are at high risk of invasive fungal infections. However, there is a lack of information about the utilisation of the recommended Australian antifungal prophylaxis guidelines in haematology outpatients. Objective To assess the impact of a weekly pharmacist review of high-risk adult haematology outpatients on the utilisation of appropriate antifungal prophylaxis. Setting Outpatient cancer centre, tertiary referral hospital in Sydney, Australia. Method A 3-month pre-and post-interventional study was conducted. A retrospective audit was conducted to obtain baseline utilisation of antifungal guidelines in adult haematology outpatients with acute myeloid leukemia, acute lymphoblastic leukemia and myelodysplastic syndrome receiving chemotherapy. This was followed by a weekly pharmacist review over a 3-month period of all eligible outpatients assessing the appropriateness of antifungal agent, dose, use of therapeutic drug monitoring and presence of drug-interactions/contraindications. Recommendations to physicians were conveyed weekly and outcomes recorded. Main outcome measure Appropriate utilisation of antifungal prophylaxis guidelines in outpatient haematology patients before and after implementation of a 3-month weekly pharmacist review service. Results Forty patients were included in the retrospective group, equating to 348 reviews, while 42 patients equating to 269 reviews were included in the prospective group. Appropriate utilisation of antifungal prophylaxis guidelines increased from 31 to 54% post implementation of a pharmacist review (Odds Ratio = 2.44, 95% Confidence Interval: 1.07-5.58, p = 0.0344). The most common reason for nonadherence to guidelines in both groups was lack of therapeutic drug monitoring and failure to prescribe antifungal prophylaxis where indicated. The percentage of appropriate use of antifungal prophylaxis in patients with acute myeloid leukemia increased from 13 to 46% (p value < 0.01) after pharmacist intervention. The pharmacist made 153 recommendations from 269 reviews, with a percentage uptake of 40%. Moderate to severe drug interactions were identified in 19 reviews from 10 patients. One major azole antifungal-chemotherapy interaction was avoided. Conclusions Appropriate utilisation of antifungal prophylaxis guidelines can be improved through a regular pharmacist review. Future studies should identify whether improving adherence to antifungal guidelines leads to improved patient outcomes.

A Comparison of Three Music Therapy Introduction Dialogues on Acceptance of Music Therapy Services by Patients in an Outpatient Cancer Center

Abstract Music therapy is not often well understood by patients with cancer; therefore, patients may be initially hesitant to accept music therapy services. The purpose of this study was to compare the effectiveness of three different scripts (described from here on as “introduction dialogues”) used to offer music therapy services to patients in an outpatient cancer center. Relationships between patient-reported anxiety levels, gender, and age with the acceptance rate of music therapy services were also examined. Patients (n = 59) were offered music therapy using one of three different introduction dialogues, asked to complete an anxiety Visual Analogue Scale (VAS), and provided with music therapy services if accepted. Results showed that introduction dialogue #2 (benefits of music therapy explained, including research) had the greatest acceptance rate. Moderate anxiety levels, males, and individuals 61+ years of age also showed greatest acceptance rates. A breakdown of different variables influencing patient response, limitations of the study, and future recommendations are also discussed.

Transitioning an Infection Prevention and Control Program to a New Outpatient Hospital-Based Cancer Center

Background In order to create a more patient-centric, multidisciplinary approach to cancer care, a large non-profit health system moved cancer treatment services from across the system to a newly renovated office complex consisting of over 400,000 square feet and 100 acres. The move brought together clinical operations from both the acute care and outpatient care settings. In mid-2019, the new hospital-based outpatient cancer institute was opened. Unifying infection prevention and control (IPC) practices across the newly formed clinical setting created a challenging environment for implementing an effective IPC program. Methods The combination and integration of different clinical areas from across the system highlighted inconsistency in IPC practices. To identify the IPC needs throughout the cancer center clinical practices, a comprehensive assessment was performed. A current state matrix helped identify several gaps in infection control knowledge and practices. The deficiencies with the highest risk to patients were addressed first with focus on high- and low-level disinfection, sterile processing, safe infection practices, standard and transmission-based precautions and hand hygiene. Results With the assistance of front-line staff and evidence-based, best practice guidance, new processes and procedures were developed and rolled out facility wide. To support and unify IPC practices, staff attended educational sessions where the special concerns for preventing infections in the cancer patient populations were discussed. Conclusions Even though infection control principles are the same across care settings, the new environment and targeted patient population required a tailored approach in order to maintain consistent IPC practices. Furthermore, understanding the special needs of oncology patient care, building strong relationships with clinical leadership and maintaining visibility throughout the facility have been critical in providing and maintaining an effective program. In order to create a more patient-centric, multidisciplinary approach to cancer care, a large non-profit health system moved cancer treatment services from across the system to a newly renovated office complex consisting of over 400,000 square feet and 100 acres. The move brought together clinical operations from both the acute care and outpatient care settings. In mid-2019, the new hospital-based outpatient cancer institute was opened. Unifying infection prevention and control (IPC) practices across the newly formed clinical setting created a challenging environment for implementing an effective IPC program. The combination and integration of different clinical areas from across the system highlighted inconsistency in IPC practices. To identify the IPC needs throughout the cancer center clinical practices, a comprehensive assessment was performed. A current state matrix helped identify several gaps in infection control knowledge and practices. The deficiencies with the highest risk to patients were addressed first with focus on high- and low-level disinfection, sterile processing, safe infection practices, standard and transmission-based precautions and hand hygiene. With the assistance of front-line staff and evidence-based, best practice guidance, new processes and procedures were developed and rolled out facility wide. To support and unify IPC practices, staff attended educational sessions where the special concerns for preventing infections in the cancer patient populations were discussed. Even though infection control principles are the same across care settings, the new environment and targeted patient population required a tailored approach in order to maintain consistent IPC practices. Furthermore, understanding the special needs of oncology patient care, building strong relationships with clinical leadership and maintaining visibility throughout the facility have been critical in providing and maintaining an effective program.

Patient Flow Analysis Using Real-Time Locating System Data: A Case Study in an Outpatient Oncology Center.

Electronic health records (EHRs) have been mainly used to analyze bottlenecks in care processes of outpatient oncology clinics. However, EHR data lead to some limitations in understanding patient flow because they are manually entered and not updated in real time. Data generated from a real-time location system (RTLS) can supplement EHR data. This study aims to demonstrate how RTLS data combined with EHR data can be used to evaluate potential interventions to improve patient flow in an outpatient cancer center. EHR and RTLS data obtained from a large cancer center in central Virginia were analyzed to estimate process times and determine the various patient paths patients follow during their visit for infusion. Using the input data, we developed a discrete-event simulation (DES) model and assessed 5 what-if scenarios involving changes in staff scheduling and care processes. Raw RTLS data including > 3.5 million observations were preprocessed to remove noise and extract meaningful information. The DES results showed that new nursing schedules for the infusion center and improved pharmacy processes have positive impacts on reducing patient waiting times by approximately 20% and overall length of stay by approximately 3.4% to 4.6%, compared with the current system. Combining EHR and RTLS data, we were able to capture dynamic aspects of patient flow more realistically. DES models that represent a complex system based on accurate input data can help decision making on determining operational changes to improve patient flow.

Palliative Care's Role Managing Cancer Pain During the Opioid Crisis: A Qualitative Study of Patients, Caregivers, and Clinicians

ContextPatients with cancer face symptoms because of disease and treatment, and pain is common and complex. The opioid crisis may complicate patients' and clinicians' experiences of managing pain in cancer care. ObjectivesIn our study of perceptions and experiences with palliative care (PC) at an outpatient cancer center, we examined communication around symptom management throughout cancer care, and pain and its management emerged as particularly salient. The objective of this article is to describe, from the perspectives of patients, caregivers, and oncology health care professionals, the role of PC in navigating the complicated dynamics of pain management amidst the opioid crisis. MethodsA qualitative descriptive study with grounded theory components was designed to investigate experiences with and perceptions of specialist PC and symptom management, including pain. Interviews were audiorecorded and transcribed, and focused coding identified themes related to pain and pain management from all three perspectives. ResultsAbout 44 patients, caregivers, and non-PC health care professionals completed interviews. Patients with cancer and their caregivers had many concerns about pain management and were specifically concerned about opioid use and stigma. For patients, PC improved pain management and helped to destigmatize appropriate pain management. Oncology clinicians reported that partnering with PC facilitated complex pain management and also provided moral support around difficult opioid recommendations for patients. ConclusionPC offers the potential to uniquely support both patients and other oncology professionals in optimally navigating the complexity around pain management for cancer care in the midst of the opioid crisis.

When a global pandemic complicates cancer care: Although oncologists and their patients are accustomed to fighting tough battles against a lethal disease, Coronavirus Disease 2019 (COVID-19) has posed an unprecedented challenge.

When a global pandemic complicates cancer care: Although oncologists and their patients are accustomed to fighting tough battles against a lethal disease, Coronavirus Disease 2019 (COVID-19) has posed an unprecedented challenge.

Malnutrition Screening: An Interprofessional Approach in Outpatient Oncology.

Malnutrition is highly prevalent in the oncology population and is associated with poor treatment outcomes. This study aimed to implement a malnutrition screening process using a validated tool in three outpatient cancer centers. Nursing and nutrition department leaders collaborated to establish malnutrition screening. The Malnutrition Screening Tool (MST) was embedded in the electronic health record. Based on the MST, a score of 2 or greater is considered at risk for malnutrition. Nurses were educated on screening all patients completing their first cycle of infusion chemotherapy. Data were collected for six months. Interprofessional collaboration established a process to implement malnutrition screening. Twenty-eight percent of patients with cancer were at risk for malnutrition. Fifty-three percent were at risk for malnutrition based on MST scores of 2. Compliance with the MST at first infusion visit was 30%-81% across the three cancer centers.