Cancer Outpatients Research Articles

How English- and Spanish-preferring patients with cancer decide on emergency care.

Despite widespread efforts to reduce emergency department (ED) visits, patients newly diagnosed with cancer often use the ED for commonly anticipated acute care needs. Existing delivery innovations to reduce ED use are underused, and reasons for this are not understood. Patients who recently visited the ED may provide insights into these patterns of care. Qualitative study of semistructured patient interviews from April 2019 to April 2022. We interviewed patients diagnosed with cancer within the prior 6 months from the University of Texas Southwestern Medical Center and its academically affiliated but clinically distinct safety-net health system Parkland Health who had recently visited their respective ED. We completed 29 interviews in English and 11 in Spanish, then analyzed the interviews with the constant comparativemethod. Nearly all patients were unaware of, but interested in using, 24/7 telephone triage and oncology urgent care clinics. Safety-net patients, especially Spanish-preferring patients, reported less access to outpatient cancer teams. Patients did not weigh symptom severity to decide between sites of care, but insured patients were concerned about the cost of hospital visits. Patients did not look forward to visiting the ED but understood its advantages, and for safety-net patients, the ED was the main way to access physicians. When patients were discharged home, they were relieved not to be hospitalized, and the good clinical experience inadvertently reinforced future ED use. Even robust education programs for patients with cancer may have difficulty conveying the availability of innovative clinical services. Patient perspectives on avoidable ED visits may differ from policy makers' definitions.

Quality of Life Based Health Economics Research on Pharmaceutical Intervention in Cancer Chemotherapy

The adverse chapter of cancer chemotherapy negatively impact QOL, and pharmacists play a key role in improving QOL by providing optimal drug therapy through pharmaceutical interventions. Although outpatient cancer chemotherapy is now common, the impact of pharmaceutical interventions from a QOL perspective has not been thoroughly studied. Therefore, this study investigated the impact and cost-effectiveness of pharmaceutical interventions on QOL using the EuroQol 5 Dimension (EQ-5D) and Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs (QOL-ACD). The study was conducted between 2013 and 2015 on 39 patients who underwent their first outpatient chemotherapy for breast cancer at Gifu Municipal Hospital. The results showed that pharmaceutical interventions improved social relationship QOL in patients experiencing fatigue during the first cycle and enhanced psychological QOL in patients with adverse events of nausea during the second cycle. Furthermore, the maximum incremental cost-effectiveness ratio (ICER) was found to be 1.3 million yen per quality-adjusted life years (QALY) according to cost utility analysis. The pharmaceutical interventions by pharmacists in outpatient cancer chemotherapy improve QOL, and the ICER remains well below the Japanese threshold, signifying clear medical and economic benefits.

Бережливые технологии как инструмент организации пациентоцентричного подхода к оказанию медицинской помощи пациентам центра амбулаторной онкологической помощи

It is crucial to implement and use patient-centered approach towards communication between doctors and patients and towards management of treatment and diagnostics. The instruments of lean production can be used in order to find problems of organizational processes and to solve and improve them. Purpose of the study is to evaluate the possibility of using lean production to improve patient-centered approach towards the work of Outpatient Cancer Center. Materials and methods. The scientific articles from databases pubmed, cyberleninka, elibrary were studied. The performance results of Outpatient Cancer Center were analyzed. Results. During research the performance of Outpatient Cancer Center and its change as a result of using lean production instruments was analyzed. The positive results including the improvement of availability of diagnostics and consultations were found out. The medical and patient ratings of organizations have also shown significant improvement. Findings. Thus, the use of lean production not only in outpatient clinic but also in Outpatient Cancer Center is relevant nowadays. The instruments of lean production can improve healthcare processes and make them more patient-centered.

Unleashing the potential of eHealth in outpatient cancer care for patients undergoing immunotherapy-a quantitative study considering patients' needs and current healthcare challenges.

The use of online information and communication is globally increasing in the healthcare sector. In addition to known benefits in other medical fields, possible specific potentials of eHealth lie in the monitoring of oncological patients undergoing outpatient therapy. Specifically, the treatment with immune checkpoint inhibitors (ICI) requires intensive monitoring due to various possible negative side effects. The present study explores cancer patients' perspectives on eHealth and demonstrates how eHealth applications, from the patients' point of view, can contribute to further improving outpatient immunotherapy. Our multicenter study was executed at the university hospitals in Bonn and Aachen. A structured questionnaire was distributed to patients receiving outpatient immunotherapy. Contents addressed were (1) the patients' attitude towards eHealth applications, (2) the use of modern information and communications technologies (ICT) in (2a) everyday life and (2b) health-related information search including eHealth literacy, (3) the use of internet-enabled devices as well as (4) socio-demographic data. 164 patients were included in the study, of whom 39.0% were female and 61.0% male and the average age was 62.8 years. Overall, there was a high distribution of internet-enabled devices for everyday use and a great interest in integrating eHealth applications into outpatient immunotherapy. The assessment of eHealth potentials significantly depended on age. The younger participants demonstrated a broader use of modern ICT and a higher affinity for its use in outpatient immunotherapy. In some aspects, level of education and gender were also relevant factors influencing the patients' view on eHealth. This study demonstrates the potential for further integration of eHealth applications into outpatient immunotherapy from the patients' perspective. It indicates a dependency on age and educational level for the further integration of eHealth into patient care in oncology. Due to particular patient needs regarding age, level of education, gender and other subgroups, specific education and training as well as target-group specific digital health interventions are necessary to fully utilize the potentials of eHealth for outpatient immunotherapy. Future studies are required to specifically address target-group specific usability of eHealth applications and eHealth literacy, as well as to address information security and data protection.

Malnutrition risk screening in adult oncology outpatients: An ASPEN systematic review and clinical recommendations.

Malnutrition screening is not widely practiced in outpatient cancer centers. This review aims to determine the validity of malnutrition screening tools and provide recommendations for clinical use. Studies identified by a systematic review assessed the general validity of screening tools in adult oncology outpatients from five databases through 2022. The American Society for Parenteral and Enteral Nutrition (ASPEN) convened a working group of members from the Academy of Nutrition and Dietetics, Academy of Oncology Nurse and Patient Navigators, American Cancer Society, American Society for Clinical Oncology, American Society for Nutrition, American Society for Radiation Oncology, Association of Cancer Care Centers, and Oncology Nursing Society to answer the following questions: (1) should clinicians screen for malnutrition, (2) which malnutrition screening tools are recommended, and (3) what are the clinical applications for malnutrition risk screening in adult oncology outpatients? Twenty of 738 studies met the criteria and were reviewed. Six screening tools with specific cut-points demonstrated validity and are recommended, including the Mini Nutritional Assessment (≤23.5), Malnutrition Screening Tool (MST; MST ≥ 2 and patient-led MST ≥ 2), Malnutrition Universal Screening Tool (MUST; MUST ≥ 1 and MUST ≥ 2), Nutrition Risk Screening-2002 (NRS-2002; NRS-2002 ≥ 2 and NRS-2002 ≥ 3), NUTRISCORE ≥ 5, and Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF; PG-SGA SF ≥ 7 and PG-SGA SF ≥ 8). Six screening tools are valid for malnutrition risk identification in oncology ambulatory settings and recommended before treatment initiation and regularly thereafter, depending on treatment course. Research is needed to understand to what extent early diagnosis and management of malnutrition improves the clinical care of oncology patients.

Role of distress tolerance, meaning in life and social support in the relationship between posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) among Nigerian cancer patients

We examined the moderating roles of distress tolerance, meaning in life, and social support in the relationship between posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) among cancer patients. Participants included 301 cancer outpatients randomly selected from the oncology unit of a tertiary healthcare institution in Nigeria (female = 60.1%%; age range = 21 to 85 years, mean age = 52.30 years, SD = 12.64 years). They completed self-report measures on distress tolerance, meaning in life, social support, posttraumatic stress symptoms (PTSS), and PTG. Following series of moderation analysis using Hayes PROCESS macro for SPSS Model 1, results showed that higher PTSS was associated with lower PTG at low and moderate, but not at high levels of distress tolerance. Moreover, meaning in life and social support moderators the PTSS and PTG relationship for higher PTG. Therefore, intervention programmes to promote PTG among cancer patients should consider meaning in life, and social support for their protective potentials in improving positive posttraumatic outcome and recovery with distress tolerance.

Characterizing access for oral oncolytics used to treat breast cancer at an academic medical center.

116 Background: Everolimus, CDK 4/6, PIK3CA, Her2 tyrosine kinase, and PARP inhibitors are commonly used oral oncolytic agents for breast cancer patients. However, oral oncolytics are tiered differently for insurance cost coverage than IV therapies. We characterized the financial toxicity associated with breast cancer oral oncolytics, investigated the prevalence of financial assistance mechanisms utilized, and explored the association of these mechanisms with timing of treatment initiation in adult breast cancer patients. Methods: Patients 18 years or older with a primary breast cancer diagnosis who received care at the outpatient breast cancer clinic and were prescribed an oral oncolytic by a Michigan Medicine provider were included. Using the electronic medical record, we identified initial prescriptions for everolimus, CDK 4/6 inhibitors (palbociclib, ribociclib, abemaciclib), PIK3CA inhibitor (alpelisib), HER2 tyrosine kinase inhibitors (lapatinib, neratinib, tucatinib), and PARP inhibitors (olaparib, talazoparib) dated between January 1, 2014 and November 30, 2022. Patient demographics, adjuvant versus metastatic status, insurance coverage, monthly out-of-pocket costs, financial assistance obtained, prescribed date, planned medication start date, pill-to-mouth date, duration of treatment and reason for treatment discontinuation were collected. Results: There were 418 unique patients in our final cohort. Almost one third of all prescriptions were filled with financial assistance (n=126, 31.2%). The three most common assistance mechanisms were copay cards (n=55, 43.6%), grants (n=34, 26.9%) and patient assistance programs (n=31, 24.6%). For monthly out-of-pocket costs before any financial assistance was obtained, the three most common cost groups were $0-$15 (n=155, 36%), $15-$100 (n=101, 23.7%) and >$500 (n=91, 21%). Among the 48 prescriptions that were never filled, almost one third were due to prohibitive cost (n=15, 28.3%). For insurance coverage, the three most common types were commercial (n=224, 54%), Medicare Part D (n=108, 26%), and Medicaid (n=57, 14%). The median number of days treatment was delayed was 10 days (range 0-495 days). Insurance approval/denial delays accounted for 33.9% of delays (n=120). Conclusions: One third of breast cancer oral oncolytic prescriptions were filled with financial assistance. In the instances in which patients were not able to receive timely treatment for their cancer, one out of three times it was due to insurance delay.

New cancer medicines in Europe 2010–2020: comparison of medicines with or without extensions of indications

IntroductionDuring the last decade, extensions of therapeutic indications have been one of the most common methods to extend the lifecycle of a medical product in the post-authorisation phase and to...

Oncology care model cost data for breast, lung, and multiple myeloma: Influence of outpatient rehabilitation therapy services.

14 Background: High value cancer care is defined by access to coordinated, appropriate healthcare services that achieve optimal outcomes at a reasonable cost. Evidence supports outpatient cancer rehabilitation (physical, occupational or speech therapy) as a mechanism to improve outcomes such as health-related quality of life, suggesting that integration of these services is beneficial for cancer survivors. However, the impact of outpatient rehabilitation services on healthcare costs is unknown. We aimed to compare cost segments between those who attended community-based outpatient rehabilitation therapy services (Rehab) versus those who did not (Non-rehab). We hypothesized that healthcare costs would be lower for the Rehab group in the following cost segments: emergency department (ED), part D drugs, home health services, skilled nursing facility services (SNF), inpatient rehabilitation facilities (IRF), and hospice. Methods: This is a retrospective cohort study of Medicare beneficiaries who received chemotherapy at a large community oncology practice that participated in the oncology care model (OCM) program from 2018 to 2021. Two data sources were linked, OCM cost data and the rehabilitation medical record. This yielded sufficient sample sizes for analysis of breast, lung, or multiple myeloma (MM) cancer types. Rehab cases were then matched to Non-rehab cases 3:1 based on cancer type, stage, and sex. Cost variables included total cost of care (TCOC) and cost segments using OCM methodology. Mann-Whitney-Wilcoxon statistic (p<.05) was used for analysis. Results: Cases (N=3,033) primarily had early-stage cancer (0 to 2, 74.8%) and were 70.4±7.3 (Rehab) or 71.6±8.5 years old at diagnosis (Non-rehab). Most had breast cancer (81.2%), followed by lung cancer (11.7%) and MM (7.2%). TCOC was $32,387 and $26,257 for the Rehab and Non-rehab groups, respectively. Costs were significantly lower for the Rehab group in five of the six segments analyzed; IRF costs were lower, but not statistically significant (Table). Conclusions: To our knowledge, this is the first study to explore the influence of real-world, outpatient cancer rehabilitation therapy services on the cost of cancer care. Community-based therapy services were associated with significantly lower costs in ED, part D drugs, home health, SNF, and hospice segments. Future studies examining rehabilitation services as a relatively low-cost supportive care option to meet patient needs and enhance high-value care are warranted. Healthcare segment costs for rehab vs. non-rehab cases. Rehab Non-rehab Between-group Difference Mean, (SD) Mean (SD) p-value ED $85 (260) $104 (372) .019 Part D drugs $4,813 (18,221) $5,675 (18,797) <.001 Home health $433 (1,600) $705 (2,118) <.001 SNF $160 (1,988) $386 (3,943) .046 Hospice $75 (770) $198 (1,529) <.001 IRF $245 (2,275) $384 (3,277) .434

Dietary Practices of Cancer Outpatients at Nyeri County Referral Hospital, Kenya; A Cross Sectional Survey

The global burden of non-communicable diseases remains unacceptably high and Kenya is among the countries experiencing an epidemiological transition from the communicable to non-communicable diseases. In Kenya, cancer is the second leading cause of non-communicable disease related mortalities after the cardiovascular diseases and Nyeri County is among the counties that are leading in this burden of non-communicable diseases. This study sought to assess the dietary practices of the cancer patients on chemotherapy at Nyeri County and Referral Hospital in comparison with the recommended dietary practices. Analytical cross-sectional study design was employed and the data on the dietary practices was collected using a 24-hour recall and a Food Frequency Questionnaire (FFQ). Sixty one percent of the respondents were female while 39% were male. Sixty one percent had acquired primary school education and half of the respondents survive on a monthly income of between 0-10,000. Breast cancer was the most common cancer type in the population (39%), followed by esophageal and throat cancer at 14.5% and gastric cancer at 14%. Prostate cancer was the most prevalent among the male respondents at 11%. The mean energy intake of the respondents was 1068+- 520 Kcals which was not meeting the requirements as per the ESPEN clinical guidelines on cancer. The dietary patterns identified from the research were, excessive consumption of foods from the starchy foods and the fats category (65.1%) and less than half (41.9%) were not attaining the minimum daily requirements of the fruit’s servings recommended by the World Health Organization (WHO). Nutrition education and counselling is key in improving the dietary practices among the cancer patients. However, 44.19% had not received nutrition education and counselling regarding the appropriate diet to consume in the course of their treatment. This study found out that the dietary practices of the cancer patients do not meet the recommended clinical guidelines on cancer nutrition and almost half of the population had not received nutrition education and counselling services. Social and behavior change is one of the possible strategies that could be adopted to deliver nutrition information to the population, to improve the knowledge, attitude and dietary practices of cancer patients in Kenya, which in turn will improve their nutrition outcomes.

Стоимость лекарственного лечения пациентов с онкологическими заболеваниями в амбулаторных условиях, рассчитанная на основании стандартов медицинской помощи.

Modern oncology has achieved impressive results in terms of increasing life expectancy and reducing mortality of patients with malignant neoplasms. This has led to many patients requiring long-term outpatient treatment. The purpose of the study is to calculate the cost of treatment of patients with malignant neoplasms in the Russian Federation in an outpatient setting based on standards of medical care. Materials and methods. Based on the standards of medical care, the cost of drug treatment for patients with cancer in an outpatient setting was calculated. A comparison was made of the estimated amount with the actual costs of purchasing drugs for outpatient use. Results. Current regulations do not determine the place of use of drugs under the conditions of medical care. Criteria for classifying drugs as drugs for outpatient use are proposed. The highest drug costs for outpatient cancer patients are for the treatment of breast cancer, melanoma, kidney cancer and ovarian cancer. Conclusions. Calculating the cost of drug treatment for patients with cancer in an outpatient setting based on standards of care does not reflect the true need for treatment based on clinical guidelines.

Abstract C130: Evaluation of key performance indicators of a community-focused patient navigation program in an outpatient cancer center

Abstract Background: In 2021, Dana-Farber Cancer Institute’s (DFCI) Cancer Care Equity Program (CCEP) implemented a Community-Focused Patient Navigation (CFPN) program to support adult medical oncology patients from historically marginalized groups by proactively identifying and addressing patients’ barriers to cancer treatment. The program has been sequentially implemented in five cancer treatment centers, gastrointestinal, breast, thoracic, and gynecologic oncology and hematologic malignancies with plans to expand further. The purpose of this analysis is to evaluate CFPN against key performance indicators (KPIs) in gastrointestinal oncology, where the program was implemented first. Methods: Patients included in the analysis met CFPN eligibility criteria: adult medical oncology patients from zip codes in the Greater Boston area with significant socio-economic disparities and who agreed to receive support from the patient navigator. Program KPIs included in the analysis were appointment no show rate, New Patient Intake Questionnaire (NPIQ) response rate, and social work encounter rate. A pre- post analysis was used to identify trends in the KPIs of interest among navigated patients from the start of the program in October 2021 through May 2024 compared to similar groups of patients seen one year prior to the launch of the program who would have met CFPN eligibility criteria if the program had existed at that time. The data were taken from the cancer center’s electronic medical record system and visualized in a dashboard. Results: Preliminary findings show a significant decrease in appointment no show rate from 4.07% to 2.29% (p<0.05) and an increase in NPIQ response rate from 20.97% to 34.74% (p<0.05) among all navigated patients after the program was implemented compared to one year prior to the program launch. While not statistically significant, there was an increase from 28.23% to 43.16% in the social work encounter rate for patients engaged with the patient navigator. Conclusion: Preliminary analysis of CFPN demonstrates a positive trend toward meeting KPIs in gastrointestinal oncology and reveals outcomes that will guide further quantitative and qualitative analysis to identify areas of programmatic success and improvement. Next steps include conducting a more in-depth quantitative analysis on additional KPIs, including patient retention rate, stratified by demographics. CCEP also plans to conduct a qualitative analysis to identify patient and care team perceptions of CFPN through focus groups and/or structured interviews. An abstract describing CFPN program design was accepted for online publication at ASCO. This project was undertaken as a Quality Improvement Initiative at DFCI, and as such was not formally supervised by the Institutional Review Board per policy. Citation Format: Sarah Pohl, Emma Green, Katherine Miller, Ludmila Svoboda, Magnolia Contreras, Christopher Lathan. Evaluation of key performance indicators of a community-focused patient navigation program in an outpatient cancer center [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C130.

Malnutrition Diagnosis Among Cancer Outpatients Using Malnutrition Universal Screening Tool in Nyeri County Referral Hospital, Kenya

Cancer burden remain unacceptably high with global incidence of 19.3 Million and 10million cancer mortalities according to the 2020 global cancer estimates. There has been notable improvement in cancer care in Kenya but malnutrition in cancer patients remain highly under-recognised and the malnutrition screening tools remain under-utilised especially in Nyeri county. The main objective of this study was to determine the malnutrition risk among the cancer outpatients attending Nyeri County Referral Hospital using Malnutrition Universal Screening Tool using analytical cross-sectional study design. Sixty one percent of the respondents were female while 39% were male. Breast cancer was the most common cancer type in the population (39%), followed by esophageal and throat cancer at 14.5% and gastric cancer at 14%. Prostate cancer was the most prevalent among the male respondents at 11%. Using the MUST, more than half (51.7%) of the respondents were at a high risk of developing malnutrition, followed by low risk (32.6%) with only 15.7% respondents being at a medium risk of malnutrition. Using the BMI, half of the respondents, (50%) had a normal nutrition status and only 19.8% respondents were underweight. There is a significant difference between classifying nutrition status of cancer patients using BMI and Malnutrition Universal Screening Tool (P<0.05). Malnutrition Universal Screening tool is easy to use and has the ability to identify the risk of malnutrition among cancer patients and can be adopted in cancer care to improve cancer prognosis and reduce malnutrition rates among cancer patients.

Risk of significant functional impairment across cancer diagnosis and care continuum

ABSTRACTBackgroundThe authors examined baseline physical functional (PF) impairment among cancer outpatients in the National Cancer Institute Cancer Moonshot study Northwestern University Improving the Management of Symptoms During and Following Cancer Treatment (NU IMPACT). They hypothesized that PF impairment, measured with the Patient Reported Outcome Measurement Information System–Physical Function (PROMIS‐PF) survey, would (1) be common and more prevalent for patients receiving treatment compared with no treatment and (2) differ across tumor types, independent of cancer continuum phase.MethodsAdults who were diagnosed with cancer in NU IMPACT (n = 2273) were sampled, and their PROMIS‐PF scores were compared across tumor types and cancer continuum (curative, noncurative, or no treatment), with scores ≤40 indicating moderate–severe impairment. Multivariable logistic regression models were used to evaluate the relation among patient and cancer factors and PF scores using a 95% confidence interval.ResultsForty percent of the surveyed patients reported moderate–severe PF impairment. Patients with melanoma reported the least impairment, and those with lung cancer were 6.5 times more likely to have moderate–severe impairment (95% confidence interval, 2.393–17.769). The noncurative group was 1.5 times more likely to have moderate–severe impairment (95% confidence interval, 1.045–2.145; mean score, 43; p < .001) than the curative (mean score, 6) and no treatment (mean score, 48) groups. One‐third of those who reported PF impairment also had significant pain and/or fatigue.ConclusionsA sizeable minority experienced PF impairment across tumor types for which pain and/or fatigue co‐occurred, particularly in the noncurative group. The PROMIS‐PF survey effectively identified variations in physical function. Future studies will explore how screening for PF impairment can be used to refer patients for appropriate cancer rehabilitation services.

Development and psychometric evaluation of the self-care of informal caregivers inventory

BackgroundIn recent years, a growing body of literature on informal caregivers’ health and well-being has emerged, highlighting the need for a tool to measure their self-care practices. ObjectiveThe aim of the study was to develop a theory-based instrument measuring the self-care behaviors of informal caregivers and test its psychometric properties. DesignThe initial phase of instrument development entailed a detailed, six-step process (conceptualization, theoretical adaptation, back-translation and cultural adaptation, cognitive interviewing, item enhancement, and content validity), followed by formal psychometric testing (participant engagement, validity, internal consistency reliability, test-retest reliability). SettingStudy conducted at a hospital located in Tehran, Iran. ParticipantsA sample of 234 informal caregivers of cancer outpatients receiving treatment in oncology wards was enrolled. Caregivers had to be 18 years or older, recognized as the primary caregiver by the patient, and willing to provide informed consent. MethodsThe Self-Care of Informal Caregivers Inventory items comprise three dimensions: self-care maintenance (11 items), self-care monitoring (7 items), and self-care management (9 items), which achieved a content validity index rating of 100 % in a panel of experts. Data were collected from caregivers during routine clinic visits. Construct validity was verified through exploratory structural equation modelling and reliability was verified using Cronbach's α and multidimensional model-based reliability. Test-retest reliability was evaluated using the Intraclass Correlation Coefficient. ResultsAll three dimensions showed good model fit indices (self-care maintenance: Comparative Fit Index = 1.00, Tucker-Lewis Index = 0.99, Root Mean Square Error of Approximation = 0.044; self-care monitoring: Comparative Fit Index = 1.00, Tucker-Lewis Index = 1.00, Root Mean Square Error of Approximation = 0.027; self-care management: Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.99, Root Mean Square Error of Approximation = 0.048) and Cronbach's α of 0.88, 0.88, and 0.91, respectively. The overall multidimensional model-based reliability was 0.93. The Intraclass Correlation Coefficient values for the three dimensions were 0.94, 0.60, and 0.51, respectively. ConclusionPreliminary testing provides support for use of the Self-Care of Informal Caregivers Inventory in research. Using this theory-based instrument to assess the self-care practices of informal caregivers can assist in identifying topics to discuss and opportunities for guidance. Tweetable AbstractThe Self-Care of Informal Caregivers Inventory: A validated tool for informal caregivers is useful for research. #Informalcaregivers #SelfCare

Editorial Comment on “Effect of Private Equity Ownership on Access to Outpatient Urologic Cancer Care in Medicare Recipients”

Editorial Comment on “Effect of Private Equity Ownership on Access to Outpatient Urologic Cancer Care in Medicare Recipients”

The handling of hazardous medications by nurses and midwives: A retrospective cohort study

BackgroundOccupational exposure of healthcare workers to hazardous medications can be potentially harmful. Hazardous medications can be carcinogenic, developmentally toxic, reproductively toxic, genotoxic and/or toxic to organs at low doses. These hazardous medications can be used in many healthcare settings, but published research of occupational exposure has focused almost exclusively on cancer services. AimTo identify the healthcare settings where nurses and midwives are responsible for the administration of hazardous medications. MethodA retrospective cohort study was undertaken of all medication administration events occurring during a two-week period at a public metropolitan health service in 2023. All medication administration events from six hospital sites were identified using the electronic (Oracle Health-Cerner-Millennium®) and paper (Chemotherapy Chart) medication administration records. From all of the medications administered, the subset of medications classified as hazardous were identified based on the Victorian Therapeutics Advisory Group Framework for Handling of Hazardous Medicines (2021) and other guidelines. Poisson regression modelling was used to explore associations between the number of hazardous medications and the healthcare area where they were administered (p < 0.001). ResultsOf the 121,567 administration events, 6054 (5.0 %) involved hazardous medications. The healthcare areas with the highest rate of hazardous medication administration events, as a proportion of all medication administration events, were outpatient cancer service (301/695, 43.3 %), birth suite (13/86, 15.1 %) and mental health (404/4011, 10.1 %) areas. During the two-week period, 6054 hazardous medication administration events occurred, involving 117 different medications. The greatest number of these events took place in the medical (1729/6054, 28.6 %) and geriatric (1579/6054, 26.1 %) inpatient healthcare areas. A total of 1258 nurses and midwives were directly involved in either administering, or checking and witnessing the administration of hazardous medications to 996 patients (25.2 % of the total 3958 patients). Most hazardous medications administered to patients were in an oral dosage form (5426/6054, 89.6 %). ConclusionHazardous medications were administered in all healthcare areas, with the exception of endoscopy services. Nurses and midwives were at risk of occupational exposure from hazardous medications.

Experience of organizing BCG therapy for localized bladder cancer in outpatient cancer care centers

Experience of organizing BCG therapy for localized bladder cancer in outpatient cancer care centers

Venous thromboembolism prevention program implementation in a community oncology practice: a cohort study

While national guidelines recommend Venous Thromboembolism (VTE) risk assessment in cancer outpatients and consideration of pharmacologic prophylaxis in high-risk patients, prophylaxis rates are low in community oncology practices. A successful model for guideline implementation (the Vermont Model, VM) is validated in an academic tertiary oncology setting. We undertook an implementation study to determine the success of this model in a multi-site community oncology practice. The study objectives were to: 1) adapt the VM to the community practice setting; 2) implement the adapted VM into practice; and 3) evaluate clinical and implementation outcomes. The study was carried out in three phases: (1) Pre-implementation, a multidisciplinary team addressed the need to adapt the VM to the local context including electronic medical record (EMR) optimisation and clinician education; (2) implementation of the strategies adapted to the local context, informed by VM and adapted based on stakeholder feedback; (3) prospective evaluation of clinical and implementation outcomes at six months after implementation. Following creation of a comprehensive initiation roadmap for the adaptation of VM program to the community practice, 302 cancer outpatients initiating new treatment met inclusion criteria over a 6 month implementation period. VTE risk education was provided to 100% of patients, and 98% (296) of patients received a VTE risk assessment. Of 52 patients (18%) who scored as high risk based on a modified Khorana (Protecht) score, 14 (27%) initiated prophylaxis. Barriers to program adaptation included EMR optimization challenges and practice-level responsibility assignment, time constraints, concern about potential drug interactions, and financial & insurance issues. Implementation of a multidisciplinary VTE prevention model in the community-based oncology setting successfully increased VTE education and risk assessment rates. AC prophylaxis rates were modestly increased, highlighting the need to understand and address barriers to anticoagulant prophylaxis prescribing in this setting. Northern New England Clinical Oncology Society Research Funding Program.

Body image discontentment among head and neck cancer patients in Visakhapatnam district: An empirical study

Head and neck cancers, which comprise tumours of the oral cavity, throat, nasal cavity, and thyroid, pose substantial physical and psychological issues. These tumours frequently require harsh therapies such as surgery, radiation therapy, and chemotherapy, which can result in apparent changes in appearance and physical function. As a result, patients are frequently subjected to body image distress, low self-esteem, and overall unhealthy psychological well-being. This study aims to investigate head and neck cancer patients' self-perceptions and body image problems, with an emphasis on feelings of self-consciousness, physical attractiveness, and general body dissatisfaction amongst head and neck cancer out patients undergoing treatment in HCG cancer hospital in Visakhapatnam. This study was conducted on 50 head and neck cancer outpatients undergoing treatment at an oncology centre Healthcare Global Enterprises ltd (HCG) hospital Visakhapatnam during the period of (May 2023 to June 2023) who were willing to participate in the study and were 20 years of age and above. An interview schedule was prepared by the researcher and administered to the patients comprising section A (questions pertaining to the demographic and clinical details of the patient), section B (modified 6 item Body Image Scale). Majority of the patients were male (62%) while female constituted 38% with the majority aged between 20- 39 years (61%) and the most common cancer being that of oral cavity (58%). The findings reveal a sizable proportion of respondents reporting feeling self-conscious and less physically attractive as a result of their sickness or treatment. Many individuals are dissatisfied with their appearance and overall body image, with a significant percentage reporting that these issues interfere with their social relationships and sense of wholeness. These findings highlight the need of addressing psychological and emotional support in the treatment and care of head and neck cancer patients. Integrating mental health and body image counselling into cancer treatment programmes has the potential to greatly improve patients' overall well-being and quality of life.