Cancer Outpatients Research Articles

NUTRISCORE Compared to NRS-2002 for Detection of Malnutrition in Hospitalized Cancer Patients; A Cross Sectional Study

The most commonly recommended screening test for determining the nutritional status of hospitalized cancer patients is Nutrition Risk Screening-2002 (NRS-2002). NUTRISCORE, on the other hand, is an outpatient cancer patient-specific nutritional screening test that is easier to administer than NRS-2002 and queries tumor location and treatment information received from the patient. We aimed to investigate the validity of NUTRISCORE, in hospitalized cancer patients. In total, 112 patients were enrolled in this study. The NRS 2002 and NUTRISCORE screening tests were performed. The data obtained with NUTRISCORE were compared to the reference test NRS-2002 using the κ test and ROC curve analysis. The NRS-2002 identified 45.5% of patients as being at risk of malnutrition, while the NUTRISCORE test identified 48.2% (k = 0.516, p < 0.005). The AUC value was 0.759 (95% CI:0.67-0.85) as shown in the ROC analysis. Using the NRS-2002 as a reference test, the sensitivity (S), specificity (SP), Positive Predictive (PPD), and Negative Predictive (NPD) values for the NUTRISCORE test were 76.5% (95% CI:63.7-86.6), 75.4% (95.CI:63.7–85), 72.2% (95% CI:59.4–83), 79%, (95% CI:67.7-88.3) respectively. NUTRISCORE can be used for screening of malnutrition in hospitalized cancer patients.

Stressors related to the COVID-19 pandemic and their association with distress, depressive, and anxiety symptoms in cancer out-patients.

Patients with cancer might be particularly prone to stress caused by the COVID-19 pandemic. The aim of this study was to investigate the impact of pandemic-related stressors on oncological patients' psychological well-being. During the second wave of the COVID-19 pandemic in Germany 122 cancer out-patients of the Comprehensive Cancer Center Munich reported on COVID-19-related stressors (information satisfaction, threat perception, and fear of disease deterioration) and answered standardized questionnaires for psychosocial distress (DT) as well as depression and anxiety symptoms (PHQ-2, GAD-2). Multiple linear regression analyses were used to identify associations of the COVID-19-related stressors with psychological symptoms, controlling for sociodemographic, psychological (self-efficacy, ASKU) and clinical (somatic symptom burden, SSS-8) variables. Initially, satisfaction with information was significantly negatively associated with all three outcome variables. Fear of disease deterioration was associated with distress and depressive symptoms. After controlling for additional variables, only satisfaction with information remained an independent determinant of anxiety (β = -0.35, p < 0.001). All three outcomes were most strongly determined by somatic symptom burden (β ≥ 0.40, p < 0.001). The results of this study tentatively suggest that physical well-being overrides the relevance of some COVID-19-related stressors for oncological patients' psychological wellbeing. Physical symptoms are strongly tied to personal wellbeing as they are associated with suffering from cancer, which might be more central to personal wellbeing than the possibility of getting infected with SARS-CoV-2. However, satisfaction with the information received seems to be important beyond physical wellbeing, as this emerged as an independent determinant of anxiety.

MT26 Evaluating the Impact of Digital Proms Collection in an Outpatient Breast Cancer Clinic: A Feasibility Pilot

The benefits of patient-reported outcomes measures (PROMs) to guide patient care during cancer treatment is well-established. Paper-based PROMs are now increasingly collected electronically. The study aimed to evaluate PROMs completion rates and operational efficiencies using a novel digital health platform.

Newly diagnosed lung cancer in hospitalized patients during the COVID-19 pandemic: How well are LDCTs utilized?

10624 Background: Medicare covers the cost of lung cancer screening in individuals aged 50-77 years with a high-risk smoking history. The COVID-19 pandemic caused a decrease in outpatient visits and cancer screenings. The objective of this study was to provide a comparison between the multitude of lung cancer diagnoses upon presentation to the hospital predating and during the COVID-19 pandemic in patients with varying insurance types. Methods: We retrospectively reviewed fifteen hospitals in West Florida with newly diagnosed lung cancer during the pre-pandemic period from March 2019-August 2020 and the pandemic period from March 2020- August 2021. These patients were split into subcategories based on insurance type: private medical insurance; Medicare; Medicaid; no insurance; and other. The chi-square test was used for statistical analysis. Results: A total of 1409 inpatients, 676 during the pre-pandemic and 733 during the pandemic, were identified with a new diagnosis of lung cancer upon presentation to the hospital. 74% of the pandemic population and 77% of the pre-pandemic population were patients insured with Medicare. Hospitals without LDCT screening programs were found to have 317 lung cancer diagnoses during the pre-pandemic period and 292 during the pandemic period. Hospitals with LDCT screening programs were found to have 359 lung cancer diagnoses during the pre-pandemic period and 441 during the pandemic period. Chi-square tests comparing pre-pandemic to pandemic did not show a p-value of statistical significance. Conclusions: A substantial number of patients with Medicare were newly diagnosed with lung cancer during the pre-pandemic and pandemic periods compared to patients with other insurance types. Although Medicare provides LDCT screening for lung cancer in high-risk populations at no out-of-pocket cost, about 75% of West Florida’s patients were diagnosed with lung-cancer upon presentation to the hospital. Hospitals with LDCT screening programs had an increase in cancer diagnoses during the pandemic, consistent with prior research data. Instead, the pandemic did not seem to affect hospitals without LDCT screening programs. We need to address the barriers in implementation of LDCT hospital-based screening programs to increase early diagnoses and decrease hospitalization diagnoses, leading to improved lung cancer mortality. [Table: see text]

Abstract 67: Perceived Factors for Late Diagnosis in Women With Advanced Breast Cancer in Northern Tanzania

Abstract Purpose: In Tanzania, women often present with advanced stage breast cancer leading to treatment delays and poor outcomes. Factors influencing late hospital presentation of breast cancer have not been investigated. In this study, we aimed to explore patient perception of factors contributing to the late diagnosis of breast cancer. Methods: Women diagnosed with late- stage breast cancer in an outpatient cancer care center were identified by clinic nurses and recruited for study participation. Semi-structured interviews were conducted by a single proctor. Interviews were recorded, transcribed verbatim, and coded by three independent reviewers using NVivo 12. Themes were identified using a grounded theory approach. Results: Twenty patients (10 rural and 10 urban) participated in the interviews. The average age was 56; 11 (55%) completed primary education, 10 (50%) were unemployed, and 5 (25%) were married. Fourteen (70 %) of the patients had stage 4 breast cancer, 3 (15%) had stage 3, and 3 (15%) had stage 2. Nineteen (95%) of our respondents misunderstood the etiology of breast cancer as well as its causes, signs, and symptoms. Misconceptions led to experiences of stigma in 19 (95%) participants. One participant stated: “…I failed to tell people because… once I tell them that I have problem they will start to run away from me and even if you ask for assistance they think that I cannot pay them back because they think they might help me today and I die tomorrow before I pay them back…” Fifteen (75%) of the participants experienced rejection from their partners. Thirteen (65%) participants expressed financial concerns and eighteen (90%) participants were initially treated by a traditional healer, both of which lead to delays in hospital presentation. Conclusion: Lack of knowledge about breast cancer among patients, societal stigma, lack of spousal support, financial barriers, and initial treatment by traditional healers all contribute to delays in diagnosis and treatment of breast cancer in Northern Tanzania. Stigma reduction and educational interventions may reduce these delays, and further research is needed to improve access to cancer care in this population. Citation Format: Elizabeth Msoka-Bright, Mackenzie Abraham, Polina Zmijewski, Furaha Serventi, Perry Cyril, Brenda Kitali, Vivian Saria, Jackline Kwayu, Adelide Kavishe, Gileard Masenga, Blandina Mmbaga, Lily Gutnik. Perceived Factors for Late Diagnosis in Women With Advanced Breast Cancer in Northern Tanzania [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 67.

Do external factors such as weather affect patient reported outcomes of patients with malignant diseases?

e18715 Background: The QLQ-C30 is one of the most widely used patient-reported outcome (PRO) instrument to assess health-related quality of life in cancer patients developed by the European Organization for Research and Treatment of Cancer (EORTC). Even if only little scientific evidence is published on this topic, patients often report that their emotional and physical state varies depending on climatic conditions. To enhance the understanding of quality of life in cancer patients, this study analyzed whether external factors like weather data and season can influence PRO measures and cancer patients’ well-being. Methods: Over a period of 12 months data was obtained from inpatient and outpatient cancer patients in two German cancer centers using the QLQ-C30. Items were assigned to five functional scales, three symptom scales, a global health status/QoL scale, and a number of single items assessing symptoms commonly reported by cancer patients.Patients were approached by their medical oncologist or nursing staff to complete the questionnaire anonymously once or multiple times. QoL data were linked to weather factors including temperature, hours of sunshine and season. Results: We received a total of n = 5040 responses (54 % male). Regarding global health status/QoL, the best result was recorded at 25 - 30 degrees, and the lowest value was measured at 5 - 10 degrees (mean 61.3 vs. 52.6, p &lt; 0.001). Insomnia was most pronounced at &lt; = 0 degrees and least present at 25 – 30 degrees (mean 39.3 vs. 29.5, p &lt; 0.001). Overall, best scores were obtained at 25 – 30 degrees, whereas quality of life and symptom burden were worst at 5 – 10 degrees. Global health/QoL was highest at 8 hours of sunshine and lowest at 0 hours of sunshine (mean 56.9 vs. 50.9, p .003). Global health/QoL was lower in winter months than in summer (mean 53.8 vs. 57.4, p &lt; 0.001) presenting highest scores in June and July. Conclusions: The findings of our study indicate that quality of life in cancer patients as well as PROs can be influenced systematically by external factors like season or weather conditions. This could possibly also be of importance when interpreting the results of studies that use standardized instruments to assess health-related quality of life in cancer patients -e.g., if the questionnaires were only answered in certain month (summer/winter) or under external conditions that were not evenly distributed.

A new anticoagulant strategy: the factor XI inhibitors

In the last 10 years the introduction of the direct oral anticoagulants (DOACs) has revolutionized the anticoagulant treatment, one of the cornerstones of the therapy for cardiovascular diseases. Thanks to their efficacy at least not inferior compared to vitamin K antagonists and their better safety profile, particularly with regard to intracranial bleeding, DOACs are now the first choice for the prevention of cardioembolism in patients with non-valvular atrial fibrillation and for the treatment of venous thromboembolism (VTE). Other areas of clinical use for DOACs include the prevention of VTE in orthopedic and oncology surgery and in outpatient cancer patients treated with anticancer therapy, or the use of low-dose in association with aspirin in patients with coronary or peripheral artery disease.An increased risk of gastrointestinal bleeding has been reported for some DOACs. In addition, DOACs have also experienced some failures including stroke prevention in patients with mechanical prosthetic valves or rheumatic diseases and VTE therapy in patients with antiphospholipid antibody syndrome. Also, no data are available on DOACs in some particular areas, including severe renal impairment and thrombocytopenia.In recent years, the clinical use of factor XI and factor XII inhibitors has been proposed. Currently, factor XI inhibitors have more clinical data than factor XII inhibitors. This article will report the rationale for the clinical use and the main evidences currently available on factor XI inhibitors.

Virtual nutrition services in oncology.

e13504 Background: In 2016, the National Academy of Sciences, Engineering and Medicine convened a workshop to examine challenges patients experience accessing specialized nutrition care in outpatient cancer treatment settings. Inadequate Registered Dietitian Nutritionist (RDN) staffing and reimbursement were identified as barriers to timely care. Staffing challenges at our three destination community cancer centers led to a backlogged queue of nutrition consults resulting in a ≥ 4-week wait time for an appointment. A quality improvement project to address delays in care for patients at risk for malnutrition, resulted in implementation of a hybrid model utilizing remote RDNs to provide virtual Medical Nutrition Therapy (MNT) to supplement onsite RDNs. Methods: After approved in June 2022, two remote RDNs were hired to provide virtual patient care. Nationwide recruitment allowed for hiring rare talent. A project team was created to assure we followed all regulatory guidelines related to licensing and billing. RDNs were individually licensed in 14 states to cover where ≥ 70% of our patients reside. System-wide criteria and licensure alerts for appointments were established between scheduling and nutrition leaders. The first patients were seen virtually on October 14, 2022, with units of service (uos) logged in 15-minute increments. Results: Appointments were tracked from October 14, 2022, through February 3, 2023. 69.2% of 302 scheduled appointments were successfully delivered virtually via telehealth platform with a mean of 1.7 uos. The main reasons for nonuse of the platform were no shows (52.7%) and the need to convert to a phone call (32.3%). The mean uos was significantly higher in new patients compared to returning patients (2.23 versus 1.53; p&lt;0.001). Conclusions: A hybrid model of onsite and virtual care RDNs has potential to improve access to nutrition care. New patient appointments averaged &gt; 30 minutes, and follow-ups averaged &lt; 30 minutes. This may help inform future scheduling of virtual MNT appointments. This model may allow for recruitment from a wider pool of RDNs. It may also help avoid delays in care for patients at risk for malnutrition and gaps in their cancer treatment. [Table: see text]

Impact of COVID-19 pandemic on lung cancer diagnosis in a community hospital.

e18634 Background: Coronavirus disease 2019 (COVID 19) pandemic saw its first case in the United States in 2020. Although lung imaging for COVID-19 patients theoretically increased chances of detecting cancerous lung nodules, strict quarantine measures disrupting routine cancer screening was a concern. Real-world data on lung cancer diagnosis during the pandemic at community level is less known. Methods: We conducted a retrospective chart review on patients newly diagnosed of lung cancer from 2018- 2022 in our community hospital. Demographic details, year of diagnosis, type and stage of cancer, inpatient or outpatient diagnosis and mode of diagnosis (surveillance, incidental or symptomatic) was noted. Descriptive analysis of the above parameters was conducted across three eras- 2018 and 2019 as pre-COVID era (PreCo), 2020 and 2021 as COVID era (Cov) and 2022 as post-COVID era (PosCo) irrespective of COVID-19 diagnosis. Results: Out of 287 patients included, 40% (116) were diagnosed during PreCo, 27.5% (79) during Cov and 32% (92) during PosCo. In the PreCo, 16% (19) were incidentally detected, 21% (24) were ISym, 48% (56) on surveillance, and 15% (17) were OSym. In Cov, 13.9% (11) were incidentally detected, 53.3% (42) were ISym 13.9% (11) on surveillance, and 18.9% (15) were OSym. In PosCo, 11.3% (11) were incidentally detected, 19% (18) were ISym, 44% (41) on surveillance, and 24% (22) were OSym. Stage IV cancers among new lung cancer diagnoses were noted to be highest in PosCo (43.4%) followed by PreCo (31.9%) and Cov (26.6%). Conclusions: Cov saw a decrease in the annual rate of new lung cancer diagnosis compared to PreCo likely secondary to reduced routine screening. A staggering increase in new and stage IV cancers were noted in PosCo which could stem from missed screening as well as rapid progression of undiagnosed cancers during the pandemic. In Cov, there was a dramatic increase in symptomatic inpatient lung cancer cases (53.3%) as symptoms of COVID-19 and lung cancer overlap. Comparable rates of cancer diagnosis via surveillance in PosCo (44%) and PreCo (48%) hints at possible restoration of access to outpatient cancer care. [Table: see text]

The broader impact of specialized outpatient cancer rehabilitation on health and quality of life among breast cancer survivors.

e18881 Background: After diagnosis and treatment, women with cancer often experience significant functional decline from which most do not recover. Functional deficits, especially when persistent, are related to poorer health and quality of life (QOL). Interventions to mitigate declines in function, health and QOL are necessary given their known associations with morbidity and mortality yet are understudied and underutilized. While there is evidence supporting cancer rehabilitation’s (Physical or Occupational therapy, PT/OT) ability to improve physical function and upper extremity disability among breast cancer survivors (BCS), the impact of cancer PT or OT on health and QOL is unknown. To understand this broader impact, we examined the rehabilitation needs and outcomes of BCS who attended specialized, community-based cancer PT/OT. Methods: In this retrospective study, we extracted case characteristics and patient-reported outcomes (PRO) measures of health, function and QOL from a national sample of BCS who attended cancer-specialized outpatient PT or OT. We examined ICD-10 codes to identify rehabilitation needs. PROs collected at baseline and discharge from rehabilitation included: Patient Reported Outcome Measuring System (PROMIS) global physical health, global mental health, physical function, and ability to participate in social roles and activities. To examine change from baseline to discharge we used paired t-tests ( p&lt; .05) and calculated effect size (Cohen’s d). Results: PT/OT patients (N = 2,706; PT, n = 2,245; OT, n = 461) were 99.6% female, 58.33±12.50 years old and attended approximately 10 (IQR: 7.0 – 17.0) sessions. Needs included: muscle atrophy, weakness or ataxia (PT: 44%, OT: 32%); lymphedema (PT: 40%, OT: 56%); upper extremity impairment (PT: 44%, OT: 28%); pain (PT: 44%, OT: 25%); and scar tissue or fibrosis (PT: 15%, OT: 16%). At discharge, all health, function and QOL-related outcomes improved significantly (p &lt; .001) in both PT and OT. Specifically, significant gains in PROMIS global physical health (PT: M∆ = 3.56±7.21, d= 0.49; OT: M∆ = 2.26±7.03, d= 0.32), global mental health (PT: M∆ = 2.01±6.91, d= 0.29; OT: M∆ = 1.34±7.20, d= 0.19), physical function (PT: M∆ = 2.81±7.45, d= .38, M∆ = 1.91±7.39, d= .26), and participation in social roles &amp; activities (PT: M∆ = 3.24±9.09, d= .36; OT: M∆ = 1.91±8.41, d= .23) were observed. Conclusions: BCS presented to community-based outpatient rehabilitation with a variety of needs yet, despite this variety, demonstrated significant improvement in self-perceived health, physical function and QOL. Significant gains were reported for both PT and OT interventions. For providers working with BCS, these results can be used to increase awareness of the role of cancer rehabilitation and support referral to these services. Future research should evaluate the impact of specialized PT/OT on individuals with other cancer types.

Investigation of Oral Mucositis Incidence and Risk Factors in Patients Receiving Chemotherapy

Abstract&#x0D; Purpose: Oral mucositis is a common complication of cancer treatment that may negatively impact the patient’s cancer treatment outcome. This study was done to determine the incidence of oral mucositis development and risk factors in patients receiving chemotherapy. &#x0D; Material and Methods: This prospective cohort study included 150 participants undergoing outpatient cancer chemotherapy. To determine the development of oral mucositis, the participants were evaluated for the first course of chemotherapy (day 0) and the next course of chemotherapy treatment (day 14). ‘Patient Information Form’ and the World Health Organization’ Mucositis Grading Scale’ were used to collect data for the study. Descriptive statistics, chi-squared test, and logistic regression were used to analyze the results. &#x0D; Results: According to oral mucosal assessment, incidence of oral mucositis was 27.3%. The mean onset and the mean recovery of oral mucositis were 4.16 ± 2.13 days and 8.72 ± 2.32 days. The most common oral problems were mouth dryness (53.3%), dental caries (44%), and decreased sense of taste (32%). In the oral mucosal assessment performed on the 14th day, 9 patients were found to be grade 1. Patients with a history of mucositis (OR = 5.76, Cl = 2.33–14.24, p = 0.00) showed a significantly higher incidence of oral mucositis. &#x0D; Conclusion: In this study, the incidence of oral mucositis and risk factors that may affect the development of oral mucositis in patients receiving chemotherapy were investigated. Mucositis history was found as a risk factor in oral mucositis development. Early recovery of oral mucositis after chemotherapy was observed. Therefore, patients should be followed up in the early period after chemotherapy.

Does Geography Play a Role in the Receipt of End-of-Life Care for Advanced Cancer Patients? Evidence from an Australian Local Health District Population-Based Study.

Objectives: To assess the influence of geographic remoteness on health care utilization at end of life (EOL) by people with advanced cancer in a geographically diverse Australian local health district, using two objective measures of rurality and travel-time estimations to health care facilities. Methods: This retrospective cohort study examined the association between rurality (using the Modified Monash Model) and travel-time estimation, and demographic and clinical factors, with the receipt of >1 inpatient and outpatient health service in the last year of life in multivariate models. The study cohort comprised of 3546 patients with cancer, aged ≥18 years, who died in a public hospital between 2015 and 2019. Results: Compared with decedents from metropolitan areas, decedents from some rural areas had higher rates of emergency department visits (small rural towns: aRR 1.29, 95% CI: 1.07-1.57) and ICU admissions (large rural towns: aRR 1.32, 95% CI: 1.03-1.69), but lower rates of acute hospital admissions (large rural towns: aRR 0.83, 95% CI: 0.76-0.90), inpatient palliative care (PC) (regional centers: aRR 0.85, 95% CI: 0.75-0.97), and inpatient radiotherapy (lowest in small rural towns: aRR 0.07, 95% CI: 0.03-0.18). Decedents from rural and regional centers had lower rates of outpatient chemotherapy and radiotherapy use, yet higher rates of outpatient cancer service utilization (p < 0.05). Shorter travel times (10-<30 minutes) were associated with higher rates of inpatient specialist PC (aRR 1.48, 95% CI: 1.09-1.98). Conclusions: Reporting on a series of inpatient and outpatient services used in the last year of life, measures of rurality and travel-time estimates can be useful tools to estimate geographic variation in EOL cancer care provision, with significant gaps uncovered in inpatient PC and outpatient service utilization in rural areas. Policies aimed at redistributing EOL resources in rural and regional communities to reduce travel times to health care facilities could help to reduce regional disparities and ensure equitable access to EOL care services.

Retrospective study on the efficacy and tolerability of dose modification of PD-1 and PD-L1 inhibitors in hospital-system community outpatient cancer clinics.

Anti-programmed cell death (PD)-1 and anti-PD-L1 medications inhibit the PD-1 and PD-L1 interaction and have been shown to be effective in treating several forms of advanced cancers. Since the approval of these agents, standard dosing protocols have been utilized. However, a small population of patients in the community setting has received dose-modified PD-1 and PD-L1 inhibitors secondary to a lack of tolerability. Data from this study suggests possible benefit with different dosing strategies. The purpose of this retrospective study is to assess the efficacy and tolerability in terms of time to progression and adverse effects in patients receiving dose-modified PD-1 and PD-L1 inhibitors in Food and Drug Administration (FDA)-labeled indications. This single-institution retrospective chart review was conducted in an outpatient community setting on patients with cancer that received nivolumab, pembrolizumab, durvalumab, or atezolizumab for an FDA indication at one of the Houston Methodist Hospital infusion clinic site between September 1, 2017 and September 30, 2019. Data collection included demographics, adverse effects, dosing, treatment delay, and number of immunotherapy cycles administered per patient. This study included 221 patients, who received either nivolumab (n = 81), pembrolizumab (n = 93), atezolizumab (n = 21), or durvalumab (n = 26). There were 11 patients who experienced a dose reduction and 103 patients who experienced a treatment delay. Of the patients with a treatment delay, the median time to progression was 197 days, and for patients with a dose reduction, the median time to progression was 299 days. The results of this study found that the immunotherapy associated adverse effects led to dosing and frequency changes for tolerance with continued therapy. Our data suggests that there could be potential benefits of dose modifications to immunotherapy treatment, but further large studies are needed to assess the efficacy of specific immunotherapy dose modifications on both outcomes and adverse effects.

Potentially Avoidable Admissions and Prolonged Hospitalization in Patients with Suspected Colon Cancer.

Suspicion of cancer in the Emergency Department (ED) may lead to potentially avoidable and prolonged admissions. We aimed to examine the reasons for potentially avoidable and prolonged hospitalizations after admissions from the ED for new colon cancer diagnoses (ED-dx). A retrospective, single-institution analysis was conducted of patients with ED-dx between 2017 and 2018. Defined criteria were used toidentify potentially avoidable admissions. Patients without avoidable admissions were examined for ideal length of stay (iLOS), using separate defined criteria. Prolonged length of stay (pLOS) was defined as actual length of stay (aLOS) being greater than 1 day longer than iLOS. Of 97 patients with ED-dx, 12% had potentially avoidable admissions, most often (58%) forcancer workup. Very little difference in demographic, tumor characteristics, or symptoms were found, except patients with potentially avoidable admissions were more functional (Eastern Cooperative Oncology Group [ECOG] score 0-1: 83% vs. 46%; p=0.049) and had longer symptom duration prior to ED presentation {24 days (interquartile range [IQR] 7-75) vs. 7 days (IQR 2-21)}. Among the 60patients who had necessary admissions but did not require urgent intervention, 78% hadpLOS, most often for non-urgent surgery (60%) and further oncologic workup. The median difference between iLOS and aLOS was 12 days (IQR 8-16) for pLOS. Potentially avoidable admissions following Ed-dx were uncommon but were mostly for oncologic workup. Once admitted, the majority of patients had pLOS, most often for definitive surgery and further oncologic workup. This suggests a lack of systems to safely transition to outpatient cancer management.

Evaluation of a short instrument for measuring health-related quality of life in oncological patients in routine care (HELP-6): an observational study.

Patient-reported outcomes have not been sufficiently implemented into the routine care of cancer patients because the existing instruments are often too long and complex or not cancer-specific. The aim of this study is the determination of psychometric properties and item reduction of a newly developed health-related quality of life (HrQoL) questionnaire for use in oncological clinical routines. This observational study with a repeated measurements design included oncological inpatients and outpatients. A total of 630 patients participated at the first point of measurement and 404 at the second point of measurement. To evaluate the instrument, we conducted hierarchical confirmative factor analyses and for further validation correlated the resulting factors with standardized and validated HrQoL measurements. Test-retest reliability and responsiveness to change were tested. The developed questionnaire "HELP-6" ("Hamburg Inventory for Measuring Quality of Life in Oncological Patients") has a six-factor structure and has moderate-to-good convergent validity (r= -0.25 --0.68). Test-retest reliability was moderate-to-good (r =0.56-0.81, p < 0.001). Indications for responsiveness to change were found for three dimensions. The final version of the questionnaire HELP-6 has six dimensions with one item each. With the HELP-6 instrument for measuring HrQoL in cancer patients, we provide a short and practical patient-reported outcome instrument. Though responsiveness to change could not be confirmed for all dimensions in this study, the HELP-6 includes time-efficient completion and evaluation and is informative in relevant HrQoL dimensions of cancer patients. Therefore, the HELP-6 poses an important addition to inpatient and outpatient routine cancer care. This study was registered at Open Science Framework (https://osf.io/y7xce/), on 9 June 2018.

Performance of a simplified nutrition screening tool for outpatient radiotherapy cancer patients.

Public hospitals in Thailand recently adopted a new nutrition screening tool to satisfy documentation requirements for reimbursements through the diagnosis-related group system. However, data on the performance of this instrument remains limited. This study was designed to assess the validity and cutoff points of the Society of Parenteral and Enteral Nutrition of Thailand (SPENT) nutrition screening tool against the patient-generated subjective global assessment (PG-SGA) and malnutrition diagnostic criteria proposed by the global leadership initiative on malnutrition (GLIM) in cancer patients receiving outpatient radiation therapy. A cross-sectional study of 350 patients was conducted from August 2018 to September 2020. All patients were screened for malnutrition using the SPENT nutrition screening tool. The instrument's sensitivity, specificity, positive predictive value, negative predictive value, and agreement were calculated using either the PG-SGA or GLIM malnutrition diagnosis as benchmarks. The cutoff that gave the highest sensitivity and specificity of the SPENT nutrition screening tool was selected. The mean age standard deviation of the 350 cancer patients was 59.9 (13.9) years, and 191 (54.6%) were men. Head and neck cancers were the most common type (35.7%). Against PG-SGA and GLIM malnutrition diagnosis, the SPENT nutrition screening tool demonstrated good sensitivity (85.3% and 82.8%), specificity (84.1% and 59.4%), positive predictive value (90.5% and 64.0%), negative predictive value (76.3% and 79.9%), with moderate strength of agreement (Cohen kappa 0.678, P < .001 and 0.414, P < .001). Using only the first 2 out of 4 questions revealed an acceptable sensitivity and specificity. The SPENT nutrition screening tool is an accurate, sensitive, and specific tool for malnutrition screening in cancer patients receiving outpatient radiotherapy.

Antiviral Prescribing Among Patients at an Ambulatory Cancer Center With Laboratory-Confirmed Influenza.

Among 133 cancer outpatients diagnosed with influenza between 2016 and 2018, 110 (83%) were prescribed oseltamivir. Among 109 with a known symptom onset date, 53% presented for care and 31% were prescribed oseltamivir within 48 hours. Patient/provider education and rapid diagnostics are needed to improve early oseltamivir use among cancer patients with influenza.

Chairside Yoga Therapy Alleviates Symptoms in Patients Concurrently Receiving Outpatient Cancer Infusions: A Promising Feasibility Study.

Purpose: To evaluate effectiveness of chairside yoga therapy on perceptions of fatigue, pain, nausea, anxiety, and distress among oncology patients concurrently receiving outpatient cancer infusion therapy. Design: This prospective pilot study used pre-/post-survey design in convenience sample of cancer patients in outpatient setting. Methods: Researchers developed and administered the Outpatient Cancer Symptom Assessment Scale (OCSAS) comprised of cancer- or treatment-related symptoms commonly reported in the oncology population (nausea, pain, fatigue, anxiety, and distress). Following IRB approval, symptoms were rated using Likert scale of 0 (not present) to 10 (severe) before and after chairside yoga therapy delivered concurrently with outpatient infusions. Qualitative data was collected related to patients' overall infusion experience. Findings: Participants (n = 82) reported positive patient experiences and statistically less pain (p < 0.001), fatigue (p < 0.001), anxiety (p < 0.001), and distress (p < 0.001) following the yoga intervention compared to baseline. Nausea was not significantly impacted by the yoga intervention. Conclusions: Yoga therapy received concurrently during outpatient cancer infusion is consistent with a holistic and integrative approach to care for the oncology population. Yoga therapy offers promise for reducing symptoms which negatively impact quality of life, including pain, fatigue, anxiety, and distress. Qualitative data suggests patients' overall infusion experience was enhanced with yoga therapy.

Holistic needs assessment in outpatient cancer care: a randomised controlled trial

DesignAnalyst blinded, parallel, multi-centre, randomised controlled trial (RCT).ParticipantsPeople with confirmed diagnoses of cancer (head and neck, skin or colorectal) attending follow-up consultation 3 months post-treatment between 2015 and 2020.InterventionHolistic needs...

Implementation of medication reconciliation in outpatient cancer care

BackgroundMedication reconciliation (MedRec) is a process where providers work with patients to document and communicate comprehensive medication information by creating a complete medication list (best possible medication history (BPMH)) then...