Outpatient Oncology Research Articles

Trend analysis of pharmacist involvement in cancer care in Japan from 2015 to 2020: A nationwide survey study on hospital pharmacy practice.

Pharmacists are needed as members of oncology teams. The Japanese Society of Hospital Pharmacists (JSHP) conducts a nationwide survey annually to analyze the actual situation and generate fundamental information about hospital pharmacy practice in Japan. Using data from this large-scale survey, we described pharmacists' involvement in cancer chemotherapy. We explored the factors related to the acceleration of pharmacists' tasks or involvement in clinical practice, primarily in oncology. Data were obtained from annual surveys conducted by JSHP from 2015 to 2020. All variables were expressed as categorical variables and tabulated. The Chi-square and Fisher's exact tests were used to compare the categorical variables. The Cochran-Armitage trend test was used to identify significant trends. From 2015 to 2020, 22,362 responses were recorded. After applying the exclusion criteria, 20,906 were analyzed. The proportion of hospitals enrolling pharmacists with oncology-related certifications significantly increased in all hospitals providing cancer care. Multivariable logistic regression analysis indicated that a smaller number of beds per pharmacist significantly correlated with additional fees for outpatient pharmacy services (p = 0.0002 for trend). Hospitals charging increased fees for outpatient oncology pharmacy services were associated with a smaller number of beds per pharmacist, regardless of hospital size. A balance between the number of beds and pharmacists, particularly certified oncology pharmacists, is crucial for safe and high-quality cancer treatment.

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

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

Identifying Malnutrition in Oncology Outpatients Using Different Screening Tools.

To compare the results of different nutritional screening tools, including NRS-2002, PG-SGA, and NUTRISCORE for the detection of malnutrition in oncology outpatients. A descriptive study. Place and Duration of the Study: Daily Chemotherapy Unit, Umraniye Training and Research Hospital, Istanbul, Turkiye, between June and July 2021. A total of 69 patients were included in the study, receiving cancer therapy in an outpatient setting. The NRS-2002, PG-SGA, and NUTRISCORE scores were calculated to determine the nutritional status. The mean age of the patients was 56.74 ± 13.48 years, and 59.4% were females. The mean BMI was 27.29 ± 5.27 kg/m2. Among the patients, 55.1% had insufficient nutritional intake or were at risk of malnutrition according to the NRS-2002, 40.6% according to NUTRISCORE, and 59.4% according to the PG-SGA. There was a significant agreement between the results of the NRS-2002 and PG-SGA in a McNemar test (Kappa: 0.320, p = 0.008). NRS-2002 and PG-SGA tools offered greater sensitivity in terms of capturing more patients in the precachectic state than NUTRISCORE. Among these, the NRS-2002 is a shorter test, and thus, would seem to be more practical than the PG-SGA. Oncology, Malnutrition, Screening tools, NRS-2002, PG-SGA, NUTRISCORE.

Implementation of a pharmacogenetic panel-based test for pharmacotherapy-based supportive care in an adult oncology clinic.

The University of Florida Health conducted a pragmatic implementation of a pharmacogenetics (PGx) panel-based test to guide medications used for supportive care prescribed to patients undergoing chemotherapy. The implementation was in the context of a pragmatic clinical trial for patients with non-hematologic cancers being treated with chemotherapy. Patients were randomized to either the intervention arm or control arm and received PGx testing immediately or at the end of the study, respectively. Patients completed the MD Anderson Symptom Inventory (MDASI) to assess quality of life (QoL). A total of 150 patients received PGx testing and enrolled in the study. Clinical decision support and implementation infrastructure were developed. While the study was originally planned for 500 patients, we were underpowered in our sample of 150 patients to test differences in the patient-reported MDASI scores. We did observed a high completion rate (92%) of the questionnaires; however, there were few medication changes (n = 6 in the intervention arm) based on PGx test results. Despite this, we learned several lessons through this pragmatic implementation of a PGx panel-based test in an outpatient oncology setting. Most notably, patients were less willing to undergo PGx testing if the cost of the test exceeded $100. In addition, to enhance PGx implementation success, reoccurring provider education is necessary, clinical decision support needs to appear in a more conducive way to fit in with oncologists' workflow, and PGx test results need to be available earlier in treatment planning.

Improving quality of care by standardising patient data collection in electronic medical records in an oncology department in Spain

BackgroundEvaluation of quality of care in oncology is key in ensuring patients receive adequate treatment. American Society of Clinical Oncology’s (ASCO) Quality Oncology Practice Initiative (QOPI) Certification Program (QCP) is...

Symptoms and prophylaxis of venous thromboembolism in the population of cancer and hospice patients-what is known?

In a group of palliative patients, venous thromboembolism (VTE) is a significant cause of death and reduction in quality of life. Current guidelines and scientific research on thromboprophylaxis most often refer to the population of oncology patients, who differ in many aspects from patients receiving palliative care. Thus, doctors working with patients undergoing palliative treatment have to face many problems related to safety and effectiveness of antithrombotic therapy in this type of care. In the case of chronically ill patients, diagnostic process may be somewhat difficult because the symptoms resulting from the underlying diseases can mask VTE symptoms. The aim of this article is to review the literature on symptoms and thromboprophylaxis in this group of patients. According to the latest guidelines of the American Society of Clinical Oncology (ASCO), it is not recommended to use VTE prophylaxis in outpatient oncology patients routinely, but it should be considered in high-risk patients who received a Khorana score of at least 2 before starting a new chemotherapy cycle. In patients diagnosed with VTE, in long-term prophylaxis lasting at least 6 months, due to greater effectiveness, it is recommended to use low-molecular-weight heparins, edoxaban, rivaroxaban or apixaban instead of vitamin K antagonists, which can be used if the previously mentioned drugs are unavailable. There are some studies which show that thromboprophylaxis may be beneficial for patients in palliative care. On the other hand, another studies’ results suggest that patients won’t gain any benefit from prevention. As our article shows it is very crucial to conduct scientific research on palliative patients and create clear guidelines for prophylaxis for this group of people.

EP 60 - Implementation of Transmission-Based Precaution Contingency Guidelines in an Outpatient Pediatric Oncology Clinic during a Regional Respiratory Virus Surge

EP 60 - Implementation of Transmission-Based Precaution Contingency Guidelines in an Outpatient Pediatric Oncology Clinic during a Regional Respiratory Virus Surge

Effects of telehealth on uptake and timeliness of genetic counseling and genetic testing among patients with endometrial cancer.

e22531 Background: The COVID-19 pandemic prompted genetic counseling (GC) services to shift from in-person to remote telehealth visits. Prior studies identified that telehealth allowed uninterrupted access to cancer GC during the pandemic. However, germline genetic testing (GT) completion decreased. Before the pandemic, studies found that patients with endometrial cancer (EC) had suboptimal rates of referral to GC and GT for Lynch syndrome (LS). We sought to determine how the transition to telehealth impacted EC patients’ uptake of and timeliness to, guideline-recommended GC and GT. Methods: Adults with newly diagnosed EC who completed outpatient gynecologic oncology visits were identified from a tertiary care oncology center’s tumor registry and through retrospective review of electronic medical records. Patients were assigned to the pre-pandemic and pandemic cohorts if diagnosed 9/1/2018-3/31/2020 and 4/1/2020-12/31/2020, respectively. Patients were also assigned based on whether they met guideline-based criteria for LS GT (diagnosed under the age of 50, had abnormal MSI/IHC testing, or had a synchronous LS tumor). Chi-square, two-sample t-test, and descriptive statistics were performed, with a statistically significant p-value &lt; 0.05. In total,443 patients with EC were included; 330 and 113 in pre-pandemic and pandemic cohorts, respectively.The pandemic cohort had higher rates of GC (24% vs 19%, p = 0.22) and GT (23% and 16%, p = 0.08). Eighty-five (25.8%) of the pre-pandemic and 23 (20.4%) of the pandemic cohorts met LS criteria for GT. Of patients who met LS criteria, the pandemic cohort also had higher rates of GC (57% vs 42%, p = 0.23) and GT (48% vs 40%, p = 0.08). Results: The median time from diagnosis to GC was 138 days for the pre-pandemic and 87 days for the pandemic cohorts (p = 0.09) The median time to GT was 144 days for the pre-pandemic and 114 days for the pandemic cohorts (p = 0.19). Of patients who met GT criteria, the pre-pandemic cohort had a median of 135 days from diagnosis to GC compared to the pandemic cohort’s median of 86 days (p = 0.37). The median time to GT was 131 days for pre-pandemic and 112 days for pandemic cohorts (p = 0.27). Conclusions: Uptake of GC and GT among patients with newly diagnosed EC, including those who met GT criteria, was higher and more timely in the pandemic cohort. While differences were not statistically significant, results suggest that telehealth may have improved delivery of GC and GT for EC patients. Overall, rates of GC and GT remain low (less than 50%), and further study of sustained effects of telehealth in this population after 2020 is needed.

Evaluating the impact of socioeconomic status on patient satisfaction in radiation oncology.

e23166 Background: Patient satisfaction (PS) is a critical indicator in evaluating healthcare quality. While the impact of socioeconomic status (SES), on healthcare outcomes is well-documented, its specific connection to PS in the context of radiation oncology remains unclear. This study aims to delineate the correlation between SES, as determined by the Area Deprivation Index (ADI), and PS within our healthcare system. Methods: In this single institution study, National Research Council (NRC) PS survey questionnaires were prospectively collected from patients who visited 4 separate outpatient academic radiation oncology sites between May 2021 and November 2023. Area Deprivation Index (ADI) data for these patients was sourced from the Neighborhood Atlas, encompassing both national percentiles and state deciles, with higher values indicating a greater level of SES disadvantage. To assess the data, univariate (UVA) and multivariable (MVA) logistic regression analyses were performed on the survey's recommendation scores, which ranged from 0 to 10, with scores of 9 or higher suggesting a greater propensity to recommend the facility or provider. Results: Our analysis included 7,501 survey responses with a cohort that was majority female (55.3%), curative intent (81.5%), and had a breast cancer diagnosis (30.4%). Most survey responses were follow-up visits (69.0%). Mean state and national ADI scores were 3.94 and 50.75, respectively. The UVA revealed curative intent (OR 1.68, p &lt; 0.001), follow-up visits (OR 1.69, p &lt; 0.001), and breast cancer diagnosis (OR 1.42, p = 0.018) as predictors of higher likelihood to recommend the facility or the provider. Patients with a national ADI above the mean were less likely to recommend the facility (OR 0.81, p = 0.050) or the provider (OR 0.71, p = 0.002). The MVA, outlined in Table 1, showed the influence of national ADI on provider recommendations remained significant (OR 0.730, p = 0.005) but not for facility recommendations (OR 0.832, p = 0.089). All other variables remained significant on the MVA. Conclusions: Respondents experiencing greater SES disadvantage were significantly less likely to recommend their provider. These findings underscore the necessity of incorporating SES as a factor when evaluating PS. Further research is necessary to determine the root cause of the impact of SES on PS and to explore the complex dynamics of patient-provider interactions. [Table: see text]

Obstacles to receiving postoperative radiation therapy following separation surgery for metastatic spine disease.

Obtaining timely postoperative radiotherapy (RT) following separation surgery is critical to avoid local recurrence of disease yet can be a challenge due to scheduling conflicts, insurance denials, and travel arrangements. In patients undergoing metastatic spine surgery for spinal cord compression, the authors sought to: 1) report the rate of postoperative RT, 2) describe reasons for patients not receiving postoperative RT, and 3) investigate factors that may predict whether a patient receives postoperative RT. A single-center retrospective case series was undertaken of all patients who underwent metastatic spine surgery for extradural disease between January 2010 and January 2021. Inclusion criteria were patients with intermediate or radioresistant tumors with evidence of spinal cord compression who underwent surgery. The primary outcome was the occurrence of RT within 3 months following surgery. Multivariable logistic regression analysis was performed controlling for age, BMI, race, total number of decompressed levels, tumor size, other organ metastasis, and preoperative RT or chemotherapy to predict patients receiving postoperative RT. Of 239 patients undergoing spine surgery for metastatic disease, 113 (47.3%) received postoperative RT while 126 (52.7%) did not. In the postoperative RT group, 24 (21.2%) received stereotactic body radiation therapy while 89 (78.8%) received conventional external-beam radiation therapy. The most common reasons for patients not receiving postoperative RT included death or transfer to hospice (31.0%), RT not being recommended by radiation oncology (30.2%), and loss to follow-up (23.8%). On critical review with the radiation oncology department, the authors estimated that 101 of 126 (80.2%) patients who did not receive postoperative RT were potential candidates for postoperative RT. Patients who received postoperative RT had more documented inpatient (48.7% vs 32.5%, p < 0.001) and outpatient (100.0% vs 65.1%, p < 0.001) radiation oncology consultations than those who did not. Additionally, patients who received postoperative RT had a higher rate of postoperative chemotherapy (53.1% vs 25.4%, p < 0.001), while patients who did not receive postoperative RT had a higher rate of preoperative RT (7.1% vs 31.0%, p < 0.001). Multivariable analysis confirmed that patients who received preoperative RT had lower odds of undergoing postoperative RT (OR 0.14, 95% CI 0.06-0.34; p < 0.001), and patients who underwent postoperative chemotherapy had higher odds of undergoing postoperative RT (OR 3.83, 95% CI 2.05-7.17; p < 0.001). In the current study reflecting real-world care of patients with metastatic spine disease after undergoing separation surgery, 47% of patients did not receive postoperative RT, and 80% of those patients were potential candidates for postoperative RT. Radiation oncology consultation and postoperative chemotherapy were significantly associated with receiving postoperative RT, whereas preoperative RT was significantly associated with not receiving postoperative RT. The lack of timely postoperative RT highlights a potential gap in metastatic spine tumor care and underscores the necessity for prompt radiation oncology consultation and effective planning.

Weighted Blanket: An Anxiety Reduction Tool in the Outpatient Oncology Infusion Setting.

Adults with cancer experience a significantly higher level of anxiety compared with the general population. Anxiety is reported at diagnosis and throughout the cancer trajectory, and it is particularly heightened at the initiation of infusion treatments. In 2020, the COVID-19 pandemic exacerbated anxiety levels in patients receiving cancer treatments. This evidence-based practice project evaluated the feasibility and effectiveness of using medical-grade weighted blankets to reduce anxiety in patients with cancer receiving the first two infusion treatments in the ambulatory setting. Patients completed a modified version of the Visual Analog Scale for Anxiety to self-report anxiety pre- and postimplementation. Patients and nurses completed feasibility surveys. Patients reported reduced anxiety after using a weighted blanket and described weighted blankets as comforting and soothing. More than 90% of surveyed patients agreed or strongly agreed that the blanket was comfortable, not too heavy, and easy to put on, and did not interfere with nursing care or their own activities. Nurses valued the ease of use and adherence to infection control standards.

Blood type as a risk factor for pancreatic ductal adenocarcinoma.

10559 Background: Non-O blood type has been associated with increased risk of pancreatic ductal adenocarcinoma (PDAC), the third leading cause of cancer death in the United States (US), in largely white populations. We aimed to explore PDAC risk across blood types in the racially diverse Veteran’s Health Administration (VA), the largest integrated healthcare system in the US. Methods: We included all individuals in the VA from 2002 - 2022 with at least one inpatient or outpatient encounter and a non-missing race. We defined the index date as 1.5 years after the initial VA encounter and excluded individuals with prior PDAC. We defined the exposure by non-O (A, B, AB) or type O blood type. We defined PDAC based on a previously validated algorithm of ≥2 sources (cancer registry, hospitalizations, or outpatient oncology encounters) with 95% positive predictive value. Using time to PDAC as the outcome in a multivariable Cox regression, we evaluated the association between blood type and PDAC risk, adjusting for age, sex, BMI, smoking, alcohol use, Hepatitis C (HCV) and diabetes. We censored at time of death, 1.5 years after the last VA encounter, or the end of the study period. We performed a subgroup analysis to evaluate the association of blood type by race. Results: Of the 2.5 million individuals with an available blood type, 1.35 million (52.6%) had a non-O blood type (Table) and over a quarter of our cohort (28.2%, 725,878) were over baseline age 50. Median time to PDAC diagnosis was 8.6 years. There were 877 PDAC cases (0.03%), with 530 (60.4%) of those having a non-O blood type. Compared to those with type O blood, risk of PDAC for individuals with non-O blood type was higher overall [adjusted HR = 1.37 (95% CI 1.20-1.57)], and higher among Whites (n=1,689,092, HR 1.52, 95% CI 1.27-1.82) than Black patients (n=525,666, HR 1.15, 95% CI 0.90-1.48), though this was limited by smaller sample size. Conclusions: Non-O blood type was associated with higher risk of PDAC in a diverse population. Given the potential differences between races, we will further explore the impact of neighborhood-level socioeconomic data on PDAC risk. [Table: see text]

An AI-assisted navigation approach for patients with radiographic suspicion of new pancreas cancer.

11002 Background: The traditional cancer care paradigm relies on passive referral streams, resulting in suboptimal care delivery. Here, we assessed the results of an AI-assisted navigation approach to proactively coordinate specialty cancer care services for patients with radiographically suspected pancreas cancer. Methods: A natural language processing (NLP) classifier was trained to identify radiology reports suspicious for pancreas cancer from imaging reports generated within Northwell Health. The daily workflow consists of the following: the NLP flags reports with suspicion of pancreas cancer, a coordinator validates the finding, a GI oncologist and navigator coordinates specialty oncology and tumor board referral, and a clinical research coordinator pre-screens for research studies. Patients determined to be hospice-bound or with non-PDAC malignancy are excluded. Care delivery metrics were compared by Mann-Whitney U tests. Results: Prior to implementation, patients with new suspicion of pancreas cancer at our institution experienced a mean of 22 days to biopsy, 32 days to oncology visit, and 56 days to treatment initiation from radiology report with 17% referred to pancreatic multidisciplinary clinic (PMDC). Per monthly average, 1.8 patients were approached for biospecimen studies, 1.5 were consented, and 0.9 were enrolled. In the month following implementation of the AI-assisted navigation pilot, reports from 1666 patients were flagged, resulting in 38 patients with new suspicion of pancreas cancer identified (Table). Of these, 53% underwent biopsy, 50% were seen by an outpatient oncologist, 29% were referred to PMDC, and 42% received treatment at our institution. From date of radiology report, these patients underwent biopsy at a mean of 7 days (p&lt;0.01), outpatient oncology visit at 15 days (p=0.285), and treatment initiation at 34 days (p=0.3479). A monthly average of 4 patients were approached for biospecimen studies, 4 were consented, and 3.2 were enrolled. Conclusions: An AI-guided navigation workflow identified patients earlier in the diagnostic timeline; reduced time to biopsy, follow-up, and treatment initiation; increased patient referrals to PMDC; and tripled participation in biospecimen studies at our institution. [Table: see text]

Sexual health and therapy adherence of hormone-sensitive breast cancer survivors on maintenance endocrine therapy: The SHE-CAN project in Toronto, Canada.

536 Background: Endocrine therapy (ET) is the standard of care for hormone sensitive (HR) breast cancer. While these drugs are highly efficacious and patients remain on them for extended periods of time, there are many side effects. It is estimated that 20-30% of women on ET stop early due to these side effects, most commonly due to gynecological symptoms of menopause (GSM). The purpose of this study is to better understand the vaginal health, sexual health, quality of life, sexual dysfunction, and adherence to therapy for HR breast cancer patients treated with anti-estrogen therapy. Methods: From August 2021 to January 2024, women from Mount Sinai Hospital’s outpatient oncology clinic and Women’s College Hospital After Cancer Treatment Transition (ACTT) clinic, who presented with HR breast cancer and who were being treated with anti-estrogen agents for a minimum of three months, were invited to participate in the study. Participants were asked to complete a survey examining their treatment experience and adherence, occurrence and frequency of GSM, patient-provider communication, along with two validated measurement tools (Female Sexual Function Index [FSFI} and Menopause-Specific Quality of Life questionnaire [MENQOL]). Medical history was also reviewed from the participant’s medical chart. Analysis was conducted using Excel. Results: A total of 417 participants completed the questionnaire. The median age was 60 years [IQR:52-69] with 401 participants (96.2%) being treated in the adjuvant setting versus 16 patients (3.8%) in the metastatic setting. At the time of diagnosis, 156 participants (37.4%) were pre-menopausal, 52 participants (12.5%) were peri-menopausal, and 185 participants (44.4%) were post-menopausal. When surveyed, 134 participants (32.1%) were on tamoxifen and 272 participants (65.2%) were on an aromatase inhibitor. Within six months prior to survey completion, 214 participants (51.3%) stopped taking their medication for a period of time. Within the past year, participants reported experiencing the following symptoms “all of the time”: vaginal dryness (24.9%), hot flashes (24.7%), and decreased sex drive (34.5%). Only 144 participants (34.5%) reported that a healthcare provider had asked them about experiencing GSM. The mean FSFI score was 21.9 ± 7.7 among 168 sexually active participants. Of these 168 participants, 116 (69.0%) had a final score of 26.5 or less, the cut-point used to demonstrate female sexual dysfunction. Symptoms captured in the MENQOL’s sexual domain (3.7 ± 2.3) and physical domain (3.7 ± 1.4) were found to be most bothersome. Conclusions: In our study, patients with breast cancer on ET report significant sexual dysfunction. Management of GSM and improved communication between patients and healthcare providers is required and should be prioritized to improve sexual dysfunction and treatment adherence.

The use of complementary and alternative medicine (CAM) among patients with cancer in Hawaii.

e24070 Background: Complementary and alternative medicine (CAM) involves medical products and practices that are not part of standard medical care. Various studies demonstrate potential benefits of CAM in alleviating certain side effects associated with cancer and cancer treatments. Our project aims to elucidate the prevalence, pattern of use, and proposed benefits of CAM among Hawaii residents with cancer. Methods: Our questionnaire based study recruited cancer patients from several outpatient oncology clinics across Oahu (n = 126). Patients were asked about CAM use and associated symptom benefit. Sociodemographic information was collected along with details about cancer type, treatment, and associated side effects. Participation was anonymous and optional. Results: At least one CAM therapy was used by 72/126 (57.1%) patients, while 54 (42.9%) did not use any CAM therapy. Among the CAM therapies, meditation and herbal supplements were most commonly used 26 (36.6%), followed by massage 25 (32.4%), and yoga 18 (25.4%). Stress reduction was the most common symptom benefit identified for various CAM therapies including meditation 13 (50%), herbal supplement 13 (50%), massage 13 (52%), and yoga 14 (77.8%). Anxiety reduction was another symptom benefit reported for meditation 13 (50%). Massage 13 (52%), CBD 14 (82.4%), and acupuncture 9 (64.3%) were also used for pain reduction. THC 12 (75%) and CBD 14 (82.4%) were used for sleep. Among the CAM users (n = 72), 52 (72.2%) did not speak to their clinician about CAM. We found that 107 (84.9%) patients experienced at least one side effect. The most common side effects experienced by patients were fatigue 81 (64.3%), hair loss 61 (48.4%), and constipation and/or diarrhea 57 (45.2%). The most commonly reported demographic information were the following: 95 (75.4%) female, 57 (45.2%) Asian, 33 (26.2%) 60-69 years old, 80 (63.5%) with breast cancer, and 33 (26.2%) with stage 4. Conclusions: We discovered that stress reduction is a symptom benefit associated with the most commonly used CAM therapies by cancer patients in Hawaii. Other symptom benefits involve anxiety, pain, and sleep. The modalities utilized were similar to nonpharmacologic therapies recommended by the NCCN guidelines for cancer survivorship, with the exception of herbal supplements. There is a lack of physician discussion regarding CAM use, which could impact the cancer burden in Hawaii. [Table: see text]

Effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy in Port Said City: A pre-post quasi-experimental study.

Emphasizing the pivotal role of caregivers in the cancer care continuum, a program designed to educate caregivers of cancer patients undergoing chemotherapy underscores their significance. The palliative care education initiative strives to cultivate a compassionate and effective care environment, benefiting both patients and caregivers. By imparting education, fostering positive attitudes, offering support, encouraging appropriate behaviors, and providing essential resources, the program aims to enhance the overall caregiving experience and contribute to the well-being of those navigating the challenges of cancer treatment. To evaluate the effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy. The research employed a purposive sample comprising 155 caregivers who were actively present with their cancer patients throughout the pre- and post-test phases within a quasi-experimental research design. The study took place at the outpatient oncology center of Al-Shifa Medical Complex in Port Said City, Egypt. To gather comprehensive data, 4 instruments were utilized: a demographic questionnaire, a nurse knowledge questionnaire, a scale measuring attitudes toward palliative care, and an assessment of reported practices in palliative care. This methodological approach allowed for a thorough exploration of caregiver perspectives, knowledge, attitudes, and practices within the context of a palliative care education program. Before the palliative care education program, only 1.3% of caregivers had a good overall level of knowledge about cancer and palliative care; this increased to 40.6% after the program. Similarly, before the palliative care education program, 32.9% of caregivers had a positive overall attitude, which increased to 72.3% after the program. Similarly, 27.1% of caregivers had an overall appropriate palliative care practice during the pre-test phase, which increased to 93.5% after the palliative care education program. The palliative care education program significantly improved caregivers' knowledge, attitudes, and practice scores. It is strongly recommended that caregivers of cancer patients receive continuing education in palliative care. In addition, it is crucial to conduct further research with a larger sample size in different situations in Egypt.

Characteristics of hospital admission during checkpoint-inhibition therapy.

e14510 Background: Immune checkpoint inhibitors (ICI) have enriched the therapeutic armamentarium in outpatient oncology care; however, data on necessity of hospitalizations associated with immune-related adverse event (irAEs) are scarce. Here, we retrospectively characterize hospitalizations of patients (pts) undergoing ICI. Methods: Between 12/2019 and 06/2022, 237 pts were included. Clinical data and characteristics of ICI were collected during a 6-month observation period after the initiation of therapy. Descriptive Statistics and Kaplan-Meier statistics were administered. Results: 30 out of 237 pts were hospitalized (HA+). Most common underlying tumor entities in the overall cohort were malignant melanoma (59.5%), renal cell carcinoma (13.1%), and non-small cell lung carcinoma (12.7%). Hospitalized pts exhibited an increased rate of pulmonary and cerebral metastases. We observed a significantly higher hospitalization rate during dual ICI with Nivolumab and Ipilimumab. The predominant irAEs for hospitalization were colitis (26.7), followed by hypophysitis (13.3%), leading to a median hospitalization of 7 days (range 1-34). Most pts were treated on the general ward (76.7%). Interdisciplinary consultations were frequent, especially to gastroenterology (46.7%) and neurology (26.7%). Although a trend towards an overall survival in the HA+ subgroup was identified, no statistically significant difference was found among the subgroups. Conclusions: The hospitalization rate of 12.6% is comparable to the literature. There was a disproportionate admission of patients with immune-related colitis and hypophysitis compared to the prevalence described under ICI. We observed a high need for interdisciplinary consults in line with the heterogeneity of immune-mediated side effects. When compared to non-hospitalized pts, there was no survival disadvantage in the cohort of hospitalized patients.

Ambulatory care hematology/oncology pharmacy services: A comprehensive review by the Saudi Oncology Pharmacy Assembly

AbstractSaudi Vision 2030 has driven significant changes in ambulatory care pharmacy services in the Kingdom of Saudi Arabia (KSA), transitioning pharmaceutical care from inpatient to outpatient settings. With a growing need to address non‐communicable diseases, particularly cancer, ambulatory care oncology pharmacy services are of paramount importance. This study aims to evaluate the potential benefits and challenges of establishing such services in the KSA and offers recommendations for clinical pharmacists. A comprehensive literature search was conducted using PubMed, MEDLINE, EMBASE, and Google Scholar, encompassing research from inception to September 2023. The search focused on English language studies related to ambulatory care oncology/hematology pharmacy services. Among the 1351 studies found, those assessing the impact of clinical pharmacists on patient outcomes in outpatient oncology clinics were included. The review of the literature highlights the substantial impact of clinical pharmacists in outpatient hematology/oncology settings. A selection of several studies revealed their role in improving patient care, reducing health care costs, and enhancing treatment outcomes. Notable findings include a high acceptance rate of pharmacist interventions with significant cost savings, increased pharmacist involvement in patient encounters, and reduced emergency department visits and inpatient admissions due to pharmacist interventions. These results showed the valuable contributions of clinical pharmacists in the international outpatient oncology setting. Establishing ambulatory care hematology/oncology pharmacy services in Saudi Arabia is critical, considering the rising cancer burden. The value of specialized oncology clinical pharmacists in the outpatient setting is emphasized by various studies conducted in the United States. This review proposes a framework for patient‐centered oncology practices, serving as a valuable resource for the strategic development of ambulatory care oncology pharmacy services in Saudi Arabia. These efforts align with Saudi Vision 2030's broader goals of enhancing health care quality and patient care.

Impact of the economic crisis and drug shortage on Lebanese cancer patients' care.

As a consequence of the economic crisis, the sociopolitical instability and the advent of the coronavirus disease-19 pandemic, nested challenges faced the Lebanese healthcare system. These have resulted in critical shortages of essential resources, including medications vital for oncologic patients. To assess the ramifications of the ongoing economic crisis on oncology patient care focusing on our outpatient oncology department. A questionnaire was distributed during the month of February 2022 to oncology patients in Hôtel Dieu de France University Hospital in Beirut during their outpatient therapy. The primary objective was to assess the far-reaching impact of the economic crisis on patient care and the resulting psychological implications. Among 182 interviewed patients, 31.87% experienced treatment interruption mainly due to acute drug shortages. Despite 87.91% of the patients benefiting from third-party coverage, 69.60% had to self-pay for their medications leading to 69.78% of patients perceiving that healthcare was more difficult to access after 2020. Psychologically, one-third of the patients exhibited symptoms of anxiety and/or depression, with 7 patients reporting suicidal ideations. Notably, 37.93% of patients who interrupted cancer treatment reported a history of comorbidities, and 89.66% who altered their treatment cited financial difficulties. Lebanese cancer patients face complex challenges spanning economic, healthcare, and psychological realms. Income inequalities exacerbated by the economic crisis hindered healthcare access.

Level of competence of rural physicians in primary health care in the diagnosis of malignant neoplasms of main localizations

Objective. To analize the level of rural PHC doctors` competence on the issues of diagnosis and routing patients with suspected cancer. Materials and methods. The study was conducted using a survey of medical workers involved in the diagnosis of malignant neoplasms of four main localizations (specialist doctors and paramedics of examination rooms) of the Central District Hospital of five rural municipal districts of the Magnitogorsk oncological cluster of Chelyabinsk region. 35 physicians took part in the study. Results. The results of the survey were quite negative: the minority of respondents are aware of the exact duration of the mandatory initial diagnostic examination, the period of informing the oncologist about the patient diagnosed with cancer, and the scheme for assigning municipal medical organizations to outpatient oncology centers. Conclusions. The surveyed contingent is characterized by: low oncological alertness and unsatisfactory competence concerning the initial manifestations of malignancies; inclusion of symptoms of the formed cancer in the number of early manifestations of malignancies, which means that a doctor, unsure of the diagnosis, as if waiting for the appearance of an obvious, from his point of view, symptom of a tumor, and as a result, the patient has an advanced stage of cancer; 3) flawed ideas about the full list of necessary methods for diagnosing malignant neoplasms of leading localizations; unsatisfactory knowledge of regulatory documentation on the routing of patients with suspected cancer.