Care Of Oncology Patients Research Articles

Investigating of the role of CT scan for cancer patients during the first wave of COVID-19 pandemic.

Amidst this current COVID-19 pandemic, we undertook this systematic review to determine the role of medical imaging, with a special emphasis on computed tomography (CT), on guiding the care and management of oncologic patients. Study selection focused on articles from 01/02/2020 to 04/23/2020. After removal of irrelevant articles, all systematic or non-systematic reviews, comments, correspondence, editorials, guidelines and meta-analysis and case reports with less than 5 patients were also excluded. Full-text articles of eligible publications were reviewed to select all imaging-based publications, and the existence or not of an oncologic population was reported for each publication. Two independent reviewers collected the following information: ( 1) General publication data; (2) Study design characteristics; (3) Demographic, clinical and pathological variables with percentage of cancer patients if available; (4) Imaging performances. The sensitivity and specificity of chest CT (C-CT) were pooled separately using a random-effects model. The positive predictive value (PPV) and negative predictive value (NPV) of C-CT as a test was estimated for a wide range of disease prevalence rates. A total of 106 publications were fully reviewed. Among them, 96 were identified to have extractable data for a two-by-two contingency table for CT performance. At the end, 53 studies (including 6 that used two different populations) were included in diagnosis accuracy analysis (N = 59). We identified 53 studies totaling 11,352 patients for whom the sensitivity (95CI) was 0.886 (0.880; 0.894), while specificity remained low: in 93% of cases (55/59), specificity was ≤ 0.5. Among all the 106 reviewed studies, only 7 studies included oncologic patients and were included in the final analysis for C-CT performances. The percentage of patients with cancer in these studies was 0.3% (34/11352 patients), lower than the global prevalence of cancer. Among all these studies, only 1 (0.9%, 1/106) reported performance specifically in a cohort of cancer patients, but it however only reported true positives. There is a concerning lack of COVID-19 studies involving oncologic patients, showing there is a real need for further investigation and evaluation of the performance of the different medical imaging modalities in this specific patient population.

Breast Cancer Management During the COVID-19 Pandemic: the Radiation Oncology Perspective.

Purpose of ReviewThe coronavirus disease 19 (COVID-19) pandemic has caused disruption in healthcare throughout the world. The limitations placed on hospital resources and the need to limit potential exposure to SARS-CoV-2 for both patients and healthcare staff have affected oncologic care for patients with breast cancer (BC), including radiation therapy (RT). This review highlights published guidelines regarding the provision of radiotherapy for BC patients and their adoption by radiation oncology centers.Recent FindingsMultiple international and national consortiums plus select institutions have published formal recommendations regarding radiation therapy for BC during the COVID-19 pandemic. They embody the principles of limiting in-person visits, proper triage, and the judicious use of delay, abbreviation, or omission of RT as appropriate.SummarySince the start of the pandemic, multiple publications have provided guidance regarding RT for BC during this challenging time. The pandemic has led to increased use of telemedicine and abbreviated radiation therapy courses in the setting of BC, which are likely to persist. Future research is needed to establish the effect of these changes on oncologic outcomes.

Be Smart to Identify the Stroke-Like Migraine Attacks After Radiation Therapy (SMART) Syndrome

Stroke-like migraine attacks after radiation therapy (SMART) are uncommon, often occurring years or decades after brain radiation therapy. This syndrome is a diagnosis of exclusion, and only about 40 cases describing SMART have been published, each one describing a constellation of symptoms and findings. Because symptoms can arise years after initial radiation therapy, the ability of physicians to recognize SMART and rule out other possible causes of symptoms is critical for the long-term care of oncology patients who have undergone cranial radiation. Here we present the case of a 55-year-old man who experienced SMART nine years after radiation therapy and who was successfully treated with steroids.

Future steps in cardio-oncology—a national multidisciplinary survey among healthcare professionals in the Netherlands

BackgroundThe awareness of cancer therapy–related adverse cardiac effects is fueled by recent literature on cardiotoxicity incidence and detection strategies. Although this influences the sense of urgency, in current practice, cardiotoxicity monitoring and treatment is not structurally performed. With this study, we aimed to evaluate current perspectives on cardio-oncology and to assess needs, ultimately to determine an agenda for improvements in current practice.Material and methodsA national multidisciplinary 36-question survey was conducted. The survey was developed by a multidisciplinary team, theoretically based on an implementation checklist and distributed by email, through cardiology and oncology societies as well as social media.ResultsOne hundred ninety professionals completed the survey, of which 66 were cardiologists, 66 radiation oncologists, and 58 medical oncologists and hematologists. Many professionals were unaware of their specialisms’ cardio-oncology guidelines: 62.1% of cardiologists and 29.3% of the hematologists and medical oncologists respectively. Many cardiologists (N = 46; 69.7%), radiation oncologists (N = 45; 68.2%), and hematologists and medical oncologists (N = 38; 65.5%) expressed that they did not have sufficient knowledge to treat cardio-oncology patients and would either refer a patient or aspire to gain more knowledge on the topic.ConclusionThe field of cardio-oncology is advancing rapidly, with progress in stratification and detection strategies leading to the development of new guidelines and consensus statements. However, the application of these guidelines in current practice appears to be lagging. Professionals express a need for additional training and a practical guideline including risk stratification, monitoring, and treatment strategies. Multidisciplinary discussion and consensus on cardio-oncology care is vital to improve implementation of cardio-oncology guidelines, ultimately to improve cardiac care for oncology patients.

Disparities in Access to Oncologic Care in Pancreatic Cancer: A Systematic Review.

Pancreatic cancer care is complex, and multiple disparities in receipt of therapies have been documented. The authors aimed to conduct a systematic review of the literature to critically assess and summarize disparities in access to oncologic therapies for pancreatic cancer. A search of PubMed, Scopus, Web of Science, and Cochrane databases were performed for studies reporting disparities in access to oncologic care for pancreatic cancer. Primary research articles published in the United States from 2000 to 2020 were included. Data were independently extracted, and risk of bias was assessed using the modified Newcastle-Ottawa scale. The inclusion criteria were met by 47 studies. All the studies used retrospective data, with 70 % involving national database studies, 41 assessing the impact of race/ethnicity, 22 assessing the impact of socioeconomic status, 18 assessing the impact of insurance status, 23 assessing the impact of gender, 26 assessing the impact of age, and 3 assessing the impact of location on the delivery of cancer-directed therapies. Race, socioeconomic status, insurance status, gender, and age- based disparities in receipt of surgical resection, treatment at high-volume facilities and multimodal therapy for resectable pancreatic cancer, receipt of systemic chemotherapy for metastatic cancer, and receipt of expected standard-of-care treatment are reported. Significant sociodemographic disparities in access to equitable oncologic care exist along the continuum of pancreatic cancer care. Multiple patient, provider, and systemic factors contribute to these disparities. The ongoing study of these disparities is important to elucidate processes that may be targeted to improve access to equitable oncologic care for patients with pancreatic cancer.

Harnessing big data to characterize immune-related adverse events.

Immune-checkpoint inhibitors (ICIs) have transformed patient care in oncology but are associated with a unique spectrum of organ-specific inflammatory toxicities known as immune-related adverse events (irAEs). Given the expanding use of ICIs, an increasing number of patients with cancer experience irAEs, including severe irAEs. Proper diagnosis and management of irAEs are important to optimize the quality of life and long-term outcomes of patients receiving ICIs; however, owing to the substantial heterogeneity within irAEs, and despite multicentre initiatives, performing clinical studies of these toxicities with a sufficient cohort size is challenging. Pioneering studies from the past few years have demonstrated that aggregate clinical data, real-world data (such as data on pharmacovigilance or from electronic health records) and multi-omics data are alternative tools well suited to investigating the underlying mechanisms and clinical presentations of irAEs. In this Perspective, we summarize the advantages and shortcomings of different sources of 'big data' for the study of irAEs and highlight progress made using such data to identify biomarkers of irAE risk, evaluate associations between irAEs and therapeutic efficacy, and characterize the effects of demographic and anthropometric factors on irAE risk. Harnessing big data will accelerate research on irAEs and provide key insights that will improve the clinical management of patients receiving ICIs.

Association of adult attachment with delays in accessing specialist care in women with ovarian cancer

ABSTRACT Objective Advanced stage at diagnosis and delayed presentation are common in ovarian cancer (OC). The objective of the current study was to explore the association of adult attachment pattern with delays in accessing specialist oncology care in patients with OC. Methods A cross-sectional structured interview study of patients with OC presenting to an Indian cancer center was undertaken. Consenting patients completed Experiences of Close Relationships–Relationship Style questionnaire (ECR-RS) and Medical Outcome Survey–Social Support Survey (MOS–SSS). Multivariate linear regression with “time to presentation to cancer specialist” as the dependent variable was undertaken. Results In all, 132 of 155 (85%) patients with OC who were invited were interviewed. An increased ECR-RS attachment anxiety score (P = .01) and being part of a multigenerational extended household (P = .04) were both independently associated with delay in presentation to a cancer specialist. There was no association between delay in presentation and social support. Conclusions Among patients with OC, adult attachment may contribute to delays in presentation. It may be important for the cancer symptom awareness efforts in primary care to include educating physicians on recognizing and interacting with patients with insecure attachment styles. The association of delays in presentation for women with OC living in multigenerational extended households needs more indepth exploration. Supplemental data for this article is available online at https://doi.org/10.1080/07347332.2022.2025510 .

Abstract IA-24: Implicit bias in oncology: Towards a more inclusive workforce

Abstract Implicit bias includes those unconscious attitudes, biases, and stereotypes that shape our behaviors and interactions with others. While implicit biases are known to adversely affect the care of oncology patients, they are also deeply imbued in the culture of our workforce and permit a non-inclusive environment. The consequences of implicit bias are profound, including repeated microaggressions, detraction from academic work, the biased language of evaluation, the cumulative effects of such biases on promotions, and the lack of diversity in leadership positions. Dismantling such a system requires conscious effort rooted in organizational commitment. This session will begin to address these issues by applying a tangible approach to recruitment, highlighting the intentionality of overhauling a recruitment process. Such an approach can be replicated in other settings when grounded in a firm dedication to inclusion and an openness to self-education and self-reflection. Citation Format: Jessica W Tsai. Implicit bias in oncology: Towards a more inclusive workforce [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-24.

Profile of Surgical Oncological Patient Care Services Provided for Oral Cancer Patients by a Premier Public Dental Hospital in Sri Lanka Amidst COVID-19 Pandemic

Profile of Surgical Oncological Patient Care Services Provided for Oral Cancer Patients by a Premier Public Dental Hospital in Sri Lanka Amidst COVID-19 Pandemic

Systematic Review: Tele-Nursing a Universal Access to Care for Oncology Patients

Telenursing is a way of caring for and educating oncology patients to promote self-care management at home. The objective of the study was to analyze the scientific evidence on telenursing in the care of oncology patients. This was a systematic and descriptive review in Spanish, Portuguese and English which was available in 3 databases: BMC, Pubmed and Scielo. The articles were selected in English, Spanish and Portuguese with data from 2010-2020. It was found that tele-nursing, a new form of access to the care service provided by nursing professionals to patients with oncology treatment, including technological tools allow a direct and timely relationship to respond to the detection of adverse events after chemotherapy, promote self-care and control and monitor the patient's health status at home. Conclusions: There is a need to use tele-nursing as an opportunity to care for the patient at home through virtual means by providing relevant information to promote self-care and quality of life.

The population-based study of oncology surgery department service during COVID-19 pandemic in Indonesia Single Center Hospital

Background: The COVID-19 pandemic has posed an unprecedented threat to global healthcare delivery. Moewardi Hospital was appointed by the government of Indonesia to be a COVID-19 one of regional hospital by June 2020. Other than COVID-19 cases, the hospital also provides care for other diseases which also provides care for oncology patients. The aim of the study: to assess the impact of the social restriction on oncology services in this hospital. Materials and Methods: This study compares the number of patients undergoing oncology surgery in the Central Surgery Unit and the number of patients attending the Outpatient Surgical Oncology Unit in March to July 2020 with the number of patients in the same timeframe in the previous year (2019). Results: The number of oncology operations in the Central Surgery Unit of Moewardi Hospital declined substantially during the 5-month pandemic period compared to the same period in the previous year, 2019 (p<0.001). There was also a significant drop in the number of patients attending the outpatient surgical oncology clinic during the pandemic period compared to the previous year (p<0.001) The lowest number of oncology surgeries occurred in April 2020, which was 20 patients. The lowest number of patients visited was 170 outpatients in March 2020. Thyroid and skin cancer cases were the most notable decline in surgical oncology cases in the Central Surgery Unit. The largest number of outpatients in the outpatient surgical oncology clinic during the COVID-19 pandemic was mammae and thyroid cancer. Conclusions: There was a decline in surgical oncology activities, which culminated in a significant decrease in surgical oncology patients in the Central Surgery Unit and the patient visit to the Moewardi Hospital outpatient oncology clinic during the COVID-19 pandemic.

Clinical and Economic Impact of Pharmacists' Intervention on Care of Pediatric Hematology and Oncology Patients.

Children with cancer may be one of the most vulnerable groups to drug-related adverse events because they possess characteristics of patients with cancer as well as pediatric patients. To evaluate the clinical and economic impact of pharmacists' intervention on the care of pediatric hematology and oncology patients in the inpatient and outpatient settings of a children's hospital. The pharmacist-intervention records from 2017 were retrospectively reviewed. Intervention rate, type of drug-related problems, acceptance rate, and frequently involved drugs in pharmacist interventions were analyzed. One physician and one pharmacist evaluated the clinical significance of each intervention. A cost-benefit analysis was conducted from hospital and patient perspective. The benefit from cost savings by reducing the number of prescribed drugs that are disposed was estimated as the benefit from hospital perspective. The benefit from cost avoidance based on the potential to avoid an adverse drug event (ADE) was estimated as the benefit from patient perspective. The cost of reviewing prescriptions was estimated based on the pharmacists' salary and the time involved. In 2017, 2361 interventions were performed in 381 pediatric patients with cancer. The acceptance rate was 97.2%. More than half of the interventions were regarded as clinically "significant" (58.8%) and "very significant" (14.6%). The cost-benefit of US$28,705 was determined from hospital perspective, with a cost-benefit ratio of 1.45:1. The cost-benefit of US$35,611 was calculated from patient perspective, with a cost-benefit ratio of 1.55:1. Pharmacists' intervention in the care of hematology and oncology pediatric patients was effective in preventing clinically significant ADEs and had a positive economic impact on the health-care budget from both hospital and patient perspective.

Ultrasound-assisted Lumbar Puncture for Obese Pediatric Oncology Patients: A Feasibility Study.

Lumbar punctures (LPs) are performed frequently on children with leukemia and lymphoma as part of the standard of care. They are typically performed by pediatric oncology providers for both diagnostic and therapeutic interventions with the aid of moderate or deep sedation. Point-of-Care Ultrasound (POCUS) has emerged as a promising strategy to aid in LP procedures and has been found to be associated with lower number of attempts, and higher success rates. We describe our experience using POCUS to assist with LPs in a subgroup of pediatric oncology patients identified to be procedurally difficult secondary to obesity. This collaboration was well received and resulted in successful LPs in most (8/9) cases. This is a promising modality to improve the delivery of care and LP success in pediatric oncology patients.

Oral manifestation in acute myeloid leukemia: case report

Oral changes can be the first signs and symptoms of systemic alterations. It is an alert to the dental surgeon, who can make an early diagnosis of a systemic alteration through oral alterations. Acute myeloid leukemia (AML) is a malignant immunosuppressive disease in which systemic alterations frequently lead to oral alterations as the first sign of the disease. The dentist must be attentive to the possible oral signs to make a quick diagnosis. Objective: To describe an unusual oral manifestation of AML, with gingival overgrowth and necrosis located on the interdental papilla on the upper central incisors. Case report: A 15-year-old female is described with AML. She presented the following oral changes as the first manifestations of the disease: gingival bleeding, petechiae, and gingival enlargement necrosis located on the interdental papilla on the upper central incisors. The dental surgeon performed an oral evaluation, and, following the clinical signs, the symptoms, and a hematological exam, AML was suspected. The patient was quickly referred to an oncologist, but she died due to the severity of the disease. Conclusion: Dentists and multidisciplinary teams have a fundamental role in the early diagnosis of diseases with primary signs in the oral cavity and caring for oncology patients.

Improving Patient Care in Radiation Oncology: Redefining the Role of the Clinical Medical Physicist.

Improving Patient Care in Radiation Oncology: Redefining the Role of the Clinical Medical Physicist.

Knowledge of Dental Students from Croatia, Slovenia, and Bosnia and Herzegovina about Dental Care of Oncology Patients.

The central role of the dentist in the treatment of oncology patients is to care for the patient’s oral cavity before, during, and after radio/chemotherapy. The aim of this research was to determine the knowledge of dental students from five universities in three neighboring countries, Croatia (Split, Rijeka, and Zagreb), Bosnia and Herzegovina (Sarajevo), and Slovenia (Ljubljana), about oncology patients’ dental care. A total of 140 students in their fourth, fifth, and sixth year of dental medicine studies participated in this research. A questionnaire with 36 specific questions was designed for this research and included questions about dental care of oncologic patients before, during, and after the oncology therapy. Most students are familiar with the incidence and most common type of head and neck tumors, while knowledge about tumor treatment and the side-effects of radiation therapy and/or chemotherapy is weak. Students did not show satisfactory knowledge about osteoradionecrosis, which is the most serious side-effect of radiotherapy; therefore, the emphasis on additional education should be greatest in this area. Teaching staff should be aware of lack of student knowledge and try to offer more information and practice in providing dental care for oncology patients.

Pediatric Oncology Palliative Care Programs in Central America: Pathways to Success.

Palliative care offers children who have life-limiting and life-threatening oncologic illnesses and their families improved quality of life. In some instances, impeccable symptom control can lead to improved survival. Cultural and financial barriers to palliative care in oncology patients occur in all countries, and those located in Central America are no exception. In this article, we summarize how the programs participating in the Asociación de Hemato-Oncólogos Pediatras de Centro America (AHOPCA) have developed dedicated oncology palliative care programs. The experience in Guatemala, El Salvador, Costa Rica, Panama, Dominican Republic and Haiti is detailed, with a focus on history, the barriers that have impeded progress, and achievements. Future directions, which, of course, may be impacted by the COVID-19 pandemic, are described as well.

An Italian Model for the Management of Cancer Patients during COVID-19 Pandemic: The Regional Center for Oncological Orientation (COrO) of Taranto (ROP)

Objective: The recent outbreak of COVID-19 limited the resources of the National Health System necessitating the formulation of novel practice recommendations for oncological care. To date, management guidelines for cancer patients in case of pandemic are not available. Each center tried to manage its own needs and requests independently, often reducing access to treatment and diagnostic exams to patients. Here, we have described the management of cancer patients during COVID-19 infection with suggestions of some practical approaches applied by our Regional Center for Oncological Orientation (COrO) in S.G. Moscati Hospital (Taranto, Italy). Subjects and Methods: Our strategy was to minimize any interruption of cancer treatment through the extension of Taranto’s Health Regional (COrO). The extension of the oncological network, assisted by the General Management of Taranto ASL through agreements with private structures in Taranto’s area, allowed cancer patients to receive up to 11 different types of services, according to their needs (first investigation or follow-up), and represents an exclusive organization on the entire Italian territory. Results: Thanks to the organization of the COrO in 2020, 1,406 first oncological visits and 566 preparatory treatments were carried out, 372 of exemption for oncological pathology (free health care) were activated, and 1,742 instrumental investigations and 7 cases of civil invalidity were performed (certificate of disability). Conclusions: We have overcome barriers to care of oncology patients leading to a reduction of waiting lists representing a practical application model that can be extended to other healthcare settings.

Nursing diagnoses among oncology patients in medical units: a retrospective study of patients' records.

ObjectiveNursing care plans for oncology patients are complex and overlapping enough to warrant the need for systematised documentation that ensures high quality, flawless and comprehensive care. Addressing the patients’ needs through nursing diagnoses is the initial step that shapes the subsequent care. Therefore, the current study aimed to identify the frequent NANDA-I diagnoses reported in nursing care plans for medical oncology patients.Data sourcesA retrospective design was used to collect data from 260 electronic nursing care records of oncology patients admitted to medical floors at an accredited oncology centre in Jordan.ConclusionThe complexity of nursing care for oncology patients can be inferred from the high number of reported nursing diagnoses. This study summarises the most common nursing diagnoses and their combinations that can be used as a guide to formulate nursing care plans for oncology patients in medical units.Implications for nursing practiceOncology nurses may refer to this study to guide and support their care and documentations to maintain a high standard of nursing practice. Besides, the reported diagnoses can be integrated to generate pre-printed, standardised nursing care plans, where diagnoses are listed for nurses to select the applicable ones for their patients. Similarly, the combinations of nursing diagnoses may guide nurses to search for a concurrent diagnosis, thus improving patients’ outcomes. This study revealed the complexity of patients’ care in medical oncology units, which alarms the nursing managers to reconsider the nurse–patient ratio in these settings to meet patients’ care demands and maintain their safety.

A Review of Disparities in Oncology Care for Patients with Limited Access and Minorities, in an Oncology Setting, an Unmet Need for this Group of Patients to Experimental Therapies

It is expected that half of the population in the US by 2045 are expected to be non Hispanic white, per US census Bureau projections.