Utilization Of Supportive Care Research Articles

The impact of compliance to oncology pathways that include G-CSF rules for use on ER visits/hospitalizations in a multistate program.

135 Background: CareFirst BCBS initiated a multistate oncology pathway program in 2008, which reduced chemotherapy and hospitalization expenditures and also increased supportive care drug utilization. This study evaluated the impact of following pathways including supportive care versus not following pathways on ER visits/hospitalizations and associated costs as a result of anemia, neutropenia, and chemotherapy-induced nausea and vomiting (CINV). Methods: The CareFirst claims database was utilized to evaluate data two years after initiation of the pathways program. Frequency of ER visits/hospitalizations for neutropenia, anemia and CINV was the primary outcome measured and was compared between compliant and noncompliant pathway utilization of granulocyte colony-stimulating factors (G-CSFs), erythropoiesis-stimulating agents (ESAs), and antiemetics, respectively. Logistic regression analyses were used to control for expenditures of ESAs, CSFs, and antiemetics in the context of compliance and the corresponding visit types. Costs associated with ER visits/hospitalizations were also compared between compliant and noncompliant pathway utilization of supportive care. Results: Overall, 46 sites with 1,586 patients were evaluated. There were a total of 12 ER visits/hospitalizations for anemia, 231 for neutropenia, and 360 for CINV. G-CSF pathway compliance resulted in a relative reduction in ER visits/hospitalizations of 67.2% (from 28.3% to 11.5%, p<0.001). Logistic regression showed consistent results when controlling for costs with a 69.5% relative reduction of ER visits/hospitalizations (p<0.001). A comparison of ER visits/hospitalization costs as a result of neutropenia demonstrated G-CSF pathway compliance producing an average savings of $1,173 per line of therapy (p=0.001). Analogous analyses did not demonstrate a significant relationship between ESA and antiemetic utilizations and their corresponding ER visits/hospitalizations. Conclusions: Adherence to oncology pathways, including G-CSF use rules, is associated with a significantly lower ER visits/hospitalization rates and costs associated with febrile neutropenia.

Toxicities and outcomes among septuagenarians and octogenarians with diffuse large B-cell lymphoma treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone therapy

The diagnosis of non-Hodgkin lymphoma (NHL) is increasingly common among the elderly and it is well recognized that this patient population may benefit from therapy. No guidelines exist for chemotherapy dosing in the elderly population, and a clear assessment of treatment toxicity and benefits has not been previously reported. In this single-institution study, we report the toxicities and treatment outcomes of septuagenarians and octogenarians with large cell lymphoma treated with chemo-immunotherapy with or without radiation, as primary therapy with curative intent. We identified 37 patients over the age of 70 years diagnosed with large cell lymphoma treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) and compared their experience with 65 patients aged less than 70 years. Our retrospective analysis suggests that elderly patients are more susceptible to treatment-related toxicity despite more frequent chemotherapy dose reductions and greater utilization of supportive care. While our aged patients experienced greater frequency of hospitalization during R-CHOP treatment, the vast majority were able to receive relative chemotherapy dose-intensity greater than 70% and experienced similar rates of complete remission.

A multilevel investigation of inequalities in clinical and psychosocial outcomes for women after breast cancer

BackgroundIn Australia, breast cancer is the most common cancer affecting Australian women. Inequalities in clinical and psychosocial outcomes have existed for some time, affecting particularly women from rural areas and from areas of disadvantage. We have a limited understanding of how individual and area-level factors are related to each other, and their associations with survival and other clinical and psychosocial outcomes.Methods/DesignThis study will examine associations between breast cancer recurrence, survival and psychosocial outcomes (e.g. distress, unmet supportive care needs, quality of life). The study will use an innovative multilevel approach using area-level factors simultaneously with detailed individual-level factors to assess the relative importance of remoteness, socioeconomic and demographic factors, diagnostic and treatment pathways and processes, and supportive care utilization to clinical and psychosocial outcomes. The study will use telephone and self-administered questionnaires to collect individual-level data from approximately 3, 300 women ascertained from the Queensland Cancer Registry diagnosed with invasive breast cancer residing in 478 Statistical Local Areas Queensland in 2011 and 2012. Area-level data will be sourced from the Australian Bureau of Statistics census data. Geo-coding and spatial technology will be used to calculate road travel distances from patients' residence to diagnostic and treatment centres. Data analysis will include a combination of standard empirical procedures and multilevel modelling.DiscussionThe study will address the critical question of: what are the individual- or area-level factors associated with inequalities in outcomes from breast cancer? The findings will provide health care providers and policy makers with targeted information to improve the management of women with breast cancer, and inform the development of strategies to improve psychosocial care for women with breast cancer.

Femininity and breast cancer, original approach of announcement in oncology

The measure number 40 of French Plan against Cancer requires taking into consideration patient's personality and its effect on social relations. However, this psychological impact is different for each cancer. The aim of the present study is to discuss the resulting effects after discovery of breast cancer. Breast cancer is the most common malignancy in women and it's becomes a greater fear of our society. Psychological impact of breast cancer discovery is double: first, it is linked to the bad image of cancer which means suffering and death, then to the good image of breast, symbol of femininity, sexuality and maternity. Considering together these two components can permit to optimize information, listening, help and finally adhesion to treatment. And, if the psycho-oncology is now essential, tomorrow socio-esthetic will come within the framework of more human practice in oncology. Paradoxically, whereas early diagnosis is more frequent and its treatment is improved, breast cancer remains an alarming disease. So, physician can propose since announcement a best utilization of supportive care in order to limit personal and social impact.