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Pyramidal Decision Support Framework Leverages Subspecialty Expertise across Enterprise to Achieve Superior Cancer Outcomes and Personalized, Precision Care Plans.

The complexity of cancer care requires integrated and continuous support to deliver appropriate care. An expert network with complementary expertise and the capability of multidisciplinary care is an integral part of contemporary oncology care. Appropriate infrastructure is necessary to empower this network to deliver personalized precision care to their patients. Providing decision support as cancer care becomes exponentially more complex with new diagnostic and therapeutic choices remains challenging. City of Hope has developed a Pyramidal Decision Support Framework to address these challeng

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… Unlike traditional tumor boards where a large majority of cases are evaluated, our model allows the community practice oncologists to select only the complex cases. … The composition of disease-specific tumor boards includes the traditional disciplines of providers including a surgeon, medical oncologist, and radiation oncologist, as well as pathologist and radiologist, while the Precision Oncology tumor board has a higher number of geneticists and non-physicians …

The Impact of an Embedded Oncology Pharmacist in an Outpatient Oncology Center in the Treatment of Hematologic Malignancies.

BackgroundThe growing demand for clinicians in the ambulatory oncology setting to reduce fragmentation of care and improve patient outcomes represents a need for oncology pharmacists as advanced practitioners in the provision of direct patient-centered care. These provisions can include supportive care management, drug-drug interaction evaluation, and selection of appropriate chemotherapy regimens to reduce physician workload in a cost-effective manner, while increasing physician and patient satisfaction. However, robust data are currently lacking to support the impact of pharmacists in the am

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… During the study period, pharmacists primarily worked with three medical oncologists and two advanced practice nurses (APNs). Consultations for the pharmacist to see the patient collaboratively with the oncologist or APN in the clinic started on March 4, 2019. … Projected supply of and demand for oncologists and radiation oncologists through 2025: An aging, better-insured population will result in shortage . …

Exercise barriers and facilitators during hematopoietic stem cell transplantation: a qualitative study.

ObjectiveAlthough exercise is beneficial in patients undergoing hematopoietic stem cell transplantation (HSCT), motivating patients to exercise is challenging. We aimed to understand exercise barriers and facilitators during HSCT treatment while participating in a daily unsupervised exercise programme.ParticipantsPatients scheduled to have HSCT.Study design6 participants were included in this descriptive qualitative study during HSCT treatment while participating in an exercise programme to identify perceived barriers and facilitators of the exercise. An average of three semi-structured interv

A survey to determine usual care after cancer treatment within the United Kingdom national health service.

BackgroundApproximately one third of cancer survivors in the United Kingdom face ongoing and debilitating psychological and physical symptoms related to poor quality of life. Very little is known about current post-cancer treatment services.MethodsOncology healthcare professionals (HCPs) were invited to take part in a survey, which gathered both quantitative and free text data about the content and delivery of cancer aftercare and patient needs. Analysis involved descriptive statistics and content analysis.ResultsThere were 163 complete responses from 278 survey participants; 70% of NHS acute

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… HCPs identified that clinical nurse specialists (92%), clinical oncologists (62%), medical oncologists (54%), counsellors (51%), physiotherapists (52%), psychologists (45%), surgeons (40%), and occupational therapists (35%) were involved in post-treatment follow-up care. … (Medical Oncologist) Family and peer support was also highlighted as an important element of the post-treatment follow-up pathway. …

Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies.

We conducted a randomized controlled trial in older adults with hematologic malignancies to determine the impact of geriatrician consultation embedded in our oncology clinic alongside standard care. From February 2015 to May 2018, transplant-ineligible patients aged ≥75 years who presented for initial consultation for lymphoma, leukemia, or multiple myeloma at Dana-Farber Cancer Institute (Boston, MA, USA) were eligible. Pre-frail and frail patients, classified based on phenotypic and deficit-accumulation approaches, were randomized to receive either standard oncologic care with or without con

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… All oncologists were blinded to the initial geriatric screening and frailty classification, precluding an influence on initial treatment recommendations. … Hematologic oncologists’ and other clinicians’ perceived value of geriatric consultation Thirty-five of 65 (53.8%) hematologic oncologists, nurse practitioners, and physician assistants whose patients had received geriatric consultation responded to the survey evaluating the perceived value of geriatric …

How to talk about death? A cross-sectional survey on patients', informal caregivers' and health care professionals' views in the setting of allogenic hematopoietic stem cell transplantation.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment, which carries a high risk of complications and mortality, highlighting the necessity of discussions about life threat. This study explores the perspectives of patients, informal caregivers (ICs), and healthcare professionals (HCPs) regarding the timing, content, and challenges of these discussions. Multicenter cross-sectional survey in comprehensive care centers across Germany, involving patients with allo-HSCT, ICs, and HCPs. Questionnaires assessed perceived concerns about life threat, communi

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… of End-of-Life Discussions for Blood Cancers: A National Survey of Hematologic Oncologists. … Hui D Cerana MA Park M Hess K Bruera E Impact of Oncologists’ Attitudes Toward End-of-Life Care on Patients’ Access to Palliative Care Oncologist 2016 21 1149 1155 10.1634/theoncologist.2016-0090 27412394 PMC5016076 Hui D, Cerana MA, Park M, Hess K, Bruera E (2016) Impact of Oncologists’ Attitudes Toward …

Emergency department-initiated palliative care for advanced cancer patients: protocol for a pilot randomized controlled trial.

BackgroundFor patients with advanced cancer, visits to the emergency department (ED) are common. Such patients present to the ED with a specific profile of palliative care needs, including burdensome symptoms such as pain, dyspnea, or vomiting that cannot be controlled in other settings and a lack of well-defined goals of care. The goals of this study are: i) to test the feasibility of recruiting, enrolling, and randomizing patients with serious illness in the ED; and ii) to evaluate the impact of ED-initiated palliative care on health care utilization, quality of life, and survival.Methods/de

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… A list of all oncologists with admitting privileges was made, and is continually updated specifying whether the oncologist prefers to be called in advance for every patient. … If research staff identify a potential qualifying ED patient based on chart review, s/he discusses the patient with the ED attending and oncologist (if the oncologist requests this). …

Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review.

The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical outcomes and in cost-effectiveness remains to be fully established, and CGA is still far from being routinely implemented in geriatric oncology. This narrative review aims to analyse the available evidence on the cost-effectiveness of CGA adopted in geriatric oncology,

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… It allows to properly categorise patients as fit, vulnerable or frail, which, in turn, is supposed to help oncologists make more appropriate treatment decisions. … The intervention that was evaluated was CGA-coupled with the geriatric assessment-guided management recommendations provided to the community oncologists. …

Chinese expert consensus recommendations for the administration of immune checkpoint inhibitors to special cancer patient populations.

Immune checkpoint inhibitors (ICIs) targeting programmed cell death 1, programmed cell death ligand 1, and cytotoxic T lymphocyte-associated antigen-4 have shown significantly durable clinical benefits and tolerable toxicities and have improved the survival of patients with various types of cancer. Since 2018, the National Medical Products Administration of China has approved 17 ICIs as the standard treatment for certain advanced or metastatic solid tumors. As ICIs represent a broad-spectrum antitumor strategy, the populations eligible for cancer immunotherapy are rapidly expanding. However, t

Demystifying the oncologic patient in the intensive care unit.

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… Intensivists must remain aware of how these advancements reshape their daily practices, partnering with oncologists and hematologists and continuing to provide exemplary, dedicated, compassionate, and evidence-based care to critically ill patients. REFERENCES 1. … Oncologists' and intensivists' attitudes toward the care of critically ill patients with cancer. J Intensive Care Med . 2019;34(10):811–817. doi: 10.1177/0885066617716105. 15. Jackson VA, Emanuel L. Navigating and communicating about serious illness and end of life. …

Palliative care utilization in oncology and hemato-oncology: a systematic review of cognitive barriers and facilitators from the perspective of healthcare professionals, adult patients, and their families.

BackgroundDespite the high potential to improve the quality of life of patients and families, palliative care services face significant obstacles to their use. In countries with high-resource health systems, the nonfinancial and nonstructural obstacles to palliative care services are particularly prominent. These are the cognitive barriers -knowledge and communication barriers- to the use of palliative care. To date no systematic review has given the deserved attention to the cognitive barriers and facilitators to palliative care services utilization. This study aims to synthesize knowledge on

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… Studies with diverse perspectives were included (e.g., hemato-oncologists’ and GPs’ perspectives). … Salas Coronado, et al., 2014 [ 53 ] To explore hematologic oncologists’ perspectives and decision-making processes regarding end-of-life care Qualitative 20 hematologic oncologists - USA Focus group 39 Patel, M. I., Periyakoil, V. …

Predicting which patients with cancer will see a psychiatrist or counsellor from their initial oncology consultation document using natural language processing.

BackgroundPatients with cancer often have unmet psychosocial needs. Early detection of who requires referral to a counsellor or psychiatrist may improve their care. This work used natural language processing to predict which patients will see a counsellor or psychiatrist from a patient's initial oncology consultation document. We believe this is the first use of artificial intelligence to predict psychiatric outcomes from non-psychiatric medical documents.MethodsThis retrospective prognostic study used data from 47,625 patients at BC Cancer. We analyzed initial oncology consultation documents

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… There has been more NLP work in oncology 51 – 54 , including our recent work predicting survival from oncologist consultations 55 . … BC Cancer provides most cancer care in British Columbia, and is affiliated with all radiation oncologists and over 85% of medical oncologists in the province. …

Predictive Factors for Failed Nonsurgical Management of Long Bone Metastasis and Myeloma.

BACKGROUND: Understanding the risk factors for failing nonsurgical management of metastatic bone disease is necessary to determine those patients who will benefit from prophylactic stabilization; however, standard predictive models do not include several clinically relevant factors. The primary and secondary objectives of this study were to evaluate comprehensive patient- and disease-related factors as potential predictors of failure of radiation therapy alone for long bone lesions and overall survival in metastatic disease and myeloma. METHODS: All patients who underwent radiation therapy fo

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… Notably, patients were referred for local control radiation therapy based on medical and surgical decision making by a multidisciplinary team of radiation oncologists and orthopaedic oncologists. … Primary histologies were categorized according to general responsiveness of bone disease to radiation therapy by a radiation oncologist and orthopaedic oncologist. High-risk histology included renal cell carcinoma, melanoma, and colon carcinoma. …

European Cancer Organisation Essential Requirements for Quality Cancer Care: Hematological malignancies.

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… Provide personalized information for patients on their drug therapy to support adherence and help medical oncologists monitor side effects. Work with hematologists on clinical cancer trials. … Hematologists/medical oncologists should support patient involvement in decision‐making, providing tailored information and choices aligned with the patients' disease, circumstances, and preferences. …

Catchment area and cancer population health research through a novel population-based statewide database: a scoping review.

BackgroundPopulation-based linked datasets are vital to generate catchment area and population health research. The novel Cancer Information and Population Health Resource (CIPHR) links statewide cancer registry data, public and private insurance claims, and provider- and area-level data, representing more than 80% of North Carolina's large, diverse population of individuals diagnosed with cancer. This scoping review of articles that used CIPHR data characterizes the breadth of research generated and identifies further opportunities for population-based health research.MethodsArticles publishe

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… Patients treated by medical oncologists, as opposed to surgical or gynecologic oncologists, were more likely to receive gene expression profile testing. … to have a consultation with a medical oncologist ( 42 ). …

A hybrid model of acute unscheduled cancer care provided by a hospital-based acute care clinic and the emergency department: a descriptive study.

PurposePatients with cancer often experience medical events that require immediate evaluation. These evaluations typically occur in an emergency department (ED), but there is increasing interest in providing this care in other settings. We report on a novel care model whereby a nursing hotline is used to triage patients to the ED or to the North Carolina Cancer Hospital Infusion Center (NCCHIC).MethodsA retrospective study of adult patients with a neoplasm diagnosis seeking acute care at a large academic hospital pre- and post-initiation of the novel care model in January of 2016. Patients wer

Do non-responders of a geriatric screening questionnaire face lower one-year survival compared to responders? A retrospective cohort study.

PURPOSE: A geriatric screening questionnaire was implemented in 2020 at the Department of Oncology, Gødstrup Hospital, Denmark, to identify frailty and individualize cancer care for all patients aged ≥ 60 years. However, not all patients answered. The primary aim of this study was to investigate the association between response status to the geriatric screening questionnaire and one-year survival. A secondary aim was to compare one-year survival according to the responders’ frailty status. METHODS: We conducted a retrospective cohort study including all patients with cancer aged ≥ 60 who were

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… PS was classified by the oncologist according to the ECOG method at the time of the diagnosis [ 10 ]. If the oncologist had registered that the patient was between two PS descriptions, the better PS was selected. … Firstly, the GS ePRO solution provided the oncologists with more precise information about a patient’s frailty status. …

Integrating Palliative Care into Oncology Care Worldwide: The Right Care in the Right Place at the Right Time.

Opinion statementWhile the benefits of early palliative care are indisputable, most of the current evidence has emerged from resource-rich settings in urban areas of high-income countries, with an emphasis on solid tumors in outpatient settings; this model of palliative care integration is not currently scalable internationally. A shortage of specialist palliative care clinicians means that in order to meet the needs of all patients who require support at any point along their advanced cancer trajectory, palliative care must also be provided by family physicians and oncology clinicians who req

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… While these clinics are for patients with a variety of cancer diagnoses, referrals tend to come more often from medical oncologists who specialize in solid tumors than malignant hematologists. … Referrals from oncologists are triaged based on urgency, with prioritization of highly symptomatic patients for same-day visits while those with less urgent concerns are booked into a visit that coincides with a future clinic visit to their oncologist [ 31 ]. …

Opportunities for Savings in Risk Arrangements for Oncologic Care.

ImportanceAs the US accelerates adoption of alternative payment through global payment models such as Accountable Care Organizations (ACOs) or Medicare Advantage (MA), high spending for cancer care is a potential target for savings.ObjectiveTo quantify the extent to which ACOs and other risk-bearing organizations operating in a specific geographic area (hospital referral region [HRR]) could achieve savings by steering patients to efficient medical oncology practices.Design, setting, and participantsThis observational study included serial cross-sections of Medicare beneficiaries with cancer fr

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… The latter may suggest priority areas to focus on for oncologists and practice managers seeking to improve the value of cancer care in the context of local health care practice patterns. … Assessment of patient attribution to care from medical oncologists, surgeons, or radiation oncologists after newly diagnosed cancer. JAMA Netw Open. 2021;4(5):e218055. doi: 10.1001/jamanetworkopen.2021.8055 18. Interactive Apps. Dartmouth Atlas of Health Care. …

Oral cancer therapy: policy implications for the uninsured and underinsured populations.

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… When surveyed, the majority of oncologists at two major academic centers in Boston stated that cost does not influence the oncologists’ clinical practice, nor should it limit access to "effective" care. … The oncologist 2013 18 381 390 23442307 10.1634/theoncologist.2012-0279 PMC3639525 …