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Research and Reviews for the Practicing Oncologist
Contemporary management of small renal tumors
The incidence of kidney cancer in the United States is rising because the increased use of cross-sectional imaging is resulting in more tumors being detected and because the population is aging. In addition, a stage migration in kidney cancer has been observed, again because of improved detection, with an increase in stage T1 tumors and a concomitant decrease in the number of stage T2 to T4 tumors. Recent studies have shown that up to 80% of small renal tumors (SRTs) either have an indolent course or are histologically benign. These findings raise the question of what the optimal management of SRTs should be. Radical nephrectomy, the traditional, most aggressive, and still most frequently used extirpative surgery, has been shown to increase the risk of chronic kidney disease. Therefore, during the past 2 decades there has been a shift toward nephron-sparing surgery in carefully selected patients as such procedures have demonstrated equivalent oncologic outcomes with a decrease in long-term renal-induced morbidities.
Click on the PDF icon at the top of this introduction to read the full article.
The incidence of kidney cancer in the United States is rising because the increased use of cross-sectional imaging is resulting in more tumors being detected and because the population is aging. In addition, a stage migration in kidney cancer has been observed, again because of improved detection, with an increase in stage T1 tumors and a concomitant decrease in the number of stage T2 to T4 tumors. Recent studies have shown that up to 80% of small renal tumors (SRTs) either have an indolent course or are histologically benign. These findings raise the question of what the optimal management of SRTs should be. Radical nephrectomy, the traditional, most aggressive, and still most frequently used extirpative surgery, has been shown to increase the risk of chronic kidney disease. Therefore, during the past 2 decades there has been a shift toward nephron-sparing surgery in carefully selected patients as such procedures have demonstrated equivalent oncologic outcomes with a decrease in long-term renal-induced morbidities.
Click on the PDF icon at the top of this introduction to read the full article.
The incidence of kidney cancer in the United States is rising because the increased use of cross-sectional imaging is resulting in more tumors being detected and because the population is aging. In addition, a stage migration in kidney cancer has been observed, again because of improved detection, with an increase in stage T1 tumors and a concomitant decrease in the number of stage T2 to T4 tumors. Recent studies have shown that up to 80% of small renal tumors (SRTs) either have an indolent course or are histologically benign. These findings raise the question of what the optimal management of SRTs should be. Radical nephrectomy, the traditional, most aggressive, and still most frequently used extirpative surgery, has been shown to increase the risk of chronic kidney disease. Therefore, during the past 2 decades there has been a shift toward nephron-sparing surgery in carefully selected patients as such procedures have demonstrated equivalent oncologic outcomes with a decrease in long-term renal-induced morbidities.
Click on the PDF icon at the top of this introduction to read the full article.
A supportive care clinic for cancer patients embedded within an oncology practice
Background Most cancer patients have symptoms from their disease or treatment. Symptoms are not ideally managed in the context of busy clinics, resulting in potentially avoidable emergency department (ED) visits and hospitalizations. Adjunct supportive care clinics (SCCs) may more effectively address patient needs, but they contribute to fractionation of care if different personnel are involved.
Objective We describe an SCC embedded within a physician practice in which an employed nurse practitioner delivered most of the care. We measured the disposition of patients from the SCC to the ED, and the effect on ED visits and admissions for symptom management.
Methods We conducted a retrospective review of the patients attending the SCC over a period of 11 months. Demographics and disposition outcomes were tracked and compared with pre-intervention controls.
Results In all, 340 visits were recorded from 330 unique patients. Same-day and next-day appointments with a nurse practitioner were arranged for 62% and 25% of patients, respectively. The most common complaints related to pain and gastrointestinal issues. Most of the patients were discharged home. A few needed hospitalization or ED-level care. Admissions for symptom-related care fell by 31%. An estimated 66 ED visits were avoided by patients accessing the SCC.
Limitations The study was retrospective. It did not include detailed financial data. Results may not be generalizable because of the high level of central planning and use of a shared electronic medical record system, which may be lacking in some practices.
Conclusions An embedded supportive care clinic allowed rapid access to experienced oncology care under supervision by the patient’s own oncologists. The clinic was associated with less use of the ED and need for hospitalization. New methods of reimbursing medical care will increasingly require oncology practices to improve patient access to symptom-related care to avoid unnecessary admissions. An embedded SCC can accomplish these goals while avoiding further fractionation of care.
Click on the PDF icon below for the full article.
Background Most cancer patients have symptoms from their disease or treatment. Symptoms are not ideally managed in the context of busy clinics, resulting in potentially avoidable emergency department (ED) visits and hospitalizations. Adjunct supportive care clinics (SCCs) may more effectively address patient needs, but they contribute to fractionation of care if different personnel are involved.
Objective We describe an SCC embedded within a physician practice in which an employed nurse practitioner delivered most of the care. We measured the disposition of patients from the SCC to the ED, and the effect on ED visits and admissions for symptom management.
Methods We conducted a retrospective review of the patients attending the SCC over a period of 11 months. Demographics and disposition outcomes were tracked and compared with pre-intervention controls.
Results In all, 340 visits were recorded from 330 unique patients. Same-day and next-day appointments with a nurse practitioner were arranged for 62% and 25% of patients, respectively. The most common complaints related to pain and gastrointestinal issues. Most of the patients were discharged home. A few needed hospitalization or ED-level care. Admissions for symptom-related care fell by 31%. An estimated 66 ED visits were avoided by patients accessing the SCC.
Limitations The study was retrospective. It did not include detailed financial data. Results may not be generalizable because of the high level of central planning and use of a shared electronic medical record system, which may be lacking in some practices.
Conclusions An embedded supportive care clinic allowed rapid access to experienced oncology care under supervision by the patient’s own oncologists. The clinic was associated with less use of the ED and need for hospitalization. New methods of reimbursing medical care will increasingly require oncology practices to improve patient access to symptom-related care to avoid unnecessary admissions. An embedded SCC can accomplish these goals while avoiding further fractionation of care.
Click on the PDF icon below for the full article.
Background Most cancer patients have symptoms from their disease or treatment. Symptoms are not ideally managed in the context of busy clinics, resulting in potentially avoidable emergency department (ED) visits and hospitalizations. Adjunct supportive care clinics (SCCs) may more effectively address patient needs, but they contribute to fractionation of care if different personnel are involved.
Objective We describe an SCC embedded within a physician practice in which an employed nurse practitioner delivered most of the care. We measured the disposition of patients from the SCC to the ED, and the effect on ED visits and admissions for symptom management.
Methods We conducted a retrospective review of the patients attending the SCC over a period of 11 months. Demographics and disposition outcomes were tracked and compared with pre-intervention controls.
Results In all, 340 visits were recorded from 330 unique patients. Same-day and next-day appointments with a nurse practitioner were arranged for 62% and 25% of patients, respectively. The most common complaints related to pain and gastrointestinal issues. Most of the patients were discharged home. A few needed hospitalization or ED-level care. Admissions for symptom-related care fell by 31%. An estimated 66 ED visits were avoided by patients accessing the SCC.
Limitations The study was retrospective. It did not include detailed financial data. Results may not be generalizable because of the high level of central planning and use of a shared electronic medical record system, which may be lacking in some practices.
Conclusions An embedded supportive care clinic allowed rapid access to experienced oncology care under supervision by the patient’s own oncologists. The clinic was associated with less use of the ED and need for hospitalization. New methods of reimbursing medical care will increasingly require oncology practices to improve patient access to symptom-related care to avoid unnecessary admissions. An embedded SCC can accomplish these goals while avoiding further fractionation of care.
Click on the PDF icon below for the full article.
Targeted sessions for targeted therapies at ASCO
It’s likely that you have just returned from ASCO 2014 in Chicago with 33,000 of your closest oncology friends, or that you have at least heard all about the meeting and some of the exciting presentations. Either way, you must be wondering how best to sift through the mountain of data and information that came out of the meeting so that you can organize it, absorb it, and here’s the real challenge, apply it in the real-clinic setting going forward.
Click on the PDF icon at the top of this introduction to read the full article.
It’s likely that you have just returned from ASCO 2014 in Chicago with 33,000 of your closest oncology friends, or that you have at least heard all about the meeting and some of the exciting presentations. Either way, you must be wondering how best to sift through the mountain of data and information that came out of the meeting so that you can organize it, absorb it, and here’s the real challenge, apply it in the real-clinic setting going forward.
Click on the PDF icon at the top of this introduction to read the full article.
It’s likely that you have just returned from ASCO 2014 in Chicago with 33,000 of your closest oncology friends, or that you have at least heard all about the meeting and some of the exciting presentations. Either way, you must be wondering how best to sift through the mountain of data and information that came out of the meeting so that you can organize it, absorb it, and here’s the real challenge, apply it in the real-clinic setting going forward.
Click on the PDF icon at the top of this introduction to read the full article.
Guideline updates for non-Hodgkin lymphomas
At the 2014 National Comprehensive Cancer Network annual conference in Hollywood, Florida, Dr Andrew D Zelenetz, chair of the NCCN Non-Hodgkin Lymphomas Guidelines panel, presented guideline updates for non-Hodgkin lymphomas.
Click on the PDF icon at the top of this introduction to read the full article.
At the 2014 National Comprehensive Cancer Network annual conference in Hollywood, Florida, Dr Andrew D Zelenetz, chair of the NCCN Non-Hodgkin Lymphomas Guidelines panel, presented guideline updates for non-Hodgkin lymphomas.
Click on the PDF icon at the top of this introduction to read the full article.
At the 2014 National Comprehensive Cancer Network annual conference in Hollywood, Florida, Dr Andrew D Zelenetz, chair of the NCCN Non-Hodgkin Lymphomas Guidelines panel, presented guideline updates for non-Hodgkin lymphomas.
Click on the PDF icon at the top of this introduction to read the full article.
PSA flare after initiation of abiraterone acetate
Prostate cancer is the second-most common cause of male cancer-related death among US men. The American Cancer Society estimates that in 2014 there will be about 233,000 new cases of prostate cancer and about 29,500 deaths due to prostate cancer.1 Sixty percent of cases are diagnosed in men aged 65 years or older. Localized prostate cancers are managed with active surveillance or external beam radiation therapy or radical prostatectomy after risk stratification. Advanced prostate cancers are managed with hormonal therapy for castrate sensitive prostate cancer and with novel androgen blocking therapies, chemotherapy, or radio-immunotherapy for castrate resistant prostate cancers. Prostate-specific antigen (PSA) flare is characterized by a rise in the PSA level, followed by a decline to below baseline values after starting therapies such as androgen deprivation therapy, systemic chemotherapy, or local therapies such as brachytherapy or cryotherapy.
Click on the PDF icon at the top of this introduction to read the full article.
Prostate cancer is the second-most common cause of male cancer-related death among US men. The American Cancer Society estimates that in 2014 there will be about 233,000 new cases of prostate cancer and about 29,500 deaths due to prostate cancer.1 Sixty percent of cases are diagnosed in men aged 65 years or older. Localized prostate cancers are managed with active surveillance or external beam radiation therapy or radical prostatectomy after risk stratification. Advanced prostate cancers are managed with hormonal therapy for castrate sensitive prostate cancer and with novel androgen blocking therapies, chemotherapy, or radio-immunotherapy for castrate resistant prostate cancers. Prostate-specific antigen (PSA) flare is characterized by a rise in the PSA level, followed by a decline to below baseline values after starting therapies such as androgen deprivation therapy, systemic chemotherapy, or local therapies such as brachytherapy or cryotherapy.
Click on the PDF icon at the top of this introduction to read the full article.
Prostate cancer is the second-most common cause of male cancer-related death among US men. The American Cancer Society estimates that in 2014 there will be about 233,000 new cases of prostate cancer and about 29,500 deaths due to prostate cancer.1 Sixty percent of cases are diagnosed in men aged 65 years or older. Localized prostate cancers are managed with active surveillance or external beam radiation therapy or radical prostatectomy after risk stratification. Advanced prostate cancers are managed with hormonal therapy for castrate sensitive prostate cancer and with novel androgen blocking therapies, chemotherapy, or radio-immunotherapy for castrate resistant prostate cancers. Prostate-specific antigen (PSA) flare is characterized by a rise in the PSA level, followed by a decline to below baseline values after starting therapies such as androgen deprivation therapy, systemic chemotherapy, or local therapies such as brachytherapy or cryotherapy.
Click on the PDF icon at the top of this introduction to read the full article.
Gemicitabine-induced radiation recall phenomenon in 2 distinctive sites on the same patient
Radiation recall phenomenon is an acute inflammatory reaction that develops in previously irradiated areas after administration of inciting agents systemically. The most common agents are anticancer drugs.1 Gemcitabine, a fluorine-substituted deoxycytidine analog, is widely used as a chemotherapy medication. Its antitumor effect results from the blockade of DNA synthesis and DNA repair. It has been used in advanced pancreatic, non–small-cell lung, bladder, and ovarian cancers; soft-tissue sarcoma; and non-Hodgkin lymphoma.2 It has occasionally been reported to cause radiation recall phenomenon.3 The time between radiation and recall may range from weeks to almost a year.
Click on the PDF icon at the top of this introduction to read the full article.
Radiation recall phenomenon is an acute inflammatory reaction that develops in previously irradiated areas after administration of inciting agents systemically. The most common agents are anticancer drugs.1 Gemcitabine, a fluorine-substituted deoxycytidine analog, is widely used as a chemotherapy medication. Its antitumor effect results from the blockade of DNA synthesis and DNA repair. It has been used in advanced pancreatic, non–small-cell lung, bladder, and ovarian cancers; soft-tissue sarcoma; and non-Hodgkin lymphoma.2 It has occasionally been reported to cause radiation recall phenomenon.3 The time between radiation and recall may range from weeks to almost a year.
Click on the PDF icon at the top of this introduction to read the full article.
Radiation recall phenomenon is an acute inflammatory reaction that develops in previously irradiated areas after administration of inciting agents systemically. The most common agents are anticancer drugs.1 Gemcitabine, a fluorine-substituted deoxycytidine analog, is widely used as a chemotherapy medication. Its antitumor effect results from the blockade of DNA synthesis and DNA repair. It has been used in advanced pancreatic, non–small-cell lung, bladder, and ovarian cancers; soft-tissue sarcoma; and non-Hodgkin lymphoma.2 It has occasionally been reported to cause radiation recall phenomenon.3 The time between radiation and recall may range from weeks to almost a year.
Click on the PDF icon at the top of this introduction to read the full article.
The importance of hematologic, cytogenetic, and molecular testing and mutational analysis in chronic myeloid leukemia
The introduction of BCR-ABL1 tyrosine kinase inhibitors (TKIs) for treatment of chronic myeloid leukemia (CML) has made it possible for this cancer to be controlled in many patients for long periods with chronic medication and regular monitoring of disease status. Hematologic and cytogenetic testing, molecular monitoring, and BCR-ABL1 mutational analysis have become integral to the routine management of CML. The information that each type of test provides is essential to confirm a diagnosis, determine the disease stage, assess response to treatment, and monitor for signals of disease progression – all of which can be used to identify patients who might require further evaluation, closer follow-up, and additional intervention, and to guide clinical decisions.
Click on the PDF icon at the top of this introduction to read the full article.
The introduction of BCR-ABL1 tyrosine kinase inhibitors (TKIs) for treatment of chronic myeloid leukemia (CML) has made it possible for this cancer to be controlled in many patients for long periods with chronic medication and regular monitoring of disease status. Hematologic and cytogenetic testing, molecular monitoring, and BCR-ABL1 mutational analysis have become integral to the routine management of CML. The information that each type of test provides is essential to confirm a diagnosis, determine the disease stage, assess response to treatment, and monitor for signals of disease progression – all of which can be used to identify patients who might require further evaluation, closer follow-up, and additional intervention, and to guide clinical decisions.
Click on the PDF icon at the top of this introduction to read the full article.
The introduction of BCR-ABL1 tyrosine kinase inhibitors (TKIs) for treatment of chronic myeloid leukemia (CML) has made it possible for this cancer to be controlled in many patients for long periods with chronic medication and regular monitoring of disease status. Hematologic and cytogenetic testing, molecular monitoring, and BCR-ABL1 mutational analysis have become integral to the routine management of CML. The information that each type of test provides is essential to confirm a diagnosis, determine the disease stage, assess response to treatment, and monitor for signals of disease progression – all of which can be used to identify patients who might require further evaluation, closer follow-up, and additional intervention, and to guide clinical decisions.
Click on the PDF icon at the top of this introduction to read the full article.
Molecular monitoring and minimal residual disease in the management of chronic myelogenous leukemia
The introduction of BCR-ABL1 tyrosine kinase inhibitors (TKIs) in 2001 for treatment of chronic myelogenous leukemia (CML) marked a paradigm shift in management of the disease. With that advance, CML has been largely managed as a chronic condition, with daily medication and frequent monitoring. Optimizing monitoring methods and identifying factors associated with response and long-term outcomes has thus been a major clinical research focus. Given the improved understanding of surveillance techniques in CML and the advent of several recently approved second- and third-generation TKIs, there have been recent updates to clinical practice guidelines.
Click on the PDF icon at the top of this introduction to read the full article.
The introduction of BCR-ABL1 tyrosine kinase inhibitors (TKIs) in 2001 for treatment of chronic myelogenous leukemia (CML) marked a paradigm shift in management of the disease. With that advance, CML has been largely managed as a chronic condition, with daily medication and frequent monitoring. Optimizing monitoring methods and identifying factors associated with response and long-term outcomes has thus been a major clinical research focus. Given the improved understanding of surveillance techniques in CML and the advent of several recently approved second- and third-generation TKIs, there have been recent updates to clinical practice guidelines.
Click on the PDF icon at the top of this introduction to read the full article.
The introduction of BCR-ABL1 tyrosine kinase inhibitors (TKIs) in 2001 for treatment of chronic myelogenous leukemia (CML) marked a paradigm shift in management of the disease. With that advance, CML has been largely managed as a chronic condition, with daily medication and frequent monitoring. Optimizing monitoring methods and identifying factors associated with response and long-term outcomes has thus been a major clinical research focus. Given the improved understanding of surveillance techniques in CML and the advent of several recently approved second- and third-generation TKIs, there have been recent updates to clinical practice guidelines.
Click on the PDF icon at the top of this introduction to read the full article.
Performance status of real-world oncology patients before and after first course of chemotherapy
Background Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores are used to quantify overall disease status and are widely used to stratify participants at clinical trial entry. Longitudinal ECOG-PS measurement between 2 tumor types may provide important data for patient management in community settings.
Objective To describe oncology patients’ performance status before and after their first course of chemotherapy.
Methods ECOG-PS scores from electronic medical records (EMRs) of 47 oncology clinics across the United States were retrieved. The included patients had breast, lymphoma, prostate, colorectal, or lung cancers and ECOG-PS scores within ± 14 days of initiation and completion of the first chemotherapy course. Descriptive statistics of ECOG-PS were analyzed and compared within tumor types (via the Wilcoxon signed-rank test) and between tumor types (via the Kruskal-Wallis test).
Results In all, 7,912 cancer patients were identified as having breast cancer, lymphoma, prostate cancer, colorectal cancer, or lung cancer. At baseline, patients’ mean (SD) ECOG-PS scores were breast cancer, 0.51 (0.01); lymphoma, 0.82 (0.02); prostate cancer, 1.04 (0.05); colorectal cancer, 0.72 (0.02); and lung cancer, 0.97 (0.02). The percentages of patients with ECOG-PS < 2 at chemotherapy start were 94%, 86%, 78%, 89%, and 81% for each tumor, respectively; percentages at the end of the first course were 88%, 80%, 68%, 84%, and 66%, respectively. All pre- and postchemotherapy comparisons of scores between tumor types were statistically significantly different (P < .001), with the exceptions of lung and prostate cancer before chemotherapy, and lung, prostate, lymphoma, and colorectal cancers after chemotherapy. Changes of ECOG-PS scores from baseline to postchemotherapy assessments were statistically significant in all tumor types (P < .01).
Limitations The lack of a standardized method for collecting ECOG-PS scores in routine oncology practice led to the unavailability of scores for many patients.
Conclusions This study describes a national sample of community oncology patients’ performance status. Even though there was a significant drop in ECOG-PS scores from pre- to postchemotherapy, good ECOG-PS scores were maintained in a majority of patients. These findings demonstrate that ECOG-PS scores can be routinely assessed and can aid in decisions throughout chemo- therapy and in the planning for future treatments.
Funding Amgen Inc funded the study.
Click on the PDF icon at the top of this introduction to read the full article.
Background Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores are used to quantify overall disease status and are widely used to stratify participants at clinical trial entry. Longitudinal ECOG-PS measurement between 2 tumor types may provide important data for patient management in community settings.
Objective To describe oncology patients’ performance status before and after their first course of chemotherapy.
Methods ECOG-PS scores from electronic medical records (EMRs) of 47 oncology clinics across the United States were retrieved. The included patients had breast, lymphoma, prostate, colorectal, or lung cancers and ECOG-PS scores within ± 14 days of initiation and completion of the first chemotherapy course. Descriptive statistics of ECOG-PS were analyzed and compared within tumor types (via the Wilcoxon signed-rank test) and between tumor types (via the Kruskal-Wallis test).
Results In all, 7,912 cancer patients were identified as having breast cancer, lymphoma, prostate cancer, colorectal cancer, or lung cancer. At baseline, patients’ mean (SD) ECOG-PS scores were breast cancer, 0.51 (0.01); lymphoma, 0.82 (0.02); prostate cancer, 1.04 (0.05); colorectal cancer, 0.72 (0.02); and lung cancer, 0.97 (0.02). The percentages of patients with ECOG-PS < 2 at chemotherapy start were 94%, 86%, 78%, 89%, and 81% for each tumor, respectively; percentages at the end of the first course were 88%, 80%, 68%, 84%, and 66%, respectively. All pre- and postchemotherapy comparisons of scores between tumor types were statistically significantly different (P < .001), with the exceptions of lung and prostate cancer before chemotherapy, and lung, prostate, lymphoma, and colorectal cancers after chemotherapy. Changes of ECOG-PS scores from baseline to postchemotherapy assessments were statistically significant in all tumor types (P < .01).
Limitations The lack of a standardized method for collecting ECOG-PS scores in routine oncology practice led to the unavailability of scores for many patients.
Conclusions This study describes a national sample of community oncology patients’ performance status. Even though there was a significant drop in ECOG-PS scores from pre- to postchemotherapy, good ECOG-PS scores were maintained in a majority of patients. These findings demonstrate that ECOG-PS scores can be routinely assessed and can aid in decisions throughout chemo- therapy and in the planning for future treatments.
Funding Amgen Inc funded the study.
Click on the PDF icon at the top of this introduction to read the full article.
Background Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores are used to quantify overall disease status and are widely used to stratify participants at clinical trial entry. Longitudinal ECOG-PS measurement between 2 tumor types may provide important data for patient management in community settings.
Objective To describe oncology patients’ performance status before and after their first course of chemotherapy.
Methods ECOG-PS scores from electronic medical records (EMRs) of 47 oncology clinics across the United States were retrieved. The included patients had breast, lymphoma, prostate, colorectal, or lung cancers and ECOG-PS scores within ± 14 days of initiation and completion of the first chemotherapy course. Descriptive statistics of ECOG-PS were analyzed and compared within tumor types (via the Wilcoxon signed-rank test) and between tumor types (via the Kruskal-Wallis test).
Results In all, 7,912 cancer patients were identified as having breast cancer, lymphoma, prostate cancer, colorectal cancer, or lung cancer. At baseline, patients’ mean (SD) ECOG-PS scores were breast cancer, 0.51 (0.01); lymphoma, 0.82 (0.02); prostate cancer, 1.04 (0.05); colorectal cancer, 0.72 (0.02); and lung cancer, 0.97 (0.02). The percentages of patients with ECOG-PS < 2 at chemotherapy start were 94%, 86%, 78%, 89%, and 81% for each tumor, respectively; percentages at the end of the first course were 88%, 80%, 68%, 84%, and 66%, respectively. All pre- and postchemotherapy comparisons of scores between tumor types were statistically significantly different (P < .001), with the exceptions of lung and prostate cancer before chemotherapy, and lung, prostate, lymphoma, and colorectal cancers after chemotherapy. Changes of ECOG-PS scores from baseline to postchemotherapy assessments were statistically significant in all tumor types (P < .01).
Limitations The lack of a standardized method for collecting ECOG-PS scores in routine oncology practice led to the unavailability of scores for many patients.
Conclusions This study describes a national sample of community oncology patients’ performance status. Even though there was a significant drop in ECOG-PS scores from pre- to postchemotherapy, good ECOG-PS scores were maintained in a majority of patients. These findings demonstrate that ECOG-PS scores can be routinely assessed and can aid in decisions throughout chemo- therapy and in the planning for future treatments.
Funding Amgen Inc funded the study.
Click on the PDF icon at the top of this introduction to read the full article.
Barriers to palliative care research for emergency department patients with advanced cancer
Background Patients with advanced cancer often visit the emergency department (ED). Little is known about their willingness or ability to engage in palliative care research, although enrollment in clinical trials of other seriously ill ED patients -- those with stroke, for example -- has been shown to be feasible.
Objective To identify barriers to the enrollment of ED patients with advanced cancer in palliative care research.
Methods We prospectively tracked factors that affected patient accrual into a trial of palliative care for adults with metastatic solid tumors at an urban, academic ED. Research staff screened the electronic medical records for patients admitted to the hospital with metastatic solid tumors 8-12 hours a day, Monday through Friday. The ED attending of record and the patient’s medical oncologist had to agree before research staff invited the patient to participate. Informed consent was obtained at the bedside in the ED, and patients were offered a $20 incentive to participate.
Results Attempts were made to enroll 150 eligible patients in the study, and 73 were enrolled (49% enrollment rate). Barriers to enrollment for the 77 patients who did not participate were deduced from the field notes and placed into the following categories: patient refusal (n = 38, 49%), diagnostic uncertainty regarding cancer stage (n = 11, 14%), symptom burden (n = 9, 12%), family refusal (n = 7, 9%), physician refusal (n = 7, 9%), and/or patient unaware of illness or stage (n = 5, 7%).
Limitations The findings are descriptive and do not test predetermined hypotheses.
Conclusion Patient refusal, symptom burden, and diagnostic disparities are common barriers encountered when recruiting ED patients with advanced cancer. Despite the barriers, recruitment was feasible for such ED patients.
Funding/sponsor This study was funded by a Mentored Research Scholar Grant from the American Cancer Society (Dr Grudzen), a Medical Student Training in Aging Research Grant from the American Federation on Aging (Mr Kandarian), and by a Mid- Career Investigator Award in Patient Oriented Research (K24 AG022345) from the National Institute on Aging (Dr Morrison).
Click on the PDF icon at the top of this introduction to read the full article.
Background Patients with advanced cancer often visit the emergency department (ED). Little is known about their willingness or ability to engage in palliative care research, although enrollment in clinical trials of other seriously ill ED patients -- those with stroke, for example -- has been shown to be feasible.
Objective To identify barriers to the enrollment of ED patients with advanced cancer in palliative care research.
Methods We prospectively tracked factors that affected patient accrual into a trial of palliative care for adults with metastatic solid tumors at an urban, academic ED. Research staff screened the electronic medical records for patients admitted to the hospital with metastatic solid tumors 8-12 hours a day, Monday through Friday. The ED attending of record and the patient’s medical oncologist had to agree before research staff invited the patient to participate. Informed consent was obtained at the bedside in the ED, and patients were offered a $20 incentive to participate.
Results Attempts were made to enroll 150 eligible patients in the study, and 73 were enrolled (49% enrollment rate). Barriers to enrollment for the 77 patients who did not participate were deduced from the field notes and placed into the following categories: patient refusal (n = 38, 49%), diagnostic uncertainty regarding cancer stage (n = 11, 14%), symptom burden (n = 9, 12%), family refusal (n = 7, 9%), physician refusal (n = 7, 9%), and/or patient unaware of illness or stage (n = 5, 7%).
Limitations The findings are descriptive and do not test predetermined hypotheses.
Conclusion Patient refusal, symptom burden, and diagnostic disparities are common barriers encountered when recruiting ED patients with advanced cancer. Despite the barriers, recruitment was feasible for such ED patients.
Funding/sponsor This study was funded by a Mentored Research Scholar Grant from the American Cancer Society (Dr Grudzen), a Medical Student Training in Aging Research Grant from the American Federation on Aging (Mr Kandarian), and by a Mid- Career Investigator Award in Patient Oriented Research (K24 AG022345) from the National Institute on Aging (Dr Morrison).
Click on the PDF icon at the top of this introduction to read the full article.
Background Patients with advanced cancer often visit the emergency department (ED). Little is known about their willingness or ability to engage in palliative care research, although enrollment in clinical trials of other seriously ill ED patients -- those with stroke, for example -- has been shown to be feasible.
Objective To identify barriers to the enrollment of ED patients with advanced cancer in palliative care research.
Methods We prospectively tracked factors that affected patient accrual into a trial of palliative care for adults with metastatic solid tumors at an urban, academic ED. Research staff screened the electronic medical records for patients admitted to the hospital with metastatic solid tumors 8-12 hours a day, Monday through Friday. The ED attending of record and the patient’s medical oncologist had to agree before research staff invited the patient to participate. Informed consent was obtained at the bedside in the ED, and patients were offered a $20 incentive to participate.
Results Attempts were made to enroll 150 eligible patients in the study, and 73 were enrolled (49% enrollment rate). Barriers to enrollment for the 77 patients who did not participate were deduced from the field notes and placed into the following categories: patient refusal (n = 38, 49%), diagnostic uncertainty regarding cancer stage (n = 11, 14%), symptom burden (n = 9, 12%), family refusal (n = 7, 9%), physician refusal (n = 7, 9%), and/or patient unaware of illness or stage (n = 5, 7%).
Limitations The findings are descriptive and do not test predetermined hypotheses.
Conclusion Patient refusal, symptom burden, and diagnostic disparities are common barriers encountered when recruiting ED patients with advanced cancer. Despite the barriers, recruitment was feasible for such ED patients.
Funding/sponsor This study was funded by a Mentored Research Scholar Grant from the American Cancer Society (Dr Grudzen), a Medical Student Training in Aging Research Grant from the American Federation on Aging (Mr Kandarian), and by a Mid- Career Investigator Award in Patient Oriented Research (K24 AG022345) from the National Institute on Aging (Dr Morrison).
Click on the PDF icon at the top of this introduction to read the full article.