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Palliative Care in Oncology Symposium
‘Co-rounding’ decreases patient length of stay
BOSTON – When a palliative care oncologist partners with a medical oncologist on everyday rounds and in everyday practice on an inpatient floor, both patients and the clinicians who provide their care benefit from the arrangement, an oncologist reports.
At Duke University Medical Center in Durham, N.C., where palliative care is integrated with medical oncology on an inpatient oncology ward, the “co-rounding” model is associated with improvements in quality outcomes, improved nursing and physician satisfaction, and increased collaboration and communication, said Dr. Richard F. Riedel of the medical center.
In a study comparing the periods before and after implementation of the co-rounding model, lengths of stay and 7- and 30-day readmission rates were significantly shorter with co-rounding.
“I’d like to think that decreased resource utilization through decreased ICU transfer rates and decreased readmissions will result in a cost savings that would certainly justify putting a second provider up on an inpatient ward,” he said at the Palliative Care in Oncology Symposium.
The co-rounding model was introduced at Duke in 2011. Under this system, a medical oncologist and palliative care oncologist meet three times daily with house staff, fellows, and other team members to discuss the care of all patients on the unit. They decide which physician will oversee care of which patient. Patients who have high symptom burdens, for example, might be assigned to the palliative care physician. The physicians and staff go on rounds together with support staff, including internal medicine house staff, physician assistants, and pharmacists, allowing both formal and “curbside” consultations about how best to manage each patient.
“Critical to the success of this model is open communication and collaboration. We have three points where we meet throughout the day, and we emphasize to our colleagues that we are one team – we do not work in silos,” Dr. Riedel said.
Before and after
To see whether the co-rounding model was really, as they thought, a better way of doing business, Dr. Riedel and his colleagues conducted a retrospective cohort analysis of all patients admitted to the solid tumor inpatient service before the intervention – 731 patients admitted from September 2008 through June 2010 – compared with 783 admitted from September 2011 through June 2012, in the first year of co-rounding.
They found that co-rounding was associated with a significantly lower mean length of stay (4.51 days pre-intervention to 4.16 post, P =.02), and in both 7-day and 30-day readmission rates (12.1% vs. 9.3%, P <.0001, and 32.1% vs 28.3%, P = .048, respectively).
Although there were numerically fewer ICU transfers post intervention, this difference was not significant. Similarly, there was a trend, albeit nonsignificant, toward more hospice referrals under co-rounding.
When the researchers surveyed registered nurses who worked in the unit during both periods, they found that most agreed that adding a palliative care specialist improved quality of care, allowed for earlier goals-of-care discussions with patients, improved the involvement of nurses in care planning, reduced stresses on the staff, and improved symptom management.
Importantly, the improvements came without making rounds take longer or detracting from any appropriate focus on oncologic care, the authors found.
Medical oncology faculty who had rounded at least 2 weeks under the new regimen were surveyed, and they uniformly reported that the palliative care providers added a valuable skill set, that palliative care was a necessary component of cancer care, and that the rounding experience was more enjoyable. They also agreed that palliative care is different from hospice care, and said they felt that the discussion of hospice for those patients with incurable disease did not come too soon in the course of care,
“Importantly, the majority of physicians felt that they learned some new ways to manage symptoms, and I can tell you that I certainly have. I’m a medical oncologist, I’m not a palliative-care trained physician,” Dr. Riedel said.
He acknowledged that the study was limited by its retrospective design and the lack of a patient satisfaction component. Also, the intervention occurred at a single large academic medical center, and involved a smaller physician-to-patient ratio that could have confounded results.
The symposium was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
Why is this study important? The researchers show that this model has modified a health care quality outcome, and that’s always very important. When we in the field change some quality outcome, that is something to further explore. They carefully measured the satisfaction of physicians and nurses, and that’s not always something we pay attention to. We can do a wonderful efficacy study, and then everybody hates doing it, and we shelve it, and nobody else does it. So seeing that people really like doing this is important.
Dr. Eduardo Bruera, the invited discussant, is with the University of Texas MD Anderson Cancer Center, Houston.
Why is this study important? The researchers show that this model has modified a health care quality outcome, and that’s always very important. When we in the field change some quality outcome, that is something to further explore. They carefully measured the satisfaction of physicians and nurses, and that’s not always something we pay attention to. We can do a wonderful efficacy study, and then everybody hates doing it, and we shelve it, and nobody else does it. So seeing that people really like doing this is important.
Dr. Eduardo Bruera, the invited discussant, is with the University of Texas MD Anderson Cancer Center, Houston.
Why is this study important? The researchers show that this model has modified a health care quality outcome, and that’s always very important. When we in the field change some quality outcome, that is something to further explore. They carefully measured the satisfaction of physicians and nurses, and that’s not always something we pay attention to. We can do a wonderful efficacy study, and then everybody hates doing it, and we shelve it, and nobody else does it. So seeing that people really like doing this is important.
Dr. Eduardo Bruera, the invited discussant, is with the University of Texas MD Anderson Cancer Center, Houston.
BOSTON – When a palliative care oncologist partners with a medical oncologist on everyday rounds and in everyday practice on an inpatient floor, both patients and the clinicians who provide their care benefit from the arrangement, an oncologist reports.
At Duke University Medical Center in Durham, N.C., where palliative care is integrated with medical oncology on an inpatient oncology ward, the “co-rounding” model is associated with improvements in quality outcomes, improved nursing and physician satisfaction, and increased collaboration and communication, said Dr. Richard F. Riedel of the medical center.
In a study comparing the periods before and after implementation of the co-rounding model, lengths of stay and 7- and 30-day readmission rates were significantly shorter with co-rounding.
“I’d like to think that decreased resource utilization through decreased ICU transfer rates and decreased readmissions will result in a cost savings that would certainly justify putting a second provider up on an inpatient ward,” he said at the Palliative Care in Oncology Symposium.
The co-rounding model was introduced at Duke in 2011. Under this system, a medical oncologist and palliative care oncologist meet three times daily with house staff, fellows, and other team members to discuss the care of all patients on the unit. They decide which physician will oversee care of which patient. Patients who have high symptom burdens, for example, might be assigned to the palliative care physician. The physicians and staff go on rounds together with support staff, including internal medicine house staff, physician assistants, and pharmacists, allowing both formal and “curbside” consultations about how best to manage each patient.
“Critical to the success of this model is open communication and collaboration. We have three points where we meet throughout the day, and we emphasize to our colleagues that we are one team – we do not work in silos,” Dr. Riedel said.
Before and after
To see whether the co-rounding model was really, as they thought, a better way of doing business, Dr. Riedel and his colleagues conducted a retrospective cohort analysis of all patients admitted to the solid tumor inpatient service before the intervention – 731 patients admitted from September 2008 through June 2010 – compared with 783 admitted from September 2011 through June 2012, in the first year of co-rounding.
They found that co-rounding was associated with a significantly lower mean length of stay (4.51 days pre-intervention to 4.16 post, P =.02), and in both 7-day and 30-day readmission rates (12.1% vs. 9.3%, P <.0001, and 32.1% vs 28.3%, P = .048, respectively).
Although there were numerically fewer ICU transfers post intervention, this difference was not significant. Similarly, there was a trend, albeit nonsignificant, toward more hospice referrals under co-rounding.
When the researchers surveyed registered nurses who worked in the unit during both periods, they found that most agreed that adding a palliative care specialist improved quality of care, allowed for earlier goals-of-care discussions with patients, improved the involvement of nurses in care planning, reduced stresses on the staff, and improved symptom management.
Importantly, the improvements came without making rounds take longer or detracting from any appropriate focus on oncologic care, the authors found.
Medical oncology faculty who had rounded at least 2 weeks under the new regimen were surveyed, and they uniformly reported that the palliative care providers added a valuable skill set, that palliative care was a necessary component of cancer care, and that the rounding experience was more enjoyable. They also agreed that palliative care is different from hospice care, and said they felt that the discussion of hospice for those patients with incurable disease did not come too soon in the course of care,
“Importantly, the majority of physicians felt that they learned some new ways to manage symptoms, and I can tell you that I certainly have. I’m a medical oncologist, I’m not a palliative-care trained physician,” Dr. Riedel said.
He acknowledged that the study was limited by its retrospective design and the lack of a patient satisfaction component. Also, the intervention occurred at a single large academic medical center, and involved a smaller physician-to-patient ratio that could have confounded results.
The symposium was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
BOSTON – When a palliative care oncologist partners with a medical oncologist on everyday rounds and in everyday practice on an inpatient floor, both patients and the clinicians who provide their care benefit from the arrangement, an oncologist reports.
At Duke University Medical Center in Durham, N.C., where palliative care is integrated with medical oncology on an inpatient oncology ward, the “co-rounding” model is associated with improvements in quality outcomes, improved nursing and physician satisfaction, and increased collaboration and communication, said Dr. Richard F. Riedel of the medical center.
In a study comparing the periods before and after implementation of the co-rounding model, lengths of stay and 7- and 30-day readmission rates were significantly shorter with co-rounding.
“I’d like to think that decreased resource utilization through decreased ICU transfer rates and decreased readmissions will result in a cost savings that would certainly justify putting a second provider up on an inpatient ward,” he said at the Palliative Care in Oncology Symposium.
The co-rounding model was introduced at Duke in 2011. Under this system, a medical oncologist and palliative care oncologist meet three times daily with house staff, fellows, and other team members to discuss the care of all patients on the unit. They decide which physician will oversee care of which patient. Patients who have high symptom burdens, for example, might be assigned to the palliative care physician. The physicians and staff go on rounds together with support staff, including internal medicine house staff, physician assistants, and pharmacists, allowing both formal and “curbside” consultations about how best to manage each patient.
“Critical to the success of this model is open communication and collaboration. We have three points where we meet throughout the day, and we emphasize to our colleagues that we are one team – we do not work in silos,” Dr. Riedel said.
Before and after
To see whether the co-rounding model was really, as they thought, a better way of doing business, Dr. Riedel and his colleagues conducted a retrospective cohort analysis of all patients admitted to the solid tumor inpatient service before the intervention – 731 patients admitted from September 2008 through June 2010 – compared with 783 admitted from September 2011 through June 2012, in the first year of co-rounding.
They found that co-rounding was associated with a significantly lower mean length of stay (4.51 days pre-intervention to 4.16 post, P =.02), and in both 7-day and 30-day readmission rates (12.1% vs. 9.3%, P <.0001, and 32.1% vs 28.3%, P = .048, respectively).
Although there were numerically fewer ICU transfers post intervention, this difference was not significant. Similarly, there was a trend, albeit nonsignificant, toward more hospice referrals under co-rounding.
When the researchers surveyed registered nurses who worked in the unit during both periods, they found that most agreed that adding a palliative care specialist improved quality of care, allowed for earlier goals-of-care discussions with patients, improved the involvement of nurses in care planning, reduced stresses on the staff, and improved symptom management.
Importantly, the improvements came without making rounds take longer or detracting from any appropriate focus on oncologic care, the authors found.
Medical oncology faculty who had rounded at least 2 weeks under the new regimen were surveyed, and they uniformly reported that the palliative care providers added a valuable skill set, that palliative care was a necessary component of cancer care, and that the rounding experience was more enjoyable. They also agreed that palliative care is different from hospice care, and said they felt that the discussion of hospice for those patients with incurable disease did not come too soon in the course of care,
“Importantly, the majority of physicians felt that they learned some new ways to manage symptoms, and I can tell you that I certainly have. I’m a medical oncologist, I’m not a palliative-care trained physician,” Dr. Riedel said.
He acknowledged that the study was limited by its retrospective design and the lack of a patient satisfaction component. Also, the intervention occurred at a single large academic medical center, and involved a smaller physician-to-patient ratio that could have confounded results.
The symposium was cosponsored by AAHPM, ASCO, ASTRO, and MASCC.
AT THE PALLIATIVE CARE IN ONCOLOGY SYMPOSIUM
Key clinical point: A system of joint rounding of medical oncologists with palliative care specialists improved patient outcomes.
Major finding: Length of stay on an impatient solid tumor oncology unit decreased by 8% after the co-rounding model was introduced.Data source: Retrospective cohort analysis comparing 731 patients treated under the standard model of care, and 783 treated under the co-rounding model.
Disclosures: The study was supported by Duke University Medical Center. Dr. Riedel disclosed ties with several companies, but none were relevant to the study. Dr. Bruera reported having no disclosures.
Insured cancer patients forgo care, scrimp to get by
cancer patient and her father
Credit: Rhoda Baer
Despite having insurance, many US cancer patients may forgo medical care and change their lifestyles due to treatment-related financial burdens, a new survey suggests.
Nearly 40% of the 174 patients surveyed adopted medical care-altering strategies, such as skipping recommended testing and treatment.
And nearly 9 out of 10 patients made at least one lifestyle change, such as spending less money on food and clothing or selling their possessions.
Prior research has suggested that about 13% of patients suffer from high out-of-pocket financial burden after they are diagnosed with cancer. According to the American Cancer Society, as many as 20% of Americans with cancer spend their life savings to pay for their care.
“We need a better, more open dialogue between patients and providers about the financial burden associated with cancer care costs,” said lead study author Ryan Nipp, MD, of Dana-Farber Cancer Institute in Boston.
“We found that people use a range of different cost-coping strategies, and we need to engage with patients on their choices and develop screening tools to identify patients who are likely to make potentially harmful decisions about their treatment.”
Dr Nipp presented these findings (abstract 161*) in a presscast in advance of the 2014 Palliative Care in Oncology Symposium, which is taking place October 24-25 at the Westin Boston Waterfront in Boston.
The researchers surveyed 174 patients (median age 67, 96% female, 83% white) undergoing treatment for cancer (85% breast, 4% colorectal, 11% other solid tumors). All patients were insured and had requested financial assistance through a national copay assistance program.
Overall, 89% of participants used at least one lifestyle-altering strategy, and 39% used at least one medical care-altering strategy.
The most common medical care-altering strategies were not filling a prescription (28%) and taking less medication than prescribed (22%). Patients also reported skipping tests (10%), forgoing procedures (8%), and missing doctor’s appointments (6%).
Lifestyle-altering strategies included spending less on leisure activities (78%), spending less on basics like food and clothing (57%), borrowing money (54%), spending savings (50%), selling possessions (18%), and having family members work more (15%).
Younger age, higher education, and shorter time on chemotherapy were all associated with a greater likelihood of adopting lifestyle coping strategies compared to older age, lower education, and longer time on chemotherapy.
Younger patients were also more likely to use care-altering strategies compared to older patients. And lower-income patients used more care-altering strategies than higher-income patients. 
*Data in the abstract differ from data presented.
cancer patient and her father
Credit: Rhoda Baer
Despite having insurance, many US cancer patients may forgo medical care and change their lifestyles due to treatment-related financial burdens, a new survey suggests.
Nearly 40% of the 174 patients surveyed adopted medical care-altering strategies, such as skipping recommended testing and treatment.
And nearly 9 out of 10 patients made at least one lifestyle change, such as spending less money on food and clothing or selling their possessions.
Prior research has suggested that about 13% of patients suffer from high out-of-pocket financial burden after they are diagnosed with cancer. According to the American Cancer Society, as many as 20% of Americans with cancer spend their life savings to pay for their care.
“We need a better, more open dialogue between patients and providers about the financial burden associated with cancer care costs,” said lead study author Ryan Nipp, MD, of Dana-Farber Cancer Institute in Boston.
“We found that people use a range of different cost-coping strategies, and we need to engage with patients on their choices and develop screening tools to identify patients who are likely to make potentially harmful decisions about their treatment.”
Dr Nipp presented these findings (abstract 161*) in a presscast in advance of the 2014 Palliative Care in Oncology Symposium, which is taking place October 24-25 at the Westin Boston Waterfront in Boston.
The researchers surveyed 174 patients (median age 67, 96% female, 83% white) undergoing treatment for cancer (85% breast, 4% colorectal, 11% other solid tumors). All patients were insured and had requested financial assistance through a national copay assistance program.
Overall, 89% of participants used at least one lifestyle-altering strategy, and 39% used at least one medical care-altering strategy.
The most common medical care-altering strategies were not filling a prescription (28%) and taking less medication than prescribed (22%). Patients also reported skipping tests (10%), forgoing procedures (8%), and missing doctor’s appointments (6%).
Lifestyle-altering strategies included spending less on leisure activities (78%), spending less on basics like food and clothing (57%), borrowing money (54%), spending savings (50%), selling possessions (18%), and having family members work more (15%).
Younger age, higher education, and shorter time on chemotherapy were all associated with a greater likelihood of adopting lifestyle coping strategies compared to older age, lower education, and longer time on chemotherapy.
Younger patients were also more likely to use care-altering strategies compared to older patients. And lower-income patients used more care-altering strategies than higher-income patients.
*Data in the abstract differ from data presented.
cancer patient and her father
Credit: Rhoda Baer
Despite having insurance, many US cancer patients may forgo medical care and change their lifestyles due to treatment-related financial burdens, a new survey suggests.
Nearly 40% of the 174 patients surveyed adopted medical care-altering strategies, such as skipping recommended testing and treatment.
And nearly 9 out of 10 patients made at least one lifestyle change, such as spending less money on food and clothing or selling their possessions.
Prior research has suggested that about 13% of patients suffer from high out-of-pocket financial burden after they are diagnosed with cancer. According to the American Cancer Society, as many as 20% of Americans with cancer spend their life savings to pay for their care.
“We need a better, more open dialogue between patients and providers about the financial burden associated with cancer care costs,” said lead study author Ryan Nipp, MD, of Dana-Farber Cancer Institute in Boston.
“We found that people use a range of different cost-coping strategies, and we need to engage with patients on their choices and develop screening tools to identify patients who are likely to make potentially harmful decisions about their treatment.”
Dr Nipp presented these findings (abstract 161*) in a presscast in advance of the 2014 Palliative Care in Oncology Symposium, which is taking place October 24-25 at the Westin Boston Waterfront in Boston.
The researchers surveyed 174 patients (median age 67, 96% female, 83% white) undergoing treatment for cancer (85% breast, 4% colorectal, 11% other solid tumors). All patients were insured and had requested financial assistance through a national copay assistance program.
Overall, 89% of participants used at least one lifestyle-altering strategy, and 39% used at least one medical care-altering strategy.
The most common medical care-altering strategies were not filling a prescription (28%) and taking less medication than prescribed (22%). Patients also reported skipping tests (10%), forgoing procedures (8%), and missing doctor’s appointments (6%).
Lifestyle-altering strategies included spending less on leisure activities (78%), spending less on basics like food and clothing (57%), borrowing money (54%), spending savings (50%), selling possessions (18%), and having family members work more (15%).
Younger age, higher education, and shorter time on chemotherapy were all associated with a greater likelihood of adopting lifestyle coping strategies compared to older age, lower education, and longer time on chemotherapy.
Younger patients were also more likely to use care-altering strategies compared to older patients. And lower-income patients used more care-altering strategies than higher-income patients.
*Data in the abstract differ from data presented.
Cancer survivors face financial, work-related issues
chemotherapy
Credit: Rhoda Baer
Many US cancer survivors may be experiencing financial or work-related hardship, a new survey suggests.
Twenty-seven percent of the nearly 1600 survivors surveyed reported at least one financial problem, such as debt or bankruptcy.
And 37% reported having to modify work plans, such as taking extended time off or delaying retirement.
Women, younger survivors, racial/ethnic minorities, and uninsured survivors were all disproportionally burdened by these challenges.
This research (abstract 238*) was presented in a presscast prior to the 2014 Palliative Care in Oncology Symposium, which is scheduled to take place October 24-25 at the Westin Boston Waterfront in Boston.
“We found that many cancer survivors, particularly those who are younger or from underserved populations, experience financial or work-related hardship—even when insured and years out from treatment,” said lead study author Robin Whitney, RN, a cancer survivor and PhD student at the Betty Irene Moore School of Nursing at the University of California, Davis.
“Addressing these challenges is an important aspect of providing quality cancer care, because they can substantially impact quality of life and health outcomes.”
Whitney and her colleagues focused this study on a subset of individuals surveyed in a larger study (2011 Medical Expenditures Panel Survey Experiences with Cancer Survivorship Supplement).
Among the 1592 survivors surveyed, 47% were younger than 65 years of age, 56% were female, 88% were white, and 4% were uninsured. Fourteen percent were in active treatment, 46% were less than 5 years post-treatment, and 39% were 5 years or more post-treatment.
Overall, 27% of those surveyed reported at least one financial difficulty, such as debt, bankruptcy, and worrying about medical bills. Patients in active treatment reported 120% more financial difficulties than survivors who were less than 5 years post-treatment.
Individuals younger than 65 reported 130% more financial difficulties than older survivors. Survivors without insurance had 67% more difficulties than those with insurance. And minorities had 42% more financial difficulties than whites.
In all, 37% of survivors reported making at least one work modification due to their cancer diagnosis, such as changing to a flexible schedule or less demanding job, early or delayed retirement, and extended or unpaid time off.
Women were significantly more likely than men to make at least one work modification. Patients in active treatment made 120% more work modifications than survivors who were less than 5 years post-treatment. And minorities made 57% more modifications than whites.
According to the researchers, these findings are generalizable to the US population and point to the urgent need for screening and support for financial and work challenges across the cancer survivorship trajectory, from diagnosis to long-term survivorship.
*Information presented differs from that in the abstract.
chemotherapy
Credit: Rhoda Baer
Many US cancer survivors may be experiencing financial or work-related hardship, a new survey suggests.
Twenty-seven percent of the nearly 1600 survivors surveyed reported at least one financial problem, such as debt or bankruptcy.
And 37% reported having to modify work plans, such as taking extended time off or delaying retirement.
Women, younger survivors, racial/ethnic minorities, and uninsured survivors were all disproportionally burdened by these challenges.
This research (abstract 238*) was presented in a presscast prior to the 2014 Palliative Care in Oncology Symposium, which is scheduled to take place October 24-25 at the Westin Boston Waterfront in Boston.
“We found that many cancer survivors, particularly those who are younger or from underserved populations, experience financial or work-related hardship—even when insured and years out from treatment,” said lead study author Robin Whitney, RN, a cancer survivor and PhD student at the Betty Irene Moore School of Nursing at the University of California, Davis.
“Addressing these challenges is an important aspect of providing quality cancer care, because they can substantially impact quality of life and health outcomes.”
Whitney and her colleagues focused this study on a subset of individuals surveyed in a larger study (2011 Medical Expenditures Panel Survey Experiences with Cancer Survivorship Supplement).
Among the 1592 survivors surveyed, 47% were younger than 65 years of age, 56% were female, 88% were white, and 4% were uninsured. Fourteen percent were in active treatment, 46% were less than 5 years post-treatment, and 39% were 5 years or more post-treatment.
Overall, 27% of those surveyed reported at least one financial difficulty, such as debt, bankruptcy, and worrying about medical bills. Patients in active treatment reported 120% more financial difficulties than survivors who were less than 5 years post-treatment.
Individuals younger than 65 reported 130% more financial difficulties than older survivors. Survivors without insurance had 67% more difficulties than those with insurance. And minorities had 42% more financial difficulties than whites.
In all, 37% of survivors reported making at least one work modification due to their cancer diagnosis, such as changing to a flexible schedule or less demanding job, early or delayed retirement, and extended or unpaid time off.
Women were significantly more likely than men to make at least one work modification. Patients in active treatment made 120% more work modifications than survivors who were less than 5 years post-treatment. And minorities made 57% more modifications than whites.
According to the researchers, these findings are generalizable to the US population and point to the urgent need for screening and support for financial and work challenges across the cancer survivorship trajectory, from diagnosis to long-term survivorship.
*Information presented differs from that in the abstract.
chemotherapy
Credit: Rhoda Baer
Many US cancer survivors may be experiencing financial or work-related hardship, a new survey suggests.
Twenty-seven percent of the nearly 1600 survivors surveyed reported at least one financial problem, such as debt or bankruptcy.
And 37% reported having to modify work plans, such as taking extended time off or delaying retirement.
Women, younger survivors, racial/ethnic minorities, and uninsured survivors were all disproportionally burdened by these challenges.
This research (abstract 238*) was presented in a presscast prior to the 2014 Palliative Care in Oncology Symposium, which is scheduled to take place October 24-25 at the Westin Boston Waterfront in Boston.
“We found that many cancer survivors, particularly those who are younger or from underserved populations, experience financial or work-related hardship—even when insured and years out from treatment,” said lead study author Robin Whitney, RN, a cancer survivor and PhD student at the Betty Irene Moore School of Nursing at the University of California, Davis.
“Addressing these challenges is an important aspect of providing quality cancer care, because they can substantially impact quality of life and health outcomes.”
Whitney and her colleagues focused this study on a subset of individuals surveyed in a larger study (2011 Medical Expenditures Panel Survey Experiences with Cancer Survivorship Supplement).
Among the 1592 survivors surveyed, 47% were younger than 65 years of age, 56% were female, 88% were white, and 4% were uninsured. Fourteen percent were in active treatment, 46% were less than 5 years post-treatment, and 39% were 5 years or more post-treatment.
Overall, 27% of those surveyed reported at least one financial difficulty, such as debt, bankruptcy, and worrying about medical bills. Patients in active treatment reported 120% more financial difficulties than survivors who were less than 5 years post-treatment.
Individuals younger than 65 reported 130% more financial difficulties than older survivors. Survivors without insurance had 67% more difficulties than those with insurance. And minorities had 42% more financial difficulties than whites.
In all, 37% of survivors reported making at least one work modification due to their cancer diagnosis, such as changing to a flexible schedule or less demanding job, early or delayed retirement, and extended or unpaid time off.
Women were significantly more likely than men to make at least one work modification. Patients in active treatment made 120% more work modifications than survivors who were less than 5 years post-treatment. And minorities made 57% more modifications than whites.
According to the researchers, these findings are generalizable to the US population and point to the urgent need for screening and support for financial and work challenges across the cancer survivorship trajectory, from diagnosis to long-term survivorship.
*Information presented differs from that in the abstract.
Collaborative cancer care cuts readmission rates
while another looks on
Credit: NCI
A “co-rounding” partnership between medical oncologists and palliative care specialists has shown improvements in health-system and patient-related outcomes.
The first year of the partnership, which was tested in Duke University Hospital’s solid tumor oncology unit, brought significant decreases in the average length of hospital stay and in readmission rates, compared to a previous year in which the partnership did not exist.
There was a decrease in intensive care unit transfers and a trend toward increased hospice referrals as well, although these differences were not significant.
“The integration of palliative care, as a necessary and essential component of cancer care, is one that has been increasingly endorsed," said Richard Riedel, MD, of Duke University Hospital in Durham, North Carolina.
“The benefits of palliative care have been shown in the outpatient and consultative settings, but we didn’t know its impact on daily inpatient care. Now, we have successfully partnered with our palliative care colleagues to bring their unique skill sets and expertise directly to our admitted patients, and have shown it to be beneficial.”
Dr Riedel described this research (abstract 3*) in a presscast prior to the 2014 Palliative Care in Oncology Symposium, which is scheduled to take place October 24-25 at the Westin Boston Waterfront in Boston.
The co-rounding partnership involves 3 formal meetings each day in which members of the team, including both the attending medical oncologist and the attending palliative care physician, discuss all patients in the solid tumor unit.
The team decides which attending physician oversees direct care for a patient depending on his or her needs. For example, patients with higher symptom burden are typically assigned to the palliative care specialists.
The hospital support staff (eg, internal medicine house staff, physician assistants, and pharmacists) round with both attending physicians, and this care model allows for both formal and informal consultation between specialties.
To evaluate the effects of this model, the researchers assessed outcomes among the 731 patients admitted before the intervention began and 783 admitted in the first year of the intervention. About three-quarters of patients in both groups had metastatic cancer.
The team found a significant decrease in the average length of hospital stay from the pre-intervention period to the post-intervention period—4.51 days and 4.16 days, respectively (P=0.02).
Likewise, there was a significant decrease in readmission rates. There was 23% relative reduction in 7-day readmission rates (P<0.0001) and a 12% relative reduction in 30-day readmission rates (P=0.048).
Patient transfers to the intensive care unit decreased by 15% post-intervention, and hospice referrals increased by 17%, but these effects were not statistically significant (P=0.64 and 0.09, respectively).
The researchers said these results emphasize the value of implementing palliative medicine soon after a cancer diagnosis, rather than waiting until later in the disease’s progression.
Due to positive results with the co-rounding partnership, Duke University Hospital has established new outpatient palliative care clinics in oncology and general medicine.
The researchers are planning future studies to assess longer-term effects of the intervention on both patient and health-system outcomes, evaluate patient satisfaction, and explore potential cost savings associated with this intervention.
*Data presented differ from data in the abstract.
while another looks on
Credit: NCI
A “co-rounding” partnership between medical oncologists and palliative care specialists has shown improvements in health-system and patient-related outcomes.
The first year of the partnership, which was tested in Duke University Hospital’s solid tumor oncology unit, brought significant decreases in the average length of hospital stay and in readmission rates, compared to a previous year in which the partnership did not exist.
There was a decrease in intensive care unit transfers and a trend toward increased hospice referrals as well, although these differences were not significant.
“The integration of palliative care, as a necessary and essential component of cancer care, is one that has been increasingly endorsed," said Richard Riedel, MD, of Duke University Hospital in Durham, North Carolina.
“The benefits of palliative care have been shown in the outpatient and consultative settings, but we didn’t know its impact on daily inpatient care. Now, we have successfully partnered with our palliative care colleagues to bring their unique skill sets and expertise directly to our admitted patients, and have shown it to be beneficial.”
Dr Riedel described this research (abstract 3*) in a presscast prior to the 2014 Palliative Care in Oncology Symposium, which is scheduled to take place October 24-25 at the Westin Boston Waterfront in Boston.
The co-rounding partnership involves 3 formal meetings each day in which members of the team, including both the attending medical oncologist and the attending palliative care physician, discuss all patients in the solid tumor unit.
The team decides which attending physician oversees direct care for a patient depending on his or her needs. For example, patients with higher symptom burden are typically assigned to the palliative care specialists.
The hospital support staff (eg, internal medicine house staff, physician assistants, and pharmacists) round with both attending physicians, and this care model allows for both formal and informal consultation between specialties.
To evaluate the effects of this model, the researchers assessed outcomes among the 731 patients admitted before the intervention began and 783 admitted in the first year of the intervention. About three-quarters of patients in both groups had metastatic cancer.
The team found a significant decrease in the average length of hospital stay from the pre-intervention period to the post-intervention period—4.51 days and 4.16 days, respectively (P=0.02).
Likewise, there was a significant decrease in readmission rates. There was 23% relative reduction in 7-day readmission rates (P<0.0001) and a 12% relative reduction in 30-day readmission rates (P=0.048).
Patient transfers to the intensive care unit decreased by 15% post-intervention, and hospice referrals increased by 17%, but these effects were not statistically significant (P=0.64 and 0.09, respectively).
The researchers said these results emphasize the value of implementing palliative medicine soon after a cancer diagnosis, rather than waiting until later in the disease’s progression.
Due to positive results with the co-rounding partnership, Duke University Hospital has established new outpatient palliative care clinics in oncology and general medicine.
The researchers are planning future studies to assess longer-term effects of the intervention on both patient and health-system outcomes, evaluate patient satisfaction, and explore potential cost savings associated with this intervention.
*Data presented differ from data in the abstract.
while another looks on
Credit: NCI
A “co-rounding” partnership between medical oncologists and palliative care specialists has shown improvements in health-system and patient-related outcomes.
The first year of the partnership, which was tested in Duke University Hospital’s solid tumor oncology unit, brought significant decreases in the average length of hospital stay and in readmission rates, compared to a previous year in which the partnership did not exist.
There was a decrease in intensive care unit transfers and a trend toward increased hospice referrals as well, although these differences were not significant.
“The integration of palliative care, as a necessary and essential component of cancer care, is one that has been increasingly endorsed," said Richard Riedel, MD, of Duke University Hospital in Durham, North Carolina.
“The benefits of palliative care have been shown in the outpatient and consultative settings, but we didn’t know its impact on daily inpatient care. Now, we have successfully partnered with our palliative care colleagues to bring their unique skill sets and expertise directly to our admitted patients, and have shown it to be beneficial.”
Dr Riedel described this research (abstract 3*) in a presscast prior to the 2014 Palliative Care in Oncology Symposium, which is scheduled to take place October 24-25 at the Westin Boston Waterfront in Boston.
The co-rounding partnership involves 3 formal meetings each day in which members of the team, including both the attending medical oncologist and the attending palliative care physician, discuss all patients in the solid tumor unit.
The team decides which attending physician oversees direct care for a patient depending on his or her needs. For example, patients with higher symptom burden are typically assigned to the palliative care specialists.
The hospital support staff (eg, internal medicine house staff, physician assistants, and pharmacists) round with both attending physicians, and this care model allows for both formal and informal consultation between specialties.
To evaluate the effects of this model, the researchers assessed outcomes among the 731 patients admitted before the intervention began and 783 admitted in the first year of the intervention. About three-quarters of patients in both groups had metastatic cancer.
The team found a significant decrease in the average length of hospital stay from the pre-intervention period to the post-intervention period—4.51 days and 4.16 days, respectively (P=0.02).
Likewise, there was a significant decrease in readmission rates. There was 23% relative reduction in 7-day readmission rates (P<0.0001) and a 12% relative reduction in 30-day readmission rates (P=0.048).
Patient transfers to the intensive care unit decreased by 15% post-intervention, and hospice referrals increased by 17%, but these effects were not statistically significant (P=0.64 and 0.09, respectively).
The researchers said these results emphasize the value of implementing palliative medicine soon after a cancer diagnosis, rather than waiting until later in the disease’s progression.
Due to positive results with the co-rounding partnership, Duke University Hospital has established new outpatient palliative care clinics in oncology and general medicine.
The researchers are planning future studies to assess longer-term effects of the intervention on both patient and health-system outcomes, evaluate patient satisfaction, and explore potential cost savings associated with this intervention.
*Data presented differ from data in the abstract.