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Novel blood test for early-stage liver cancer shows promise
, increasing the likelihood of potentially curative therapy and improved patient prognosis.
HCC accounts for the majority of primary liver cancers and mainly occurs in patients with cirrhosis or chronic hepatitis B virus infection. The prognosis of HCC is poor, largely owing to advanced disease stage at diagnosis.
The current guidelines recommend surveillance with twice-yearly liver ultrasound, with or without serum alpha-fetoprotein, for patients at risk for HCC, although the diagnostic performance is suboptimal.
The new “liquid biopsy” uses HCC-associated extracellular vesicles (EVs) to establish an HCC EV ECG score for distinguishing patients with early-stage HCC from at-risk controls with cirrhosis from a 400-mcL plasma sample.
“We’re the first team looking at extracellular vesicles as a detection biomarker for early-stage liver cancer, and our study showed it had outstanding performance,” study investigator Ju Dong Yang, MD, with Cedars-Sinai Medical Center, Los Angeles, said in a news release.
The study was published online in Hepatology.
In a phase 2 biomarker (case-control) study, the investigators tested their blood test in a training cohort of 106 individuals (45 patients with treatment-naive early-stage HCC and 61 with cirrhosis) and an independent validation cohort with 72 participants (35 patients with treatment-naive early-stage HCC and 37 with cirrhosis).
The HCC EV ECG score had “excellent accuracy” for discriminating between HCC and cirrhosis, with an area under the receiver operating characteristic curve (AUROC) of 0.95 and 0.93 in the training and validation cohorts, respectively, they report.
The diagnostic performance “remained excellent” among the subpopulations of HCC etiology and those with tumors within the Milan criteria.
Adding the serum alpha-fetoprotein level to the HCC EV ECG score did not improve its performance.
The researchers say that further validation of the blood test in a larger phase 2 study and a subsequent phase 3 study are needed to confirm its utility in clinical settings.
“We are planning on doing larger-scale studies to further validate this test and bring it into routine clinical practice here – and globally,” Dr. Yang said.
“In addition to its excellent performance, this marker has the advantages of being user friendly, cost efficient, and having a fast turnaround time – within 6 hours from sample collection to result,” Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer, who is not an author on the study, said in the news release.
“Once this marker has been validated in subsequent studies, it can be easily adopted by existing PCR [polymerase chain reaction] facilities,” Dr. Theodorescu added.
The study was supported by an American College of Gastroenterology Junior Faculty Development Award, a Department of Defense Peer Reviewed Cancer Research Program Career Development Award, and the National Institutes of Health. Dr. Yang provides a consulting service for Exact Sciences, Gilead Sciences, and Eisai. Dr. Theodorescu reports no relevant financial relationships.
A version of this article first appeared on Medscape.com.
, increasing the likelihood of potentially curative therapy and improved patient prognosis.
HCC accounts for the majority of primary liver cancers and mainly occurs in patients with cirrhosis or chronic hepatitis B virus infection. The prognosis of HCC is poor, largely owing to advanced disease stage at diagnosis.
The current guidelines recommend surveillance with twice-yearly liver ultrasound, with or without serum alpha-fetoprotein, for patients at risk for HCC, although the diagnostic performance is suboptimal.
The new “liquid biopsy” uses HCC-associated extracellular vesicles (EVs) to establish an HCC EV ECG score for distinguishing patients with early-stage HCC from at-risk controls with cirrhosis from a 400-mcL plasma sample.
“We’re the first team looking at extracellular vesicles as a detection biomarker for early-stage liver cancer, and our study showed it had outstanding performance,” study investigator Ju Dong Yang, MD, with Cedars-Sinai Medical Center, Los Angeles, said in a news release.
The study was published online in Hepatology.
In a phase 2 biomarker (case-control) study, the investigators tested their blood test in a training cohort of 106 individuals (45 patients with treatment-naive early-stage HCC and 61 with cirrhosis) and an independent validation cohort with 72 participants (35 patients with treatment-naive early-stage HCC and 37 with cirrhosis).
The HCC EV ECG score had “excellent accuracy” for discriminating between HCC and cirrhosis, with an area under the receiver operating characteristic curve (AUROC) of 0.95 and 0.93 in the training and validation cohorts, respectively, they report.
The diagnostic performance “remained excellent” among the subpopulations of HCC etiology and those with tumors within the Milan criteria.
Adding the serum alpha-fetoprotein level to the HCC EV ECG score did not improve its performance.
The researchers say that further validation of the blood test in a larger phase 2 study and a subsequent phase 3 study are needed to confirm its utility in clinical settings.
“We are planning on doing larger-scale studies to further validate this test and bring it into routine clinical practice here – and globally,” Dr. Yang said.
“In addition to its excellent performance, this marker has the advantages of being user friendly, cost efficient, and having a fast turnaround time – within 6 hours from sample collection to result,” Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer, who is not an author on the study, said in the news release.
“Once this marker has been validated in subsequent studies, it can be easily adopted by existing PCR [polymerase chain reaction] facilities,” Dr. Theodorescu added.
The study was supported by an American College of Gastroenterology Junior Faculty Development Award, a Department of Defense Peer Reviewed Cancer Research Program Career Development Award, and the National Institutes of Health. Dr. Yang provides a consulting service for Exact Sciences, Gilead Sciences, and Eisai. Dr. Theodorescu reports no relevant financial relationships.
A version of this article first appeared on Medscape.com.
, increasing the likelihood of potentially curative therapy and improved patient prognosis.
HCC accounts for the majority of primary liver cancers and mainly occurs in patients with cirrhosis or chronic hepatitis B virus infection. The prognosis of HCC is poor, largely owing to advanced disease stage at diagnosis.
The current guidelines recommend surveillance with twice-yearly liver ultrasound, with or without serum alpha-fetoprotein, for patients at risk for HCC, although the diagnostic performance is suboptimal.
The new “liquid biopsy” uses HCC-associated extracellular vesicles (EVs) to establish an HCC EV ECG score for distinguishing patients with early-stage HCC from at-risk controls with cirrhosis from a 400-mcL plasma sample.
“We’re the first team looking at extracellular vesicles as a detection biomarker for early-stage liver cancer, and our study showed it had outstanding performance,” study investigator Ju Dong Yang, MD, with Cedars-Sinai Medical Center, Los Angeles, said in a news release.
The study was published online in Hepatology.
In a phase 2 biomarker (case-control) study, the investigators tested their blood test in a training cohort of 106 individuals (45 patients with treatment-naive early-stage HCC and 61 with cirrhosis) and an independent validation cohort with 72 participants (35 patients with treatment-naive early-stage HCC and 37 with cirrhosis).
The HCC EV ECG score had “excellent accuracy” for discriminating between HCC and cirrhosis, with an area under the receiver operating characteristic curve (AUROC) of 0.95 and 0.93 in the training and validation cohorts, respectively, they report.
The diagnostic performance “remained excellent” among the subpopulations of HCC etiology and those with tumors within the Milan criteria.
Adding the serum alpha-fetoprotein level to the HCC EV ECG score did not improve its performance.
The researchers say that further validation of the blood test in a larger phase 2 study and a subsequent phase 3 study are needed to confirm its utility in clinical settings.
“We are planning on doing larger-scale studies to further validate this test and bring it into routine clinical practice here – and globally,” Dr. Yang said.
“In addition to its excellent performance, this marker has the advantages of being user friendly, cost efficient, and having a fast turnaround time – within 6 hours from sample collection to result,” Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer, who is not an author on the study, said in the news release.
“Once this marker has been validated in subsequent studies, it can be easily adopted by existing PCR [polymerase chain reaction] facilities,” Dr. Theodorescu added.
The study was supported by an American College of Gastroenterology Junior Faculty Development Award, a Department of Defense Peer Reviewed Cancer Research Program Career Development Award, and the National Institutes of Health. Dr. Yang provides a consulting service for Exact Sciences, Gilead Sciences, and Eisai. Dr. Theodorescu reports no relevant financial relationships.
A version of this article first appeared on Medscape.com.
FROM HEPATOLOGY
VA Launches Virtual Tumor Board
SAN DIEGO – The US Department of Veterans Affairs (VA) TeleOncology program has rolled out a virtual tumor board that brings medical professionals together to offer insight and guidance about challenging hematology cases. Over the past 6 months the board has held 10 sessions and reviewed about 20 cases. A small survey found that participants think the meetings are beneficial.
“Virtual tumor boards help to connect experts across the country to leverage the expertise within the VA,” he-matologist/oncologist Thomas Rodgers, MD, of the Duke Cancer Institute and Durham Veterans Affairs Medical Center, told Federal Practitioner in an interview. He is the lead author of a poster about the program that was pre-sented here at the annual meeting of the Association of VA Hematology/Oncology (AVAHO).
As Dr. Rodgers noted, tumor boards are already in place at some VA centers. However, “they are not available at every VA and often are not set up to cover every cancer type.”
The VA National TeleOncology program created the virtual tumor board program as part of its mission to ex-tend hematology/oncology services across the system. “Cancer care has become increasingly complex. Beyond ad-vancing therapeutics, patient care often involves multiple specialties and medical disciplines,” Dr. Rodgers said. “A tumor board offers a forum for these specialists to communicate with each other in real time, not only to help estab-lish the correct diagnosis and stage of cancer but also to form a consensus on the most fitting treatment option. Think of it as getting all of the people involved in a person’s care in the same room.”
Currently, he said, the virtual tumor boards cover patients with malignant hematology diagnoses such as leuke-mia, multiple myeloma, and lymphomas. “We welcome submissions. If a provider is interested in submitting a case, they can email us and will be provided with a short intake form. Once submitted, we will collect necessary imaging and pathology for review. The provider will then present the patient case on the day of the tumor board.”
Typically, more than 30 medical professionals participate in the virtual tumor boards, Dr. Rodgers said, repre-senting medical oncology/hematology, pathology, radiology, palliative care, pharmacy, social work, and die-tary/nutrition.
According to the poster presented at AVAHO, 9 participants responded to a survey after 4 tumor board sessions. All found the boards to be beneficial or somewhat beneficial, and 55% reported that they were “highly applicable” to their practice.
Pathologist Claudio A. Mosse, MD, PhD, of Vanderbilt University Medical Center and VA Tennessee Valley Healthcare System, praised the virtual tumor board program. “It’s been incredibly useful from my end as a pathologist as it shows me which diagnoses are most challenging for my colleagues,” Dr. Mosse said in an inter-view. “Reviewing and then presenting these challenging cases forces me to go into the published literature to come to a unitary diagnosis based on the patient history, radiology, various laboratory tests, and the biopsy I was asked to review.”
He added that “as a pathologist, I learn so much from the hematologists as they discuss the possible therapeutic options, and that strengthens my ability as a pathologist because I have to understand how one diagnosis versus an-other affects their therapeutic decision tree.”
What’s next for the virtual tumor board program? The next step is to expand to solid tumors, said VA Pittsburgh Healthcare System hematologist/oncologist Vida Almario Passero, MD, MBA, chief medical officer of National TeleOncology, in an interview.
No disclosures were reported.
SAN DIEGO – The US Department of Veterans Affairs (VA) TeleOncology program has rolled out a virtual tumor board that brings medical professionals together to offer insight and guidance about challenging hematology cases. Over the past 6 months the board has held 10 sessions and reviewed about 20 cases. A small survey found that participants think the meetings are beneficial.
“Virtual tumor boards help to connect experts across the country to leverage the expertise within the VA,” he-matologist/oncologist Thomas Rodgers, MD, of the Duke Cancer Institute and Durham Veterans Affairs Medical Center, told Federal Practitioner in an interview. He is the lead author of a poster about the program that was pre-sented here at the annual meeting of the Association of VA Hematology/Oncology (AVAHO).
As Dr. Rodgers noted, tumor boards are already in place at some VA centers. However, “they are not available at every VA and often are not set up to cover every cancer type.”
The VA National TeleOncology program created the virtual tumor board program as part of its mission to ex-tend hematology/oncology services across the system. “Cancer care has become increasingly complex. Beyond ad-vancing therapeutics, patient care often involves multiple specialties and medical disciplines,” Dr. Rodgers said. “A tumor board offers a forum for these specialists to communicate with each other in real time, not only to help estab-lish the correct diagnosis and stage of cancer but also to form a consensus on the most fitting treatment option. Think of it as getting all of the people involved in a person’s care in the same room.”
Currently, he said, the virtual tumor boards cover patients with malignant hematology diagnoses such as leuke-mia, multiple myeloma, and lymphomas. “We welcome submissions. If a provider is interested in submitting a case, they can email us and will be provided with a short intake form. Once submitted, we will collect necessary imaging and pathology for review. The provider will then present the patient case on the day of the tumor board.”
Typically, more than 30 medical professionals participate in the virtual tumor boards, Dr. Rodgers said, repre-senting medical oncology/hematology, pathology, radiology, palliative care, pharmacy, social work, and die-tary/nutrition.
According to the poster presented at AVAHO, 9 participants responded to a survey after 4 tumor board sessions. All found the boards to be beneficial or somewhat beneficial, and 55% reported that they were “highly applicable” to their practice.
Pathologist Claudio A. Mosse, MD, PhD, of Vanderbilt University Medical Center and VA Tennessee Valley Healthcare System, praised the virtual tumor board program. “It’s been incredibly useful from my end as a pathologist as it shows me which diagnoses are most challenging for my colleagues,” Dr. Mosse said in an inter-view. “Reviewing and then presenting these challenging cases forces me to go into the published literature to come to a unitary diagnosis based on the patient history, radiology, various laboratory tests, and the biopsy I was asked to review.”
He added that “as a pathologist, I learn so much from the hematologists as they discuss the possible therapeutic options, and that strengthens my ability as a pathologist because I have to understand how one diagnosis versus an-other affects their therapeutic decision tree.”
What’s next for the virtual tumor board program? The next step is to expand to solid tumors, said VA Pittsburgh Healthcare System hematologist/oncologist Vida Almario Passero, MD, MBA, chief medical officer of National TeleOncology, in an interview.
No disclosures were reported.
SAN DIEGO – The US Department of Veterans Affairs (VA) TeleOncology program has rolled out a virtual tumor board that brings medical professionals together to offer insight and guidance about challenging hematology cases. Over the past 6 months the board has held 10 sessions and reviewed about 20 cases. A small survey found that participants think the meetings are beneficial.
“Virtual tumor boards help to connect experts across the country to leverage the expertise within the VA,” he-matologist/oncologist Thomas Rodgers, MD, of the Duke Cancer Institute and Durham Veterans Affairs Medical Center, told Federal Practitioner in an interview. He is the lead author of a poster about the program that was pre-sented here at the annual meeting of the Association of VA Hematology/Oncology (AVAHO).
As Dr. Rodgers noted, tumor boards are already in place at some VA centers. However, “they are not available at every VA and often are not set up to cover every cancer type.”
The VA National TeleOncology program created the virtual tumor board program as part of its mission to ex-tend hematology/oncology services across the system. “Cancer care has become increasingly complex. Beyond ad-vancing therapeutics, patient care often involves multiple specialties and medical disciplines,” Dr. Rodgers said. “A tumor board offers a forum for these specialists to communicate with each other in real time, not only to help estab-lish the correct diagnosis and stage of cancer but also to form a consensus on the most fitting treatment option. Think of it as getting all of the people involved in a person’s care in the same room.”
Currently, he said, the virtual tumor boards cover patients with malignant hematology diagnoses such as leuke-mia, multiple myeloma, and lymphomas. “We welcome submissions. If a provider is interested in submitting a case, they can email us and will be provided with a short intake form. Once submitted, we will collect necessary imaging and pathology for review. The provider will then present the patient case on the day of the tumor board.”
Typically, more than 30 medical professionals participate in the virtual tumor boards, Dr. Rodgers said, repre-senting medical oncology/hematology, pathology, radiology, palliative care, pharmacy, social work, and die-tary/nutrition.
According to the poster presented at AVAHO, 9 participants responded to a survey after 4 tumor board sessions. All found the boards to be beneficial or somewhat beneficial, and 55% reported that they were “highly applicable” to their practice.
Pathologist Claudio A. Mosse, MD, PhD, of Vanderbilt University Medical Center and VA Tennessee Valley Healthcare System, praised the virtual tumor board program. “It’s been incredibly useful from my end as a pathologist as it shows me which diagnoses are most challenging for my colleagues,” Dr. Mosse said in an inter-view. “Reviewing and then presenting these challenging cases forces me to go into the published literature to come to a unitary diagnosis based on the patient history, radiology, various laboratory tests, and the biopsy I was asked to review.”
He added that “as a pathologist, I learn so much from the hematologists as they discuss the possible therapeutic options, and that strengthens my ability as a pathologist because I have to understand how one diagnosis versus an-other affects their therapeutic decision tree.”
What’s next for the virtual tumor board program? The next step is to expand to solid tumors, said VA Pittsburgh Healthcare System hematologist/oncologist Vida Almario Passero, MD, MBA, chief medical officer of National TeleOncology, in an interview.
No disclosures were reported.
Implementation of a Bone Marrow Biopsy Clinic: Effect on Wait Times for the Procedure, Diagnosis and Treatment Initiation
Clinical Situation
Bone marrow biopsies often need to be performed expeditiously in order to alleviate patient concerns and quickly determine a diagnosis and treatment plan. However, with increasing subspecialization there are fewer hematology/oncology providers available to perform this procedure.
Literature
Our VA previously addressed this issue by having all bone marrow biopsies performed through Interventional Radiology (IR). The average time from order to procedure, though, was 18.6 days (Arfons LM, AVAHO 2016).
Intervention
A weekly bone marrow biopsy clinic was formed, utilizing a small group (heme/onc physician, nurse practitioner and key nursing staff). In collaboration with pathology, interior design, pharmacy, facilities and environmental services, a standard operating procedure was developed, which included a staffing model, procedural checklist, documentation template, scheduling and ordering system.
Outcomes/Implications
Bone marrow biopsies performed before and after initiation of the bone marrow biopsy clinic were tracked for time from order placement to: procedure being done; diagnosis rendered; and for those whose biopsy result needed therapy, initiation of treatment. From 8/4/2020 to 8/12/2021 there were 140 bone marrow biopsies performed, all through IR. The average time from order to the procedure was 23.1 days; from order to diagnosis was 27.8 days and from order to treatment was 54.8 days. After implementation of the bone marrow biopsy clinic, from 9/8/2021 to 5/25/2022 there have been 61 bone marrow biopsies performed (those ordered through IR were excluded). The average time from order to the procedure was 6.8 days; from order to diagnosis was 11.4 days and from order to treatment was 27.3 days. The differences in the average wait times for all 3 measures (time to procedure, diagnosis and treatment) were highly statistically significant (P < .001 for each), in favor of shorter wait times for those performed in the bone marrow clinic as compared to those done through IR. Implementation of a dedicated weekly bone marrow biopsy clinic significantly reduced wait times for the procedure, diagnosis and treatment initiation. This should be considered at other VA centers to improve the care of our veterans.
Clinical Situation
Bone marrow biopsies often need to be performed expeditiously in order to alleviate patient concerns and quickly determine a diagnosis and treatment plan. However, with increasing subspecialization there are fewer hematology/oncology providers available to perform this procedure.
Literature
Our VA previously addressed this issue by having all bone marrow biopsies performed through Interventional Radiology (IR). The average time from order to procedure, though, was 18.6 days (Arfons LM, AVAHO 2016).
Intervention
A weekly bone marrow biopsy clinic was formed, utilizing a small group (heme/onc physician, nurse practitioner and key nursing staff). In collaboration with pathology, interior design, pharmacy, facilities and environmental services, a standard operating procedure was developed, which included a staffing model, procedural checklist, documentation template, scheduling and ordering system.
Outcomes/Implications
Bone marrow biopsies performed before and after initiation of the bone marrow biopsy clinic were tracked for time from order placement to: procedure being done; diagnosis rendered; and for those whose biopsy result needed therapy, initiation of treatment. From 8/4/2020 to 8/12/2021 there were 140 bone marrow biopsies performed, all through IR. The average time from order to the procedure was 23.1 days; from order to diagnosis was 27.8 days and from order to treatment was 54.8 days. After implementation of the bone marrow biopsy clinic, from 9/8/2021 to 5/25/2022 there have been 61 bone marrow biopsies performed (those ordered through IR were excluded). The average time from order to the procedure was 6.8 days; from order to diagnosis was 11.4 days and from order to treatment was 27.3 days. The differences in the average wait times for all 3 measures (time to procedure, diagnosis and treatment) were highly statistically significant (P < .001 for each), in favor of shorter wait times for those performed in the bone marrow clinic as compared to those done through IR. Implementation of a dedicated weekly bone marrow biopsy clinic significantly reduced wait times for the procedure, diagnosis and treatment initiation. This should be considered at other VA centers to improve the care of our veterans.
Clinical Situation
Bone marrow biopsies often need to be performed expeditiously in order to alleviate patient concerns and quickly determine a diagnosis and treatment plan. However, with increasing subspecialization there are fewer hematology/oncology providers available to perform this procedure.
Literature
Our VA previously addressed this issue by having all bone marrow biopsies performed through Interventional Radiology (IR). The average time from order to procedure, though, was 18.6 days (Arfons LM, AVAHO 2016).
Intervention
A weekly bone marrow biopsy clinic was formed, utilizing a small group (heme/onc physician, nurse practitioner and key nursing staff). In collaboration with pathology, interior design, pharmacy, facilities and environmental services, a standard operating procedure was developed, which included a staffing model, procedural checklist, documentation template, scheduling and ordering system.
Outcomes/Implications
Bone marrow biopsies performed before and after initiation of the bone marrow biopsy clinic were tracked for time from order placement to: procedure being done; diagnosis rendered; and for those whose biopsy result needed therapy, initiation of treatment. From 8/4/2020 to 8/12/2021 there were 140 bone marrow biopsies performed, all through IR. The average time from order to the procedure was 23.1 days; from order to diagnosis was 27.8 days and from order to treatment was 54.8 days. After implementation of the bone marrow biopsy clinic, from 9/8/2021 to 5/25/2022 there have been 61 bone marrow biopsies performed (those ordered through IR were excluded). The average time from order to the procedure was 6.8 days; from order to diagnosis was 11.4 days and from order to treatment was 27.3 days. The differences in the average wait times for all 3 measures (time to procedure, diagnosis and treatment) were highly statistically significant (P < .001 for each), in favor of shorter wait times for those performed in the bone marrow clinic as compared to those done through IR. Implementation of a dedicated weekly bone marrow biopsy clinic significantly reduced wait times for the procedure, diagnosis and treatment initiation. This should be considered at other VA centers to improve the care of our veterans.
NP-Led Suspicion of Cancer Clinic Improves Timeliness of Care for Veterans
Clinical Situation
Delays in diagnosis affect outcomes in veterans with cancer. Veterans sent into the community for suspected cancer frequently experience delays in diagnosis and treatment. This is further complicated by inappropriate workup, resulting in additional delays. Retaining veterans within the VA system for care and providing guidance to primary care providers (PCPs) to assist with expedited workup was an identified need. The Suspicion of Cancer Clinic (SOCC) was developed to address barriers to timely cancer diagnosis and care.
Literature
Researched private sector models of rapid cancer diagnostic and suspicion clinics. Literature analyzed showed improved outcomes through reduction of diagnostic delay. Nurse practitioner (NP)-led clinics were determined to be effective in expediting diagnosis and reducing cancer care delays.
Intervention
The Suspicion of Cancer Clinic is a tele-clinic, staffed with a NP. Diagnostic consult for the NP to assume the workup upon discovery of high suspicion of cancer, or via non-visit consult (NVC) to provide diagnostic guidance are available to PCPs. Outreach and education were performed prior initial clinic launch and post-launch, when need for further clarification of role and scope of the clinic was identified, based on consult trends.
Outcomes/Implications
The SOCC received 133 consults between 9/1/2021 and 6/6/2022 for veterans ranging age 29-94 years. Of these consults, 25 were expedited, diagnostic workups, 47 were NVCs, eliminating unnecessary or incomplete workups, yielding 23 veterans diagnosed with one of 8 types cancer. An additional 34 consults were forwarded to other appropriate service, and 27 were not appropriate for clinic and cancelled. Further outreach and education resulted in a 55% decrease in inappropriate consults. The NP retained 10 veterans (50%) within the VA for diagnostics, who had planned to receive community workup, which is an average four-week delay to schedule in the community. The SOCC was developed utilizing existing staff. The tele-clinic relieves workspace burden. Veterans received timely and appropriate cancer workups, reducing diagnostic delays. PCPs received additional support and guidance. Veterans retained within the VA system is more cost-effective and avoids community care delays. NP-led suspicion/rapid diagnostic clinic effectively reduced care delays by immediate initiation of further diagnostics and appropriate utilization of resources.
References
Campbell C, Nowell A, Karagheusian K, Giroux J, Kiteley C, Martelli L, McQuestion M, Quinn M, Rowe Samadhin YP, Touw M, Moody L. Practical innovation: Advanced practice nurses in cancer care. Can Oncol Nurs J. 2020 Jan 1;30(1):9-15. doi:10.5737/23688076301915. PMID: 33119001; PMCID: PMC7585714.
Drudge-Coates L, Khati V, Ballesteros R, Martyn-Hemphill C, Brown C, Green J, Challacombe B, Muir G. A nurse practitioner model for the assessment of suspected prostate cancer referrals is safe, cost and time efficient. Ecancermedicalscience. 2019 Dec 18;13:994. doi:10.3332/ecancer.2019.994. PMID: 32010218; PMCID: PMC6974368.
Nixon S, Bezverbnaya K, Maganti M, Gullane P, Reedijk M, Kuruvilla J, Prica A, Kridel R, Kukreti V, Bennett S, Rogalla P, Delabie J, Pintilie M, Crump M. Evaluation of Lymphadenopathy and Suspected Lymphoma in a Lymphoma Rapid Diagnosis Clinic. JCO Oncol Pract. 2020 Jan;16(1):e29-e36. doi:10.1200/JOP.19.00202. Epub 2019 Oct 1. PMID: 31573831.
Vasilakis C, Forte P. Setting up a rapid diagnostic clinic for patients with vague symptoms of cancer: a mixed method process evaluation study. BMC Health Serv Res. 2021 Apr 17;21(1):357. doi: 10.1186/s12913-021-06360-0. PMID: 33865373; PMCID: PMC8052708.
Clinical Situation
Delays in diagnosis affect outcomes in veterans with cancer. Veterans sent into the community for suspected cancer frequently experience delays in diagnosis and treatment. This is further complicated by inappropriate workup, resulting in additional delays. Retaining veterans within the VA system for care and providing guidance to primary care providers (PCPs) to assist with expedited workup was an identified need. The Suspicion of Cancer Clinic (SOCC) was developed to address barriers to timely cancer diagnosis and care.
Literature
Researched private sector models of rapid cancer diagnostic and suspicion clinics. Literature analyzed showed improved outcomes through reduction of diagnostic delay. Nurse practitioner (NP)-led clinics were determined to be effective in expediting diagnosis and reducing cancer care delays.
Intervention
The Suspicion of Cancer Clinic is a tele-clinic, staffed with a NP. Diagnostic consult for the NP to assume the workup upon discovery of high suspicion of cancer, or via non-visit consult (NVC) to provide diagnostic guidance are available to PCPs. Outreach and education were performed prior initial clinic launch and post-launch, when need for further clarification of role and scope of the clinic was identified, based on consult trends.
Outcomes/Implications
The SOCC received 133 consults between 9/1/2021 and 6/6/2022 for veterans ranging age 29-94 years. Of these consults, 25 were expedited, diagnostic workups, 47 were NVCs, eliminating unnecessary or incomplete workups, yielding 23 veterans diagnosed with one of 8 types cancer. An additional 34 consults were forwarded to other appropriate service, and 27 were not appropriate for clinic and cancelled. Further outreach and education resulted in a 55% decrease in inappropriate consults. The NP retained 10 veterans (50%) within the VA for diagnostics, who had planned to receive community workup, which is an average four-week delay to schedule in the community. The SOCC was developed utilizing existing staff. The tele-clinic relieves workspace burden. Veterans received timely and appropriate cancer workups, reducing diagnostic delays. PCPs received additional support and guidance. Veterans retained within the VA system is more cost-effective and avoids community care delays. NP-led suspicion/rapid diagnostic clinic effectively reduced care delays by immediate initiation of further diagnostics and appropriate utilization of resources.
References
Campbell C, Nowell A, Karagheusian K, Giroux J, Kiteley C, Martelli L, McQuestion M, Quinn M, Rowe Samadhin YP, Touw M, Moody L. Practical innovation: Advanced practice nurses in cancer care. Can Oncol Nurs J. 2020 Jan 1;30(1):9-15. doi:10.5737/23688076301915. PMID: 33119001; PMCID: PMC7585714.
Drudge-Coates L, Khati V, Ballesteros R, Martyn-Hemphill C, Brown C, Green J, Challacombe B, Muir G. A nurse practitioner model for the assessment of suspected prostate cancer referrals is safe, cost and time efficient. Ecancermedicalscience. 2019 Dec 18;13:994. doi:10.3332/ecancer.2019.994. PMID: 32010218; PMCID: PMC6974368.
Nixon S, Bezverbnaya K, Maganti M, Gullane P, Reedijk M, Kuruvilla J, Prica A, Kridel R, Kukreti V, Bennett S, Rogalla P, Delabie J, Pintilie M, Crump M. Evaluation of Lymphadenopathy and Suspected Lymphoma in a Lymphoma Rapid Diagnosis Clinic. JCO Oncol Pract. 2020 Jan;16(1):e29-e36. doi:10.1200/JOP.19.00202. Epub 2019 Oct 1. PMID: 31573831.
Vasilakis C, Forte P. Setting up a rapid diagnostic clinic for patients with vague symptoms of cancer: a mixed method process evaluation study. BMC Health Serv Res. 2021 Apr 17;21(1):357. doi: 10.1186/s12913-021-06360-0. PMID: 33865373; PMCID: PMC8052708.
Clinical Situation
Delays in diagnosis affect outcomes in veterans with cancer. Veterans sent into the community for suspected cancer frequently experience delays in diagnosis and treatment. This is further complicated by inappropriate workup, resulting in additional delays. Retaining veterans within the VA system for care and providing guidance to primary care providers (PCPs) to assist with expedited workup was an identified need. The Suspicion of Cancer Clinic (SOCC) was developed to address barriers to timely cancer diagnosis and care.
Literature
Researched private sector models of rapid cancer diagnostic and suspicion clinics. Literature analyzed showed improved outcomes through reduction of diagnostic delay. Nurse practitioner (NP)-led clinics were determined to be effective in expediting diagnosis and reducing cancer care delays.
Intervention
The Suspicion of Cancer Clinic is a tele-clinic, staffed with a NP. Diagnostic consult for the NP to assume the workup upon discovery of high suspicion of cancer, or via non-visit consult (NVC) to provide diagnostic guidance are available to PCPs. Outreach and education were performed prior initial clinic launch and post-launch, when need for further clarification of role and scope of the clinic was identified, based on consult trends.
Outcomes/Implications
The SOCC received 133 consults between 9/1/2021 and 6/6/2022 for veterans ranging age 29-94 years. Of these consults, 25 were expedited, diagnostic workups, 47 were NVCs, eliminating unnecessary or incomplete workups, yielding 23 veterans diagnosed with one of 8 types cancer. An additional 34 consults were forwarded to other appropriate service, and 27 were not appropriate for clinic and cancelled. Further outreach and education resulted in a 55% decrease in inappropriate consults. The NP retained 10 veterans (50%) within the VA for diagnostics, who had planned to receive community workup, which is an average four-week delay to schedule in the community. The SOCC was developed utilizing existing staff. The tele-clinic relieves workspace burden. Veterans received timely and appropriate cancer workups, reducing diagnostic delays. PCPs received additional support and guidance. Veterans retained within the VA system is more cost-effective and avoids community care delays. NP-led suspicion/rapid diagnostic clinic effectively reduced care delays by immediate initiation of further diagnostics and appropriate utilization of resources.
References
Campbell C, Nowell A, Karagheusian K, Giroux J, Kiteley C, Martelli L, McQuestion M, Quinn M, Rowe Samadhin YP, Touw M, Moody L. Practical innovation: Advanced practice nurses in cancer care. Can Oncol Nurs J. 2020 Jan 1;30(1):9-15. doi:10.5737/23688076301915. PMID: 33119001; PMCID: PMC7585714.
Drudge-Coates L, Khati V, Ballesteros R, Martyn-Hemphill C, Brown C, Green J, Challacombe B, Muir G. A nurse practitioner model for the assessment of suspected prostate cancer referrals is safe, cost and time efficient. Ecancermedicalscience. 2019 Dec 18;13:994. doi:10.3332/ecancer.2019.994. PMID: 32010218; PMCID: PMC6974368.
Nixon S, Bezverbnaya K, Maganti M, Gullane P, Reedijk M, Kuruvilla J, Prica A, Kridel R, Kukreti V, Bennett S, Rogalla P, Delabie J, Pintilie M, Crump M. Evaluation of Lymphadenopathy and Suspected Lymphoma in a Lymphoma Rapid Diagnosis Clinic. JCO Oncol Pract. 2020 Jan;16(1):e29-e36. doi:10.1200/JOP.19.00202. Epub 2019 Oct 1. PMID: 31573831.
Vasilakis C, Forte P. Setting up a rapid diagnostic clinic for patients with vague symptoms of cancer: a mixed method process evaluation study. BMC Health Serv Res. 2021 Apr 17;21(1):357. doi: 10.1186/s12913-021-06360-0. PMID: 33865373; PMCID: PMC8052708.
The Use of Aromatherapy as a Complementary Alternative Medicine in the Management of Cancer-Related Pain
Purpose
To identify the effectiveness of aromatherapy as an adjunct in improving pain and overall sense of well-being among patients with cancer receiving hospice care.
Background
There is limited data available on the use of aromatherapy for pain management among patients with cancer receiving end-of-life care. This project identifies the benefits of aromatherapy in a population where it was not previously evaluated.
Methods
Patients with cancer who were admitted to the hospice unit of a local hospital within a large healthcare system for at least 24 hours and taking opioids for neoplasm related pain at least once a day were included in the study. Patients with allergy to essential oils, and those suffering from allergic rhinitis and common cold, and a history of asthma were excluded. Patients who were unable to consent for study participation were also excluded.
Data Analysis
Retrospective chart analysis and surveys were used to collect the data. Univariate descriptive statistics were used for patient characteristics. A Wilcoxon Signed Rank Test was used to determine opioid use before and after aromatherapy. The t test was used to compare pain scores before and after aromatherapy. A 5-point Likert scale was used to evaluate how soothing the participants found the treatment to be. The Numeric Pain Intensity Scale was used for pain scores.
Results
There was a total of 40 participants, all of whom were male with an average age of 69 years. Pain scores before and after treatment were found to be statistically significant at an average of 5.15/10 vs 3.68/10, respectively. On a scale from 1-5 with 5 being the most soothing, there was an average rating of 3.87 among participants. There was not a statistically significant decline in opioid use from pre-treatment to post-treatment. Higher pain scores before intervention were associated with rating the lotion as more soothing.
Conclusions
The use of aromatherapy as a complement to opioids for cancer-related pain in the end-of-life was associated with an increase sense of well-being, resulted in lower pain scores and seems to have subjective comfort merit.
Implications
This study shows the potential benefits of using aromatherapy in end-of-life care among patients with cancer.
Purpose
To identify the effectiveness of aromatherapy as an adjunct in improving pain and overall sense of well-being among patients with cancer receiving hospice care.
Background
There is limited data available on the use of aromatherapy for pain management among patients with cancer receiving end-of-life care. This project identifies the benefits of aromatherapy in a population where it was not previously evaluated.
Methods
Patients with cancer who were admitted to the hospice unit of a local hospital within a large healthcare system for at least 24 hours and taking opioids for neoplasm related pain at least once a day were included in the study. Patients with allergy to essential oils, and those suffering from allergic rhinitis and common cold, and a history of asthma were excluded. Patients who were unable to consent for study participation were also excluded.
Data Analysis
Retrospective chart analysis and surveys were used to collect the data. Univariate descriptive statistics were used for patient characteristics. A Wilcoxon Signed Rank Test was used to determine opioid use before and after aromatherapy. The t test was used to compare pain scores before and after aromatherapy. A 5-point Likert scale was used to evaluate how soothing the participants found the treatment to be. The Numeric Pain Intensity Scale was used for pain scores.
Results
There was a total of 40 participants, all of whom were male with an average age of 69 years. Pain scores before and after treatment were found to be statistically significant at an average of 5.15/10 vs 3.68/10, respectively. On a scale from 1-5 with 5 being the most soothing, there was an average rating of 3.87 among participants. There was not a statistically significant decline in opioid use from pre-treatment to post-treatment. Higher pain scores before intervention were associated with rating the lotion as more soothing.
Conclusions
The use of aromatherapy as a complement to opioids for cancer-related pain in the end-of-life was associated with an increase sense of well-being, resulted in lower pain scores and seems to have subjective comfort merit.
Implications
This study shows the potential benefits of using aromatherapy in end-of-life care among patients with cancer.
Purpose
To identify the effectiveness of aromatherapy as an adjunct in improving pain and overall sense of well-being among patients with cancer receiving hospice care.
Background
There is limited data available on the use of aromatherapy for pain management among patients with cancer receiving end-of-life care. This project identifies the benefits of aromatherapy in a population where it was not previously evaluated.
Methods
Patients with cancer who were admitted to the hospice unit of a local hospital within a large healthcare system for at least 24 hours and taking opioids for neoplasm related pain at least once a day were included in the study. Patients with allergy to essential oils, and those suffering from allergic rhinitis and common cold, and a history of asthma were excluded. Patients who were unable to consent for study participation were also excluded.
Data Analysis
Retrospective chart analysis and surveys were used to collect the data. Univariate descriptive statistics were used for patient characteristics. A Wilcoxon Signed Rank Test was used to determine opioid use before and after aromatherapy. The t test was used to compare pain scores before and after aromatherapy. A 5-point Likert scale was used to evaluate how soothing the participants found the treatment to be. The Numeric Pain Intensity Scale was used for pain scores.
Results
There was a total of 40 participants, all of whom were male with an average age of 69 years. Pain scores before and after treatment were found to be statistically significant at an average of 5.15/10 vs 3.68/10, respectively. On a scale from 1-5 with 5 being the most soothing, there was an average rating of 3.87 among participants. There was not a statistically significant decline in opioid use from pre-treatment to post-treatment. Higher pain scores before intervention were associated with rating the lotion as more soothing.
Conclusions
The use of aromatherapy as a complement to opioids for cancer-related pain in the end-of-life was associated with an increase sense of well-being, resulted in lower pain scores and seems to have subjective comfort merit.
Implications
This study shows the potential benefits of using aromatherapy in end-of-life care among patients with cancer.
Academic/Research Facility Utilization and Survival Outcomes in Osteosarcoma: An NCDB Analysis
Background
Previous studies have reported that treatment at academic/research facilities is associated with improved survival in cancer patients. The objective of this study was to investigate the impact of treatment facility type on overall survival for patients presenting with osteosarcoma.
Methods
The National Cancer Database (NCDB) was used to identify patients diagnosed with Osteosarcoma from 2004 to 2018. Facility types were identified as assigned by the Commission on Cancer Accreditation program. Data was analyzed using SPSS and statistical significance was set at P = .05.
Results
Of 2085 patients queried, 39.6% were treated at an academic/research program. The stage-adjusted difference in median survival between academic/research and non-academic programs was found to be statistically significant on log-rank comparison (P < .001). At each NCDB analytic stage (stage I-IV), academic/research programs were associated with decreased hazard and improved median survival. A Cox proportional hazards model showed a decreased likelihood of mortality in patients with osteosarcoma who underwent treatment at an academic/research program (HR, 0.882; 95% CI, .802-.969; P = .009). Chi-square testing revealed that patients at academic/research programs were more likely than those at non-academic/research centers to have private insurance, less likely to have Medicare, and more likely to live in counties of > 1 million people. These facilities were also more likely to have undergone Medicaid expansion in 2014. (P < .05). Patients at non-academic/research programs were more likely to have advanced disease (stage III and IV) and higher comorbidity scores. Additionally, they were less likely to receive surgery and/or chemotherapy at the institution in which they were diagnosed. (P < .05).
Conclusions
This study showed that Osteosarcoma patients treated in an academic/research program facility experienced increased survival compared with non-academic/research facilities. Patients at academic/research facilities tend to have less comorbidities, have private insurance, and present with more treatable disease. Despite these favorable prognostic factors, the data suggest an intrinsic benefit to being treated at an academic/research facility.
Background
Previous studies have reported that treatment at academic/research facilities is associated with improved survival in cancer patients. The objective of this study was to investigate the impact of treatment facility type on overall survival for patients presenting with osteosarcoma.
Methods
The National Cancer Database (NCDB) was used to identify patients diagnosed with Osteosarcoma from 2004 to 2018. Facility types were identified as assigned by the Commission on Cancer Accreditation program. Data was analyzed using SPSS and statistical significance was set at P = .05.
Results
Of 2085 patients queried, 39.6% were treated at an academic/research program. The stage-adjusted difference in median survival between academic/research and non-academic programs was found to be statistically significant on log-rank comparison (P < .001). At each NCDB analytic stage (stage I-IV), academic/research programs were associated with decreased hazard and improved median survival. A Cox proportional hazards model showed a decreased likelihood of mortality in patients with osteosarcoma who underwent treatment at an academic/research program (HR, 0.882; 95% CI, .802-.969; P = .009). Chi-square testing revealed that patients at academic/research programs were more likely than those at non-academic/research centers to have private insurance, less likely to have Medicare, and more likely to live in counties of > 1 million people. These facilities were also more likely to have undergone Medicaid expansion in 2014. (P < .05). Patients at non-academic/research programs were more likely to have advanced disease (stage III and IV) and higher comorbidity scores. Additionally, they were less likely to receive surgery and/or chemotherapy at the institution in which they were diagnosed. (P < .05).
Conclusions
This study showed that Osteosarcoma patients treated in an academic/research program facility experienced increased survival compared with non-academic/research facilities. Patients at academic/research facilities tend to have less comorbidities, have private insurance, and present with more treatable disease. Despite these favorable prognostic factors, the data suggest an intrinsic benefit to being treated at an academic/research facility.
Background
Previous studies have reported that treatment at academic/research facilities is associated with improved survival in cancer patients. The objective of this study was to investigate the impact of treatment facility type on overall survival for patients presenting with osteosarcoma.
Methods
The National Cancer Database (NCDB) was used to identify patients diagnosed with Osteosarcoma from 2004 to 2018. Facility types were identified as assigned by the Commission on Cancer Accreditation program. Data was analyzed using SPSS and statistical significance was set at P = .05.
Results
Of 2085 patients queried, 39.6% were treated at an academic/research program. The stage-adjusted difference in median survival between academic/research and non-academic programs was found to be statistically significant on log-rank comparison (P < .001). At each NCDB analytic stage (stage I-IV), academic/research programs were associated with decreased hazard and improved median survival. A Cox proportional hazards model showed a decreased likelihood of mortality in patients with osteosarcoma who underwent treatment at an academic/research program (HR, 0.882; 95% CI, .802-.969; P = .009). Chi-square testing revealed that patients at academic/research programs were more likely than those at non-academic/research centers to have private insurance, less likely to have Medicare, and more likely to live in counties of > 1 million people. These facilities were also more likely to have undergone Medicaid expansion in 2014. (P < .05). Patients at non-academic/research programs were more likely to have advanced disease (stage III and IV) and higher comorbidity scores. Additionally, they were less likely to receive surgery and/or chemotherapy at the institution in which they were diagnosed. (P < .05).
Conclusions
This study showed that Osteosarcoma patients treated in an academic/research program facility experienced increased survival compared with non-academic/research facilities. Patients at academic/research facilities tend to have less comorbidities, have private insurance, and present with more treatable disease. Despite these favorable prognostic factors, the data suggest an intrinsic benefit to being treated at an academic/research facility.
Development of an Informatics Infrastructure and Frontend Dashboard for Monitoring Clinical Operations of the National TeleOncology Service
Background
Since inception, the Veterans Affairs (VA) National TeleOncology (NTO) service has monitored clinical operations through data tools produced by the Veterans Health Administration Support Service Center (VSSC). Unfortunately, pertinent data are spread across multiple reports, making it difficult to continually harmonize needed information. Further, the VSSC does not account for NTO’s hub and spoke clinical model, leading to inaccuracies when attempting to analyze unique encounters. To address these challenges, NTO partnered with the VA Salt Lake City Health Care System Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS) to develop an informatics architecture and frontend NTO Clinical Operations Dashboard (NCOD). Here, we summarize our dashboard development process and the finalized key reporting components of the NCOD.
Methods
The VA Corporate Data Warehouse (CDW) serves as the primary data source for the NCOD. SQL Server Integration Services was used to build the backend data architecture. Data from the CDW were isolated into a staging data mart for reporting purposes using an extract, transform, load (ETL) approach. The frontend user interface was developed using Power BI. We used a participatory approach1 in determining reporting requirements. Stakeholders included the IDEAS dashboard development team and potential end users from NTO, including leadership, program managers, support assistants, and telehealth coordinators.
Results
The NCOD ETL is scheduled to refresh the data nightly to provide end users with a near real-time experience. The NCOD is comprised of the following four data views: clinic availability, team productivity, patient summary, and encounter summary. The clinic availability view summarizes clinic capacity, no shows, overbookings, and percent utilization. Relative value unit- based productivity is summarized in the team productivity view. The patient summary view presents aggregated data for veterans served by NTO, including geographic distribution, with patient-level drill down displaying demographics, cancer characteristics, and treatment history. Lastly, the encounter view displays utilization trends by modality, while accurately accounting for the hub and spoke clinical model.
Conclusions
An informatics architecture and frontend information display that is capable of synthesizing EHR data into a consumable format has been pivotal in obtaining accurate and timely insight into the demand and capacity of services provided by NTO.
- Esquer Rochin MA, Gutierrez-Garcia JO, Rosales JH, Rodriguez LF. Design and evaluation of a dashboard to support the comprehension of the progression.
Background
Since inception, the Veterans Affairs (VA) National TeleOncology (NTO) service has monitored clinical operations through data tools produced by the Veterans Health Administration Support Service Center (VSSC). Unfortunately, pertinent data are spread across multiple reports, making it difficult to continually harmonize needed information. Further, the VSSC does not account for NTO’s hub and spoke clinical model, leading to inaccuracies when attempting to analyze unique encounters. To address these challenges, NTO partnered with the VA Salt Lake City Health Care System Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS) to develop an informatics architecture and frontend NTO Clinical Operations Dashboard (NCOD). Here, we summarize our dashboard development process and the finalized key reporting components of the NCOD.
Methods
The VA Corporate Data Warehouse (CDW) serves as the primary data source for the NCOD. SQL Server Integration Services was used to build the backend data architecture. Data from the CDW were isolated into a staging data mart for reporting purposes using an extract, transform, load (ETL) approach. The frontend user interface was developed using Power BI. We used a participatory approach1 in determining reporting requirements. Stakeholders included the IDEAS dashboard development team and potential end users from NTO, including leadership, program managers, support assistants, and telehealth coordinators.
Results
The NCOD ETL is scheduled to refresh the data nightly to provide end users with a near real-time experience. The NCOD is comprised of the following four data views: clinic availability, team productivity, patient summary, and encounter summary. The clinic availability view summarizes clinic capacity, no shows, overbookings, and percent utilization. Relative value unit- based productivity is summarized in the team productivity view. The patient summary view presents aggregated data for veterans served by NTO, including geographic distribution, with patient-level drill down displaying demographics, cancer characteristics, and treatment history. Lastly, the encounter view displays utilization trends by modality, while accurately accounting for the hub and spoke clinical model.
Conclusions
An informatics architecture and frontend information display that is capable of synthesizing EHR data into a consumable format has been pivotal in obtaining accurate and timely insight into the demand and capacity of services provided by NTO.
Background
Since inception, the Veterans Affairs (VA) National TeleOncology (NTO) service has monitored clinical operations through data tools produced by the Veterans Health Administration Support Service Center (VSSC). Unfortunately, pertinent data are spread across multiple reports, making it difficult to continually harmonize needed information. Further, the VSSC does not account for NTO’s hub and spoke clinical model, leading to inaccuracies when attempting to analyze unique encounters. To address these challenges, NTO partnered with the VA Salt Lake City Health Care System Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS) to develop an informatics architecture and frontend NTO Clinical Operations Dashboard (NCOD). Here, we summarize our dashboard development process and the finalized key reporting components of the NCOD.
Methods
The VA Corporate Data Warehouse (CDW) serves as the primary data source for the NCOD. SQL Server Integration Services was used to build the backend data architecture. Data from the CDW were isolated into a staging data mart for reporting purposes using an extract, transform, load (ETL) approach. The frontend user interface was developed using Power BI. We used a participatory approach1 in determining reporting requirements. Stakeholders included the IDEAS dashboard development team and potential end users from NTO, including leadership, program managers, support assistants, and telehealth coordinators.
Results
The NCOD ETL is scheduled to refresh the data nightly to provide end users with a near real-time experience. The NCOD is comprised of the following four data views: clinic availability, team productivity, patient summary, and encounter summary. The clinic availability view summarizes clinic capacity, no shows, overbookings, and percent utilization. Relative value unit- based productivity is summarized in the team productivity view. The patient summary view presents aggregated data for veterans served by NTO, including geographic distribution, with patient-level drill down displaying demographics, cancer characteristics, and treatment history. Lastly, the encounter view displays utilization trends by modality, while accurately accounting for the hub and spoke clinical model.
Conclusions
An informatics architecture and frontend information display that is capable of synthesizing EHR data into a consumable format has been pivotal in obtaining accurate and timely insight into the demand and capacity of services provided by NTO.
- Esquer Rochin MA, Gutierrez-Garcia JO, Rosales JH, Rodriguez LF. Design and evaluation of a dashboard to support the comprehension of the progression.
- Esquer Rochin MA, Gutierrez-Garcia JO, Rosales JH, Rodriguez LF. Design and evaluation of a dashboard to support the comprehension of the progression.
Team-based Genetic Consultation: An Effective System of Care for Delivery of Precision Oncology Services
Objectives
US Department of Veterans Affairs (VA) patients with genetics referrals are 1.5 times more likely to have multiple cancer screening and preventive procedures if they completed their genetic consultations, but only when completed under a VA traditional model staffed by a team of clinical geneticists and genetic counselors versus a VA nontraditional, centralized telehealth model staffed by genetic counselors working independently. We sought to understand the reasons for these differences in cancer screening and prevention uptake.
Methods
We reviewed randomly selected medical records of patients with cancer genetics referrals stratified by model (142 records from each model). We conducted semi-structured interviews with 15 genetics providers and 36 referring clinicians from 13 VA facilities using purposive sampling. We analyzed annotated medical records and interview transcripts using a rapid assessment process. We characterized annotations as personalized recommendations (eg, begin colonoscopy at age 30 then every 1-2 years), options (eg, consider bilateral mastectomy), and generic messages (eg, refer to guidelines or another provider).
Results
Cancer screening or prevention was documented in 80 traditional-model records (141 annotations) and 106 nontraditional-model records (143 annotations). Personalized recommendations comprised 69% (97/141) of annotations within traditional-model records and 30% (43/143) within nontraditional-model records. Generic messages comprised 17% (24/141) of annotations in traditional-model records and 51% (73/143) in nontraditional-model records. From interview data, referring clinicians expected a broad range of services from genetics providers, including management and screening recommendations, and stated their role was to follow through on recommendations made. Under the traditional model, geneticists formulated recommendations documented by genetic counselors. Under the nontraditional model, scope of practice limited how genetic counselors addressed cancer screening and prevention.
Conclusions/Impacts
Personalized recommendations were typical of traditional-model records, whereas nontraditional-model records usually had generic messages. Compared with the nontraditional model, the traditional model was more patient-centered and better meets expectations of referring clinicians, which might explain in part the differences in patient uptake of cancer screening and preventive procedures.
As the demand for genetic services grows, the VA should promote team-based care under the traditional model for a more patient-centered, coordinated, and effective system of care for precision oncology.
Objectives
US Department of Veterans Affairs (VA) patients with genetics referrals are 1.5 times more likely to have multiple cancer screening and preventive procedures if they completed their genetic consultations, but only when completed under a VA traditional model staffed by a team of clinical geneticists and genetic counselors versus a VA nontraditional, centralized telehealth model staffed by genetic counselors working independently. We sought to understand the reasons for these differences in cancer screening and prevention uptake.
Methods
We reviewed randomly selected medical records of patients with cancer genetics referrals stratified by model (142 records from each model). We conducted semi-structured interviews with 15 genetics providers and 36 referring clinicians from 13 VA facilities using purposive sampling. We analyzed annotated medical records and interview transcripts using a rapid assessment process. We characterized annotations as personalized recommendations (eg, begin colonoscopy at age 30 then every 1-2 years), options (eg, consider bilateral mastectomy), and generic messages (eg, refer to guidelines or another provider).
Results
Cancer screening or prevention was documented in 80 traditional-model records (141 annotations) and 106 nontraditional-model records (143 annotations). Personalized recommendations comprised 69% (97/141) of annotations within traditional-model records and 30% (43/143) within nontraditional-model records. Generic messages comprised 17% (24/141) of annotations in traditional-model records and 51% (73/143) in nontraditional-model records. From interview data, referring clinicians expected a broad range of services from genetics providers, including management and screening recommendations, and stated their role was to follow through on recommendations made. Under the traditional model, geneticists formulated recommendations documented by genetic counselors. Under the nontraditional model, scope of practice limited how genetic counselors addressed cancer screening and prevention.
Conclusions/Impacts
Personalized recommendations were typical of traditional-model records, whereas nontraditional-model records usually had generic messages. Compared with the nontraditional model, the traditional model was more patient-centered and better meets expectations of referring clinicians, which might explain in part the differences in patient uptake of cancer screening and preventive procedures.
As the demand for genetic services grows, the VA should promote team-based care under the traditional model for a more patient-centered, coordinated, and effective system of care for precision oncology.
Objectives
US Department of Veterans Affairs (VA) patients with genetics referrals are 1.5 times more likely to have multiple cancer screening and preventive procedures if they completed their genetic consultations, but only when completed under a VA traditional model staffed by a team of clinical geneticists and genetic counselors versus a VA nontraditional, centralized telehealth model staffed by genetic counselors working independently. We sought to understand the reasons for these differences in cancer screening and prevention uptake.
Methods
We reviewed randomly selected medical records of patients with cancer genetics referrals stratified by model (142 records from each model). We conducted semi-structured interviews with 15 genetics providers and 36 referring clinicians from 13 VA facilities using purposive sampling. We analyzed annotated medical records and interview transcripts using a rapid assessment process. We characterized annotations as personalized recommendations (eg, begin colonoscopy at age 30 then every 1-2 years), options (eg, consider bilateral mastectomy), and generic messages (eg, refer to guidelines or another provider).
Results
Cancer screening or prevention was documented in 80 traditional-model records (141 annotations) and 106 nontraditional-model records (143 annotations). Personalized recommendations comprised 69% (97/141) of annotations within traditional-model records and 30% (43/143) within nontraditional-model records. Generic messages comprised 17% (24/141) of annotations in traditional-model records and 51% (73/143) in nontraditional-model records. From interview data, referring clinicians expected a broad range of services from genetics providers, including management and screening recommendations, and stated their role was to follow through on recommendations made. Under the traditional model, geneticists formulated recommendations documented by genetic counselors. Under the nontraditional model, scope of practice limited how genetic counselors addressed cancer screening and prevention.
Conclusions/Impacts
Personalized recommendations were typical of traditional-model records, whereas nontraditional-model records usually had generic messages. Compared with the nontraditional model, the traditional model was more patient-centered and better meets expectations of referring clinicians, which might explain in part the differences in patient uptake of cancer screening and preventive procedures.
As the demand for genetic services grows, the VA should promote team-based care under the traditional model for a more patient-centered, coordinated, and effective system of care for precision oncology.
Duty to Assist: Assisting Veterans With Exposures to Hazardous Materials
Background
Veterans are not well informed of the presumptive conditions associated with toxic exposures endured during military service. A quality improvement project was created to increase awareness. The purpose of this project was to: Raise awareness of presumptive conditions associated with Agent Orange, Camp LeJeune contaminated water and Southwest Asia Burn Pit (fine particulate) exposure, to notify veterans how to initiate the disability benefits application process, and to inform veterans and providers of new changes in legislation (ie, Blue Water and Southwest Asia).
Methods
Using the Cancer Registry, the cancer access coordinator identified veterans with a diagnosis on each of the 3 presumptive condition lists for Agent Orange, Camp Lejeune, and Southwest Asia. These lists were then forwarded to informatics who further screened for military service history. Informative mailers were then sent to the identified veterans, alerting them to their potential eligibility for disability benefits. In addition, the mailers informed veterans how to initiate the benefits application process, how to schedule Disability Benefit Questionnaire (DBQ) exams to expedite the process, as well as contact information for local Veteran’s Service Commission (VSC) and the Veterans Benefits Administration (VBA) for further assistance. These letters were also distributed throughout the medical facility and was shared at cancer committee meetings to increase provider awareness.
Results
In 2021, 604 veterans were identified as potentially eligible for disability benefits and were contacted via mailer. As a result, 153 veterans have been granted service-connected benefits for their identified condition. An additional 91 mailers have been sent since January 2022.
Conclusions
Utilizing this simple practice increases both veteran and provider awareness of presumptive conditions, and aids in veterans receiving the disability compensation they are entitled to. In addition, this practice improves the overall quality of care the veterans receive through the VA and gives us a chance to give back to our veterans.
Background
Veterans are not well informed of the presumptive conditions associated with toxic exposures endured during military service. A quality improvement project was created to increase awareness. The purpose of this project was to: Raise awareness of presumptive conditions associated with Agent Orange, Camp LeJeune contaminated water and Southwest Asia Burn Pit (fine particulate) exposure, to notify veterans how to initiate the disability benefits application process, and to inform veterans and providers of new changes in legislation (ie, Blue Water and Southwest Asia).
Methods
Using the Cancer Registry, the cancer access coordinator identified veterans with a diagnosis on each of the 3 presumptive condition lists for Agent Orange, Camp Lejeune, and Southwest Asia. These lists were then forwarded to informatics who further screened for military service history. Informative mailers were then sent to the identified veterans, alerting them to their potential eligibility for disability benefits. In addition, the mailers informed veterans how to initiate the benefits application process, how to schedule Disability Benefit Questionnaire (DBQ) exams to expedite the process, as well as contact information for local Veteran’s Service Commission (VSC) and the Veterans Benefits Administration (VBA) for further assistance. These letters were also distributed throughout the medical facility and was shared at cancer committee meetings to increase provider awareness.
Results
In 2021, 604 veterans were identified as potentially eligible for disability benefits and were contacted via mailer. As a result, 153 veterans have been granted service-connected benefits for their identified condition. An additional 91 mailers have been sent since January 2022.
Conclusions
Utilizing this simple practice increases both veteran and provider awareness of presumptive conditions, and aids in veterans receiving the disability compensation they are entitled to. In addition, this practice improves the overall quality of care the veterans receive through the VA and gives us a chance to give back to our veterans.
Background
Veterans are not well informed of the presumptive conditions associated with toxic exposures endured during military service. A quality improvement project was created to increase awareness. The purpose of this project was to: Raise awareness of presumptive conditions associated with Agent Orange, Camp LeJeune contaminated water and Southwest Asia Burn Pit (fine particulate) exposure, to notify veterans how to initiate the disability benefits application process, and to inform veterans and providers of new changes in legislation (ie, Blue Water and Southwest Asia).
Methods
Using the Cancer Registry, the cancer access coordinator identified veterans with a diagnosis on each of the 3 presumptive condition lists for Agent Orange, Camp Lejeune, and Southwest Asia. These lists were then forwarded to informatics who further screened for military service history. Informative mailers were then sent to the identified veterans, alerting them to their potential eligibility for disability benefits. In addition, the mailers informed veterans how to initiate the benefits application process, how to schedule Disability Benefit Questionnaire (DBQ) exams to expedite the process, as well as contact information for local Veteran’s Service Commission (VSC) and the Veterans Benefits Administration (VBA) for further assistance. These letters were also distributed throughout the medical facility and was shared at cancer committee meetings to increase provider awareness.
Results
In 2021, 604 veterans were identified as potentially eligible for disability benefits and were contacted via mailer. As a result, 153 veterans have been granted service-connected benefits for their identified condition. An additional 91 mailers have been sent since January 2022.
Conclusions
Utilizing this simple practice increases both veteran and provider awareness of presumptive conditions, and aids in veterans receiving the disability compensation they are entitled to. In addition, this practice improves the overall quality of care the veterans receive through the VA and gives us a chance to give back to our veterans.
Oncologists’ wealth and debt: COVID had little impact
concludes the latest Medscape Oncologist Wealth & Debt Report 2022.
Comparing the findings with those in the larger Medscape Physician Wealth & Debt Report 2022, which surveyed more than 13,000 physicians in 29 specialties, the findings for oncologists show how they compare with those who chose other paths in medicine.
Oncologists’ income rose, on average, by 2% in the past year and now stands at an average of $411,000 annually, up from $403,000 in the 2021 report.
This puts oncologists in the top third of specialties, with plastic surgeons again in the top slot (with average income of $576,000 in 2022).
One-fifth (20%) of oncologists surveyed reported a family worth of more than $5 million, which represents substantial family wealth, the report comments.
However, 22% of oncologists reported that their family net worth was less than $500,000, and another 10% estimated that it to fall between $500,000 and $1 million.
For comparison, the average U.S. family net worth is about $749,000, according to data from the Federal Reserve.
Most live ‘within their means’
Most oncologists (94%) and also most (94%) of all of the physicians surveyed said that they live within or below their means.
How does one do this? Just paying off credit cards each month and contributing enough to a 401(k) account to receive an employer match does not meet this standard, said Joel Greenwald MD, CFP, a wealth management advisor for physicians. To live within or below your means, you also need to be saving at least 20% toward retirement, pay down student loans, contribute to your kids’ college savings, and set aside rainy day cash, he explained.
When physicians were asked about their favorite cost-cutting tactics, replies included bringing lunch to work, keeping a car for 15 years, and carrying out their own household maintenance and repairs. One doctor described a “24-hour rule” when it comes to shopping: “Revisit the desired purchase after 24 hours to see if it’s still desired.”
But how well do these tactics go down with ‘the other half’ and the rest of the household? Two-thirds (66%) of oncologists, and a similar proportion of all physicians, said that they argue with their significant other about spending. This appears to be high in comparison with the finding from a recent survey that across the United States, about one in four couples (25%) argue about money at least once a month.
Regarding spending, the top expense among oncologists was for childcare (16%), private tuition for offspring (14%), mortgage on a second home (14%), college tuition for offspring (14%), and a car lease (12%).
Around 17% of oncologists reported that they are still paying off their own college or medical school loans. For this statistic, they are about in the middle of all specialties.
The report notes that freeing oneself from medical school debt is very costly. Physicians in the United States pay an average of $356,000-$440,000, about half of which is interest.
Little change over 2021
The COVID pandemic had much less of an impact on physicians than it had on the general population when it comes to keeping up with payments, and most physicians were not affected. Only 3% of oncologists said they fell behind with payments for mortgage; 6% fell behind with payments for other bills.
In comparison, nearly half (46%) of Americans missed one or more payments of rent or mortgage because of COVID, according to a 2021 industry survey.
Over the past year, most oncologists (70%) did not change their spending habits, and only 11% cut expenses by deferring or refinancing loans. Also, most oncologists (75%) avoided major financial loses. Only 8% reported financial losses because of problems at their medical practice.
However, a slightly higher percentage of oncologists reported a stock or company investment that had turned sour in 2022 (37%) in comparison with 2021 (28%).
A version of this article first appeared on Medscape.com.
concludes the latest Medscape Oncologist Wealth & Debt Report 2022.
Comparing the findings with those in the larger Medscape Physician Wealth & Debt Report 2022, which surveyed more than 13,000 physicians in 29 specialties, the findings for oncologists show how they compare with those who chose other paths in medicine.
Oncologists’ income rose, on average, by 2% in the past year and now stands at an average of $411,000 annually, up from $403,000 in the 2021 report.
This puts oncologists in the top third of specialties, with plastic surgeons again in the top slot (with average income of $576,000 in 2022).
One-fifth (20%) of oncologists surveyed reported a family worth of more than $5 million, which represents substantial family wealth, the report comments.
However, 22% of oncologists reported that their family net worth was less than $500,000, and another 10% estimated that it to fall between $500,000 and $1 million.
For comparison, the average U.S. family net worth is about $749,000, according to data from the Federal Reserve.
Most live ‘within their means’
Most oncologists (94%) and also most (94%) of all of the physicians surveyed said that they live within or below their means.
How does one do this? Just paying off credit cards each month and contributing enough to a 401(k) account to receive an employer match does not meet this standard, said Joel Greenwald MD, CFP, a wealth management advisor for physicians. To live within or below your means, you also need to be saving at least 20% toward retirement, pay down student loans, contribute to your kids’ college savings, and set aside rainy day cash, he explained.
When physicians were asked about their favorite cost-cutting tactics, replies included bringing lunch to work, keeping a car for 15 years, and carrying out their own household maintenance and repairs. One doctor described a “24-hour rule” when it comes to shopping: “Revisit the desired purchase after 24 hours to see if it’s still desired.”
But how well do these tactics go down with ‘the other half’ and the rest of the household? Two-thirds (66%) of oncologists, and a similar proportion of all physicians, said that they argue with their significant other about spending. This appears to be high in comparison with the finding from a recent survey that across the United States, about one in four couples (25%) argue about money at least once a month.
Regarding spending, the top expense among oncologists was for childcare (16%), private tuition for offspring (14%), mortgage on a second home (14%), college tuition for offspring (14%), and a car lease (12%).
Around 17% of oncologists reported that they are still paying off their own college or medical school loans. For this statistic, they are about in the middle of all specialties.
The report notes that freeing oneself from medical school debt is very costly. Physicians in the United States pay an average of $356,000-$440,000, about half of which is interest.
Little change over 2021
The COVID pandemic had much less of an impact on physicians than it had on the general population when it comes to keeping up with payments, and most physicians were not affected. Only 3% of oncologists said they fell behind with payments for mortgage; 6% fell behind with payments for other bills.
In comparison, nearly half (46%) of Americans missed one or more payments of rent or mortgage because of COVID, according to a 2021 industry survey.
Over the past year, most oncologists (70%) did not change their spending habits, and only 11% cut expenses by deferring or refinancing loans. Also, most oncologists (75%) avoided major financial loses. Only 8% reported financial losses because of problems at their medical practice.
However, a slightly higher percentage of oncologists reported a stock or company investment that had turned sour in 2022 (37%) in comparison with 2021 (28%).
A version of this article first appeared on Medscape.com.
concludes the latest Medscape Oncologist Wealth & Debt Report 2022.
Comparing the findings with those in the larger Medscape Physician Wealth & Debt Report 2022, which surveyed more than 13,000 physicians in 29 specialties, the findings for oncologists show how they compare with those who chose other paths in medicine.
Oncologists’ income rose, on average, by 2% in the past year and now stands at an average of $411,000 annually, up from $403,000 in the 2021 report.
This puts oncologists in the top third of specialties, with plastic surgeons again in the top slot (with average income of $576,000 in 2022).
One-fifth (20%) of oncologists surveyed reported a family worth of more than $5 million, which represents substantial family wealth, the report comments.
However, 22% of oncologists reported that their family net worth was less than $500,000, and another 10% estimated that it to fall between $500,000 and $1 million.
For comparison, the average U.S. family net worth is about $749,000, according to data from the Federal Reserve.
Most live ‘within their means’
Most oncologists (94%) and also most (94%) of all of the physicians surveyed said that they live within or below their means.
How does one do this? Just paying off credit cards each month and contributing enough to a 401(k) account to receive an employer match does not meet this standard, said Joel Greenwald MD, CFP, a wealth management advisor for physicians. To live within or below your means, you also need to be saving at least 20% toward retirement, pay down student loans, contribute to your kids’ college savings, and set aside rainy day cash, he explained.
When physicians were asked about their favorite cost-cutting tactics, replies included bringing lunch to work, keeping a car for 15 years, and carrying out their own household maintenance and repairs. One doctor described a “24-hour rule” when it comes to shopping: “Revisit the desired purchase after 24 hours to see if it’s still desired.”
But how well do these tactics go down with ‘the other half’ and the rest of the household? Two-thirds (66%) of oncologists, and a similar proportion of all physicians, said that they argue with their significant other about spending. This appears to be high in comparison with the finding from a recent survey that across the United States, about one in four couples (25%) argue about money at least once a month.
Regarding spending, the top expense among oncologists was for childcare (16%), private tuition for offspring (14%), mortgage on a second home (14%), college tuition for offspring (14%), and a car lease (12%).
Around 17% of oncologists reported that they are still paying off their own college or medical school loans. For this statistic, they are about in the middle of all specialties.
The report notes that freeing oneself from medical school debt is very costly. Physicians in the United States pay an average of $356,000-$440,000, about half of which is interest.
Little change over 2021
The COVID pandemic had much less of an impact on physicians than it had on the general population when it comes to keeping up with payments, and most physicians were not affected. Only 3% of oncologists said they fell behind with payments for mortgage; 6% fell behind with payments for other bills.
In comparison, nearly half (46%) of Americans missed one or more payments of rent or mortgage because of COVID, according to a 2021 industry survey.
Over the past year, most oncologists (70%) did not change their spending habits, and only 11% cut expenses by deferring or refinancing loans. Also, most oncologists (75%) avoided major financial loses. Only 8% reported financial losses because of problems at their medical practice.
However, a slightly higher percentage of oncologists reported a stock or company investment that had turned sour in 2022 (37%) in comparison with 2021 (28%).
A version of this article first appeared on Medscape.com.