Journal of Oncology Practice最新文献

{"title":"Opaque Results of Federal Price Transparency Rules and State-Based Alternatives.","authors":"S. Kircher, T. Royce, Deepmala Upadhyay, B. Polite","doi":"10.1200/JOP.19.00354","DOIUrl":"https://doi.org/10.1200/JOP.19.00354","url":null,"abstract":"On January 1, 2019, the Centers for Medicare and Medicaid Services (CMS) issuedmandate CMS-1694-F, which requires inpatient and long-term care hospitals to publicly display a list, or chargemaster, of their standard charges for items and services provided. The reports must be updated annually and provided in electronically importable format (eg, .XML, .CSV files). We commend the focus on price transparency; however, this mandate falls short of its stated goal to “empower patients through better access to hospital price information.” For the insured patient, chargemaster prices demonstrate a poor correlation between the insurer payment and the patient cost-sharing responsibility. Conversely, there are state-led initiatives, such as the California Public Employees Retirement System (CalPERS), which have successfully implemented robust price transparency programs using a public all-payer claims database (APCD), demonstrating that price transparency can be a dominant solution (lower total and out of pocket [OOP] costs without worse outcomes). Price transparency is most useful for patients when costs are accurate, relevant, and paired with value-based insurance that minimize OOP costs for services deemed highest value.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900354"},"PeriodicalIF":0.0,"publicationDate":"2019-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44970797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescents and Cancer Clinical Trials: A MaGIC Mystery Tour.","authors":"T. Olson","doi":"10.1200/JOP.19.00416","DOIUrl":"https://doi.org/10.1200/JOP.19.00416","url":null,"abstract":"","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"15 8 1","pages":"443-444"},"PeriodicalIF":0.0,"publicationDate":"2019-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00416","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47366725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Deductible Health Plans and Cancer Survivorship: What Is the Association With Access to Care and Hospital Emergency Department Use?","authors":"Zhiyuan Zheng, A. Jemal, M. Banegas, Xuesong Han, K. R. Yabroff","doi":"10.1200/JOP.18.00699","DOIUrl":"https://doi.org/10.1200/JOP.18.00699","url":null,"abstract":"PURPOSE\u0000To examine the associations among high-deductible health plan (HDHP) enrollment, cancer survivorship, and access to care and utilization.\u0000\u0000\u0000MATERIALS AND METHODS\u0000The 2010 to 2017 National Health Interview Survey was used to identify privately insured adults ages 18 to 64 years (cancer survivors, n = 4,321; individuals without a cancer history, n = 95,316). We used multivariable logistic regressions to evaluate the associations among HDHP/health savings account (HSA) status, delayed/forgone care for financial reasons, and hospital emergency department (ED) visits among cancer survivors compared with individuals without a cancer history.\u0000\u0000\u0000RESULTS\u0000Among cancer survivors, HDHPs with or without HSA (8.9% and 13.9%, respectively; both P < .05) were associated with more delayed/forgone care compared with low-deductible health plans (LDHPs) (7.9%). HSA enrollment was associated with less delayed/forgone care among HDHP cancer survivors (P < .05). ED visits were similar by insurance type. Among individuals without a cancer history, HDHP with or without HSA (9.5% and 10.8%, respectively; both P < .05) were both associated with more delayed/forgone care compared with LDHPs (5.9%). HSA enrollment also was associated with less delayed/forgone care among HDHP enrollees without a cancer history. A small difference in ED visits was observed between HDHPs without HSA (15.3%) and LDHPs (14.1%; P < .05) or HDHPs with HSA (13.4%; P < .05) among individuals without a cancer history.\u0000\u0000\u0000CONCLUSION\u0000HDHP enrollment and HSA status affect access to care and hospital ED visits similarly by cancer history. HDHP enrollment may serve as a barrier to access to care among cancer survivors, although HSA enrollment coupled with an HDHP may mitigate the impact on access. HDHPs and HSA status were not associated with ED visits among cancer survivors. Improvement to care coordination efforts may be needed to reduce ED visits among privately insured cancer survivors.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1800699"},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.18.00699","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49479796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreasing Time to Initiation of Chemotherapy for Patients Electively Admitted to a Hematologic Malignancy Service.","authors":"J. Galeas, S. Packer, R. Browne, Susan Sakalian, A. Binder","doi":"10.1200/JOP.19.00120","DOIUrl":"https://doi.org/10.1200/JOP.19.00120","url":null,"abstract":"PURPOSE\u0000Delays in initiating elective inpatient chemotherapy can decrease patient satisfaction and increase length of stay. At our institution, we observed that 86% of patients who were admitted for elective chemotherapy experienced a delay-more than 6 hours-with a median time to chemotherapy of 18.9 hours. We developed a process improvement initiative to improve time to chemotherapy for elective chemotherapy admissions.\u0000\u0000\u0000METHODS\u0000Our outcome measure was the time from admission to chemotherapy administration in patients who were admitted for elective chemotherapy. Process measures were identified and monitored. We collected baseline data and used performance improvement tools to identify key drivers. We focused on these key drivers to develop multiple plan-do-study-act cycles to improve our outcome measure. Once we started an intervention, we collected data every 2 weeks to assess our intervention.\u0000\u0000\u0000RESULTS\u0000At the time of interim analysis, we observed a median decrease in time to chemotherapy administration from 18.9 hours to 8.85 hours (P = .005). Median time to laboratory results resulted decreased from 3.17 hours to 0.00 hours. There was no change in time from signing chemotherapy to nurse releasing the chemotherapy. We noted that more providers were signing the chemotherapy before patient admission.\u0000\u0000\u0000CONCLUSION\u0000By implementing new admission workflows, optimizing our use of the electronic medical record to communicate among providers, and improving preadmission planning we were able to reduce our median time to chemotherapy for elective admissions by 53.2%. Improvement is still needed to meet our goals and to ensure the sustainability of these ongoing efforts.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900120"},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45961906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Findings From the Oncology Care Model Evaluation.","authors":"G. Brooks, Shalini Jhatakia, Amanda S Tripp, M. Landrum, T. Christian, G. Newes-Adeyi, Susannah G. Cafardi, A. Hassol, Carol Simon, N. Keating","doi":"10.1200/JOP.19.00265","DOIUrl":"https://doi.org/10.1200/JOP.19.00265","url":null,"abstract":"PURPOSE\u0000The Oncology Care Model (OCM) is an alternative payment model administered by the Centers for Medicare & Medicaid Services (CMS) that is structured around 6-month chemotherapy treatment episodes. This report describes the CMS-sponsored OCM evaluation and summarizes early evaluation findings.\u0000\u0000\u0000METHODS\u0000The OCM evaluation examines health care spending and use, quality of care, and patient experience during chemotherapy treatment episodes. Because OCM participation is voluntary, the evaluation compares participating physician practices with a propensity-matched group of nonparticipating practices by using a difference-in-differences approach. This report examines 6-month episodes initiated during the first OCM performance period (July 1, 2016, through January 1, 2017).\u0000\u0000\u0000RESULTS\u0000During the first OCM performance period, there was no statistically significant impact of OCM on total episode payments. There were small declines in intensive care unit (ICU) admissions (7 per 1,000 episodes) and emergency department visits (15 per 1,000 episodes); there was no statistically significant impact on hospitalizations or 30-day readmissions. Analyses of care quality and end-of-life care showed statistically significant impacts of OCM on the proportion of patients with inpatient hospitalizations in the last 30 days of life (1.5% absolute decrease) and ICU admissions in the last 30 days of life (2.1% decrease). There was no significant OCM impact on measures of hospice use.\u0000\u0000\u0000CONCLUSION\u0000Early findings from the OCM evaluation demonstrate modest program-related impacts on some acute care services and no change in total episode payments. Early findings may not reflect practice redesign efforts that were phased in after the beginning of OCM.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900265"},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00265","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44178664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining If a Somatic Tumor Mutation Is Targetable and Options for Accessing Targeted Therapies.","authors":"S. Bruinooge, Shimere Sherwood, S. Grubbs, R. Schilsky","doi":"10.1200/JOP.19.00262","DOIUrl":"https://doi.org/10.1200/JOP.19.00262","url":null,"abstract":"Targeted cancer therapies are drugs and biologics designed to affect cancer cell growth by blocking or interfering with specific molecular pathways in the cancer cell. Use of targeted agents usually requires verification through molecular testing that the patient's tumor harbors the molecular biomarker that is the target of the drug or is predictive of treatment benefit. Genomic mutations may be clinically actionable if they are associated with response or resistance to a potential therapy. If a genomic test reveals an actionable alteration, there are several options for accessing the targeted therapy. This article is intended to help clinicians determine if a tumor mutation is potentially treatable with a marketed or investigational drug or biologic product and to offer guidance on how to access the product of interest.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900262"},"PeriodicalIF":0.0,"publicationDate":"2019-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00262","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48931539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proposed Criteria for Systematic Evaluation of Qualitative Oncology Research.","authors":"S. Hannum, S. Dy, K. Smith, A. Kamal","doi":"10.1200/JOP.19.00125","DOIUrl":"https://doi.org/10.1200/JOP.19.00125","url":null,"abstract":"Oncology has made significant advances in standardizing how clinical research is conducted and reported. The advancement of such research that improves oncology practice requires an expansion of not only our research questions but also the research methods we deploy to address them. In particular, there is increasing recognition of the value of qualitative research methods to develop more comprehensive understandings of phenomena of interest and to describe and explain underlying motivations and potential causes of specific outcomes. However, qualitative researchers in oncology have lacked guidance to produce and evaluate methodologically rigorous qualitative publications. In this review, we highlight characteristics of high-quality, methodologically rigorous reports of qualitative research, provide criteria for readers and reviewers to appraise such publications critically, and proffer guidance for preparing publications for submission to Journal of Oncology Practice. Namely, the quality of qualitative research in oncology practice is best assessed according to key domains that include fitness of purpose, theoretical framework, methodological rigor, ethical concerns, analytic comprehensives, and the dissemination/application of findings. In particular, determinations of rigor in qualitative research in oncology practice should consider definitions of the appropriateness of qualitative methods for the research objectives against the setting of current literature, use of an appropriate theoretical framework, inclusion of a rigorous and innovative measurement plan, application of appropriate analytic techniques, and clear explanation and dissemination of the research findings.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900125"},"PeriodicalIF":0.0,"publicationDate":"2019-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42850543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune-Related Adverse Events Requiring Hospitalization: Spectrum of Toxicity, Treatment, and Outcomes.","authors":"Aanika Balaji, Jiajia Zhang, B. Wills, K. Marrone, H. Elmariah, M. Yarchoan, Jacquelyn W. Zimmerman, Khalid Hajjir, D. Venkatraman, D. Armstrong, D. Laheru, R. Mehra, W. J. Ho, J. Reuss, Joseph Heng, P. Vellanki, R. Donehower, M. Holdhoff, J. Naidoo","doi":"10.1200/JOP.18.00703","DOIUrl":"https://doi.org/10.1200/JOP.18.00703","url":null,"abstract":"PURPOSE\u0000Immune checkpoint inhibitors (ICIs) cause immune-related adverse events (irAEs). The proportion of patients who are hospitalized for irAEs and their spectrum, management, and outcomes are not well described.\u0000\u0000\u0000METHODS\u0000We report the proportion of hospitalized patients in an academic center who were treated with ICIs from May to December 2017. Patient characteristics, toxicities, management, and outcomes for confirmed irAE admissions are reported. Associations between patient features and irAE hospitalizations are examined.\u0000\u0000\u0000RESULTS\u0000Twenty-three percent (n = 100) of 443 patients who were admitted to an academic oncology center over 6 months had ever received ICIs. Of these patients, 41% were admitted for suspected irAEs and 23% were confirmed irAEs. IrAEs accounted for 5% of all oncology hospitalizations (n = 23). Ninety-one percent of patients with confirmed irAEs prompted a medicine subspecialist consultation, most commonly gastroenterology (22%). Fifteen patients (65%) had their irAEs improve/resolve, seven (30%) had worsening irAEs, and three (13%) died of their irAEs. The majority of patients (n = 20; 87%) discontinued ICIs after discharge. Among ICI-treated patients who required admission, an increased likelihood of irAE-related hospitalization was associated with patient age older than 65 years (odds ratio, 5.4; 95% CI, 1.6 to 17.8) and receipt of combination immunotherapy (OR, 6.8; 95% CI, 2.0 to 23.2).\u0000\u0000\u0000CONCLUSION\u0000A notable proportion of ICI-treated patients are hospitalized for irAEs, and these patients have a high demand for multidisciplinary management. Older age and combination ICI treatment were associated with an increased risk of irAE-related hospitalization. Whereas these data are from an academic center and include patients in clinical trials, with expanding use of ICIs, these data have important implications for inpatient service planning and risk stratification.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"18 10","pages":"JOP1800703"},"PeriodicalIF":0.0,"publicationDate":"2019-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.18.00703","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41271289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Next-Generation Sequencing in 305 Consecutive Patents: Clinical Outcomes and Management Changes.","authors":"W. Davis, Gabriel S. Makar, Pallav Mehta, G. Zhu, R. Somer, Jamin C Morrison, G. Kubicek","doi":"10.1200/JOP.19.00269","DOIUrl":"https://doi.org/10.1200/JOP.19.00269","url":null,"abstract":"PURPOSE\u0000Next-generation sequencing (NGS) is increasingly used to identify actionable mutations for oncology treatment. We examined the results and use of NGS assays at our institution.\u0000\u0000\u0000PATIENTS AND METHODS\u0000We retrospectively reviewed the medical records of 305 consecutive patients who had NGS testing of tumor samples from March 2014 to April 2017. NGS was performed by FoundationOne.\u0000\u0000\u0000RESULTS\u0000Of the 305 tissue samples sent to FoundationOne, 189 reports were potentially usable. Of these reports, 76 (40.21%) demonstrated an aberration targetable by on-label therapies and 126 (66.67%) by off-label therapies, and 170 (89.94%) revealed actionable aberrations via all potential avenues, including clinical trials; 21 of these 189 potentially usable reports (11.1%) yielded a change in management, including use of on-label therapies (n = 7), use of off-label therapies (n = 6), enrollment in a clinical trial (n = 6), and discontinuation of a medication with a predicted poor response (n = 3; one report was used twice). For the six patients with off-label use, median duration of treatment was 46 days and discontinued after death (n = 3) or progression (n = 3).\u0000\u0000\u0000CONCLUSION\u0000Only a minority of NGS assay results (6.9% percent of all tests ordered and 11.1% of useable tests) resulted in a management change. A small minority of patients started off-label therapy on the basis of NSG assay results and overall had poor responses to off-label treatment. Although in theory NGS assays may improve oncologic outcomes, the results of our initial 305 patients showed low clinical utility.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900269"},"PeriodicalIF":0.0,"publicationDate":"2019-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00269","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45584116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Hospitalizations: Institution of Outpatient Infusional EPOCH-Based Chemotherapy at a Safety Net Hospital.","authors":"Neil Keshvani,&nbsp;Mary Hon,&nbsp;Arjun Gupta,&nbsp;Timothy J Brown,&nbsp;Lonnie Roy,&nbsp;Eileen Marley,&nbsp;Sandy Lindsey,&nbsp;David H Johnson,&nbsp;Navid Sadeghi,&nbsp;Hsiao C Li","doi":"10.1200/JOP.18.00738","DOIUrl":"https://doi.org/10.1200/JOP.18.00738","url":null,"abstract":"<p><strong>Purpose: </strong>EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) -based chemotherapy is traditionally administered inpatient because of its complex 96-hour protocol and number of involved medications. These routine admissions are costly, disruptive, and isolating to patients. Here, we describe our experience transitioning from inpatient to outpatient ambulatory EPOCH-based chemotherapy in a safety-net hospital, associated cost savings, and patient perceptions.</p><p><strong>Methods and materials: </strong>Guidelines for chemotherapy administration and educational materials were developed by a multidisciplinary team of physicians, nurses, and pharmacists. Data were collected via chart review and costs via the finance department. Patient satisfaction with chemotherapy at home compared with hospitalization was measured on a Likert-type scale via direct-to-patient survey.</p><p><strong>Results: </strong>From January 30, 2017, through January 30, 2018, 87 cycles of EPOCH-based chemotherapy were administered to 23 patients. Sixty-one ambulatory cycles (70%) were administered to 18 patients. Of 26 cycles administered in the hospital, 18 (69%) were the first cycle of treatment. Rates of inappropriate prophylactic antimicrobial prescription and laboratory testing were lower in the outpatient setting. Eight of nine patients surveyed preferred home chemotherapy to inpatient chemotherapy. Per-cycle drug costs were 57.6% lower in outpatients as a result of differences in the acquisition cost in the outpatient setting. In total, the transition to ambulatory EPOCH-based chemotherapy yielded 1-year savings of $502,030 and an estimated 336 days of avoided hospital confinement.</p><p><strong>Conclusion: </strong>Multiday ambulatory EPOCH-based regimens were successfully and safely administered in our safety-net hospital. Outpatient therapy was associated with significant savings through avoided hospitalizations and reductions in drug acquisition cost and improved patient satisfaction.</p>","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"15 8","pages":"e644-e651"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.18.00738","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37337461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}