Journal of Oncology Practice最新文献

{"title":"Simulated Costs of the ASCO Patient-Centered Oncology Payment Model in Medicare Beneficiaries With Newly Diagnosed Advanced Ovarian Cancer.","authors":"Haley A Moss,&nbsp;Laura J Havrilesky,&nbsp;Frances F Wang,&nbsp;Mihaela V Georgieva,&nbsp;Laura H Hendrix,&nbsp;Michaela A Dinan","doi":"10.1200/JOP.19.00026","DOIUrl":"https://doi.org/10.1200/JOP.19.00026","url":null,"abstract":"<p><strong>Purpose: </strong>Efforts to curb the rising costs of cancer care while improving quality include alternative payment models (APMs), which offer incentives to reduce avoidable spending and provide high-quality and cost-efficient care. The impact of proposed APMs has not been quantified in real-world practice. In this study, we evaluated ASCO's Patient-Centered Oncology Payment (PCOP) model in existing fee-for-service (FFS) Medicare beneficiaries to understand the magnitude of potential cost savings.</p><p><strong>Materials and methods: </strong>SEER-Medicare data were used to identify women with advanced ovarian cancer diagnosed between 2000 and 2012 who either (1) underwent primary debulking surgery followed by chemotherapy or (2) received neoadjuvant chemotherapy followed by surgery. Medicare payments in each cohort were used to compare FFS and PCOP and to estimate the potential for cost savings across health care services received, including outpatient emergency department visits, hospitalizations, and imaging.</p><p><strong>Results: </strong>Three thousand seven hundred seventy-seven primary debulking surgery and 866 neoadjuvant chemotherapy patients were included in the study, with mean total costs of $75,433 and $95,138 in 2016 US$, respectively Most costs were related to chemotherapy or hospitalization. Additional PCOP-related payments would be offset if hospitalizations could be reduced by 11.6% or imaging claims by 88%.</p><p><strong>Conclusion: </strong>APMs have the potential to reduce costs of current FFS reimbursement via either a large reduction in imaging or a modest reduction in hospitalizations during treatment of ovarian cancer. PCOP is a reasonable payment structure for oncologists if the additional payments can provide the necessary resources to invest in improved coordination of care.</p>","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"15 12","pages":"e1018-e1027"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10057683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building an Infrastructure and Standard Methodology for Actively Engaging Patients in Advance Care Planning.","authors":"Karen Stepan,&nbsp;Lara Bashoura,&nbsp;Marina George,&nbsp;Wendy Griffith,&nbsp;Margaret Meyer,&nbsp;Nico Nortjé,&nbsp;Kristen Price,&nbsp;Donna S Zhukovsky,&nbsp;Maria Alma Rodriguez","doi":"10.1200/JOP.18.00406","DOIUrl":"https://doi.org/10.1200/JOP.18.00406","url":null,"abstract":"<p><strong>Purpose: </strong>With little to no infrastructure or standardized methodology in place to actively engage patients in advance care planning (ACP), The University of Texas MD Anderson Cancer Center set out to identify needed resources, develop an intervention to improve ACP, and evaluate the intervention's effects.</p><p><strong>Methods: </strong>With the support of executive leadership, a multidisciplinary workgroup enlisted the support of ACP champions, performed a root-cause analysis, developed a detailed ACP process flow by provider role, developed patient and family education resources, and developed faculty and staff training materials. The workgroup also implemented two Plan-Do-Study-Act intervention cycles, which identified difficulty using the ACP note function in our electronic health record (EHR) as a barrier to ACP adoption. By educating patients, families, and providers and improving the EHR's functionality, the workgroup aimed to increase the percentage of ambulatory patients with a diagnosis of advanced or metastatic cancer who had a documented ACP conversation with a provider by their third office visit. Our goal was to improve this percentage from 20% at baseline to 50% after the intervention. Data were obtained from our institution's EHRs.</p><p><strong>Results: </strong>The percentage of patients who had documented ACP conversations increased from 20% at baseline to 34% at the end of fiscal year 2017 and 54% at the end of fiscal year 2018.</p><p><strong>Conclusion: </strong>Owing to the dedicated efforts of many individuals across the institution, the postintervention goal was surpassed. Additional efforts to facilitate ACP conversations are ongoing.</p>","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"15 12","pages":"e1085-e1091"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.18.00406","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10109102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considerations for Long-Term Anticoagulation for Stroke Prevention in Patients With Atrial Fibrillation and Cancer.","authors":"Chiara Melloni,&nbsp;Michel G Khouri","doi":"10.1200/JOP.19.00597","DOIUrl":"https://doi.org/10.1200/JOP.19.00597","url":null,"abstract":"","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":" ","pages":"651-652"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00597","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37447514","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":"Successful Administration of Cemiplimab to a Patient With Advanced Cutaneous Squamous Cell Carcinoma After Renal Transplantation.","authors":"S. Ali, H. Arman, Anuj Patel, R. Birhiray","doi":"10.1200/jop.19.00567","DOIUrl":"https://doi.org/10.1200/jop.19.00567","url":null,"abstract":"","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900567"},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jop.19.00567","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44772414","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":"Primary Alveolar Rhabdomyosarcoma of the Breast in a 17-Year-Old Girl.","authors":"M. Mance, Sanda Smuđ-Orehovec, Vilena Vrbanović-Mijatović, D. Mijatović","doi":"10.1200/jop.19.00476","DOIUrl":"https://doi.org/10.1200/jop.19.00476","url":null,"abstract":"","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900476"},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jop.19.00476","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45513752","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":"Integrating Touchscreen-Based Geriatric Assessment and Frailty Screening for Adults With Multiple Myeloma to Drive Personalized Treatment Decisions.","authors":"N. Nathwani, S. Kurtin, B. Lipe, S. Mohile, D. Catamero, D. Wujcik, Kristy Birchard, Agnes Davis, W. Dudley, C. Stricker, T. Wildes","doi":"10.1200/JOP.19.00208","DOIUrl":"https://doi.org/10.1200/JOP.19.00208","url":null,"abstract":"PURPOSE\u0000Geriatric assessment (GA) results predict toxicity/survival in older adults, yet GA is not routinely used in care for patients with multiple myeloma (MM). We tested a tablet-based modified GA (mGA) providing real-time results to clinicians.\u0000\u0000\u0000METHODS\u0000One hundred sixty-five patients with MM aged ≥ 65 years facing a treatment decision from 4 sites completed a tablet-based mGA with Katz Activities of Daily Living (ADL), Lawton Instrumental ADL, Charlson Comorbidity Index, and variables from the Cancer and Aging Research Group's Chemotherapy Toxicity Calculator. Providers reviewed the assessment results at the treatment visit.\u0000\u0000\u0000RESULTS\u0000Patients were white (72%; n = 86), mean age was 72 years (range, 65-85 years), and averaged 7.71 minutes (range, 2-17 minutes) for survey completion. Providers averaged 3.2 minutes (range, 1-10 minutes) to review mGA results. Using International Myeloma Working Group frailty score, patients were fit (39%; n = 64), intermediate fit (33%; n = 55), or frail (28%; n = 46). Providers selected more aggressive treatments in 16.3% of patients and decreased treatment intensity in 34% of patients; treatment intensification was more common for fit patients and milder treatments for frail patients (χ2 = 20.02; P < .0001). Transplant eligibility significantly correlated with fit status and transplant ineligibility with frail status (P = .004). Outcomes on 144 patients 3 months post study visit showed 19.4% (n = 28) had grade ≥ 3 hematologic toxicities, 38.9% (n = 56) had dose modifications, and 18% (n = 26) had early therapy cessation.\u0000\u0000\u0000CONCLUSION\u0000Limited patient time required for survey completion and provider time for results review show mGA can be easily incorporated into clinical workflow. Real-time mGA results indicating fit/frailty status influenced treatment decisions.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900208"},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00208","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44082145","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":"\"It's More Difficult…\": Clinicians' Experience Providing Palliative Care to Adolescents and Young Adults Diagnosed With Advanced Cancer.","authors":"J. Avery, Arielle Geist, N. D'Agostino, S. Kawaguchi, R. Mahtani, P. Mazzotta, Pamela J Mosher, Ahmed al-Awamer, Alisha Kassam, C. Zimmermann, Mahsa Samadi, Seline Tam, A. Srikanthan, Abha A. Gupta","doi":"10.1200/JOP.19.00313","DOIUrl":"https://doi.org/10.1200/JOP.19.00313","url":null,"abstract":"PURPOSE Adolescents and young adults (AYAs; age 15-39 years) with advanced cancer are a population in whom quality of life is uniquely affected because of their stage of life. However, training focused on palliative care for AYAs is not routinely provided for health care providers (HCPs) in oncology. This study aims to explore the experiences of HCPs involved in introducing and providing palliative care caring for AYAs with advanced cancer and their families to understand the unique challenges HCPs experience. METHODS Using a qualitative descriptive design, semistructured interviews were conducted with medical and radiation oncologists, palliative care physicians, psychiatrists, and advanced practice nurses involved in caring for AYAs diagnosed with advanced cancer (N = 19). Interviews were transcribed verbatim and analyzed using thematic analysis in combination with constant comparative analysis and theoretical sampling. RESULTS There were 19 participants, 9 men and 10 women, with a median age of 45 years (range, 24-67 years). Six were palliative care physicians, 5 medical oncologists, 4 nurse practitioners, and 2 each radiation oncologists and psychiatrists. Overall, participants perceived the provision of palliative care for AYAs to be more difficult compared with older adults. Four themes emerged: (1) challenges helping AYAs/families to engage in and accept palliative care, (2) uncertainty regarding how to involve the family, (3) HCP sense of tragedy, and (4) HCP sense of emotional proximity. CONCLUSION Findings from this study support the development of dedicated training for HCPs involved in palliative care for AYA.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900313"},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45186423","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":"Time-Driven Activity-Based Cost Analysis of Radiation Treatment Options for Spinal Metastases.","authors":"D. Boyce-Fappiano, M. Ning, N. Thaker, T. Pezzi, O. Gjyshi, S. Mesko, C. Anakwenze, Nicholas D. Olivieri, A. Guzman, J. Incalcaterra, Chad Tang, M. McAleer, J. Herman, A. Ghia","doi":"10.1200/JOP.19.00480","DOIUrl":"https://doi.org/10.1200/JOP.19.00480","url":null,"abstract":"PURPOSE\u0000Several treatment options for spinal metastases exist, including multiple radiation therapy (RT) techniques: three-dimensional (3D) conventional RT (3D-RT), intensity-modulated RT (IMRT), and spine stereotactic radiosurgery (SSRS). Although data exist regarding reimbursement differences across regimens, differences in provider care delivery costs have yet to be evaluated. We quantified institutional costs associated with RT for spinal metastases, using a time-driven activity-based costing model.\u0000\u0000\u0000METHODS\u0000Comparisons were made between (1) 10-fraction 3D-RT to 30 Gy, (2) 10-fraction IMRT to 30 Gy, (3) 3-fraction SSRS (SSRS-3) to 27 Gy, and (4) single-fraction SSRS (SSRS-1) to 18 Gy. Process maps were developed from consultation through follow-up 30 days post-treatment. Process times were determined through panel interviews, and personnel costs were extracted from institutional salary data. The capacity cost rate was determined for each resource, then multiplied by activity time to calculate costs, which were summed to determine total cost.\u0000\u0000\u0000RESULTS\u0000Full-cycle costs of SSRS-1 were 17% lower and 17% higher compared with IMRT and 3D-RT, respectively. Full-cycle costs for SSRS-3 were only 1% greater than 10-fraction IMRT. Technical costs for IMRT were 50% and 77% more than SSRS-3 and SSRS-1. In contrast, personnel costs were 3% and 28% higher for SSRS-1 than IMRT and 3D-RT, respectively (P < .001).\u0000\u0000\u0000CONCLUSIONS\u0000Resource utilization varies significantly among treatment options. By quantifying provider care delivery costs, this analysis supports the institutional resource efficiency of SSRS-1. Incorporating clinical outcomes with such resource and cost data will provide additional insight into the highest value modalities and may inform alternative payment models, operational workflows, and institutional resource allocation.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900480"},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00480","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48228849","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":"Using Quality Improvement Methodology to Implement Survivorship Care Plans.","authors":"C. M. Smith, D. Friedman, B. Patterson","doi":"10.1200/JOP.19.00209","DOIUrl":"https://doi.org/10.1200/JOP.19.00209","url":null,"abstract":"PURPOSE\u0000Accreditation requirements for cancer centers by the American College of Surgeons' Commission on Cancer have included provision of survivorship care plans (SCPs) to patients treated with curative intent soon after completion of therapy. These were traditionally provided in a dedicated survivorship clinic for our pediatric oncology patients later in the survivorship time period. Our goal was to increase timely provision of SCPs to eligible patients in our acute care pediatric oncology clinic and to have this serve as a bridge to longer-term survivorship care.\u0000\u0000\u0000METHODS\u0000Our pediatric oncology clinic used quality improvement methodology to implement a process for creation of SCPs. We defined eligible patients on the basis of curative intent. Cancer registry data were queried to find eligible patients, and chart reviews were done weekly. A P chart and run chart were used to monitor our process for creation of plans and overall completion rate, respectively.\u0000\u0000\u0000RESULTS\u0000During the intervention period, we increased the percentage of eligible patients with an SCP from 28% on June 30, 2017, to 53% by December 31, 2017. Since that time, we have continued to increase the percentage of patients with SCPs, reaching 69% by June 30, 2019.\u0000\u0000\u0000CONCLUSION\u0000By using quality improvement methodology, our pediatric oncology clinic was able to change its clinical practice and implement a sustainable process for provision of SCPs and survivorship planning earlier in the post-treatment course, and meet the Commission on Cancer accreditation standard.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900209"},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00209","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48266115","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":"Nationwide Survey of Patients' Perspectives Regarding Their Radiation and Multidisciplinary Cancer Treatment Experiences.","authors":"N. Shaverdian, D. Yeboa, Liz Gardner, P. Harari, K. Liao, S. McCloskey, R. Tuli, N. Vapiwala, R. Jagsi","doi":"10.1200/JOP.19.00376","DOIUrl":"https://doi.org/10.1200/JOP.19.00376","url":null,"abstract":"PURPOSE\u0000The perspectives of patients with cancer about their treatment can inform interventions to improve the approaches of treating oncologists and experiences of future patients. We sought to identify areas where current toxicity management, informed consent processes, and physician-patient communication merit improvement.\u0000\u0000\u0000METHODS\u0000In a Web-based survey administered from March to May 2018 using quota-based sampling to draw a nationwide sample of US patients with cancer treated with radiotherapy within the past 5 years, we evaluated patient perceptions of adequacy of information about adverse effects, severity of actual adverse effects experienced, and experiences divergent from expectations.\u0000\u0000\u0000RESULTS\u0000Among 403 respondents, 18% felt inadequately informed about what adverse effects to expect from radiotherapy, and 37% experienced radiation adverse effects that they wished they had known more about. Similar proportions of patients treated with chemotherapy (36%) and surgery (34%) experienced toxicities related to those treatments that they wished they had known more about. Patients who noted their adverse effects to be minimal versus severe were significantly more likely to feel informed about radiotherapy adverse effects (odds ratio, 13.05; 95% CI, 5.6 to 30.38; P < .001). Across all evaluated measures, a majority of patients indicated that they did not experience the potentially anticipated radiotherapy adverse effect or that it was the same as or better than expected.\u0000\u0000\u0000CONCLUSION\u0000This study suggests that experiences with radiation adverse effects generally are congruent with expectations. Nevertheless, improvement of pretreatment counseling across all cancer therapy modalities seems warranted to improve informed decision making and treatment experiences.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900376"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00376","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47404460","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}