Journal of Oncology Practice最新文献

{"title":"Ibrutinib-Associated Reversible Cardiomyopathy.","authors":"Shih-Hsin Liang, C. Chiu, L. Bai","doi":"10.1200/jop.19.00334","DOIUrl":"https://doi.org/10.1200/jop.19.00334","url":null,"abstract":"","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900334"},"PeriodicalIF":0.0,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jop.19.00334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44105280","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":"Systematic Approach to Selecting and Preparing a Medical Power of Attorney in the Gynecologic Oncology Center.","authors":"D. Zhukovsky, P. Soliman, Boby Mathew, Sarah Mills, D. Bodurka, M. Frumovitz, L. Meyer, S. Westin, Marisa Nowitz, L. Archie, Shauna L. Fenton, Kai E. Lang, Janet L. Williams, Valentine Boving, E. Bruera","doi":"10.1200/jop.19.00109","DOIUrl":"https://doi.org/10.1200/jop.19.00109","url":null,"abstract":"PURPOSE\u0000Advance care planning (ACP) supports national priorities of patient engagement, person-centered care, and safety. A systematic approach is uncommon in most care settings. Our institution offers all patients with cancer new to the institution an opportunity to select and prepare a medical decision maker (MDM) after social work counseling. The goals of this study were to determine the success of a systematic institutional process for selecting a prepared MDM. The primary objectives were that (1) 70% or more of new patients would have one or more documented social work ACP discussions by the third office visit within 4 months, and (2) there would be a two-fold increase in scanned medical power of attorney (MPOA) documents available in the electronic health record (EHR). The secondary objectives were (1) improved surrogate preparedness for medical decision making, and (2) to determine whether patients with metastatic disease demonstrated greater readiness for selection of an MDM than those with localized disease.\u0000\u0000\u0000MATERIALS AND METHODS\u0000We conducted a retrospective chart review of consecutive gynecology oncology outpatients.\u0000\u0000\u0000RESULTS\u0000Of 133 patients, 93 (70%) had metastatic disease. The median number of visits was two (one to three). Forty-seven patients (39.3%) met with social work by visit 3. Review of ACP notes suggested that most patients were in the early stages of selecting a prepared MDM. At visit 1, 39 (29.3%) reported having an advance directive document; 14 (10.5%) had an MPOA in the EHR. There was no increase by visit 3. Fewer patients with metastatic disease than those with localized cancer (32.3% v 67.5%; P = .001) had three visits; no other parameter, including presence of MPOA documents in the EHR, achieved statistical significance between groups.\u0000\u0000\u0000CONCLUSION\u0000Current processes fail to engage patients in selecting and preparing an MDM.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900109"},"PeriodicalIF":0.0,"publicationDate":"2019-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jop.19.00109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46869693","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":"Coverage, Financial Burden, and the Patient Protection and Affordable Care Act for Patients With Cancer.","authors":"J. Segel, Jeah Jung","doi":"10.1200/JOP.19.00138","DOIUrl":"https://doi.org/10.1200/JOP.19.00138","url":null,"abstract":"PURPOSE\u0000Evidence suggests coverage has improved significantly for patients with cancer, particularly in the lower-income population, after the implementation of the Affordable Care Act (ACA). Yet no study has examined changes in type of coverage or the resulting effect on spending and financial burden.\u0000\u0000\u0000METHODS\u0000Using 2011 to 2015 Medical Expenditure Panel Survey data, we examine changes in type of coverage, spending, and financial burden among lower-income (< 400% of federal poverty level [FPL]) individuals diagnosed with cancer after the ACA. To better understand the changes, we compare this sample to the lower-income patients without cancer and patients with cancer with a higher income (≥ 400% of FPL). All analyses were conducted in 2018.\u0000\u0000\u0000RESULTS\u0000In adjusted analyses, we found a decline in months uninsured (-0.78 months; P = .001) and an increase in months with Medicaid coverage (0.40 months; P = .059) among the lower-income patients with cancer. This change is similar to the lower-income patients without cancer. We found an increase in total expenditures ($3,020; P = .071) but a modest decline in the fraction of family income spent on health (-0.014; P = 0.099), although neither is statistically significant. For the higher income patients with cancer, we observed significant increases in both out-of-pocket premiums and medical financial burden.\u0000\u0000\u0000CONCLUSION\u0000After the ACA, lower-income people diagnosed with cancer experienced significant gains in coverage largely through Medicaid at rates similar to lower-income patients without cancer, but patients with cancer with incomes 400% or greater of FPL faced a higher financial burden.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900138"},"PeriodicalIF":0.0,"publicationDate":"2019-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47518261","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":"In a Patient With Cancer, Not All That Enhances Is Leptomeningeal Carcinomatosis.","authors":"K. Sindhu, Sanders Chang, Jerry T. Liu, R. Bakst, K. Dharmarajan","doi":"10.1200/JOP.19.00324","DOIUrl":"https://doi.org/10.1200/JOP.19.00324","url":null,"abstract":"","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"15 10 1","pages":"558-559"},"PeriodicalIF":0.0,"publicationDate":"2019-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00324","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49645291","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":"Extranodal NK/T-Cell Lymphoma, Nasal Type: Shrouded No More.","authors":"M. Lunning","doi":"10.1200/JOP.19.00523","DOIUrl":"https://doi.org/10.1200/JOP.19.00523","url":null,"abstract":"","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"15 10 1","pages":"521-522"},"PeriodicalIF":0.0,"publicationDate":"2019-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00523","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43390875","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":"Pembrolizumab and Severe Hypertriglyceridemia Requiring Apheresis: An Immune-Related Adverse Event.","authors":"Malvi Thakker, Kalimullah Quadri, Ankuri Desai, W. Illyas, Min Young Kim, Sanket Desai, C. Rager","doi":"10.1200/JOP.19.00245","DOIUrl":"https://doi.org/10.1200/JOP.19.00245","url":null,"abstract":"","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900245"},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00245","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43190947","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":"Characteristics of Physicians Participating in Medicare's Oncology Care Model Bundled Payment Program.","authors":"Ravi B Parikh, Justin E Bekelman, Qian Huang, Joseph R Martinez, Ezekiel J Emanuel, Amol S Navathe","doi":"10.1200/JOP.19.00047","DOIUrl":"10.1200/JOP.19.00047","url":null,"abstract":"<p><strong>Purpose: </strong>The Oncology Care Model (OCM) is Medicare's first bundled payment program for patients with cancer. We examined baseline characteristics of OCM physician participants and markets with high OCM physician participation to inform generalizability and complement the ongoing practice-level evaluation of the OCM.</p><p><strong>Methods: </strong>In this cross-sectional study, we identified characteristics of US medical oncologists practicing in 2016, using a national telephone-verified physician database. We linked these data with Dartmouth Atlas and Medicare claims data from 2011 through 2016 to identify characteristics of markets with high OCM participation. We used logistic regression to examine relationships between market characteristics and OCM participation.</p><p><strong>Results: </strong>Of 10,428 US medical oncologists, 2,605 (24.9%) were listed in an OCM practice. There were no differences in sex or medical training between OCM participants and nonparticipants, although OCM participants were slightly younger. OCM participants practiced in larger (median daily patient volume, 80 <i>v</i> 55 patients) and urban practices (95.2% <i>v</i> 90.7%) and were less likely to be part of a health system (41.0% <i>v</i> 60.4%) or solo practice (45.5% <i>v</i> 67.4%; all <i>P</i> < .001). Participation was higher in southern and mid-Atlantic markets. Markets with high OCM physician participation had higher specialist density, hospital care intensity, and acute care use at the end of life (all <i>P</i> < .001). Market-level penetration of Accountable Care Organizations (adjusted odds ratio, 4.65; 95% CI 3.31 to 6.56; <i>P</i> < .001) and Medicare Advantage (adjusted odds ratio 2.82; 95% CI, 1.97 to 4.06; <i>P</i> < .001) were associated with higher OCM participation.</p><p><strong>Conclusion: </strong>In the first description of oncologists participating in the OCM, we found differences in practice demographics, care intensity, and exposure to nontraditional payment models between OCM-participating and nonparticipating physicians. Such provider-level differences may not be captured in Medicare's practice-level analysis.</p>","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"e897-e905"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46586560","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":"Etanercept for Treatment of Taxane-Induced Pneumonitis.","authors":"Arun K Singavi,&nbsp;Vijaya Ramalingam,&nbsp;Ben George","doi":"10.1200/JOP.19.00180","DOIUrl":"https://doi.org/10.1200/JOP.19.00180","url":null,"abstract":"","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"15 10","pages":"556-557"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37073102","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":"Advancements in Treatment of Refractory and Relapsed Myeloid Sarcoma.","authors":"K. Sahu, A. Mishra, A. Lal","doi":"10.1200/jop.19.00447","DOIUrl":"https://doi.org/10.1200/jop.19.00447","url":null,"abstract":"","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900447"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jop.19.00447","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41747552","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 Unwarranted Oncology Care Variation Across a Clinically Integrated Network: A Collaborative Physician Engagement Strategy.","authors":"Jon M. Richards, Trever Burgon, D. Tamondong-Lachica, J. Bitran, W. Liangco, David Paculdo, J. Peabody","doi":"10.1200/jop.18.00754","DOIUrl":"https://doi.org/10.1200/jop.18.00754","url":null,"abstract":"PURPOSE\u0000Addressing unwarranted clinical variation in oncology is a high priority for health systems that aspire to ensure consistent levels of high-quality and cost-effective care. Efforts to improve clinical practice and standardize care have proven challenging. Advocate Physician Partners undertook a patient simulation-based practice measurement and feedback project that was focused on breast and lung cancer to engage oncologists in the care standardization process.\u0000\u0000\u0000METHODS\u0000One hundred three medical oncologists cared for online simulated patients using the Clinical Performance and Value platform, receiving feedback on how their care decisions compared with evidence-based guidelines and their peers. We repeated this process every 4 months over six rounds, measuring changes in quality-of-care scores. We then compared simulated patient results with available patient-level claims data.\u0000\u0000\u0000RESULTS\u0000Over the course of the project, overall quality-of-care scores improved 11.9% (P < .001). Diagnostic accuracy increased 6.7% (P < .001) and correlated with improved treatment scores, including a nearly 10-percentage point increase in evidence-based chemotherapy regimens (P = .009) and a 56% increase in addressing palliative needs for patients with late-stage disease (P < .001). Unnecessary test ordering declined 25% (P < .001). We compared these results with available patient data and observed concordance with the metastatic imaging workup order rate for early-stage breast cancer. As unnecessary workups declined in the simulations and became more closely aligned with evidence-based guidelines, we saw similar rates of decline in the patient-level data.\u0000\u0000\u0000CONCLUSION\u0000This study demonstrates that an oncology care standardization system that combines simulated patients with serial feedback increases evidence-based and cost-effective clinical decisions in patient simulations and patient-level data.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1800754"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jop.18.00754","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49235259","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}