Journal of Oncology Practice最新文献

{"title":"\"My Family Wants Something Different\": Discordance in Perceived Personal and Family Treatment Preference and Its Association With Do-Not-Resuscitate Order Placement.","authors":"Login S. George, W. Breitbart, H. Prigerson","doi":"10.1200/JOP.19.00250","DOIUrl":"https://doi.org/10.1200/JOP.19.00250","url":null,"abstract":"PURPOSE\u0000Patients make treatment decisions based not only on what they want, but what they think their families want. Discordance in such perceived preferences may therefore pose challenges for advance care planning. This study examines discordance in preference for life-extending care versus comfort-focused care and its association with do-not-resuscitate (DNR) order placement.\u0000\u0000\u0000METHODS\u0000One hundred eighty-nine patients with advanced cancers refractory to at least one chemotherapy regimen were enrolled in a multisite observational study. In structured interviews, patients reported their preference for treatment maximizing either life extension or comfort; patients also indicated their perception of their families' preference. DNR placement was reported by patients and verified using medical records.\u0000\u0000\u0000RESULTS\u0000Approximately 23% of patients (n = 43) perceived discordance between their preference and their families' preference. Patients who perceived discordance were less likely to have completed a DNR compared with those who perceived concordance, even after controlling for relevant confounds (odds ratio = .35; P = .02). Subgroups of discordance and concordance showed varying DNR placement rates (χ2, 19.95; P < .001). DNR placement rate was lowest among discordant subgroups, where there was either a personal (26.7%; four of 15) or family preference for comfort care (28.6%; eight of 28), followed by patients who perceived concordance for wanting life-extending care (34.5%; 29 of 84) and by patients who perceived concordance in wanting comfort-focused care (66.1%; 41 of 62).\u0000\u0000\u0000CONCLUSION\u0000Many patients may perceive discordance between personal and family treatment preferences, posing impediments to advance care planning. Such patients may benefit from additional decision support.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900250"},"PeriodicalIF":0.0,"publicationDate":"2019-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00250","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41611982","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":"Practice-Level Adoption of Conservative Management for Prostate Cancer.","authors":"Parth K. Modi, S. Kaufman, L. Herrel, J. Dupree, A. Luckenbaugh, T. Skolarus, B. Hollenbeck, V. Shahinian","doi":"10.1200/JOP.19.00088","DOIUrl":"https://doi.org/10.1200/JOP.19.00088","url":null,"abstract":"PURPOSE\u0000We describe the longitudinal adoption of conservative management (ie, the absence of treatment) for prostate cancer among urology group practices in the United States and identify group practice features that influence this adoption.\u0000\u0000\u0000METHODS\u0000Using a 20% sample of Medicare claims, we identified men with incident prostate cancer from 2010 through 2014 and assigned each to his predominant urologist. We linked each urologist to a practice and characterized the practice's organization (eg, solo, single specialty, multispecialty) and ownership of intensity-modulated radiation therapy. For each group, we determined the rate of conservative management within 1 year of diagnosis. We then fit mixed-effects logistic regression models to assess relationships between practice organization and the adoption of conservative management over time, adjusted for patient characteristics.\u0000\u0000\u0000RESULTS\u0000We identified 22,178 men with newly diagnosed prostate cancer managed by 350 practices. Practices that increased use the most over time also used conservative management the most in 2010, whereas those that increased use the least used conservative management the least in 2010. Thus, the difference in average use of conservative management between highest- and lowest-use practices widened between 2010 and 2014. Urology groups increased their use of conservative management more rapidly than multispecialty groups. There was no difference in the rate of increase between intensity-modulated radiation therapy owning and nonowning groups.\u0000\u0000\u0000CONCLUSION\u0000There is increasing variation among group practices in the use of conservative management for prostate cancer. This underscores the need for a better understanding of practice-level factors that influence prostate cancer management.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900088"},"PeriodicalIF":0.0,"publicationDate":"2019-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43919546","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":"When Should Tumor Genomic Profiling Prompt Consideration of Germline Testing?","authors":"Kim DeLeonardis, L. Hogan, S. Cannistra, Deepa Rangachari, N. Tung","doi":"10.1200/JOP.19.00201","DOIUrl":"https://doi.org/10.1200/JOP.19.00201","url":null,"abstract":"Somatic genomic testing is rapidly becoming an integral part of care for patients with metastatic cancer. Extrapolation of these results beyond personalized cancer therapy is a skill being demanded of practicing oncologists without prior specialty in genetics. Up to 12% of tumor genomic profiling reports will reveal a germline pathogenic variant. Recognition of these germline variants is essential not only for optimal care of the patient with cancer but also to initiate cascade genetic testing in at-risk family members who also may carry the familial mutation. This article provides a concise and methodical, evidence-based strategy to guide oncology providers about how to identify genes associated with an inherited predisposition for cancer, determine the pathogenicity of variants reported within those genes, and understand the likelihood that these variants are of germline origin in a particular patient with cancer. Case examples are provided to illustrate clinical scenarios and facilitate application of the proposed approach.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"15 9 1","pages":"465-473"},"PeriodicalIF":0.0,"publicationDate":"2019-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00201","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46803679","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":"Tumor Genomic Sequencing as an Impetus to Screen for Germline Mutations: Primum Non Nocere.","authors":"S. Niraula","doi":"10.1200/JOP.19.00486","DOIUrl":"https://doi.org/10.1200/JOP.19.00486","url":null,"abstract":"","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"15 9 1","pages":"474-475"},"PeriodicalIF":0.0,"publicationDate":"2019-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00486","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42026829","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":"The Oncologist as Therapist.","authors":"D. McFarland, F. Hlubocky","doi":"10.1200/JOP.19.00237","DOIUrl":"https://doi.org/10.1200/JOP.19.00237","url":null,"abstract":"That day, I told Mr N that I was going on vacation. Although he was not pleased that I would not see him before his next chemotherapy appointment, Mr N had communicated that our relationship was important to him. The souvenir he requested was perhaps a consolation for the psychological bruise my absence would cause. In fact, this was real progress for him. Anger and reluctance had given way to gentle acceptance.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900237"},"PeriodicalIF":0.0,"publicationDate":"2019-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46395224","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":"Use of Endocrine Therapy for Breast Cancer Risk Reduction: ASCO Clinical Practice Guideline Update Summary.","authors":"C. Fabian, K. Visvanathan, M. Somerfield","doi":"10.1200/JOP.19.00379","DOIUrl":"https://doi.org/10.1200/JOP.19.00379","url":null,"abstract":"","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1900379"},"PeriodicalIF":0.0,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00379","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45388111","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":"Can Administrative Data Improve the Performance of Cancer Clinical Trial Economic Analyses?","authors":"Timothy P Hanna,&nbsp;Paul Nguyen,&nbsp;Joseph Pater,&nbsp;Christopher J O'Callaghan,&nbsp;Nicole Mittmann,&nbsp;Craig C Earle,&nbsp;Dongsheng Tu,&nbsp;Derek Jonker,&nbsp;Annette E Hay","doi":"10.1200/JOP.18.00691","DOIUrl":"https://doi.org/10.1200/JOP.18.00691","url":null,"abstract":"<p><strong>Purpose: </strong>Trial economic analyses, such as cost-effectiveness analysis, often rely on trial-collected data, which are burdensome and expensive to collect and may be incomplete. In contrast, administrative databases systematically collect health system encounters. We investigated whether administrative data could improve the performance of cancer trial economic analysis.</p><p><strong>Methods: </strong>Health administrative data were probabilistically linked to Ontario patient data from the Canadian Cancer Trials Group CO.17 trial (n = 572), which evaluated cetuximab plus best supportive care (75 linked Ontario patients) versus best supportive care alone (73 patients) in previously treated metastatic colorectal cancer. Trial-collected resource utilization data and vital status were compared with administrative data. Cost effectiveness in 2007 Canadian dollars was determined with bootstrap incremental cost-effectiveness ratio (ICER) CIs.</p><p><strong>Results: </strong>Up to trial date of last contact, administrative data vital status was concordant in more than 96%. Twenty-nine subsequent deaths occurred. Up to trial last contact, there were 50 net additional hospitalizations in administrative data and 33 net additional emergency department visits. Total costs were $3,023,034 for the cetuximab group and $1,191,118 for the control group up to trial last contact. The ICER was $211,128 per life-year gained (90% CI, $101,396 to $694,950) up to trial last contact and $164,378 (90% CI, -$138,260 to $644,555) up to administrative data last contact. ICER estimates were similar to the analysis using trial-collected data.</p><p><strong>Conclusion: </strong>Administrative data were more complete than trial data for hospital encounters, a key cost driver in economic analysis. There was a longer follow-up. This demonstrates the potential of administrative data to relieve the burden of collecting key data in cancer trials, which represents a considerable effort and expense.</p>","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"15 9","pages":"e807-e824"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.18.00691","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37417203","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":"Rare Case of Mixed Metastatic Placental Site Trophoblastic Tumor and Choriocarcinoma.","authors":"Lindsay E Borden,&nbsp;Elizabeth S McCuin,&nbsp;Pragna D Sheth,&nbsp;David A Iglesias","doi":"10.1200/JOP.19.00110","DOIUrl":"https://doi.org/10.1200/JOP.19.00110","url":null,"abstract":"","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"15 9","pages":"505-506"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.19.00110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37334989","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":"Quality Initiative to Improve Compliance With Perioperative Anticoagulation.","authors":"Elizabeth B Pelkofski,&nbsp;William D Baker,&nbsp;John C Rowlingson,&nbsp;Leigh A Cantrell,&nbsp;Linda R Duska","doi":"10.1200/JOP.18.00748","DOIUrl":"https://doi.org/10.1200/JOP.18.00748","url":null,"abstract":"<p><strong>Purpose: </strong>Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in gynecologic oncology surgical patients. Many centers use neuraxial analgesia (NA), which affects the timing of prophylactic anticoagulation. In 2012, we determined that the rate of VTE in patients undergoing laparotomy with NA was higher than in those who received alternative pain control. In addition, compliance with preoperative anticoagulation guidelines was only 40%. We undertook a quality initiative (QI) project to increase compliance to 80% in NA cases and maintain 90% in non-NA cases.</p><p><strong>Methods: </strong>A multidisciplinary working group designed and deployed a QI intervention bundle. Compliance was defined as the receipt of a prophylactic dose of anticoagulant within 1 hour after NA or before skin incision regardless of anesthesia type. Data were abstracted from the medical record after the study period. Cases from the year before QI were used for comparison. Primary outcome was compliance and secondary outcome was the rate of VTE.</p><p><strong>Results: </strong>One hundred women were treated under the QI project and 182 historical cases (HCs) were used for comparison. Overall compliance improved (96% QI <i>v</i> 73% HC; <i>P</i> < .001). This difference was marked in cases with NA (95% QI <i>v</i> 40% HC; <i>P</i> < .001) and remained stable in non-NA cases (97% QI <i>v</i> 91% HC; <i>P</i> = .29). The overall rate of VTE, independent of anesthesia type, remained unchanged (2.1% HC <i>v</i> 0% QI; <i>P</i> = .3).</p><p><strong>Conclusion: </strong>Relatively simple and inexpensive initiatives to improve routine processes within the surgical pathway are feasible and attract staff participation. Such efforts are likely to translate into greater levels of patient safety.</p>","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"15 9","pages":"e835-e842"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.18.00748","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37334993","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":"Fear of Cancer Recurrence: A Model Examination of Physical Symptoms, Emotional Distress, and Health Behavior Change.","authors":"Daniel L Hall,&nbsp;Rachel B Jimenez,&nbsp;Giselle K Perez,&nbsp;Julia Rabin,&nbsp;Katharine Quain,&nbsp;Gloria Y Yeh,&nbsp;Elyse R Park,&nbsp;Jeffrey M Peppercorn","doi":"10.1200/JOP.18.00787","DOIUrl":"https://doi.org/10.1200/JOP.18.00787","url":null,"abstract":"<p><strong>Purpose: </strong>Fear of cancer recurrence is highly prevalent among adult survivors of cancer. The role of fear of recurrence in the emotional distress of survivors of cancer, as well as health behaviors that may directly affect their health, remains unclear. To advance oncology practice, this study sought to examine the extent to which fear of recurrence stemming from physical symptoms accounts for emotional distress in a large sample of adult survivors of cancer and to extend the model to explain postdiagnosis self-reported health behavior change.</p><p><strong>Methods: </strong>In 2016, 258 survivors of cancer at an academic hospital completed a survey of psychosocial needs. Items assessed physical symptoms (checklist), fear of cancer recurrence (Assessment of Survivor Concerns), emotional distress (anxiety and depressed mood), and health behaviors (current alcohol use, physical activity, diet, and sunscreen use, as well as changes after cancer diagnosis) informed by National Comprehensive Cancer Network survivorship guidelines. Indirect effects regression models accounting for relevant covariates (age and treatment history) used 5,000-iteration bootstrapping.</p><p><strong>Results: </strong>Higher fear of cancer recurrence was associated with greater number of physical symptoms (<i>P</i> < .001), greater emotional distress (<i>P</i> < .05), lower moderate or vigorous physical activity (<i>P</i> < .05), higher sunscreen use (<i>P</i> < .05), and postdiagnosis increases in alcohol use (<i>P</i> < .01) and reductions in physical activity (<i>P</i> < .01). Fear of cancer recurrence models accounted for almost half of the variance in distress of survivors of cancer (<i>R</i>² = 0.44, <i>P</i> < .001) and, to a lesser yet significant extent, changes in alcohol consumption (<i>R</i>² = 0.09, <i>P</i> < .001) and physical activity (<i>R</i>² = 0.06, <i>P = .</i>003).</p><p><strong>Conclusion: </strong>Fear of cancer recurrence plays a central role in the emotional distress and key health behaviors of survivors of cancer. These findings support fear of cancer recurrence as a potential target for emotional health and health behavior change interventions.</p>","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"15 9","pages":"e787-e797"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/JOP.18.00787","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37411265","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}