Community oncology最新文献

{"title":"Assessment of physician compliance to liver function test monitoring guidance for patients treated with lapatinib","authors":"S. Landis, Clara C. Chen, J. Byrne, Stephen J. Jones, R. Dhanda, J. Nelson","doi":"10.12788/J.CMONC.0057","DOIUrl":"https://doi.org/10.12788/J.CMONC.0057","url":null,"abstract":"Methods A retrospective observational cohort study comprising 396 women with HER2 metastatic breast cancer who initiated lapatinib between March 1, 2007 and June 30, 2010. Data were captured from electronic medical records (EMR) of communitybased oncology practices. Patients were categorized by whether they initiated lapatinib before or after the label change; LFT monitoring was evaluated using a preversus post-label study design. We measured the proportion of patients who had LFTs within 30 days before lapatinib initiation, LFTs during each 6-week period of treatment, and lapatinib permanently withdrawn after experiencing an extreme LFT elevation.","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"258-265"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66798885","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 demands of cancer survivorship: the who, what, when, where, why, and how","authors":"J. Klemp, C. Knight, Lori Ranallo, C. Fabian","doi":"10.12788/J.CMONC.0056","DOIUrl":"https://doi.org/10.12788/J.CMONC.0056","url":null,"abstract":"With an exponential increase in the number of cancer survivors over the past few decades, we have an opportunity and responsibility to effectively manage cancer survivors across the continuum of cancer care. The delivery of survivorship care requires realistic deliverables with defined outcomes that focus on cost, impact on disease management and prevention, and integration within a health care delivery model. Building a framework using defined time-points and definitions can be helpful. Due to the complex nature of delivering cancer survivorship care, it is necessary to establish collaborations with specialty providers including cardiologists, reproductive specialists, endocrinology, ophthalmology, allied health professionals and cancer rehab, to name a few. Strengthening relationships with primary care providers will enhance the transition from cancer care to primary care. Essential tools to help fulfill these goals and achieve national standards include using expert recommended treatment summaries and survivorship care plans. These tools support a shared care model with the goal of high quality, coordinated healthcare for the survivorship population. With limited evidence to guide the delivery of survivorship care and national standards looming, how do we meet the demands of cancer survivorship? This article explores the “the who, what, when, where, why and how?” of cancer survivorship care.","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"266-271"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66798763","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":"Survivorship in the community oncology practice","authors":"D. Patt","doi":"10.12788/j.cmonc.0063","DOIUrl":"https://doi.org/10.12788/j.cmonc.0063","url":null,"abstract":"In this issue of COMMUNITY ONCOLOGY, we have a focus on cancer survivorship. While oncologists are knowledgeable of the need for survivorship programs to enhance quality of care along the patient care continuum, the processes of implementation of survivorship programs outside of larger organizational systems of care delivery has been limited. For those community oncologists outside of larger care delivery systems, there is a need for tools and processes to facilitate survivorship care planning. We discuss some of those issues in this month’s issue. Jennifer Klemp has done tremendous work with survivorship care training to prepare practitioners to deliver focused survivorship care. She does this by using educational videos and tools to provide education around the needs of the cancer survivor (see p. 266). In addition, there is an article out of my group in Texas Oncology discussing the practical steps of implementing a survivorship care program in a community practice (p. 272). We discuss key steps in implementation and highlight several free and publicly available tools to assist oncologists in the process of providing survivorship care. I contemplate often how we think about quality of care in oncology, and how we measure it. Donabedian has guided us in this endeavor to consider quality of care under the framework of structure, process, and then outcome (Milbank Mem Fund Q 1966;44,166-206). Oncologists have been given guidance on structural aspects of quality – survivorship programs, improvements in palliative care, the American Society on Clinical Oncology’s Quality Oncology Practice Initiative metrics – but guidance around the process of implementation in care delivery and then the true outcomes that follow is limited. Oncologists will need more help with process if we strive to improve care in meaningful ways surrounding implementation of quality initiatives. Processes will need to be efficient and effective so they can contribute to sustainable business solutions while having the primary goal of improving patient care. Then, with any luck, when we measure outcomes, they will be meaningful measures of effect and could be partnered with reimbursement strategies that facilitate quality care delivery.","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"253"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66799076","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":"Building patient-centered care through values assessment integration with advance care planning","authors":"Sabrina Q. Mikan, Cynthia B. Taniguchi, J. R. Hoverman","doi":"10.12788/J.CMONC.0043","DOIUrl":"https://doi.org/10.12788/J.CMONC.0043","url":null,"abstract":"Oncologists frequently have to make diagnoses that portend bad outcomes and difficulties in management, among them, for stage IV lung or pancreatic cancer. Many recent studies have shown the importance of appropriate implementation of palliative care and the need for discussing with the patient the goals of treatment early in diagnosis. This process has its challenges. One way to view and meet these challenges is through assessing a patient’s personal values regarding his or her life and care. Clinicians (oncologists and midlevel providers) can support a culture of patient and practitioner shared decision making, ensuring that patients with life-limiting illnesses are aware of their choices for end-of-life (EOL) care. Through “values-based” conversations, the clinicians gain perspective of the patients’ needs. This can lead to more formal conversations about EOL care and the completion of advance directive documents.","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"209-211"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66798520","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":"Reconciling patient access to care","authors":"D. Henry","doi":"10.12788/J.CMONC.0053","DOIUrl":"https://doi.org/10.12788/J.CMONC.0053","url":null,"abstract":"Sadly, the long hot summer is winding down, although the hurricane season continues for yet a few more months. Thoughts of Labor Day and back to school are now firmly in mind. This month, we have several original contributions that directly or indirectly speak to patients of any socioeconomic background and their access to health care. One of the major features of the Patient Protection and Affordable Care Act is its potential to insure some of the estimated 35 million Americans who are currently uninsured, without regard to whether or not they have pre-existing conditions. Of course, that will stress our already overburdened health system to provide both care and caregivers. To that end, Renteria and colleagues describe on page 220 the access to care and treatment of locally advanced pancreatic cancer in a socio-economically challenged population. Their analyses reveal that it can be done but it requires, in their words, “intense supportive services,” which highlights how those with poor or little insurance can still have the outcomes similar to those in clinical trials if the system rises to the occasion and makes the extra effort to deliver the appropriate care and treatment. One can only imagine what things will be like when those 35 million have guaranteed insurance-based access to care. In a similar theme, Cohen and colleagues report on a pilot study of improving access to cancer genetic counseling services. Their “collaborative” approach might help even those centers without board-certified genetic counselors provide appropriate counseling to patients who have had or would like to have genetic testing. Again, this could not be more timely. Increasingly, patients are finding laboratories popping up here and there that offer genetic testing with little explanation or discussion of how to interpret those results. Even the patient’s caregiver, who might have ordered the test or might offer help interpreting the results of these genetic tests, likely has little formal training on how to do educate the patient and interpret the results, which could mean that the patient ends up being misled and/or misinformed about the implications of the results. Again, imagine the stress on the system if 35 million more potential patients clamor for access to testing and test result interpretation. Bone metastases are a frequent problem for our patients with advanced cancer. Interestingly, half of the patients who have bony metastases may have no symptoms from them yet they may have skeletal-related events from those asymptomatic metastases. This has led to several national guidelines recommending a bone active agent be given to patients whenever bone metastases are detected to decrease the incidence of the SREs. On page 235, William Gradishar and colleagues review one of the newer agents available to treat and help prevent SREs in patients with solid tumor bony metastases. The bisphophonates have long been available for this indication and also have value for","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"219-219"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66798971","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":"Omacetaxine for chronic or accelerated phase CML in patients with resistance or intolerance to TKIs","authors":"J. Abraham, M. Kalaycio","doi":"10.12788/J.CMONC.0045","DOIUrl":"https://doi.org/10.12788/J.CMONC.0045","url":null,"abstract":"Omacetaxine mepesuccinate has been granted accelerated approval for the treatment of adult patients with chronic phase (CP) or accelerated phase (AP) chronic myeloid leukemia (CML) with resistance or intolerance to 2 or more tyrosine kinase inhibitors (TKIs). Approval was based on response rates observed in a combined cohort of adult CML patients from 2 clinical trials. As yet, no clinical trials have verified improved disease-related symptoms or increased survival with omacetaxine treatment. The mechanism of action of omacetaxine is not fully known, but it includes inhibition of protein synthesis and activity that is independent of direct BCR-ABL binding. The agent was shown to have activity in CML patients in the pre-TKI era. In studies in vitro, omacetaxine reduces levels of the BCR-ABL oncoprotein and Mcl-1 (an anti-apoptotic BCL-2 family member), and its activity is not affected by presence of BCR-ABL mutations. It exhibits activity in animal models of wild-type and T315I-mutant BCR-ABL CML and in CML patients with the T315I mutation. The combined cohort in which efficacy of omacetaxine was assessed consisted of 111 patients (76 with CP CML and 35 with AP CML) who had received 2 or more approved TKIs and had documented evidence of resistance or intolerance to dasatinib and/or nilotinib. Resistance was defined as one of the following: no complete hematologic response (CHR) by 12 weeks (whether lost or never achieved); no cytogenetic response by 24 weeks (ie, 100% Philadelphia chromosome positive [Ph ] – whether lost or never achieved); no major cytogenetic response (MCyR) by 52 weeks (ie, 35% Ph – whether lost or never achieved); or progressive leukocytosis. Intolerance was defined as one of the following: grade 3 to 4 nonhematologic toxicity that did not resolve with adequate intervention; grade 4 hematologic toxicity lasting more than 7 days; or any grade 2 or higher toxicity that was unacceptable to the patient. Patients with New York Heart Association class III or IV heart disease,","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"194-196"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66798649","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":"Occult cancer: suspected breast and BRCA gene mutations","authors":"M. Hutton, Nicoleta C. Voian, C. Farrell","doi":"10.12788/J.CMONC.0018","DOIUrl":"https://doi.org/10.12788/J.CMONC.0018","url":null,"abstract":"Currently, the best means of managing and preventing breast cancer is through early detection and identification of women who are at significantly increased risk for the disease. Those who are at increased risk are candidates for genetic testing involving the BRCA1 and BRCA2 genes. However, those who present with an occult cancer present a significant challenge in regard to etiology, which can have an impact on decisions about cancer risk management. We report here on two cases demonstrating an association between occult cancer, with suspected breast primary, and the presence of a BRCA gene mutation. These cases draw attention to the fact that occurrences of occult cancer, in particular those with a suspected breast primary, warrant consideration of genetic testing for possible mutations in the BRCA1 and BRCA2 genes. This is especially important as identification of a mutation will impact secondary cancer risk and medical management decisions.","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"202-208"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66797587","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":"Improving access with a collaborative approach to cancer genetic counseling services: a pilot study","authors":"Stephanie A Cohen, Dawn E. McIlvried","doi":"10.12788/J.CMONC.0031","DOIUrl":"https://doi.org/10.12788/J.CMONC.0031","url":null,"abstract":"Methods Patients at a collaborative site were offered a risk assessment survey that was reviewed remotely by a licensed, boardcertified GC. Patients were triaged such that the onsite registered nurse (RN) provided basic risk assessment and offered genetic testing for straight-forward hereditary breast and ovarian cases. Ongoing training and support was provided by the GC. Followup and complex cases were scheduled with the GC during a monthly outreach visit to the collaborative site.","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"227-234"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66797984","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":"C. albicans appendicitis in a neutropenic patient after induction chemotherapy","authors":"R. Mehta, D. Cohen","doi":"10.12788/J.CMONC.0032","DOIUrl":"https://doi.org/10.12788/J.CMONC.0032","url":null,"abstract":"A 62-year-old white man with a past medical history of hypertension and essential thrombocytosis diagnosed 17 years ago presented at our institution. He was being treated with hydroxyurea, with which he required occasional blood transfusions and platelets were controlled around 400 10/L range. Over a 2-month period, he developed gradually worsening exertional dyspnea, fatigue, decreased appetite, lost about 8 lb in weight. He was found to be pancytopenic, with a total white cell count of 3.26 10/L (normal, 3.8-10.6 10/L), his hemoglobin level was 7.9 gm/dL (normal, 12.9-16.9 gm/ dL), and his platelet count, 46 10/L. A bone marrow aspirate and biopsy revealed 100% cellularity, approximately 8%-10% CD34 positive blasts, and numerous atypical and hypolobated dysplastic megakaryocytes with increased reticulin fibrosis. He was diagnosed with myelofibrosis with underlying myeloproliferative disorder, which seemed to be progressing into a more accelerated phase. He was admitted for induction chemotherapy with cytarabine and idarubicin as a bridge to a matched allogeneic stem cell transplant. He completed 3 days of cytarabine 100 mg/m and 7 days of idarubicin 12 mg/m via a Hickman central venous indwelling catheter. On day 7 of the treatment, as his absolute neutrophil count dropped to 0.9 10/L, he was started on prophylactic ciprofloxacin 500 mg p.o. BID, and acyclovir 400 mg p.o. TID. Fluconazole was held due to mild hyperbilirubinemia (total bilirubin, 2.2 mg/dL [normal, 0.3-1.5 mg/dL]). On day 11, he spiked a fever of 100.5°F when his absolute neutrophil count was 0.4 10/L (normal, 0.8-3.6 10/L). He was started on cefepime; 2 days later, intravenous vancomycin was added as he continued to have intermittent fevers. He was asymptomatic and had no obvious source of infection. His intravenous catheter site appeared clean and nontender, and his blood and urine cultures were negative as was his chest X-ray. However, as he continued to have intermittent high-grade fevers up to 102.5°F, despite broad spectrum antimicrobials, consultation was sought from the infectious disease physician. On day 15, he was started on voriconazole 400 mg BID. The results of an Aspergillus galactomannan antigen test was negative (0.1; reference range, 0.5). On day 18, the patient developed mild right lower quadrant abdominal pain associated with mild dyspnea at rest. On examination, he was in mild distress due to pain. His blood pressure was 114 /80 mmHg; heart rate, 80 beats/min; respiratory rate, 28 breaths/min; pulse oximetry, 94% on 2-liter nasal cannula oxygen. His lungs were clear to auscultation. The patient was mildly tender in right lower quadrant with mild guarding but no rebound tenderness. Bowel sounds were present. A computed tomography (CT) scan of abdomen and pelvis with contrast showed a dilated appendix up to 1.3 cm in diameter with surrounding fat stranding suggestive of acute appendicitis. No fluid collection or dilated bowel loops were noted (Figure 1). A CT ","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"244-246"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66798683","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":"How can social media improve oncology care","authors":"M. Thompson","doi":"10.12788/J.CMONC.0048","DOIUrl":"https://doi.org/10.12788/J.CMONC.0048","url":null,"abstract":"Social media is a broad term that can include many types of “media.” Broadly speaking, media may be defined as “tools used to store and deliver information or data,” and social media is “media disseminated through social interaction.” So social media is more than just Twitter or Facebook posts, it includes all sorts of socially interactive information exchange. Kaplan and Haenlein described 6 types of social media (see Table 1). A similar social media organizational structure is used on the HowTo.gov site (http:// www.howto.gov/social-media), a US government Web site best described as a resource to help government workers deliver a better customer experience to citizens (see Table 2 for a glossary of social media terms). Many physicians have been hesitant to join social media for real and imagined concerns. However, despite such concerns, the Mayo Clinic has embraced social media because “our patients are doing it, so this is where we need to be.” Similarly, Ed Bennett, director of Web Strategy for the University of Maryland Medical Center, supports the use of social media because “that’s where people are. That’s the bottom line.” Social media is a tool for interacting with a changing community – of colleagues, the public, and patients – in a changing world. In addition, Timimi (@FarrisTimimi, medical director of the Mayo Clinic Center for Social Media, #MCCSM) writes in the preface to Bringing the Social Media Revolution to Health Care that “we must crowdsource the change we want to see in the world. Social media allows that to happen . . .” A study by McGowan and colleagues analyzed oncologist and primary care physician use of social media. Data from that 2012 study were collected in March 2011 and showed that about a quarter of physicians used social media at least daily to obtain medical information (passive/reading). Fewer of the study participants (14%) contributed information to social media daily (active/contributor). Users at least weekly were: passive (61%) and active (46%). Another study linked physician social media properties to the national provider identifier (NPI) database, and the findings showed that physician Twitter account creation peaked in 2009, that most physicians present themselves as health professionals, that most physicians follow fewer than 1,000 people, and that the ratio of following to followers is 1:1. This information was further analyzed by Vartabedian (@Doctor_V) in his blog 33 Charts. Twitter account creation may have peaked, but I still see new oncologists joining Twitter and an increasing use of social media by them. This is encouraging as I believe that social media can improve oncology care by helping to improve practitioners’ knowledge of their highly specialized, rapidly changing field; networking among peers within the oncology community; and education of patients, the public, and colleagues.","PeriodicalId":72649,"journal":{"name":"Community oncology","volume":"10 1","pages":"212-217"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66798269","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}