The Journal of Community and Supportive Oncology

In the July podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses an editorial by Dr Linda bosserman, in which she presents the case for pathways and the importance of processes and team work in paving the way for value-based care. Survivor care is the focus of 2 Original Reports in which investigators report on adolescent and young adult perceptions of cancer survivor care and supportive programming and on the symptoms, unmet need, and quality of life among recent breast cancer survivors. Also in the Original Report section are reports on the impact of loss of income and medicine costs on the financial burden for cancer patients in Australia and the use of a gene-panel for testing for hereditary ovarian cancer. Dr Henry also looks at 2 Case Reports, one in which a patient undergoes multivisceral resection for growing teratoma syndrome and another in which a patient presents with aleukemic acute lymphoblastic leukemia with unusual clinical features. Diabetes management in cancer patients is the topic of a lengthy and informative interview between Dr Henry and Dr Todd Brown.

Listen to the podcast below.

In the July podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses an editorial by Dr Linda bosserman, in which she presents the case for pathways and the importance of processes and team work in paving the way for value-based care. Survivor care is the focus of 2 Original Reports in which investigators report on adolescent and young adult perceptions of cancer survivor care and supportive programming and on the symptoms, unmet need, and quality of life among recent breast cancer survivors. Also in the Original Report section are reports on the impact of loss of income and medicine costs on the financial burden for cancer patients in Australia and the use of a gene-panel for testing for hereditary ovarian cancer. Dr Henry also looks at 2 Case Reports, one in which a patient undergoes multivisceral resection for growing teratoma syndrome and another in which a patient presents with aleukemic acute lymphoblastic leukemia with unusual clinical features. Diabetes management in cancer patients is the topic of a lengthy and informative interview between Dr Henry and Dr Todd Brown.

Listen to the podcast below.

In the July podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses an editorial by Dr Linda bosserman, in which she presents the case for pathways and the importance of processes and team work in paving the way for value-based care. Survivor care is the focus of 2 Original Reports in which investigators report on adolescent and young adult perceptions of cancer survivor care and supportive programming and on the symptoms, unmet need, and quality of life among recent breast cancer survivors. Also in the Original Report section are reports on the impact of loss of income and medicine costs on the financial burden for cancer patients in Australia and the use of a gene-panel for testing for hereditary ovarian cancer. Dr Henry also looks at 2 Case Reports, one in which a patient undergoes multivisceral resection for growing teratoma syndrome and another in which a patient presents with aleukemic acute lymphoblastic leukemia with unusual clinical features. Diabetes management in cancer patients is the topic of a lengthy and informative interview between Dr Henry and Dr Todd Brown.

Listen to the podcast below.

The past 5 years have witnessed a watershed moment in the management of metastatic melanoma. The successes of molecularly targeted and immune-based therapies have transformed it from an aggressively lethal malignancy into one that is readily treatable. Here, we discuss continued efforts to find new therapies and broaden the clinical impact of existing options to maintain the unprecedented momentum of improving patient outcomes.

Click on the PDF icon at the top of this introduction to read the full article.

The past 5 years have witnessed a watershed moment in the management of metastatic melanoma. The successes of molecularly targeted and immune-based therapies have transformed it from an aggressively lethal malignancy into one that is readily treatable. Here, we discuss continued efforts to find new therapies and broaden the clinical impact of existing options to maintain the unprecedented momentum of improving patient outcomes.

Click on the PDF icon at the top of this introduction to read the full article.

The past 5 years have witnessed a watershed moment in the management of metastatic melanoma. The successes of molecularly targeted and immune-based therapies have transformed it from an aggressively lethal malignancy into one that is readily treatable. Here, we discuss continued efforts to find new therapies and broaden the clinical impact of existing options to maintain the unprecedented momentum of improving patient outcomes.

Click on the PDF icon at the top of this introduction to read the full article.

Background Group-based services can improve quality-of-life outcomes for oncology patients.

Objective To assess patient preferences for supportive and wellness programming to better meet patient needs and allocate resources.

Methods Patients from 3 cancer centers in New York City completed a 15-item questionnaire about their interest in educational topics (wellness, nutrition, legal issues, etc) and services (support groups, lectures, and exercise programs).

Results 311 patients participated in the survey. Mean age was 59 years, and 74% were women. The most common cancer was breast (40%), followed by genitourinary (15%). Women preferred wellness workshops most, followed by informative sessions; men most preferred informative sessions, followed equally by posttreatment support and wellness workshops. Older age was related to an increased likelihood of group attendance. Overall, 68% of participants reported that they would be likely to attend groups. For lectures, nutrition was of greatest interest for men (43%) and women (34%), followed by anxiety management (17% and 18%, respectively). Overall, 64% of participants reported that they would be likely to attend a lecture. A majority of respondents (54%) expressed a desire for exercise programs.

Limitations Generalizability to all cancer centers is limited, because data was not tracked on those who refused to complete the questionnaire.

Conclusions Obtaining patient feedback on psychosocial programs is imperative for understanding patient preferences and developing effective support programming.

Click on the PDF icon at the top of this introduction to read the full article.​

Background Group-based services can improve quality-of-life outcomes for oncology patients.

Objective To assess patient preferences for supportive and wellness programming to better meet patient needs and allocate resources.

Methods Patients from 3 cancer centers in New York City completed a 15-item questionnaire about their interest in educational topics (wellness, nutrition, legal issues, etc) and services (support groups, lectures, and exercise programs).

Results 311 patients participated in the survey. Mean age was 59 years, and 74% were women. The most common cancer was breast (40%), followed by genitourinary (15%). Women preferred wellness workshops most, followed by informative sessions; men most preferred informative sessions, followed equally by posttreatment support and wellness workshops. Older age was related to an increased likelihood of group attendance. Overall, 68% of participants reported that they would be likely to attend groups. For lectures, nutrition was of greatest interest for men (43%) and women (34%), followed by anxiety management (17% and 18%, respectively). Overall, 64% of participants reported that they would be likely to attend a lecture. A majority of respondents (54%) expressed a desire for exercise programs.

Limitations Generalizability to all cancer centers is limited, because data was not tracked on those who refused to complete the questionnaire.

Conclusions Obtaining patient feedback on psychosocial programs is imperative for understanding patient preferences and developing effective support programming.

Click on the PDF icon at the top of this introduction to read the full article.​

Background Group-based services can improve quality-of-life outcomes for oncology patients.

Objective To assess patient preferences for supportive and wellness programming to better meet patient needs and allocate resources.

Methods Patients from 3 cancer centers in New York City completed a 15-item questionnaire about their interest in educational topics (wellness, nutrition, legal issues, etc) and services (support groups, lectures, and exercise programs).

Results 311 patients participated in the survey. Mean age was 59 years, and 74% were women. The most common cancer was breast (40%), followed by genitourinary (15%). Women preferred wellness workshops most, followed by informative sessions; men most preferred informative sessions, followed equally by posttreatment support and wellness workshops. Older age was related to an increased likelihood of group attendance. Overall, 68% of participants reported that they would be likely to attend groups. For lectures, nutrition was of greatest interest for men (43%) and women (34%), followed by anxiety management (17% and 18%, respectively). Overall, 64% of participants reported that they would be likely to attend a lecture. A majority of respondents (54%) expressed a desire for exercise programs.

Limitations Generalizability to all cancer centers is limited, because data was not tracked on those who refused to complete the questionnaire.

Conclusions Obtaining patient feedback on psychosocial programs is imperative for understanding patient preferences and developing effective support programming.

Click on the PDF icon at the top of this introduction to read the full article.​

Background Emergency department (ED) use and hospitalization is distressing to cancer patients and drives up the cost of health care. A growing body of evidence demonstrates that more than half of those visits may be avoidable.

Objective To examine the impact of a nurse practitioner (NP)-led, physician-supervised, outpatient symptom management clinic on ED use.

Methods We conducted a retrospective review of ED encounters to quantify the frequency of ED use by oncology patients at a community cancer institute 6 months before (October 2012-March 2013) and after (April-September 2013) the initiation of an NP-staffed symptom management clinic.

Results The highest use of the ED and supportive clinic was among patients with advanced cancer, most commonly with lung or breast cancer, who were receiving cytotoxic chemotherapy. Uncontrolled symptoms of shortness of breath, pain, weakness, fever, nausea, vomiting, and diarrhea commonly led to ED visits. Despite instituting the NP-staffed symptom management clinic to manage those symptoms, there was a 17.9% increase in ED use. However, of the patients seen by the NP, 95% may have avoided hospitalization.

Limitations Retrospective study

Conclusions Our study identifies a high-risk population of patients who use the ED frequently. NP-led clinics could aggressively manage the symptom burden of these patients and potentially reduce ED visits as other studies have demonstrated. Although our study did not directly demonstrate this, we have identified weaknesses of care delivery in our clinic that could be optimized. In addition, we have demonstrated that the majority of patients seen for acute symptoms by an NP avoided an ED visit. 

Click on the PDF icon at the top of this introduction to read the full article.

Background Emergency department (ED) use and hospitalization is distressing to cancer patients and drives up the cost of health care. A growing body of evidence demonstrates that more than half of those visits may be avoidable.

Objective To examine the impact of a nurse practitioner (NP)-led, physician-supervised, outpatient symptom management clinic on ED use.

Methods We conducted a retrospective review of ED encounters to quantify the frequency of ED use by oncology patients at a community cancer institute 6 months before (October 2012-March 2013) and after (April-September 2013) the initiation of an NP-staffed symptom management clinic.

Results The highest use of the ED and supportive clinic was among patients with advanced cancer, most commonly with lung or breast cancer, who were receiving cytotoxic chemotherapy. Uncontrolled symptoms of shortness of breath, pain, weakness, fever, nausea, vomiting, and diarrhea commonly led to ED visits. Despite instituting the NP-staffed symptom management clinic to manage those symptoms, there was a 17.9% increase in ED use. However, of the patients seen by the NP, 95% may have avoided hospitalization.

Limitations Retrospective study

Conclusions Our study identifies a high-risk population of patients who use the ED frequently. NP-led clinics could aggressively manage the symptom burden of these patients and potentially reduce ED visits as other studies have demonstrated. Although our study did not directly demonstrate this, we have identified weaknesses of care delivery in our clinic that could be optimized. In addition, we have demonstrated that the majority of patients seen for acute symptoms by an NP avoided an ED visit. 

Click on the PDF icon at the top of this introduction to read the full article.

Background Emergency department (ED) use and hospitalization is distressing to cancer patients and drives up the cost of health care. A growing body of evidence demonstrates that more than half of those visits may be avoidable.

Objective To examine the impact of a nurse practitioner (NP)-led, physician-supervised, outpatient symptom management clinic on ED use.

Methods We conducted a retrospective review of ED encounters to quantify the frequency of ED use by oncology patients at a community cancer institute 6 months before (October 2012-March 2013) and after (April-September 2013) the initiation of an NP-staffed symptom management clinic.

Results The highest use of the ED and supportive clinic was among patients with advanced cancer, most commonly with lung or breast cancer, who were receiving cytotoxic chemotherapy. Uncontrolled symptoms of shortness of breath, pain, weakness, fever, nausea, vomiting, and diarrhea commonly led to ED visits. Despite instituting the NP-staffed symptom management clinic to manage those symptoms, there was a 17.9% increase in ED use. However, of the patients seen by the NP, 95% may have avoided hospitalization.

Limitations Retrospective study

Conclusions Our study identifies a high-risk population of patients who use the ED frequently. NP-led clinics could aggressively manage the symptom burden of these patients and potentially reduce ED visits as other studies have demonstrated. Although our study did not directly demonstrate this, we have identified weaknesses of care delivery in our clinic that could be optimized. In addition, we have demonstrated that the majority of patients seen for acute symptoms by an NP avoided an ED visit. 

Click on the PDF icon at the top of this introduction to read the full article.

Background The American Society of Clinical Oncology (ASCO) launched the Quality Oncology Practice Initiative (QOPI) program in 2010 to promote quality cancer care. The association has subsequently influenced the use of neurokinin 1 (NK-1) receptor antagonists through articles published in peer-reviewed publications and its Choosing Wisely campaign.

Objective To explore the rationale behind the use of NK-1 receptor antagonists in clinical practice.

Methods We distributed an anonymous 12-question online survey to 650 medical oncologists in 5 states, inquiring about their use of these agents. A total of 155 responses were analyzed.

Results QOPI-certified physicians were significantly more likely than noncertified physicians to use NK-1 receptor antagonists with moderately emetogenic regimens, including weekly cisplatin for head and neck cancer (82.6% vs 27.0%, respectively; P < .001), cervical and bladder cancer (81.4% vs 32.7%, P < .001), and with CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone) with or without rituximab in lymphoma (81.4 vs 17.3%, P < .001). The majority of QOPI-certified physicians reported using these agents for the sole purpose of maintaining QOPI certification (80.0%-86.0%). Certified physicians were also significantly more likely to appropriately prescribe NK-1 antagonists with highly emetogenic chemotherapy.

Limitations Responder bias; short survey that precludes detailed analysis; small sample size may limit generalizability to the field of medical oncology.

Conclusion Our data demonstrate that providers in QOPI-certified practices are significantly more likely than those in noncertified practices to prescribe NK-1 receptor antagonists. Certified physicians report that satisfying ASCO-QOPI requirements is their primary motivation for offering these agents.

Click on the PDF icon at the top of this introduction to read the full article.

Background The American Society of Clinical Oncology (ASCO) launched the Quality Oncology Practice Initiative (QOPI) program in 2010 to promote quality cancer care. The association has subsequently influenced the use of neurokinin 1 (NK-1) receptor antagonists through articles published in peer-reviewed publications and its Choosing Wisely campaign.

Objective To explore the rationale behind the use of NK-1 receptor antagonists in clinical practice.

Methods We distributed an anonymous 12-question online survey to 650 medical oncologists in 5 states, inquiring about their use of these agents. A total of 155 responses were analyzed.

Results QOPI-certified physicians were significantly more likely than noncertified physicians to use NK-1 receptor antagonists with moderately emetogenic regimens, including weekly cisplatin for head and neck cancer (82.6% vs 27.0%, respectively; P < .001), cervical and bladder cancer (81.4% vs 32.7%, P < .001), and with CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone) with or without rituximab in lymphoma (81.4 vs 17.3%, P < .001). The majority of QOPI-certified physicians reported using these agents for the sole purpose of maintaining QOPI certification (80.0%-86.0%). Certified physicians were also significantly more likely to appropriately prescribe NK-1 antagonists with highly emetogenic chemotherapy.

Limitations Responder bias; short survey that precludes detailed analysis; small sample size may limit generalizability to the field of medical oncology.

Conclusion Our data demonstrate that providers in QOPI-certified practices are significantly more likely than those in noncertified practices to prescribe NK-1 receptor antagonists. Certified physicians report that satisfying ASCO-QOPI requirements is their primary motivation for offering these agents.

Click on the PDF icon at the top of this introduction to read the full article.

Background The American Society of Clinical Oncology (ASCO) launched the Quality Oncology Practice Initiative (QOPI) program in 2010 to promote quality cancer care. The association has subsequently influenced the use of neurokinin 1 (NK-1) receptor antagonists through articles published in peer-reviewed publications and its Choosing Wisely campaign.

Objective To explore the rationale behind the use of NK-1 receptor antagonists in clinical practice.

Methods We distributed an anonymous 12-question online survey to 650 medical oncologists in 5 states, inquiring about their use of these agents. A total of 155 responses were analyzed.

Results QOPI-certified physicians were significantly more likely than noncertified physicians to use NK-1 receptor antagonists with moderately emetogenic regimens, including weekly cisplatin for head and neck cancer (82.6% vs 27.0%, respectively; P < .001), cervical and bladder cancer (81.4% vs 32.7%, P < .001), and with CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone) with or without rituximab in lymphoma (81.4 vs 17.3%, P < .001). The majority of QOPI-certified physicians reported using these agents for the sole purpose of maintaining QOPI certification (80.0%-86.0%). Certified physicians were also significantly more likely to appropriately prescribe NK-1 antagonists with highly emetogenic chemotherapy.

Limitations Responder bias; short survey that precludes detailed analysis; small sample size may limit generalizability to the field of medical oncology.

Conclusion Our data demonstrate that providers in QOPI-certified practices are significantly more likely than those in noncertified practices to prescribe NK-1 receptor antagonists. Certified physicians report that satisfying ASCO-QOPI requirements is their primary motivation for offering these agents.

Click on the PDF icon at the top of this introduction to read the full article.

Background Multicenter clinical trials conducted primarily at academic centers have shown that breast-conserving therapy (BCT) and mastectomy lead to equivalent overall survival (OS) for women with early-stage breast cancer.

Objective To determine rates of BCT and OS after conservation therapy in a large urban community practice, compare them with national rates, and identify risk factors for survival.

Methods We identified 1,172 T1-2, N0 breast cancer patients diagnosed during 1997-2007 in our hospital tumor registry and compared the rates of BCT and adjuvant radiotherapy with a similar population in the SEER [Surveillance, Epidemiology, and End Results] database (N = 232,898) for the same treatment period. Cox proportional hazards models were used to assess the influence of age at diagnosis, tumor grade, biomarker status, margin status, and receipt of hormones, radiation, or chemotherapy on OS after BCT.

Results The rate of breast-conserving surgery (BCS) was higher in our practice compared with the national average (90.9% and 66.4%, respectively). The rate of adjuvant radiation after BCS in our practice was 93.7%; survival estimates were higher for patients treated with adjuvant radiation across all age groups, compared with the national estimates (92.5% and 72.9%). Younger age and receipt of radiation were associated with improved survival.

Limitations Retrospective study design; confounding factors such as comorbidities were not considered.

Conclusions We had high rates of BCT and adjuvant radiation in early-stage breast cancer patients in our community practice, which resulted in excellent survival rates that compared favorably with those in large academic centers and emphasizes the role of appropriate use of adjuvant radiation.

Funding Vantage Oncology

Click on the PDF icon at the top of this introduction to read the full article.

Background Multicenter clinical trials conducted primarily at academic centers have shown that breast-conserving therapy (BCT) and mastectomy lead to equivalent overall survival (OS) for women with early-stage breast cancer.

Objective To determine rates of BCT and OS after conservation therapy in a large urban community practice, compare them with national rates, and identify risk factors for survival.

Methods We identified 1,172 T1-2, N0 breast cancer patients diagnosed during 1997-2007 in our hospital tumor registry and compared the rates of BCT and adjuvant radiotherapy with a similar population in the SEER [Surveillance, Epidemiology, and End Results] database (N = 232,898) for the same treatment period. Cox proportional hazards models were used to assess the influence of age at diagnosis, tumor grade, biomarker status, margin status, and receipt of hormones, radiation, or chemotherapy on OS after BCT.

Results The rate of breast-conserving surgery (BCS) was higher in our practice compared with the national average (90.9% and 66.4%, respectively). The rate of adjuvant radiation after BCS in our practice was 93.7%; survival estimates were higher for patients treated with adjuvant radiation across all age groups, compared with the national estimates (92.5% and 72.9%). Younger age and receipt of radiation were associated with improved survival.

Limitations Retrospective study design; confounding factors such as comorbidities were not considered.

Conclusions We had high rates of BCT and adjuvant radiation in early-stage breast cancer patients in our community practice, which resulted in excellent survival rates that compared favorably with those in large academic centers and emphasizes the role of appropriate use of adjuvant radiation.

Funding Vantage Oncology

Click on the PDF icon at the top of this introduction to read the full article.

Background Multicenter clinical trials conducted primarily at academic centers have shown that breast-conserving therapy (BCT) and mastectomy lead to equivalent overall survival (OS) for women with early-stage breast cancer.

Objective To determine rates of BCT and OS after conservation therapy in a large urban community practice, compare them with national rates, and identify risk factors for survival.

Methods We identified 1,172 T1-2, N0 breast cancer patients diagnosed during 1997-2007 in our hospital tumor registry and compared the rates of BCT and adjuvant radiotherapy with a similar population in the SEER [Surveillance, Epidemiology, and End Results] database (N = 232,898) for the same treatment period. Cox proportional hazards models were used to assess the influence of age at diagnosis, tumor grade, biomarker status, margin status, and receipt of hormones, radiation, or chemotherapy on OS after BCT.

Results The rate of breast-conserving surgery (BCS) was higher in our practice compared with the national average (90.9% and 66.4%, respectively). The rate of adjuvant radiation after BCS in our practice was 93.7%; survival estimates were higher for patients treated with adjuvant radiation across all age groups, compared with the national estimates (92.5% and 72.9%). Younger age and receipt of radiation were associated with improved survival.

Limitations Retrospective study design; confounding factors such as comorbidities were not considered.

Conclusions We had high rates of BCT and adjuvant radiation in early-stage breast cancer patients in our community practice, which resulted in excellent survival rates that compared favorably with those in large academic centers and emphasizes the role of appropriate use of adjuvant radiation.

Funding Vantage Oncology

Click on the PDF icon at the top of this introduction to read the full article.