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Critical care oncology

Benjamin Kearns, Abdullah Pandor, Matt Stevenson, Jean Hamilton, Duncan Chambers, Mark Clowes, John Graham, M Satish Kumar
As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the company that manufactures cabazitaxel (Jevtana(®), Sanofi, UK) to submit evidence for the clinical and cost effectiveness of cabazitaxel for treatment of patients with metastatic hormone-relapsed prostate cancer (mHRPC) previously treated with a docetaxel-containing regimen. The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG)...
October 22, 2016: PharmacoEconomics
Walter H Reinhart
The hematocrit (Hct) determines the oxygen carrying capacity of blood, but also increases blood viscosity and thus flow resistance. From this dual role the concept of an optimum Hct for tissue oxygenation has been derived. Viscometric studies using the ratio Hct/blood viscosity at high shear rate showed an optimum Hct of 50-60% for red blood cell (RBC) suspensions in plasma. For the perfusion of an artificial microvascular network with 5-70μm channels the optimum Hct was 60-70% for high driving pressures. With lower shear rates or driving pressures the optimum Hct shifted towards lower values...
October 21, 2016: Clinical Hemorheology and Microcirculation
Laura C Cappelli, Ami A Shah, Clifton O Bingham
Immune checkpoint inhibitors (ICIs) are newly approved treatments for advanced malignancies that are increasing survival. The mechanism of these drugs, non-specifically activating T cells, also leads to immune-mediated damage of tissue or immune-related adverse events (IRAE). IRAEs with rheumatic phenotypes are increasingly being recognised. Inflammatory arthritis, sicca syndrome, inflammatory myopathy, vasculitis and lupus nephritis have been described as a result of ICIs. Use of ICIs will be expanding in the coming years for several reasons...
2016: RMD Open
Mihály Újhelyi, Dávid Pukancsik, Péter Kelemen, Ákos Sávolt, Mária Gődény, Eszter Kovács, Nóra Udvarhelyi, Mihály Bak, Csaba Polgár, Gábor Rubovszky, Miklós Kásler, Zoltán Mátrai
INTRODUCTION: The European Society of Breast Cancer Specialists has created quality indicators for breast units to establish minimum standards and to ensure specialist multimodality care with the conscious aim of improving outcomes and decreasing breast cancer mortality. AIM: The aim of this study was to analyse the breast cancer care in the National Institute of Oncology according to the European Society of Breast Cancer Specialists requirements and in a large number of cases in order to present representative clinico-pathological data on the incidence of breast cancer in Hungary...
October 2016: Orvosi Hetilap
Trang H Au, Courtney C Cavalieri, David D Stenehjem
Clinical pharmacists are important contributors to the care of patients with cancer; it is therefore critical for oncology clinical pharmacists to stay current with new anticancer therapies. This review summarizes the epidemiology and pathogenesis of non-small cell lung cancer, including the most common genetic alterations, as well as the mechanism of action, clinical development, pharmacodynamics and pharmacokinetics of the anaplastic lymphoma kinase inhibitor ceritinib for the treatment of patients with anaplastic lymphoma kinase-positive non-small cell lung cancer...
October 13, 2016: Journal of Oncology Pharmacy Practice
Lesly A Dossett, Janella N Hudson, Arden M Morris, M Catherine Lee, Richard G Roetzheim, Michael D Fetters, Gwendolyn P Quinn
Although they are critical to models of coordinated care, the relationship and communication between primary care providers (PCPs) and cancer specialists throughout the cancer continuum are poorly understood. By using predefined search terms, the authors conducted a systematic review of the literature in 3 databases to examine the relationship and communication between PCPs and cancer specialists. Among 301 articles identified, 35 met all inclusion criteria and were reviewed in-depth. Findings from qualitative, quantitative, and disaggregated mixed-methods studies were integrated using meta-synthesis...
October 11, 2016: CA: a Cancer Journal for Clinicians
Fernando G Zampieri, Fernando A Bozza, Giulliana M Moralez, Débora D S Mazza, Alexandre V Scotti, Marcelo S Santino, Rubens A B Ribeiro, Edison M Rodrigues Filho, Maurício M Cabral, Marcelo O Maia, Patrícia S D'Alessandro, Sandro V Oliveira, Márcia A M Menezes, Eliana B Caser, Roberto S Lannes, Meton S Alencar Neto, Maristela M Machado, Marcelo F Sousa, Jorge I F Salluh, Marcio Soares
PURPOSE: To assess the impact of performance status (PS) impairment 1 week before hospital admission on the outcomes in patients admitted to intensive care units (ICU). METHODS: Retrospective cohort study in 59,693 patients (medical admissions, 67 %) admitted to 78 ICUs during 2013. We classified PS impairment according to the Eastern Cooperative Oncology Group (ECOG) scale in absent/minor (PS = 0-1), moderate (PS = 2) or severe (PS = 3-4). We used univariate and multivariate logistic regression analyses to investigate the association between PS impairment and hospital mortality...
September 29, 2016: Intensive Care Medicine
Lisa M Blackburn, Nicole Bauchmire, Sarah Bender, Kelly Tomlinson-Pinkham, Scott Roberts, Sherry Rosan
BACKGROUND: Acute promyelocytic leukemia (APL), once the most lethal form of adult acute leukemia, has become the most curable. The goal of early and well-managed treatment induction is to reduce the malignant burden of promyelocytes to below the cytologically detectable level. OBJECTIVES: Oncology nurses who care for patients with APL need to be acutely aware of the basic differences in this disease from other forms of leukemia, including the two main complications for the newly diagnosed patient...
October 1, 2016: Clinical Journal of Oncology Nursing
Chunlan Wei, Yao Nengliang, Wang Yan, Fang Qiong, Changrong Yuan
AIMS AND OBJECTIVES: To explore the differing perspectives of patients and providers and their assessment of supportive care needs in breast cancer patients receiving oral chemotherapy. BACKGROUND: The patient-provider concordance in patients' needs assessment is critical to the effective management of cancer. Self-administered oral chemotherapy greatly shifts responsibilities for side-effect monitoring, symptom management and dose adjustments from the provider to the patient...
September 19, 2016: Journal of Clinical Nursing
Katy E French, Alexis B Guzman, Augustin C Rubio, John C Frenzel, Thomas W Feeley
BACKGROUND: With the movement towards bundled payments, stakeholders should know the true cost of the care they deliver. Time-driven activity-based costing (TDABC) can be used to estimate costs for each episode of care. In this analysis, TDABC is used to both estimate the costs of anesthesia care and identify the primary drivers of those costs of 11 common oncologic outpatient surgical procedures. METHODS: Personnel cost were calculated by determining the hourly cost of each provider and the associated process time of the 11 surgical procedures...
September 2016: Healthcare
Talia I Zaider, Smita C Banerjee, Ruth Manna, Nessa Coyle, Cassandra Pehrson, Stacey Hammonds, Carol A Krueger, Carma L Bylund
INTRODUCTION: Sustaining the well-being of the caregiving family is a critical agenda in cancer care. In the multidisciplinary team, nurses often serve as a bridge between the family and oncology team. Evidence suggests that dealing with difficult family dynamics is a common source of stress for oncology nurses, yet nurses typically receive very little guidance on how to achieve an effective partnership with families under these circumstances. We report on the application and preliminary evaluation of a new training module for improving nurses' skills in responding collaborative to challenging family situations...
September 2016: Families, Systems & Health: the Journal of Collaborative Family Healthcare
Allison Magnuson, James Wallace, Beverly Canin, Selina Chow, William Dale, Supriya G Mohile, Lauren M Hamel
We present the case of a 92-year-old man, MH, who was given a diagnosis of colorectal cancer. His primary care physician, surgeon, geriatric oncologist, and family members all played important roles in his care. MH's case is an example of a lack of explicit shared goal setting by the health care providers with the patient and family members and how that impeded care planning and health. This case demonstrates the importance of explicitly discussing and establishing shared goals in team-based cancer care delivery early on and throughout the care process, especially for older adults...
September 13, 2016: Journal of Oncology Practice
Rebecca H Johnson, Catherine Fiona Macpherson, Ashley W Smith, Rebecca G Block, Joann Keyton
A case of a young adult patient in the days immediately after a cancer diagnosis illustrates the critical importance of three interrelated core coordinating mechanisms-closed-loop communication, shared mental models, and mutual trust-of teamwork in an adolescent and young adult multidisciplinary oncology team. The case illustrates both the opportunities to increase team member coordination and the problems that can occur when coordination breaks down. A model for teamwork is presented, which highlights the relationships among these coordinating mechanisms and demonstrates how balance among them works to optimize team function and patient care...
September 13, 2016: Journal of Oncology Practice
Qiuling Shi, Tito R Mendoza, Xin Shelley Wang, Charles S Cleeland
OBJECTIVES: Improving, stable, or deteriorating patient functioning is critical to assess in cancer care and in oncology clinical trials. We evaluated the performance of the six-item interference subscale of the MD Anderson Symptom Inventory (MDASI) compared with two commonly used patient-reported measures of functioning as a reference: the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) and the Medical Outcomes Study Short Form 12-item health survey (SF-12)...
November 2016: European Journal of Cancer
Bo Xie, Zhaohui Su, Yihao Liu, Mo Wang, Ming Zhang
CONTEXT: Little is known about the information sources of Chinese patients with cancer and their family caregivers, yet this knowledge is critical for providing patient-centred care. OBJECTIVE: To assess and compare the information sources used by Chinese patients with cancer and their family caregivers. DESIGN: The validated Health Information Wants Questionnaire (HIWQ) was translated and administered in March 2014. SETTING: The oncology department of a general hospital in south-west China...
September 7, 2016: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
John L Moran, Patricia J Solomon
Recent viewpoints on critical care have expressed frustration at the slow development of new therapeutic agents and the failure of investigator-initiated trials. Several new directions have been proposed: personalised medicine and the embracing of "omic" technologies, resolving the heterogeneity of treatment effects, and adaptive trial designs. We examine these approaches in the context of analysis of randomised controlled trials (RCTs). The curse of treatment effect heterogeneity is found not only in critical care but also in cancer oncology...
September 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Randall F Holcombe, Michelle Evangelista, Frances Cartwright
A comprehensive quality improvement program is critically important for participation in value-based reimbursement models. Seven essential characteristics must be addressed in the development of a cancer-focused quality program. These include leadership, environment, engagement, ethos, metrics, accountability, and sustainability (Q=LE(3)MAS). This article describes how to address each essential characteristic and provides examples from the experience at Mount Sinai Hospital, a large, urban, academic hospital/health system in New York City...
September 6, 2016: Journal of Oncology Practice
O Husson, E Manten-Horst, W T A van der Graaf
Awareness of the need for collaboration across pediatric and adult cancer to care for adolescents and young adults (AYAs) arose from the recognition of the unique characteristics of AYAs with cancer. Neither pediatric nor adult oncology hospital departments are able to provide age-appropriate care single handedly. The best way to bridge the gap in care of AYA cancer patients is to centralize aspects of their care within dedicated AYA care programs, including the following essential components: provision of developmentally appropriate and multidisciplinary (supportive) care, availability of AYA inpatient and outpatient facilities and healthcare professional AYA expertise as collaboration between adult and pediatric departments...
2016: Progress in Tumor Research
Bruno Kovic, Gordon Guyatt, Michael Brundage, Lehana Thabane, Neera Bhatnagar, Feng Xie
INTRODUCTION: There is an increasing number of new oncology drugs being studied, approved and put into clinical practice based on improvement in progression-free survival, when no overall survival benefits exist. In oncology, the association between progression-free survival and health-related quality of life is currently unknown, despite its importance for patients with cancer, and the unverified assumption that longer progression-free survival indicates improved health-related quality of life...
2016: BMJ Open
Olga Gopan, Jing Zeng, Avrey Novak, Matthew Nyflot, Eric Ford
PURPOSE: The pretreatment physics plan review is a standard tool for ensuring treatment quality. Studies have shown that the majority of errors in radiation oncology originate in treatment planning, which underscores the importance of the pretreatment physics plan review. This quality assurance measure is fundamentally important and central to the safety of patients and the quality of care that they receive. However, little is known about its effectiveness. The purpose of this study was to analyze reported incidents to quantify the effectiveness of the pretreatment physics plan review with the goal of improving it...
September 2016: Medical Physics
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