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Research and Reviews for the Practicing Oncologist
Precision medicine in the making
Click on the PDF icon at the top of this introduction to read the full article.
Click on the PDF icon at the top of this introduction to read the full article.
Click on the PDF icon at the top of this introduction to read the full article.
Assessing the impact of a targeted electronic medical record intervention on the use of growth factor in cancer patients
Background Patients receiving chemotherapy are at risk for febrile neutropenia following treatment. The American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) recommend screening patients for risk of febrile neutropenia and risk stratification based on likelihood of febrile neutropenia events. The impact of the implementation of an electronic medical record (EMR) system on physician compliance with growth factor support guidelines has not been studied.
Objective To investigate whether implementation of automated orders in EMRs can improve adherence to national guidelines in prophylactic G-CSF use in chemotherapy patients.
Methods A retrospective chart review of cancer patients receiving chemotherapy from January 1, 2007 to August 1, 2008 (pre-EMR) and January 1, 2011 to December 31, 2011 (post-EMR) was conducted. Institutional adherence to ASCO and NCCN guidelines for G-CSF after the implementation of automatic electronic orders for pegfilgrastim in patients who received a high-risk chemotherapy regimen were examined. The results were compared with a similar study that had been conducted before the implementation of the EMR system.
Results The number of regimens that included guideline-driven growth factor usage and nonusage was 75.6% in the post-intervention arm, compared with 67.5% in the pre-intervention arm. This is a statistically significant difference between the pre-EMR and post-EMR compliance with national guidelines on growth factor usage (P = .041, based on chi-square test). The post-EMR implementation data of 1,042 individual new chemotherapy regimens showed correct use of G-CSF in 89.13% high-risk chemotherapy regimens and 58.74% intermediate-risk regimens, with risk factors and incorrect usage in 26.23% of intermediate-risk regimens without risk factors and 19.34% of low-risk regimens. The appropriateness of use in high- and low-risk regimens was the most compliant, because growth factor was built into chemotherapy plans of high-risk regimens and omitted from low-risk regimens.
Limitations This project was limited by a change in EMR systems at West Virginia University hospitals on January 1, 2009. All pre-EMR data was collected before 2009 and could not be further collected once the project began in 2013.
Conclusions Appropriateness of growth factor usage can be improved when integrated into an EMR. This can improve compliance and adherence to national recommendations. Further development and understanding of EMR is needed to improve usage to meet national guidelines, with particular attention paid to integration of risk factors into EMR to improve growth factor usage compliance.
Funding NIH Research Funding Development Grant, WVU office of research and graduate education
Click on the PDF icon at the top of this introduction to read the full article.
Background Patients receiving chemotherapy are at risk for febrile neutropenia following treatment. The American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) recommend screening patients for risk of febrile neutropenia and risk stratification based on likelihood of febrile neutropenia events. The impact of the implementation of an electronic medical record (EMR) system on physician compliance with growth factor support guidelines has not been studied.
Objective To investigate whether implementation of automated orders in EMRs can improve adherence to national guidelines in prophylactic G-CSF use in chemotherapy patients.
Methods A retrospective chart review of cancer patients receiving chemotherapy from January 1, 2007 to August 1, 2008 (pre-EMR) and January 1, 2011 to December 31, 2011 (post-EMR) was conducted. Institutional adherence to ASCO and NCCN guidelines for G-CSF after the implementation of automatic electronic orders for pegfilgrastim in patients who received a high-risk chemotherapy regimen were examined. The results were compared with a similar study that had been conducted before the implementation of the EMR system.
Results The number of regimens that included guideline-driven growth factor usage and nonusage was 75.6% in the post-intervention arm, compared with 67.5% in the pre-intervention arm. This is a statistically significant difference between the pre-EMR and post-EMR compliance with national guidelines on growth factor usage (P = .041, based on chi-square test). The post-EMR implementation data of 1,042 individual new chemotherapy regimens showed correct use of G-CSF in 89.13% high-risk chemotherapy regimens and 58.74% intermediate-risk regimens, with risk factors and incorrect usage in 26.23% of intermediate-risk regimens without risk factors and 19.34% of low-risk regimens. The appropriateness of use in high- and low-risk regimens was the most compliant, because growth factor was built into chemotherapy plans of high-risk regimens and omitted from low-risk regimens.
Limitations This project was limited by a change in EMR systems at West Virginia University hospitals on January 1, 2009. All pre-EMR data was collected before 2009 and could not be further collected once the project began in 2013.
Conclusions Appropriateness of growth factor usage can be improved when integrated into an EMR. This can improve compliance and adherence to national recommendations. Further development and understanding of EMR is needed to improve usage to meet national guidelines, with particular attention paid to integration of risk factors into EMR to improve growth factor usage compliance.
Funding NIH Research Funding Development Grant, WVU office of research and graduate education
Click on the PDF icon at the top of this introduction to read the full article.
Background Patients receiving chemotherapy are at risk for febrile neutropenia following treatment. The American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) recommend screening patients for risk of febrile neutropenia and risk stratification based on likelihood of febrile neutropenia events. The impact of the implementation of an electronic medical record (EMR) system on physician compliance with growth factor support guidelines has not been studied.
Objective To investigate whether implementation of automated orders in EMRs can improve adherence to national guidelines in prophylactic G-CSF use in chemotherapy patients.
Methods A retrospective chart review of cancer patients receiving chemotherapy from January 1, 2007 to August 1, 2008 (pre-EMR) and January 1, 2011 to December 31, 2011 (post-EMR) was conducted. Institutional adherence to ASCO and NCCN guidelines for G-CSF after the implementation of automatic electronic orders for pegfilgrastim in patients who received a high-risk chemotherapy regimen were examined. The results were compared with a similar study that had been conducted before the implementation of the EMR system.
Results The number of regimens that included guideline-driven growth factor usage and nonusage was 75.6% in the post-intervention arm, compared with 67.5% in the pre-intervention arm. This is a statistically significant difference between the pre-EMR and post-EMR compliance with national guidelines on growth factor usage (P = .041, based on chi-square test). The post-EMR implementation data of 1,042 individual new chemotherapy regimens showed correct use of G-CSF in 89.13% high-risk chemotherapy regimens and 58.74% intermediate-risk regimens, with risk factors and incorrect usage in 26.23% of intermediate-risk regimens without risk factors and 19.34% of low-risk regimens. The appropriateness of use in high- and low-risk regimens was the most compliant, because growth factor was built into chemotherapy plans of high-risk regimens and omitted from low-risk regimens.
Limitations This project was limited by a change in EMR systems at West Virginia University hospitals on January 1, 2009. All pre-EMR data was collected before 2009 and could not be further collected once the project began in 2013.
Conclusions Appropriateness of growth factor usage can be improved when integrated into an EMR. This can improve compliance and adherence to national recommendations. Further development and understanding of EMR is needed to improve usage to meet national guidelines, with particular attention paid to integration of risk factors into EMR to improve growth factor usage compliance.
Funding NIH Research Funding Development Grant, WVU office of research and graduate education
Click on the PDF icon at the top of this introduction to read the full article.
David Henry's JCSO podcast, February 2015
The line-up for David Henry’s monthly podcast for The Journal of Community and Supportive Oncology includes an Original Report in which investigators report complete response rates (no emesis, no rescue medication) APF530, a sustained-release granisetron, during the acute and delayed phases of chemotherapy-induced nausea and vomiting over multiple cycles of the therapy. He also discusses the findings from a study on joint breast and colorectal cancer screenings in medically underserved women, and another in women with self-reported lower limb lymphedema after treatment for gynecological cancers and their use of services. A fourth Original Report examines perceptions about participation in cancer clinical trials in New York state and how increased outreach and a team approach to educating and enrolling patients in trials are important to increase participation and ensure a diverse sample of participants. Finally, a feature article on new therapies looks at the significant challenges – and recent advances – in the treatment of head and neck cancers.
The line-up for David Henry’s monthly podcast for The Journal of Community and Supportive Oncology includes an Original Report in which investigators report complete response rates (no emesis, no rescue medication) APF530, a sustained-release granisetron, during the acute and delayed phases of chemotherapy-induced nausea and vomiting over multiple cycles of the therapy. He also discusses the findings from a study on joint breast and colorectal cancer screenings in medically underserved women, and another in women with self-reported lower limb lymphedema after treatment for gynecological cancers and their use of services. A fourth Original Report examines perceptions about participation in cancer clinical trials in New York state and how increased outreach and a team approach to educating and enrolling patients in trials are important to increase participation and ensure a diverse sample of participants. Finally, a feature article on new therapies looks at the significant challenges – and recent advances – in the treatment of head and neck cancers.
The line-up for David Henry’s monthly podcast for The Journal of Community and Supportive Oncology includes an Original Report in which investigators report complete response rates (no emesis, no rescue medication) APF530, a sustained-release granisetron, during the acute and delayed phases of chemotherapy-induced nausea and vomiting over multiple cycles of the therapy. He also discusses the findings from a study on joint breast and colorectal cancer screenings in medically underserved women, and another in women with self-reported lower limb lymphedema after treatment for gynecological cancers and their use of services. A fourth Original Report examines perceptions about participation in cancer clinical trials in New York state and how increased outreach and a team approach to educating and enrolling patients in trials are important to increase participation and ensure a diverse sample of participants. Finally, a feature article on new therapies looks at the significant challenges – and recent advances – in the treatment of head and neck cancers.
Rising to the therapeutic challenge of head and neck cancer
As a significant cause of cancer-related mortality, head and neck cancer presents an important therapeutic challenge that has proven relatively resistant to attempts to improve patient outcomes over the past several decades. In recent years, molecular profiling of head and neck cancers has provided greater insight into their significant genetic heterogeneity, creating potential opportunities for novel therapies. Here, we discuss the most promising advances.
Limited progress in HNSCC treatment
Cancers of the nasal cavity, sinuses, mouth, lips, salivary glands, throat, and larynx, collectively called head and neck cancers, are the sixth leading cause of cancer-related death worldwide. The majority of head and neck cancer arises in the epithelial cells that line the mucosal surfaces of the head and neck and is known as squamous cell carcinoma (HNSCC). If caught in the early stages, HNSCC has a high cure rate with single-modality treatment with either surgery or radiation therapy (RT).1 However, a substantial proportion of patients present with advanced disease that requires multimodality therapy and has significantly poorer outcomes. Locally advanced HNSCC is typically treated with various combinations of surgery, RT, and chemotherapy and survival rates for all patients at 5 years are 40%- 60%, compared with 70%-90% for patients with early-stage disease.1,3 Up to half of locally advanced tumors relapse within the first 2 years after treatment. For patients with recurrent/metastatic disease, various chemotherapeutic regimens are available but median survival is typically less than a year.3-5
Click on the PDF icon at the top of this introduction to read the full article.
As a significant cause of cancer-related mortality, head and neck cancer presents an important therapeutic challenge that has proven relatively resistant to attempts to improve patient outcomes over the past several decades. In recent years, molecular profiling of head and neck cancers has provided greater insight into their significant genetic heterogeneity, creating potential opportunities for novel therapies. Here, we discuss the most promising advances.
Limited progress in HNSCC treatment
Cancers of the nasal cavity, sinuses, mouth, lips, salivary glands, throat, and larynx, collectively called head and neck cancers, are the sixth leading cause of cancer-related death worldwide. The majority of head and neck cancer arises in the epithelial cells that line the mucosal surfaces of the head and neck and is known as squamous cell carcinoma (HNSCC). If caught in the early stages, HNSCC has a high cure rate with single-modality treatment with either surgery or radiation therapy (RT).1 However, a substantial proportion of patients present with advanced disease that requires multimodality therapy and has significantly poorer outcomes. Locally advanced HNSCC is typically treated with various combinations of surgery, RT, and chemotherapy and survival rates for all patients at 5 years are 40%- 60%, compared with 70%-90% for patients with early-stage disease.1,3 Up to half of locally advanced tumors relapse within the first 2 years after treatment. For patients with recurrent/metastatic disease, various chemotherapeutic regimens are available but median survival is typically less than a year.3-5
Click on the PDF icon at the top of this introduction to read the full article.
As a significant cause of cancer-related mortality, head and neck cancer presents an important therapeutic challenge that has proven relatively resistant to attempts to improve patient outcomes over the past several decades. In recent years, molecular profiling of head and neck cancers has provided greater insight into their significant genetic heterogeneity, creating potential opportunities for novel therapies. Here, we discuss the most promising advances.
Limited progress in HNSCC treatment
Cancers of the nasal cavity, sinuses, mouth, lips, salivary glands, throat, and larynx, collectively called head and neck cancers, are the sixth leading cause of cancer-related death worldwide. The majority of head and neck cancer arises in the epithelial cells that line the mucosal surfaces of the head and neck and is known as squamous cell carcinoma (HNSCC). If caught in the early stages, HNSCC has a high cure rate with single-modality treatment with either surgery or radiation therapy (RT).1 However, a substantial proportion of patients present with advanced disease that requires multimodality therapy and has significantly poorer outcomes. Locally advanced HNSCC is typically treated with various combinations of surgery, RT, and chemotherapy and survival rates for all patients at 5 years are 40%- 60%, compared with 70%-90% for patients with early-stage disease.1,3 Up to half of locally advanced tumors relapse within the first 2 years after treatment. For patients with recurrent/metastatic disease, various chemotherapeutic regimens are available but median survival is typically less than a year.3-5
Click on the PDF icon at the top of this introduction to read the full article.
Perceptions about participation in cancer clinical trials in New York state
Background Clinical trials are valuable in advancing cancer care through the investigation of ways in which to better prevent, detect and diagnose, and/or treat cancer. Recruitment of adults into clinical trials has historically been low.
Objective To survey adult cancer patients who reside in New York state to better understand their participation in and attitudes about clinical trials.
Methods From January 2012-April 2013, we conducted a one-time survey about clinical trials in 8 cancer-treatment or cancer-patient support organizations in the state. Surveys were offered in person and online to adults with a past or current cancer diagnosis. Analysis was limited to adults who resided in the state and provided a self-reported status of previous participation in clinical trials.
Results Of the 1,832 participants who completed the survey, 1,475 were included in the analysis. Our sample represented all regions of the state. Most of the respondents (68.1%) had never participated in a clinical trial. Almost 32% said they had never received information about research studies. Most (84%) felt that patients should be asked to participate in clinical trials, but fewer (70%) were willing to be approached about participation.
Limitations The sample is predominantly white and female and overrepresents breast and hematologic cancers.
Conclusions Increased outreach coupled with a team approach to educate and enroll patients in clinical trials may be the necessary first steps to increase participation in trials and ensure a diverse sample of participants.
Click on the PDF icon at the top of this introduction to read the full article.
Background Clinical trials are valuable in advancing cancer care through the investigation of ways in which to better prevent, detect and diagnose, and/or treat cancer. Recruitment of adults into clinical trials has historically been low.
Objective To survey adult cancer patients who reside in New York state to better understand their participation in and attitudes about clinical trials.
Methods From January 2012-April 2013, we conducted a one-time survey about clinical trials in 8 cancer-treatment or cancer-patient support organizations in the state. Surveys were offered in person and online to adults with a past or current cancer diagnosis. Analysis was limited to adults who resided in the state and provided a self-reported status of previous participation in clinical trials.
Results Of the 1,832 participants who completed the survey, 1,475 were included in the analysis. Our sample represented all regions of the state. Most of the respondents (68.1%) had never participated in a clinical trial. Almost 32% said they had never received information about research studies. Most (84%) felt that patients should be asked to participate in clinical trials, but fewer (70%) were willing to be approached about participation.
Limitations The sample is predominantly white and female and overrepresents breast and hematologic cancers.
Conclusions Increased outreach coupled with a team approach to educate and enroll patients in clinical trials may be the necessary first steps to increase participation in trials and ensure a diverse sample of participants.
Click on the PDF icon at the top of this introduction to read the full article.
Background Clinical trials are valuable in advancing cancer care through the investigation of ways in which to better prevent, detect and diagnose, and/or treat cancer. Recruitment of adults into clinical trials has historically been low.
Objective To survey adult cancer patients who reside in New York state to better understand their participation in and attitudes about clinical trials.
Methods From January 2012-April 2013, we conducted a one-time survey about clinical trials in 8 cancer-treatment or cancer-patient support organizations in the state. Surveys were offered in person and online to adults with a past or current cancer diagnosis. Analysis was limited to adults who resided in the state and provided a self-reported status of previous participation in clinical trials.
Results Of the 1,832 participants who completed the survey, 1,475 were included in the analysis. Our sample represented all regions of the state. Most of the respondents (68.1%) had never participated in a clinical trial. Almost 32% said they had never received information about research studies. Most (84%) felt that patients should be asked to participate in clinical trials, but fewer (70%) were willing to be approached about participation.
Limitations The sample is predominantly white and female and overrepresents breast and hematologic cancers.
Conclusions Increased outreach coupled with a team approach to educate and enroll patients in clinical trials may be the necessary first steps to increase participation in trials and ensure a diverse sample of participants.
Click on the PDF icon at the top of this introduction to read the full article.
Women with self-reported lower-limb lymphedema after treatment for gynecological cancers: are they more likely to self-report psychosocial symptoms and less likely to use services?
Background Survivorship for gynecological cancers has increased because of improved screening and treatment. Use of supportive care services after treatment is important to improve patient quality of life.
Objective To assess self-reported lower-limb lymphedema (LLL), depression, anxiety, quality of life, unmet supportive care needs, and service use among gynecological cancer survivors.
Methods In 2010, a population-based, cross-sectional mail survey was conducted among 160 gynecological cancer survivors 5-30 months after their diagnoses (response rate, 53%).
Results Overall, 30% of women self-reported symptoms of LLL, 21% and 24% self-reported symptoms of depression or anxiety, respectively. Women with LLL were more likely to also report symptoms of depression or anxiety, and had higher unmet supportive care needs. Services needed but not used by 10%-15% of women with LLL, anxiety, or depression were those of a lymphedema specialist, pain specialist, and physiotherapist for LLL, and a psychiatrist, psychologist, and pain specialist for anxiety and depression.
Limitations Small sample size, self-reported data, limited generalization to other countries, underrepresentation of older women (age >70 years) and women from non-Caucasian backgrounds.
Conclusions Women with LLL or high distress were less likely to use services they needed.
Funding Cancer Australia
Click on the PDF icon at the top of this introduction to read the full article.
Background Survivorship for gynecological cancers has increased because of improved screening and treatment. Use of supportive care services after treatment is important to improve patient quality of life.
Objective To assess self-reported lower-limb lymphedema (LLL), depression, anxiety, quality of life, unmet supportive care needs, and service use among gynecological cancer survivors.
Methods In 2010, a population-based, cross-sectional mail survey was conducted among 160 gynecological cancer survivors 5-30 months after their diagnoses (response rate, 53%).
Results Overall, 30% of women self-reported symptoms of LLL, 21% and 24% self-reported symptoms of depression or anxiety, respectively. Women with LLL were more likely to also report symptoms of depression or anxiety, and had higher unmet supportive care needs. Services needed but not used by 10%-15% of women with LLL, anxiety, or depression were those of a lymphedema specialist, pain specialist, and physiotherapist for LLL, and a psychiatrist, psychologist, and pain specialist for anxiety and depression.
Limitations Small sample size, self-reported data, limited generalization to other countries, underrepresentation of older women (age >70 years) and women from non-Caucasian backgrounds.
Conclusions Women with LLL or high distress were less likely to use services they needed.
Funding Cancer Australia
Click on the PDF icon at the top of this introduction to read the full article.
Background Survivorship for gynecological cancers has increased because of improved screening and treatment. Use of supportive care services after treatment is important to improve patient quality of life.
Objective To assess self-reported lower-limb lymphedema (LLL), depression, anxiety, quality of life, unmet supportive care needs, and service use among gynecological cancer survivors.
Methods In 2010, a population-based, cross-sectional mail survey was conducted among 160 gynecological cancer survivors 5-30 months after their diagnoses (response rate, 53%).
Results Overall, 30% of women self-reported symptoms of LLL, 21% and 24% self-reported symptoms of depression or anxiety, respectively. Women with LLL were more likely to also report symptoms of depression or anxiety, and had higher unmet supportive care needs. Services needed but not used by 10%-15% of women with LLL, anxiety, or depression were those of a lymphedema specialist, pain specialist, and physiotherapist for LLL, and a psychiatrist, psychologist, and pain specialist for anxiety and depression.
Limitations Small sample size, self-reported data, limited generalization to other countries, underrepresentation of older women (age >70 years) and women from non-Caucasian backgrounds.
Conclusions Women with LLL or high distress were less likely to use services they needed.
Funding Cancer Australia
Click on the PDF icon at the top of this introduction to read the full article.
Joint breast and colorectal cancer screenings in medically underserved women
Background Breast and colon cancer screening in rural community clinics is underused.
Objective To evaluate the effectiveness and cost-effectiveness of alternative interventions designed to promote simultaneous screening for breast and colon cancer in community clinics.
Methods A 3-arm, quasi-experimental evaluation was conducted during May 2008-August 2011 in 8 federally qualified health clinics in predominately rural Louisiana. Baseline screening rates reported by the clinics was <10% for breast cancer (using mammography) and 1%- 2% for colon cancer (using the fecal occult blood test [FOBT]). 744 women aged 50 years or older who were eligible for routine mammography and an FOBT were recruited. The combined screening efforts included: enhanced care; health literacy-informed education (education alone), or health literacy-informed education with nurse support (nurse support).
Results Postintervention screening rates for completing both tests were 28.1% with enhanced care, 23.7% with education alone, and 38.7% with nurse support. After adjusting for age, race, and literacy, patients who received nurse support were 2.21 times more likely to complete both screenings than were those who received the education alone (95% confidence interval [CI], 1.12-4.38; P = .023). The incremental cost per additional woman completing both screenings was $3,987 for education with nurse support over education alone, and $5,987 over enhanced care.
Limitations There were differences between the 3 arms in sociodemographic characteristics, literacy, and previous screening history. Not all variables that were significantly different between arms were adjusted for, therefore adjustments for key variables (age, race, literacy) were made in statistical analyses. Other limitations related generalizability of results.
Conclusions Although joint breast and colon cancer screening rates were increased substantially over existing baseline rates in all 3 arms, the completion rate for both tests was modest. Nurse support and telephone follow-up were most effective. However, it is not likely to be cost effective or affordable in clinics with limited resources.
Funding National Cancer Institute (R01-CA115869-05), supported in part by 1 U54 GM104940 from the National Institute of General Medical Sciences of the National Institutes of Health.
Click on the PDF icon at the top of this introduction to read the full article.
Background Breast and colon cancer screening in rural community clinics is underused.
Objective To evaluate the effectiveness and cost-effectiveness of alternative interventions designed to promote simultaneous screening for breast and colon cancer in community clinics.
Methods A 3-arm, quasi-experimental evaluation was conducted during May 2008-August 2011 in 8 federally qualified health clinics in predominately rural Louisiana. Baseline screening rates reported by the clinics was <10% for breast cancer (using mammography) and 1%- 2% for colon cancer (using the fecal occult blood test [FOBT]). 744 women aged 50 years or older who were eligible for routine mammography and an FOBT were recruited. The combined screening efforts included: enhanced care; health literacy-informed education (education alone), or health literacy-informed education with nurse support (nurse support).
Results Postintervention screening rates for completing both tests were 28.1% with enhanced care, 23.7% with education alone, and 38.7% with nurse support. After adjusting for age, race, and literacy, patients who received nurse support were 2.21 times more likely to complete both screenings than were those who received the education alone (95% confidence interval [CI], 1.12-4.38; P = .023). The incremental cost per additional woman completing both screenings was $3,987 for education with nurse support over education alone, and $5,987 over enhanced care.
Limitations There were differences between the 3 arms in sociodemographic characteristics, literacy, and previous screening history. Not all variables that were significantly different between arms were adjusted for, therefore adjustments for key variables (age, race, literacy) were made in statistical analyses. Other limitations related generalizability of results.
Conclusions Although joint breast and colon cancer screening rates were increased substantially over existing baseline rates in all 3 arms, the completion rate for both tests was modest. Nurse support and telephone follow-up were most effective. However, it is not likely to be cost effective or affordable in clinics with limited resources.
Funding National Cancer Institute (R01-CA115869-05), supported in part by 1 U54 GM104940 from the National Institute of General Medical Sciences of the National Institutes of Health.
Click on the PDF icon at the top of this introduction to read the full article.
Background Breast and colon cancer screening in rural community clinics is underused.
Objective To evaluate the effectiveness and cost-effectiveness of alternative interventions designed to promote simultaneous screening for breast and colon cancer in community clinics.
Methods A 3-arm, quasi-experimental evaluation was conducted during May 2008-August 2011 in 8 federally qualified health clinics in predominately rural Louisiana. Baseline screening rates reported by the clinics was <10% for breast cancer (using mammography) and 1%- 2% for colon cancer (using the fecal occult blood test [FOBT]). 744 women aged 50 years or older who were eligible for routine mammography and an FOBT were recruited. The combined screening efforts included: enhanced care; health literacy-informed education (education alone), or health literacy-informed education with nurse support (nurse support).
Results Postintervention screening rates for completing both tests were 28.1% with enhanced care, 23.7% with education alone, and 38.7% with nurse support. After adjusting for age, race, and literacy, patients who received nurse support were 2.21 times more likely to complete both screenings than were those who received the education alone (95% confidence interval [CI], 1.12-4.38; P = .023). The incremental cost per additional woman completing both screenings was $3,987 for education with nurse support over education alone, and $5,987 over enhanced care.
Limitations There were differences between the 3 arms in sociodemographic characteristics, literacy, and previous screening history. Not all variables that were significantly different between arms were adjusted for, therefore adjustments for key variables (age, race, literacy) were made in statistical analyses. Other limitations related generalizability of results.
Conclusions Although joint breast and colon cancer screening rates were increased substantially over existing baseline rates in all 3 arms, the completion rate for both tests was modest. Nurse support and telephone follow-up were most effective. However, it is not likely to be cost effective or affordable in clinics with limited resources.
Funding National Cancer Institute (R01-CA115869-05), supported in part by 1 U54 GM104940 from the National Institute of General Medical Sciences of the National Institutes of Health.
Click on the PDF icon at the top of this introduction to read the full article.
Sustained antiemetic responses with APF530 (sustained-release granisetron) during multiple cycles of emetogenic chemotherapy
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Recognition of latest CLL therapies highlights new options for other cancers
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David Henry's JCSO podcast, January 2015
In his monthly podcast for The Journal of Community and Supportive Oncology, Dr David Henry looks at Original Reports on the comparison of atropine-diphenoxylate and hyoscyamine in lowering the rates of irinotecan-related cholinergic syndrome; the effects of age and comorbidities in the management of rectal cancer in elderly patients at an institution in Portugal; the impact of a telehealth intervention on quality of life and symptom distress in patients with head and neck cancer; and the beneficial effects of animal-assisted visits on quality of life during multimodal radiation-chemotherapy regimens. He also discusses a Research Report in which the authors attempt, possibly for the first time, to quantify radiation exposure from diagnostic procedures in patients with newly diagnosed breast cancer, as well as two feature articles – a round-up of some of the presentations at the 2014 San Antonio Breast Cancer Symposium and a Journal Club presentation of therapies for lymphoproliferative disorders.
In his monthly podcast for The Journal of Community and Supportive Oncology, Dr David Henry looks at Original Reports on the comparison of atropine-diphenoxylate and hyoscyamine in lowering the rates of irinotecan-related cholinergic syndrome; the effects of age and comorbidities in the management of rectal cancer in elderly patients at an institution in Portugal; the impact of a telehealth intervention on quality of life and symptom distress in patients with head and neck cancer; and the beneficial effects of animal-assisted visits on quality of life during multimodal radiation-chemotherapy regimens. He also discusses a Research Report in which the authors attempt, possibly for the first time, to quantify radiation exposure from diagnostic procedures in patients with newly diagnosed breast cancer, as well as two feature articles – a round-up of some of the presentations at the 2014 San Antonio Breast Cancer Symposium and a Journal Club presentation of therapies for lymphoproliferative disorders.
In his monthly podcast for The Journal of Community and Supportive Oncology, Dr David Henry looks at Original Reports on the comparison of atropine-diphenoxylate and hyoscyamine in lowering the rates of irinotecan-related cholinergic syndrome; the effects of age and comorbidities in the management of rectal cancer in elderly patients at an institution in Portugal; the impact of a telehealth intervention on quality of life and symptom distress in patients with head and neck cancer; and the beneficial effects of animal-assisted visits on quality of life during multimodal radiation-chemotherapy regimens. He also discusses a Research Report in which the authors attempt, possibly for the first time, to quantify radiation exposure from diagnostic procedures in patients with newly diagnosed breast cancer, as well as two feature articles – a round-up of some of the presentations at the 2014 San Antonio Breast Cancer Symposium and a Journal Club presentation of therapies for lymphoproliferative disorders.