Nurses have an important role in the development, implementation, and evaluation of cancer survivorship programs. Growing numbers of cancer survivors challenge community oncology practices to incorporate survivorship care according to new standards and guidelines. In response, one community-based oncology clinic created an advanced practice nurse (APN)-led survivorship program using the concept of Seasons of Survival as a guide. Survivorship care, when based on a more expansive definition of survivorship as beginning at the time of diagnosis, encompasses holistic nursing and multidisciplinary care. The APN assesses each patient's concerns and quality of life using a validated measure to tailor survivorship and supportive care. This article reviews the foundation and structure of the program in detail, describes program implementation using case studies, and outlines the program evaluation process and results.
65 Background: Several organizations have created oncology pathways (pws) to support evidence-based medicine, and both standardize and improve the quality of care. Information is scarce; however, regarding the requirements for successful implementation of a pws program and monitoring of adherence. Methods: We assessed the efficacy of a quality assurance initiative called Practice Pathways Improvement (PPI) program to increase pws adherence to The US Oncology Network’s physician-developed Level I Pathways. We queried our electronic health record (EHR) iKnowMed to collect data before and after program initiation. Education was provided to address policies and procedures; leadership roles and responsibilities; integration of pws into the EHR and workflow; and the importance of correct data entry into the EHR. We then measured metrics including levels of assessable data (AD) (complete data, no missing or conflicting elements); On-Pathway adherence (ON-PW); and documented rationale for exceptions (EX) of Off-Pathway treatments. Metric performance reports were distributed monthly. Results: Since 2010, 10 practices of varying size (6-342 medical oncologists) and sites (2-47) voluntarily participated. Program duration ranged from 6-12 months (mos). There were 42,266 regimens evaluated during the program, covering 19 disease pws. Baseline averages, results at program end, and current averages (avg) for AD, ON-PW, and EX are shown in the Table. As of June 2012, average follow up was 19 mos (range 13-25). A normal approximation shows significance of p < 0.001. Conclusions: Implementation of a quality assurance initiative containing operational, leadership, and workflow elements along with continued education is important for successful pws adherence. Tailored program components are necessary to meet individual practice needs. Establishing a foundation for a pws process is important to maintain performance over time. As the reimbursement landscape in oncology evolves, the ability to demonstrate quality of care is essential. [Table: see text]
6607 Background: Pancreatic cancer (PC) is the fourth leading cause of death in the United States. It is estimated that 45,220 patients will be diagnosed in 2013 and 38,460 will die (Siegel, CA Cancer J Clin 2013). Gemcitabine has long been the standard of care chemotherapy. Recent advances in treatment created a combination regimen (oxaliplatin, irinotecan, leucovorin, fluorouracil [FOLFIRINOX]) for patients with good Karnofsky performance status (PS) (Conroy, NEJM 2011). This retrospective analysis was conducted as an update to results reported at ASCO 2012 (Ginsburg Arlen, JCO 2012) to evaluate characteristics and overall survival (OS) of patients receiving FOLFIRINOX and gemcitabine-based treatments in a large outpatient community setting. This is the largest study describing FOLFIRINOX patients to date. Methods: Patients with advanced PC treated within The US Oncology Network entered into the iKnowMed (iKM) database between June 2010 and November 2012 were included. Patterns of treatment were characterized by the median age at diagnosis, sex, PS, and first-line metastatic chemotherapy prescribed. The primary endpoints of the analysis were OS and uptake of FOLFIRINOX within the network. Results: Compared to ASCO 2012 results, 1,000 additional patients were identified in iKM. Of the 1,714 total patients, 24% received FOLFIRINOX (up from 13% in 2012) and 76% gemcitabine-based therapy (87% in 2012). Increased utilization of FOLFIRINOX for patients with good PS began in June 2010. For all patients (55% male), the median age at diagnosis was 67 years and the majority (85%) had a PS of 70% or greater. The OS was significantly longer for FOLFIRINOX (9.6 mos) versus gemcitabine (6.3 mos) (p<0.0001). This held true for PS of 70% or greater patient given FOLFIRINOX (9.6 mos) versus gemcitabine (7 mos) (p<0.0001). Conclusions: Utilization of FOLFIRINOX has continued to expand after the publication of phase III trials. Our data in a community setting supports a survival advantage for FOLFIRINOX. Although the magnitude of benefit may be smaller in the community, we agree that FOLFIRINOX should become a standard of care for good PS patients.
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