IntroductionSmoking is the number one preventable cause of death in the United States. Under the Affordable Care Act, Kansas Medicaid covers all seven FDA-approved smoking cessation therapies. However, it is estimated only 3% of Kansas Medicaid smokers use treatment compared to the national estimate of 10%. The objective is to determine systemic barriers in place that prevent optimal utilization of Medicaid smoking cessation benefits among KU Medical Center Internal Medicine patientsMethodsFor this quality improvement project, a population of 169 Kansas Medicaid smokers was identified who had been seen at the KU Internal Medicine Clinic from January 1, 2015 – February 16, 2016. Phone surveys were completed with 62 individuals about smoking status, interest in using smoking cessation treatment options, and awareness of Medicaid coverage of treatment.ResultsOf the 62 respondents, 24 (39%) were prescribed pharmacotherapy and 41 (66%) were interested in using smoking cessation treatment. There were eight who had quit smoking. Of the remaining 54 smokers, 31 (57%) were unaware that Medicaid would cover pharmacotherapy. Of 24 participants who received a prescription for pharmacotherapy, 13 (54%) were able to fill the prescription at no cost using the Medicaid benefit.ConclusionsThe majority of respondents were interested in using smoking cessation treatment yet three main barriers existed to using Medicaid smoking cessation benefits: physicians not prescribing treatment to patients, patients not aware of Medicaid coverage, and inadequate pharmacy filling. Improved physician and patient awareness of Medicaid coverage will facilitate more patients receiving smoking cessation therapy and ultimately quitting smoking.
A 63-year-old man presented to the hospital with generalised weakness, fatigue and a 22 kg weight loss 4 months after being diagnosed with sarcoidosis on a mediastinal lymph node biopsy, with minimal improvement in symptoms on prednisone and methotrexate therapy. On arrival, he was found to have a haemoglobin of 57 g/L and platelet count of 82×109/L. Further work-up revealed six of eight diagnostic criteria for haemophagocytic lymphohistiocytosis (HLH): fever >38.9°C, splenomegaly, cytopaenia, hypertriglyceridaemia, haemophagocytosis and elevated ferritin >31 000 ng/mL. He was also found to have Epstein-Barr viraemia with greater than 17 000 copies. Bone marrow biopsy showed the presence of haemophagocytic histiocytes and evidence of classic Hodgkin’s lymphoma. He was started on HLH-94 protocol. Later treatment was switched to lymphoma-directed therapy and he finished six cycles of A+AVD (brentuximab vedotin, doxorubicin, vinblastine and dacarbazine) with end-of-treatment positron emission tomography/CT and bone marrow negative for lymphoma.
Introduction: Changes in reimbursement policy have made nicotine replacement therapy (NRT) much more available, but little is known about what happens to patients after they receive their prescription. This study describes rates of successfully filling prescriptions for NRT and its association with type of insurance. Methods: We identified 224 patients who received a prescription for NRT during an outpatient visit to an academic medical center between January 1st 2016 and February 10th 2017. We conducted telephone surveys to assess whether they tried to fill their prescriptions and if so, determine the effects of insurance type on the ability to successfully fill the prescription. Results: Of 117 patients completing the survey, 23 (19.6%) did not attempt to fill and 6 (5.1%) had no insurance. Of the 90 patients with insurance who attempted to fill their prescription, 67 (74.4%) were successful and 23 (25.6%) were unsuccessful in obtaining medications. Success varied by insurance with successful fills ranging from 34 (87.2%) of those with commercial insurance, 24 (70.6%) with Medicaid, to 9 (52.9%) with Medicare. Of 37 participants living with another smoker, 31 (83.7%) wanted an NRT prescription specifically for their partner; several volunteered that they had shared patches with their partner. Conclusions: Despite widespread coverage for NRT, many patients may still encounter difficulties in getting their prescriptions filled. Some tobacco users might also benefit from getting NRT prescriptions for their partners that smoke.
Background: In accordance with Commission on Cancer (CoC) Standard 3.2, the Loyola University Chicago multidisciplinary Breast Oncology Center evaluates every new patient (pt) for cancer-related concerns and makes supportive oncology referrals accordingly (CoC Standard 3.2). We previously reported that pts with newly diagnosed early-stage BC experience high levels of physical and emotional distress (Rynar 2019, ASCO abstract 269661). This study expands upon those findings by examining relationships between psychological distress and other cancer-related concerns and referrals to supportive services in a larger cohort of pts with newly diagnosed BC. Methods: The "Patient Screening Questions for Supportive Care" (Coleman Supportive Oncology Collaborative, 2017), an aggregate of validated screening tools, was implemented across 200 new pts from April 2018 thru August 2018. Demographic information and supportive oncology referrals were obtained from medical records. Descriptive statistics and chi-square were used to assess frequencies and relationships among variables. Results: 200 female pts aged 26-94 (mean (SD) = 61.39(12.90)) completed the screening tool; 16.5% had Stage 0, 40% Stage I, 34.5% Stage II, 4.5% Stage III, 2.0% Stage IV. Commonly reported psychosocial and physical complaints included concerns about work and paying for medical care, poor sleep, tingling in hands or feet, and concerns about weight gain. 47% of pts met the threshold for referral to psychology based on a positive screen for anxiety (n=65) or depression (n=28); the majority (92.8%) had at least 1 contact with a psychologist within 12 days. 51.5% of pts screened positive for a practical need triggering a referral to social work; 72.8% of consults were completed within 3 days. 27% had nutrition concerns triggering referrals to dietician services; 77.8% completed contact within 3 days. Pts who screened positive for anxiety were significantly more likely (p<.01) to also have ≥2 physical concerns, nutrition concerns, fatigue, and concerns about physical function (p=.04). Screening positive for depression was significantly associated (p<.01) with ≥2 physical concerns, family concerns, spiritual concerns, fatigue, and pain (p=.03). Conclusions: Newly diagnosed BC pts who screen positive for anxiety or depression are more likely to report concerns across multiple biopsychosocial domains. This finding lends support for CoC, NCCN, and ASCO supportive care guidelines to evaluate and address patient reported concerns beyond psychological distress. Further, we highlight the importance of assessment and triage at the start of the cancer care continuum. Future studies should reevaluate distress at pivotal points in care to determine the impact of early interventional supportive oncology services in this population. Citation Format: Lauren Z. Rynar, Blaine A. Knox, Kristen B. Wendell, Patricia B. Mumby, Kathy S. Albain, Cathy Grace-Louthen, Hahn P. Mai, Patricia A. Robinson, Shelly S. Lo. Triaging cancer-related distress at the time of breast cancer (BC) diagnosis [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-10-01.
BackgroundHumans are genetically diverse and possess a rich immunological history. It is logical to consider that these factors may lead to differences in individual immunological responses to therapy when diagnosed with cancer. The successful implementation of immune-based therapies against cancer has brought the need to develop strategies to create meaningful profiles that faithfully depict the patient‘s immunological status. We report an in-depth immunological interrogation methodology, termed ATLAS. This system was designed to generate an accurate representation of the patient‘s immunological landscape that can be used during various time points during immune-checkpoint inhibitor (ICI) therapy.MethodsWe selected data from our prospective registry trial at Loyola University Medical Center to design individual immunological profiles of patients diagnosed with locally advanced or metastatic solid tumors planning to receive ICI. Only metastatic melanoma patients samples pre-ICI therapy are included in this first analysis. Twenty mL of peripheral blood were collected. Giving consideration to scientific rigor and limited sample availability, the assays were designed in miniaturized forms. ATLAS includes classical peripheral blood mononuclear cells (PBMCs) composition and T cell phenotypic and transcriptional analysis. To depict T cell functionality, we examined multiple parameters such as T cell receptor (TCR) signaling threshold, cell proliferation and NF-kB activation, at steady-state and in response to cell activation. To obtain both a broad and T cell-specific view, we quantified circulating chemokines and cytokines in plasma and from activated T cells.ResultsFor this first methodologic demonstration, patient characteristics are depicted in table 1. Data from different ATLAS assays were used to create individual immunological profiles presented as a dashboard for each patient. Distributional plots and measures of center (mean, median) and spread (range, variance) were used to eliminate low-information parameters from the figures. Data visualizations compared individual patients to the sample median for continuous parameters and compared patients‘ percentages to sample average relative abundance. Two patients, P011 shown in figure 1 and P021 shown in figure 2, are depicted using this approach.Abstract 52 Table 1Patient characteristicsAbstract 52 Figure 1Patient 011 dashboardAbstract 52 Figure 2Patient 021 dashboardConclusionsATLAS can be used in real-world conditions to generate comprehensive immunological profiles of cancer patients. Individual profiles indicate that immunological constitution is heterogeneous among patients, even with the same tumor type. We propose that the addition of ATLAS to our clinical and immunological toolbox may help stratify patients to articulate truly personalized oncologic therapies.Ethics ApprovalThe study was approved by Loyola University Medical Center and Loyola University Chicago Ethics Board and Institutional Review Board, approval number 209364.
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