IMPORTANCE Financial toxicity (FT), unintended and unanticipated financial burden experienced by cancer patients undergoing cancer care, is associated with negative consequences and increased risk of mortality. Older patients (Ն70 years) with cancer are at risk for FT, yet data are limited on FT and whether oncologists discuss FT with their patients. OBJECTIVE To examine the prevalence of FT in older adults with advanced cancer, its association with health-related quality of life (HRQoL), and cost conversations between oncologists and patients. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional secondary analysis was performed on baseline data from the Improving Communication in Older Cancer Patients and Their Caregivers study, a cluster randomized trial from 31 community oncology practices across the US that was
BACKGROUND Chest wall progression of breast carcinoma after failure of salvage surgery, radiation, and chemohormonal therapy is a quagmire with limited therapeutic options. Because photodynamic therapy (PDT) offers excellent results in cutaneous lesions, PDT may play a role in this indication. However, to the authors' knowledge, published data for this subgroup of patients using the only commercially available photosensitizing agent, Photofrin, often show high treatment morbidity, limiting PDT's usefulness. The authors report the feasibility of decreasing the photosensitizer drug dose as a means of exploiting photobleaching kinetics to improve the therapeutic ratio for these individuals. METHODS One hundred two chest wall sites were treated with PDT after failure of multimodality salvage therapy. In these 9 patients, lesion size ranged from 0.57 to 9 cm. Photodynamic therapy consisted of outpatient intravenous infusion of 0.8 mg/kg of Photofrin, followed 48 hours later by 630 nm light treatment of 135–170 J/cm2 delivered by a KTP:YAG laser coupled to dye unit. Two patients underwent a second PDT procedure due to new lesion formation. All patients were observed for a minimum of 6 months, and none was lost to follow‐up. RESULTS Photodynamic therapy was well tolerated with no photosensitivity reported. Despite all patients having failed surgery, full dose radiation and multiagent chemohormonal therapy, chest wall lesions healed with no scarring. Only 1 (9 cm) lesion took longer than 3 months to granulate over. The authors were able to evaluate all treatment sites, and complete response, defined as total lesion elimination, was noted in 89% of the lesions; reduction without regrowth occurred in 8% with no response in 3% of the lesions. CONCLUSIONS Despite having prior treatment and fragile tissues, low dose Photofrin‐induced PDT offers excellent clinical response with minimal morbidity. These results show that PDT should play an important role in the management of chest wall failure from breast carcinoma. Cancer 2001;91:1–8. © 2001 American Cancer Society.
PURPOSE: Cancer clinical trial accrual rates are low, and information about contributing factors is needed. We examined video-recorded clinical interactions to identify circumstances under which patients potentially eligible for a trial at a major cancer center were offered a trial. METHODS: We conducted a qualitative directed content analysis of 62 recorded interactions with physicians (n = 13) and patients with intermediate- or high-risk prostate cancer (n = 43). Patients were screened and potentially eligible for a trial. We observed and coded the interactions in 3 steps: (1) classification of all interactions as explicit offer, offer pending, trial discussed/not offered, or trial not discussed; (2) in interactions with no explicit offer, classification of whether the cancer had progressed; (3) in interactions classified as progression but no trial offered, identification of factors discussed that may explain the lack of an offer. RESULTS: Of the 62 interactions, 29% were classified as explicit offer, 12% as offer pending, 18% as trial discussed/not offered, and 39% as trial not discussed. Of those with no offer, 57% included information that the cancer had not progressed. In 68% of the remaining interactions with patients whose cancer had progressed but did not receive an offer, reasons for the lack of offer were identified, but in 32%, no explanation was provided. CONCLUSION: Even in optimal circumstances, few patients were offered a trial, often because their cancer had not progressed. Findings support professional recommendations to broaden trial inclusion criteria. Findings suggest accrual rates should reflect the proportion of eligible patients who enroll.
IntroductionCarboplatin is widely used to treat lung cancer in the United States as an alternative to cisplatin. Several studies have demonstrated that cisplatin-based regimen is associated with a high frequency of thromboembolic complications. However, there has been limited investigation directly comparing the risk of thromboembolic events (TEEs) between cisplatin- and carboplatin-treated patients with lung cancer.MethodsAll lung cancer patients treated with cisplatin or carboplatin at Wilmot Cancer Center, University of Rochester between 2011 and 2014 were included. Patient characteristics including exposure (cisplatin vs. carboplatin) and outcome (TEEs between the time of the first dose of cisplatin or carboplatin and 4 weeks after the last dose) were collected by reviewing electronic medical records. A Fisher’s exact test was used to compare the proportion of incident TEEs between cisplatin and carboplatin groups. The risk of TEE associated with carboplatin compared to cisplatin was assessed using multiple logistic regression.ResultsAmong 415 subjects, 317 patients (76.4%) received carboplatin and 98 (23.6%) patients received cisplatin. In the carboplatin group, 10.9% (33/302) of evaluable patients developed treatment-related TEEs vs. 14.7% (14/95) in the cisplatin group. There was no significant difference in the risk of developing TEEs between the two groups (P = 0.32). However, 15.2% of carboplatin-related TEEs were arterial thromboses compared to none in the cisplatin group.ConclusionsThe incidence of carboplatin-related TEEs was high in lung cancer patients without significant difference in the risk of developing TEEs between cisplatin and carboplatin groups. Potential use of prophylactic anticoagulation in all platinum-treated patients should be further investigated.
Primary treatment for classic Hodgkin lymphoma (HL) remains highly effective with chemotherapy alone or combined-modality therapy. The limitations of therapy have been related to toxicity and efficacy in subsets of patients. The introduction of a number of new and novel cytotoxic agents has provided opportunities for investigating their use in the treatment of HL. This article briefly reviews current primary treatment strategies for HL and examines the existing data for both new cytotoxic agents and other selected novel agents in the treatment of HL.
284 Background: Due to COVID-19, telehealth volume at our comprehensive cancer center rose from less than 5% of exam visits to over 25% in April 2020. We sought to understand the experience of telehealth and compare it to in-person experiences for patients and providers (physicians, nurse practitioners, and physician assistants) to identify areas for improvement. Methods: A multidisciplinary team adapted our existing patient satisfaction survey to incorporate telehealth, defined as phone and video exam visits. A technology section was created to assess aspects unique to telehealth. Questions about the patient-provider experience were the same for telehealth and in-person visits. A provider experience survey was conducted during a two-week period in May and June 2020. The provider survey aligned questions with the patient survey to compare the perceptions of the provider-patient interaction. Results: Patient experience scores for in-person and telehealth visits were comparable, with a slightly higher mean score for in-person visits. The mean scores for patient perception of care given at our cancer center was 97.5 (n=11,969) and 96.9 (n=4670) and the likelihood to recommend was 97.8 (n=12,072) and 97.4 (n=4,398) for in-person and telehealth, respectively, between June and December 2020. Patient feedback prioritized addressing technical barriers. We implemented several interventions and increased the telehealth technology section mean scores from 93.2 (n=1,095) to 95.2 (n=700) between June and December 2020. When comparing the percent of respondents scoring good or very good, provider scores showed sizable gaps between in-person and telehealth experiences on all questions (see table). The question “degree to which the care team was well coordinated” had the largest difference between in-person and telehealth scores for both patients and providers. Several interventions to adapt staffing and workflows have been implemented to improve care telehealth coordination. Conclusions: While patients reported similar satisfaction between in-person and telehealth visits, increasing coordination remains vital to improving the experience for both patients and providers. Furthermore, understanding the gap in the provider experience between in-person and telehealth is critical for successful adoption of telehealth as a long-term strategy for healthcare delivery.[Table: see text]
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