Medicine and Health Sciences Commons^™

Oncology Treatment Plan Updates In Epic-Beacon, Rose Dimarco, Pharmd, Bcps, Bcop, Gloria Espinosa, Mat, Pharmd, Bcop, Kelly Miskovsky, Pharmd, Bcop, Gina Hemmert, Pharmd

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

Background

In Medical Oncology, the utilization of EPIC-Beacon Treatment Plans is integral for prescribing and administering cancer treatments. These treatment plans typically consist of anticancer infusion medications (chemotherapy, immunotherapy, etc.), supportive care medications, required laboratory orders, and other monitoring recommendations to ensure that patients receive safe and effective care. In 2017, TJUH transitioned from Varian’s Aria to EPIC’s electronic medical record system. Since then, there has not been a formal review of existing plans, and there are many inconsistencies between plans in different cancer types.

Problem Statement:

• Currently, there is not a formal process for review of existing treatment plans, …

Guaranteed Income And Financial Treatment Trial (Gift Trial Or Giftt): A 12-Month, Randomized Controlled Trial To Compare The Effectiveness Of Monthly Unconditional Cash Transfers To Treatment As Usual In Reducing Financial Toxicity In People With Cancer Who Have Low Incomes, Meredith Doherty, Jonathan Heintz, Amy Leader, David Wittenburg, Yonatan Ben-Shalom, Jessica Jacoby, Amy Castro, Stacia West

Department of Medical Oncology Faculty Papers

Cancer-related financial hardship (i.e., financial toxicity) has been associated with anxiety and depression, greater pain and symptom burden, treatment nonadherence, and mortality. Out-of-pocket healthcare costs and lost income are primary drivers of financial toxicity, however, income loss is a pronounced risk factor for cancer patients with low incomes. There has been little progress in developing an income intervention to alleviate financial toxicity cancer patients with low incomes. Unconditional cash transfers (UCT), or guaranteed income, have produced positive health effects in experiments with general low-income populations, but have not yet been evaluated in people with cancer. The Guaranteed Income and Financial …

Telehealth-Based Music Therapy Versus Cognitive Behavioral Therapy For Anxiety In Cancer Survivors: Rationale And Protocol For A Comparative Effectiveness Trial, Kevin T Liou, Kelly M Mcconnell, M Beatriz Currier, Raymond E Baser, Jodi Macleod, Desiree Walker, Camila Casaw, Greta Wong, Lauren Piulson, Karen Popkin, Anamaria Lopez, Katherine Panageas, Joke Bradt, Jun J Mao

Department of Medical Oncology Faculty Papers

Background: Cancer survivors represent one of the fastest growing populations in the United States. Unfortunately, nearly 1 in 3 survivors experience anxiety symptoms as a long-term consequence of cancer and its treatment. Characterized by restlessness, muscle tension, and worry, anxiety worsens the quality of life; impairs daily functioning; and is associated with poor sleep, depressed mood, and fatigue. Although pharmacological treatment options are available, polypharmacy has become a growing concern for cancer survivors. Music therapy (MT) and cognitive behavioral therapy (CBT) are evidence-based, nonpharmacological treatments that have demonstrated effectiveness in treating anxiety symptoms in cancer populations and can be adapted …

Reducing Time To Antibiotics In Patients With Neutropenic Fever On A Bone Marrow Transplant Unit, Regina Mcguire, Christopher Anand Gardner, Jordan Villars, William O'Hara, Jessica Radicke, Felicia Rivera, Jill Cristiano, Joanne E. Filicko-O'Hara, Usama Gergis, Adam F. Binder

Student Papers, Posters & Projects

Background/Methods: Timely administration of antibiotics in patients with neutropenic fever (NF) is essential for reducing morbidity and mortality among oncology patients. The optimal time to antibiotics (TTA) for patients with NF is unclear, but IDSA/ASCO guidelines recommend a median TTA within one hour of documented fever. This study focused on identifying barriers at a single academic institution to timely antibiotic administration for patients admitted to the inpatient Bone Marrow Transplant (BMT) unit, and implemented new processes to reduce median TTA to less than 60 minutes.

Methods: Chart reviews were performed to identify causes for delays in antibiotics (abx). Based on …

Creating And Implementing A Principal Investigator Tool Kit For Enhancing Accrual To Late Phase Clinical Trials: Development And Usability Study., Kristin A Higgins, Alexandra Thomas, Nancy Soto, Rebecca Paulus, Thomas J George, Thomas B Julian, Sharon Hartson Stine, Merry Jennifer Markham, Maria Werner-Wasik

Kimmel Cancer Center Faculty Papers

BACKGROUND: Accrual to oncology clinical trials remains a challenge, particularly during the COVID-19 pandemic. For late phase clinical trials funded by the National Cancer Institute, the development of these research protocols is a resource-intensive process; however, mechanisms to optimize patient accrual after trial activation are underdeveloped across the National Clinical Trial Network (NCTN). Low patient accrual can lead to the premature closure of clinical trials and can ultimately delay the availability of new, potentially life-saving therapies in oncology.

OBJECTIVE: The purpose of this study is to formally create an easily implemented tool kit of resources for investigators of oncology clinical …

Crizotinib In Patients With Tumors Harboring Alk Or Ros1 Rearrangements In The Nci-Match Trial., A S Mansfield, Z Wei, R Mehra, A T Shaw, C H Lieu, P M Forde, A E Drilon, Edith P. Mitchell, J J Wright, N Takebe, E Sharon, D Hovelson, S Tomlins, J Zeng, K Poorman, N Malik, R J Gray, S Li, L M Mcshane, L V Rubinstein, D Patton, P M Williams, S R Hamilton, B A Conley, C L Arteaga, L N Harris, P J O'Dwyer, A P Chen, K T Flaherty

Department of Medical Oncology Faculty Papers

The NCI-MATCH was designed to characterize the efficacy of targeted therapies in histology-agnostic driver mutation-positive malignancies. Sub-protocols F and G were developed to evaluate the role of crizotinib in rare tumors that harbored either ALK or ROS1 rearrangements. Patients with malignancies that progressed following at least one prior systemic therapy were accrued to the NCI-MATCH for molecular profiling, and those with actionable ALK or ROS1 rearrangements were offered participation in sub-protocols F or G, respectively. There were five patients who enrolled on Arm F (ALK) and four patients on Arm G (ROS1). Few grade 3 or 4 toxicities were noted, …

Medical Outcomes, Quality Of Life, And Family Perceptions For Outpatient Vs Inpatient Neutropenia Management After Chemotherapy For Pediatric Acute Myeloid Leukemia, Kelly D Getz, Julia E Szymczak, Yimei Li, Rachel Madding, Yuan-Shung V Huang, Catherine Aftandilian, Staci D Arnold, Kira O Bona, Emi Caywood, Anderson B Collier, M Monica Gramatges, Meret Henry, Craig Lotterman, Kelly Maloney, Amir Mian, Rajen Mody, Elaine Morgan, Elizabeth A Raetz, Jeffrey Rubnitz, Anupam Verma, Naomi Winick, Jennifer J Wilkes, Jennifer C Yu, Brian T Fisher, Richard Aplenc

Department of Medicine Faculty Papers

Importance: Pediatric acute myeloid leukemia (AML) requires multiple courses of intensive chemotherapy that result in neutropenia, with significant risk for infectious complications. Supportive care guidelines recommend hospitalization until neutrophil recovery. However, there are little data to support inpatient over outpatient management.

Objective: To evaluate outpatient vs inpatient neutropenia management for pediatric AML.

Design, setting, and participants: This cohort study used qualitative and quantitative methods to compare medical outcomes, patient health-related quality of life (HRQOL), and patient and family perceptions between outpatient and inpatient neutropenia management. The study included patients from 17 US pediatric hospitals with frontline chemotherapy start dates ranging …

Avoid, Delay, Shorten. Results Of Radiation Oncology’S Covid19 Patient Exposure Risk Mitigation Guidelines, Alex Kubli, Ms, Lilya Babinski, Bs, Angelia Landers, Phd, Christian Fernandez, Md, Amy Harrison, Phd

House Staff Quality Improvement and Patient Safety Conference (2020-)

We implemented evidence-based COVID19 guidelines on 3/16/20 to minimize patient exposure risks by avoiding, delaying, and shortening patient treatments when possible.

We analyzed the effectiveness of our COVID guidelines by comparing the number of new patient starts and number of treatments before and after implementation.

Our department successfully decreased patient exposure risk by reducing new prescription starts, rates of longer treatment courses, and overall number of treatment encounters in an evidence-based approach.

Occupational Therapy’S Role In Oncology: Returning To Work During And After Treatment, Annamarie Scheidell, Otas, Stephanie Sloane, Bs, Ms, Otas, Sara Loesche, Ms, Otr/L, Cht

School of Continuing and Professional Studies Posters

Medical advances have improved the five-year survival rate for patients diagnosed with cancer and some late-stage cancers that once were terminal have now become manageable, chronic conditions. Because of this, more individuals with cancer as well as survivors of cancer are re-entering the workforce. Resuming the role of worker is considered an important step in recovery for many. Occupational therapy (OT) can play an important role in facilitating a successful transition back to work for both cancer patients and survivors.

Slc36a1-Mtorc1 Signaling Drives Acquired Resistance To Cdk4/6 Inhibitors., Akihiro Yoshida, Yiwen Bu, Shuo Qie, John Wrangle, E. Ramsay Camp, E. Starr Hazard, Gary Hardiman, Renée De Leeuw, Karen E. Knudsen, J. Alan Diehl

Department of Cancer Biology Faculty Papers

The cyclin-dependent kinase 4/6 (CDK4/6) kinase is dysregulated in melanoma, highlighting it as a potential therapeutic target. CDK4/6 inhibitors are being evaluated in trials for melanoma and additional cancers. While beneficial, resistance to therapy is a concern, and the molecular mechanisms of such resistance remain undefined. We demonstrate that reactivation of mammalian target of rapamycin 1 (mTORC1) signaling through increased expression of the amino acid transporter, solute carrier family 36 member 1 (SLC36A1), drives resistance to CDK4/6 inhibitors. Increased expression of SLC36A1 reflects two distinct mechanisms: (i) Rb loss, which drives SLC36A1 via reduced suppression of E2f; (ii) fragile X …

Impact Of Palliative Care Consultation On End Of Life Care Measures: A Retrospective Analysis Of Patients In The Oncology Care Model, Alison Greidinger, Md, Maria Vershvovsky, Md, Evan Lapinsky, Md, Alison Rhoades, Md, Amy Leader, Drph, Vittorio Maio, Pharmd, Jared Minetola, Karen Walsh, Ms, Mba, Valerie Csik, Mph, Cpps, Ruben Rhoades, Md

Department of Medical Oncology Posters

Introduction

• In 2016 ASCO recommended that patients with advanced cancer receive dedicated palliative care (PC) services1. Early PC involvement is associated with lower spending, fewer 30-day readmission rates, decreased chemotherapy administration at the end of life (EOL) and increased hospice referrals2.
• Many patients are not referred and continue to receive chemotherapy and utilize high-acuity services near the EOL.
• The Oncology Care Model (OCM) is a CMS episode-based alternative payment model promoting high-value care.
• We evaluated the effect of PC visits on EOL outcomes including code status (CS) and spending in the last 30 days of life.

The Oncology Care Model: Oncology's First Foray Away From Volume And Toward Value-Based Care., Andrew Song, Valerie P. Csik, Amy Leader, Vittorio Maio

Department of Radiation Oncology Faculty Papers

No abstract provided.

Long-Term Visual Outcomes In Optic Nerve Sheath Meningiomas Following Fractionated Stereotactic Radiotherapy, Sana Dastgheyb, Christian Fernandez, Md, Maria Werner-Wasik, Md, Voichita Bar-Ad, Md, David Andrews Md, James Evans, Md, Kevin Judy, Md, Sara Lally, Md, Carol Shields, Md, Arman Mashayekhi, Md, Wenyin Shi, Md, Phd, Christopher Farrell, Md

Sigma Xi Student Research Day

Introduction

Radiation therapy is often used for tumors of the optic nerve. The challenge with irradiating tumors surrounding structures associated with the eye is the risk of exposing the optic nerve, or other structures important to maintaining vision to potentially damaging radiation.

Fractionated stereotactic radiotherapy (FSRT) is commonly used for the treatment of optic nerve sheath meningiomas (ONSMs) for vision preservation. However, long term visual data in the literature is limited. We investigated visual outcomes in 27 patients with ONSMs after FSRT.

Differential Impact Of Rb Status On E2f1 Reprogramming In Human Cancer., Christopher Mcnair, Kexin Xu, Amy C. Mandigo, Matteo Benelli, Benjamin E. Leiby, Daniel Rodrigues, Johan Lindberg, Henrik Gronberg, Mateus Crespo, Bram De Laere, Luc Dirix, Tapio Visakorpi, Fugen Li, Felix Y. Feng, Johann De Bono, Francesca Demichelis, Mark A. Rubin, Myles Brown, Karen E. Knudsen

Department of Cancer Biology Faculty Papers

The tumor suppressor protein retinoblastoma (RB) is mechanistically linked to suppression of transcription factor E2F1-mediated cell cycle regulation. For multiple tumor types, loss of RB function is associated with poor clinical outcome. RB action is abrogated either by direct depletion or through inactivation of RB function; however, the basis for this selectivity is unknown. Here, analysis of tumor samples and cell-free DNA from patients with advanced prostate cancer showed that direct RB loss was the preferred pathway of disruption in human disease. While RB loss was associated with lethal disease, RB-deficient tumors had no proliferative advantage and exhibited downstream effects …

Case Report: Pthrp Related Hypercalcemia In Diffuse Large B-Cell Lymphoma, Ankita Mehta, Md, Evan Caruso, Md

The Medicine Forum

INTRODUCTION

Hypercalcemia is commonly associated with solid tumor malignancies, but less often with hematologic malignancies. When present in hematologic malignancies, hypercalcemia is often secondary to overproduction of Vitamin D from the tumor cells. Very few cases with parathyroid hormone related peptide (PTHrP) induced hypercalcemia in B-cell lymphomas have been reported. Here we present a 44 year old male with a history of chronic lymphoctic leukemia who presented with hypercalcemia and an elevated PTHrP, found to have a transformation to Diffuse Large B-cell Lymphoma (DLBCL).

Anorectal Melanomas: Case Series, Jinyu Zhang, Md, Matthew Sochat, Md, Edward R. Feller, Md

The Medicine Forum

INTRODUCTION

Melanoma is the most common tumor to metastasize to the gastrointestinal (GI) tract. 60% of patients who die with malignant melanoma have GI involvement at autopsy1. Symptomatic disease presenting during life is unusual. Anorectal melanoma, a rare tumor that represents 1% of all melanomas and less than 4% of all anal malignancies, manifests with a range of non-specific symptoms and physical exam findings2. In fact, about one-third of lesions may be amelanotic3,4. Initial misdiagnosis as a benign lesion such as hemorrhoid is common.

We report 3 cases of anorectal melanoma presenting as primary GI complaints all without known cutaneous …

Case Report: Uncontrolled Anasarca: Capillary Leak Syndrome, Ankita Mehta, Md, Mansi Shah, Md

The Medicine Forum

INTRODUCTION

Capillary leak syndrome (CLS) is a rare clinical disease that causes edema, hypoproteinemia, episodic hypotension, dyspnea, hyponatremia, and weight gain that can be life threatening1. Although the underlying pathology is currently unknown, CLS is thought to be secondary to a systemic process associated with hyperpermeability of the body's microcirculation, resulting from a diffuse and severe disruption of the endothelium and causing generalized edema and often acute respiratory distress2.

Pharmacists On The Front Lines Of Polypharmacy: The Individualized Medication Assessment And Planning (Imap) Project To Improve Medication Use In Senior Adults With Cancer, Ginah Nightingale Pharmd, Bcop, Laura T. Pizzi Pharmd, Mph, Emily Hajjar Pharmd, Bcps, Bcacp, Cgp, Elizabeth Pigott, Margaret Wang, Shannon Doherty, Kristine Swartz Md, Andrew Chapman Do, Facp

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.