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Effects of Adjuvant Endocrine Therapy-Specific Perceptions on Response to a Behavioral Intervention for Adjuvant Endocrine Therapy Adherence in Patients With Breast Cancer. 辅助内分泌治疗特定认知对乳腺癌患者辅助内分泌治疗依从性行为干预反应的影响。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-08-13 DOI: 10.1200/OP.24.00316
Kelcie D Willis, Emily A Walsh, Laura E Dunderdale, Kathryn Post, Nora Horick, Michael H Antoni, Steven A Safren, Ann H Partridge, Jeffrey Peppercorn, Elyse R Park, Jennifer S Temel, Joseph A Greer, Jamie M Jacobs

Purpose: Adjuvant endocrine therapy (AET) is a life-saving medication for patients with hormone-sensitive breast cancer, yet many struggle with adherence, warranting behavioral intervention. In our recent trial, participation in a group cognitive behavioral intervention (STRIDE) for symptom management and adherence was associated with improvements in symptom distress, coping, quality of life, and mood. We now explore whether baseline patient- and medication-specific factors-which may be modifiable by clinician-led discussions-moderated the effect of STRIDE on adherence rates.

Methods: From October 2019 to June 2021, 100 patients with early-stage breast cancer reporting AET-related distress were enrolled and randomly assigned to STRIDE or a medication monitoring (MM) control group. All patients stored their AET in electronic pill bottles to track objective adherence. Patients also self-reported their adherence on the Medication Adherence Report Scale-5 and their perceptions of AET on the Cancer Therapy Satisfaction Questionnaire at baseline. We conducted hierarchical linear modeling to test moderators of intervention effects on objective adherence rates. We report the time × group × moderator effects.

Results: Among patients reporting greater perceived difficulties with AET adherence at baseline, STRIDE participants had higher adherence rates over time compared with MM (b = -13.80; SE = 4.56; P < .01). Patients with greater expectations of therapeutic benefit from AET also had improved adherence rates if they were assigned to STRIDE, versus MM (b = 0.25; SE = 0.10; P = .01). Patients who perceived taking AET as convenient and had been taking their AET for less time had higher adherence rates in STRIDE, versus MM.

Conclusion: The current study identified patient- and medication-specific factors that may augment AET adherence interventions and may be modifiable through clinician-led discussions, such as perceptions of adherence problems, therapeutic efficacy, and convenience of AET.

目的:对于激素敏感性乳腺癌患者来说,辅助内分泌治疗(AET)是一种挽救生命的药物,但许多患者在坚持治疗方面存在困难,因此需要进行行为干预。在我们最近进行的试验中,参加针对症状管理和依从性的团体认知行为干预(STRIDE)与症状困扰、应对、生活质量和情绪的改善有关。现在,我们将探讨基线患者和药物特异性因素(这些因素可能可以通过临床医生主导的讨论来改变)是否会影响 STRIDE 对依从率的影响:从2019年10月到2021年6月,100名报告AET相关困扰的早期乳腺癌患者被纳入并随机分配到STRIDE或药物监测(MM)对照组。所有患者都将其 AET 储存在电子药瓶中,以跟踪客观依从性。基线时,患者还通过 "用药依从性报告量表-5"(Medication Adherence Report Scale-5)自我报告其依从性,并通过 "癌症治疗满意度问卷"(Cancer Therapy Satisfaction Questionnaire)自我报告其对 AET 的看法。我们进行了分层线性建模,以检验干预对客观依从率影响的调节因素。我们报告了时间 × 组别 × 调节因子效应:结果:在基线时报告AET依从性有较大困难的患者中,STRIDE参与者的依从率随着时间的推移高于MM(b = -13.80; SE = 4.56; P < .01)。如果患者对 AET 的治疗效果抱有更高期望,那么如果他们被分配到 STRIDE,其依从率也会高于 MM(b = 0.25;SE = 0.10;P = .01)。认为服用 AET 方便且服用 AET 时间较短的患者在 STRIDE 中的依从率高于 MM:目前的研究发现了患者和药物的特异性因素,这些因素可能会增强 AET 的依从性干预,并可通过临床医生主导的讨论进行调整,如对依从性问题、疗效和 AET 便捷性的看法。
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引用次数: 0
Quality Measurement in Oncology: Time to Take the Next Step! 肿瘤学的质量衡量:是时候迈出下一步了!
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-08-12 DOI: 10.1200/OP.24.00348
Ronald M Kline, Dora L Hughes, Michelle Schreiber

Oncology is a complex clinical specialty often requiring the close interaction of teams of different medical specialists for a successful outcome. The field is rapidly evolving scientifically, with successive discoveries of oncologic driver mutations soon followed by therapeutic agents able to interrupt the neoplastic process. Unfortunately, objective quality measurement demonstrates that many patients are not receiving optimal care, from diagnostic accuracy, therapeutic, or end-of-life perspectives. Quality measurement, reporting, and payment programs have the potential to focus attention on these care gaps and drive improvement. The federal government, as the largest single payer of health care services in the United States, has a compelling national interest to ensure that the medical care of Americans is at the highest level achievable. Accordingly, quality reporting and payment programs have been established in federal health care payment programs to drive improvements in care. This article reviews the science of quality measurement, documented gaps in oncology care, and ways to use new information technologies to decrease clinician burden associated with quality reporting. The article reviews how a measure is developed and incorporated into a Centers for Medicare & Medicaid Services (CMS) program. It also summarizes federal programs relevant to oncology care and the individual measures used in these programs. CMS looks forward to working jointly with the oncology community to drive continuous improvements in care.

肿瘤学是一门复杂的临床专科,通常需要不同医疗专家团队的密切配合才能取得成功。该领域的科学发展日新月异,随着肿瘤驱动基因突变的不断发现,能够中断肿瘤进程的治疗药物也随之问世。遗憾的是,客观的质量测量结果表明,从诊断准确性、治疗或生命终结的角度来看,许多患者并没有得到最佳的治疗。质量测量、报告和支付计划有可能使人们关注这些护理差距并推动改善。联邦政府作为美国医疗服务的最大单一支付方,有责任确保美国人的医疗服务达到最高水平。因此,在联邦医疗支付计划中设立了质量报告和支付计划,以推动医疗服务的改善。本文回顾了质量衡量的科学原理、肿瘤治疗中存在的差距,以及如何利用新的信息技术减轻临床医生在质量报告方面的负担。文章回顾了如何制定衡量标准并将其纳入医疗保险与医疗补助服务中心(CMS)计划。文章还总结了与肿瘤治疗相关的联邦计划以及这些计划中使用的各项衡量标准。CMS 期待与肿瘤界携手合作,推动医疗服务的持续改进。
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引用次数: 0
Routine Symptom Screening to Address Supportive Care Needs. 常规症状筛查,满足支持性护理需求。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-08-12 DOI: 10.1200/OP-24-00482
Breffni Hannon, Camilla Zimmermann

Routine symptom screening may identify unmet needs, but must consider patient engagement and clinician workloads.

常规症状筛查可发现未满足的需求,但必须考虑患者的参与度和临床医生的工作量。
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引用次数: 0
Advancing Care Team Adoption of Electronic Health Record Systems for Cancer Symptom Management: Findings From a Hybrid Type II, Cluster-Randomized, Stepped-Wedge Trial. 促进护理团队采用电子健康记录系统进行癌症症状管理:混合 II 型、群组随机、阶梯式楔形试验的结果。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-08-06 DOI: 10.1200/OP.24.00280
Jessica D Austin, Lila J Finney Rutten, Kristin Fischer, Jennifer Ridgeway, Sarah Minteer, Joan M Griffin, Deirdre R Pachman, Kathryn J Ruddy, Andrea Cheville

Purpose: The enhanced, electronic health record (EHR)-facilitated cancer symptom control (E2C2) trial is a cohort cluster-randomized, stepped-wedge, hybrid type II trial that leverages EHR systems to facilitate a collaborative care model (CCM) approach with the goal of improving cancer symptom management. Understanding factors that influence care team adoption of EHR systems remains a critical understudied area of research. This study examines how oncology care teams' perceptions regarding the feasibility, acceptability, and appropriateness of E2C2 EHR systems preimplementation were associated with adoption 3 months after implementation and characterizes differences in adoption by individual- and system-level factors.

Methods: Care team members completed an electronic survey before and 3 months after implementation of E2C2 for their respective sequence. Adoption was defined as frequency of use to statements aligned with care team-directed EHR systems designed to facilitate CCM approaches. Chi-square tests assessed differences in adoption while logistic regression models estimated associations between baseline mean scores of acceptability, feasibility, and appropriateness on care team adoption at 3 months.

Results: Results from 94 care team members (37.2% oncologists, 72.6% female, 55.3% in their role for 6+ years) found that adoption rates ranged from 48.9% to 71.7%, with significant differences observed by location (community-based health care systems v tertiary medical center) and professional role. Adjusting for professional role, care team members reporting higher levels of perceived acceptability and appropriateness at baseline had greater odds of adopting EHR systems at 3 months.

Conclusion: EHR systems perceived as acceptable and appropriate are more likely to be adopted by oncology care teams in our sample. Future implementation efforts should consider tailored strategies to facilitate adoption of EHR systems designed to promote CCM-based approaches to improve cancer symptom management.

目的:增强型电子病历(EHR)促进癌症症状控制(E2C2)试验是一项队列分组随机、阶梯式楔形混合 II 型试验,该试验利用电子病历系统促进协作护理模式(CCM)方法,目的是改善癌症症状管理。了解影响护理团队采用电子病历系统的因素仍然是一个研究不足的重要领域。本研究探讨了肿瘤护理团队在 E2C2 电子病历系统实施前对其可行性、可接受性和适宜性的看法与实施 3 个月后的采用情况之间的关系,并根据个人和系统层面的因素描述了采用情况的差异:方法:护理小组成员在 E2C2 实施前和实施 3 个月后分别完成了一项电子调查。采用率被定义为与护理团队指导的旨在促进 CCM 方法的电子病历系统相一致的声明的使用频率。卡方检验评估了采用率的差异,而逻辑回归模型估算了可接受性、可行性和适当性的基线平均得分与护理团队在 3 个月后采用率之间的关联:94名护理团队成员(37.2%为肿瘤学家,72.6%为女性,55.3%在其岗位上工作6年以上)的研究结果表明,采用率从48.9%到71.7%不等,不同地点(社区医疗保健系统与三级医疗中心)和专业角色之间存在显著差异。对专业角色进行调整后,基线时认为可接受性和适宜性较高的护理团队成员在 3 个月后采用电子病历系统的几率更大:结论:在我们的样本中,被认为可接受和合适的电子病历系统更有可能被肿瘤护理团队采用。未来的实施工作应考虑量身定制的策略,以促进电子病历系统的采用,从而推广基于 CCM 的方法,改善癌症症状管理。
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引用次数: 0
Re-Envisioning Electronic Health Records to Optimize Patient-Centered Cancer Care, Quality, Surveillance, and Research. 重新设计电子健康记录,优化以患者为中心的癌症护理、质量、监测和研究。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-08-05 DOI: 10.1200/OP.24.00260
Aditi P Singh, Erin P Balogh, Robert W Carlson, Mary Margaret Huizinga, Bradley A Malin, Alexander Melamed, Neal J Meropol, Etta D Pisano, Robert A Winn, K Robin Yabroff, Lawrence N Shulman

Electronic health records (EHRs) are a significant advancement over paper records. However, the full potential of EHRs for improving care quality, patient outcomes, surveillance, and research in cancer care is yet to be realized. The organic evolution of EHRs has resulted in a number of unanticipated consequences including increased time spent by clinicians interfacing with the EHR for daily workflows. Patient access to clinicians and their records has been an important advancement in patient-centered care; however, this has brought to light additional gaps and challenges in EHRs meeting these needs. A significant challenge for EHR design and physician workflows is how best to meet the complex goals and priorities of various stakeholders including providers, researchers, patients, health systems, payors, and regulatory agencies. The National Cancer Policy Forum convened a 2022 workshop, "Innovations in Electronic Health Records for Oncology Care, Research and Surveillance," to address these challenges and to facilitate collaboration across all user groups with the goal of re-envisioning EHRs that will better support shared goals of improving patient outcomes and advancing cancer care and research without overburdening clinicians with administrative tasks. Here, we summarize the current EHR ecosystem as discussed at the workshop and highlight opportunities to improve EHR contributions to oncology evidence and care.

与纸质记录相比,电子健康记录(EHR)是一项重大进步。然而,电子病历在提高癌症护理质量、改善患者预后、监测和研究方面的潜力仍有待充分发挥。电子病历的有机发展带来了许多意想不到的后果,包括临床医生在日常工作流程中与电子病历交互所花费的时间增加。病人接触临床医生及其记录是以病人为中心的护理的重要进步;然而,这也揭示了电子病历在满足这些需求方面的更多差距和挑战。电子病历设计和医生工作流程面临的一个重大挑战是如何最好地满足包括医疗服务提供者、研究人员、患者、医疗系统、付款人和监管机构在内的各利益相关方的复杂目标和优先事项。美国国家癌症政策论坛于 2022 年召开了题为 "用于肿瘤治疗、研究和监测的电子病历创新 "的研讨会,以应对这些挑战并促进所有用户群体之间的合作,目的是重新规划电子病历,从而更好地支持改善患者预后、推进癌症治疗和研究的共同目标,同时又不给临床医生带来过重的行政工作负担。在此,我们总结了研讨会上讨论的当前电子病历生态系统,并强调了改善电子病历对肿瘤证据和护理的贡献的机会。
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引用次数: 0
Reducing Cancer Drug Cost: 3-Year Analysis of Automated Dose Rounding in Electronic Health Records. 降低癌症药物成本:电子健康记录中自动剂量调整的 3 年分析。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-08-05 DOI: 10.1200/OP.23.00688
Vishal S Shah, Clayton Irvine, Robert R McWilliams, Parminder Singh, Scott A Soefje

Purpose: Globally, cancer drug expenditure exceeds $185 in US dollars (USD) billion, with the United States contributing $75 (USD) billion. Many cancer drug doses are calculated on the basis of body weight or body surface area, which often results in leftover drug in partially used single-dose vials (SDVs). The cost of wasted drug is a huge financial burden on the US health care system. We evaluated the cost savings resulting from the reduction of SDV wastage, achieved through the implementation of automated dose rounding rules in electronic health records (EHRs).

Methods: Mayo Clinic implemented automated dose rounding rules within the EHR. These rules were designed to round calculated doses to the nearest SDV if the vial size closely matched the original calculated dose, within a 10% threshold. We assessed doses administered between January 2019 and December 2021, and computed cost-savings, waste reduction, and cost of waste for chemotherapy drugs.

Results: In 3 years, 36.1% of doses were rounded down, 35.8% were rounded up, and 28.1% were exact doses. By rounding doses down to a vial size, we achieved cost-savings of $39.75 (USD) million and prevented 62,065 SDV of cancer drugs from going to waste. By rounding doses up, we avoided wasting $9.95 (USD) million worth of drugs. However, there were still instances where the rounding fell outside of the 10%, resulting in wasted drugs worth $25 (USD) million.

Conclusion: The substantial burden imposed on patients and the US health care system because of cancer drug wastage is of significant concern. Although the automated dose rounding system represents a partial solution for this issue, a comprehensive approach involves the imperative development of policy and legislative solutions to effectively mitigate the challenges associated with cancer drug waste.

目的:全球抗癌药物支出超过 1,850 亿美元,其中美国为 750 亿美元。许多抗癌药物的剂量都是根据体重或体表面积计算的,这往往会导致部分使用过的单剂量药瓶(SDV)中有剩余药物。浪费药物的成本给美国医疗系统造成了巨大的经济负担。我们评估了通过在电子病历(EHR)中实施自动剂量调整规则而减少 SDV 浪费所节省的成本:梅奥诊所在电子病历中实施了自动剂量舍入规则。这些规则旨在将计算出的剂量四舍五入到最接近的 SDV,前提是药瓶大小与原始计算剂量密切匹配,且不超过 10% 的阈值。我们评估了 2019 年 1 月至 2021 年 12 月期间的用药剂量,并计算了化疗药物的成本节约、浪费减少和浪费成本:3年中,36.1%的剂量被四舍五入,35.8%的剂量被四舍五入,28.1%的剂量为精确剂量。通过将剂量四舍五入到药瓶大小,我们节省了 3,975 万美元的成本,避免了 62,065 SDV 的抗癌药物浪费。通过四舍五入,我们避免了价值 995 万美元的药物浪费。然而,仍有四舍五入未达到 10%的情况,造成了价值 2,500 万美元的药物浪费:癌症药物浪费给患者和美国医疗系统造成的巨大负担令人深感忧虑。尽管自动剂量舍入系统是解决这一问题的部分方法,但全面的方法还包括必须制定政策和立法解决方案,以有效缓解与抗癌药物浪费相关的挑战。
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引用次数: 0
Stick With Intravenous or Give Subcutaneous a Shot? Time and Other Considerations When Evaluating Cancer Drug Formulations. 坚持静脉注射还是皮下注射?评估抗癌药物制剂时的时间和其他考虑因素。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-08-02 DOI: 10.1200/OP-24-00501
Arjun Gupta, Michelle Tregear, Makala B Pace, Rachel I Vogel

Time and other considerations when evaluating a switch to newer drug formulations (eg, subQ vs IV).

评估改用较新药物配方(例如,亚急性与静脉注射)时的时间和其他考虑因素。
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引用次数: 0
Exploring Demographic Differences and Outcomes in Early-Onset Colorectal Cancer. 探索早发结直肠癌的人口统计学差异和预后。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-02-23 DOI: 10.1200/OP.23.00671
Beas Siromoni, Adrienne Groman, Kanak Parmar, Sarbajit Mukherjee, Deepak Vadehra

Purpose: Early-onset colorectal cancer (EOCRC), defined as CRC diagnosed before age 50 years, has increased significantly worldwide. The majority of EOCRCs do not appear to be driven by genetic factors and may be influenced by environmental factors. We hypothesized that sociodemographic disparities exist in EOCRC. The purpose was of the study was to examine the geographic disparities in patients with EOCRC.

Methods: We retrospectively examined the SEER database from 1976 to 2016 to examine the geographic disparities in EOCRC. A total of 73,378 patients with EOCRC were included in the analysis. We performed univariate and multivariable analyses to evaluate overall survival (OS) and disease-specific survival (DSS). Sociodemographic factors, including the location of residence (metropolitan areas [MA] or rural areas [RA]), sex, race, insurance status, and marital status, were included in the statistical analysis.

Results: The incidence and mortality rates were consistently higher in RA versus MA during the study period. Multivariable analysis showed that patients living in RA had worse OS (hazard ratio [HR], 1.14; P < .01) and DSS (HR, 1.15; P < .001) compared with those living in MA. Similarly, non-Hispanic Black ethnicity and uninsured patients had significantly worse survival when compared with non-Hispanic White and insured patients, respectively. Married status showed better survival outcomes.

Conclusion: Patients with EOCRC living in RA have worse outcomes. Understanding the mechanisms behind such socioeconomic disparities is important so that future studies can reduce these disparities.

目的:早发结直肠癌(EOCRC)是指在 50 岁之前诊断出的结直肠癌。大多数 EOCRC 似乎并非由遗传因素驱动,而可能受到环境因素的影响。我们假设 EOCRC 存在社会人口差异。本研究的目的是探讨 EOCRC 患者的地域差异:我们回顾性地检查了 1976 年至 2016 年的 SEER 数据库,以研究 EOCRC 患者的地域差异。共有 73378 名 EOCRC 患者被纳入分析。我们进行了单变量和多变量分析,以评估总生存期(OS)和疾病特异性生存期(DSS)。统计分析还包括社会人口学因素,包括居住地(大都会地区或农村地区)、性别、种族、保险状况和婚姻状况:结果:在研究期间,RA地区的发病率和死亡率始终高于MA地区。多变量分析显示,与居住在马萨诸塞州的患者相比,居住在RA州的患者的OS(危险比[HR],1.14;P < .01)和DSS(HR,1.15;P < .001)更差。同样,非西班牙裔黑人和无保险患者的生存率也明显低于非西班牙裔白人和有保险的患者。结论:结论:生活在RA地区的EOCRC患者的预后较差。了解这种社会经济差异背后的机制非常重要,这样未来的研究才能减少这些差异。
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引用次数: 0
Ethics of Patient-Clinician Boundaries in Oncology: Communication Strategies for Promoting Clinician Well-Being and Quality Patient Care. 肿瘤学中病人与医生界限的伦理:促进临床医生健康和优质患者护理的沟通策略》。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-03-14 DOI: 10.1200/OP.23.00650
Monica S Chatwal, Polo Camacho, Banu Symington, Abby Rosenberg, Leslie Hinyard, Marianna Chavez Mac Gregor, Colleen Gallagher, Areej El-Jawahri, Molly McGinnis, Richard T Lee
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引用次数: 0
Reply to Y. Kwon et al. 对 Y. Kwon 等人的答复
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-05-29 DOI: 10.1200/OP.24.00286
Jacob Waitzman, Pranit R Sunkara, Nicholas Lenze, Michael Brenner, John D Cramer
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引用次数: 0
期刊
JCO oncology practice
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