42 results on '"Monika K Krzyzanowska"'
Search Results
2. A Web-Based Cancer Self-Management Program (I-Can Manage) Targeting Treatment Toxicities and Health Behaviors: Human-Centered Co-design Approach and Cognitive Think-Aloud Usability Testing
- Author
-
Doris Howell, Denise Bryant Lukosius, Jonathan Avery, Athina Santaguida, Melanie Powis, Tina Papadakos, Vincenzo Addario, Mike Lovas, Vishal Kukreti, Kristen Haase, Samantha J Mayo, Janet Papadakos, Saeed Moradian, and Monika K Krzyzanowska
- Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BackgroundPatients with cancer require adequate preparation in self-management of treatment toxicities to reduce morbidity that can be achieved through well-designed digital technologies that are developed in co-design with patients and end users. ObjectiveWe undertook a user-centered co-design process in partnership with patients and other knowledge end users to develop and iteratively test an evidence-based and theoretically informed web-based cancer self-management program (I-Can Manage). The specific study aims addressed in 2 phases were to (1) identify from the perspective of patients with cancer and clinicians the desired content, features, and functionalities for an online self-management education and support (SMES) program to enable patient self-management of treatment toxicities (phase 1); (2) develop the SMES prototype based on human-centered, health literate design principles and co-design processes; and (3) evaluate usability of the I-Can Manage prototype through user-centered testing (phase 2). MethodsWe developed the I-Can Manage program using multiperspective data sources and based on humanistic and co-design principles with end users engaged through 5 phases of development. We recruited adult patients with lung, colorectal, and lymphoma cancer receiving systemic treatments from ambulatory clinics in 2 regional cancer programs for the qualitative inquiry phase. The design of the program was informed by data from qualitative interviews and focus groups, persona and journey mapping, theoretical underpinnings of social cognitive learning theory, and formalized usability testing using a cognitive think-aloud process and user satisfaction survey. A co-design team comprising key stakeholders (human design experts, patients/caregiver, clinicians, knowledge end users, and e-learning and digital design experts) was involved in the developmental process. We used a cognitive think-aloud process to test usability and participants completed the Post-Study System Usability Questionnaire (PSSUQ). ResultsIn the initial qualitative inquiry phase, 16 patients participated in interviews and 19 clinicians participated in interviews or focus groups and 12 key stakeholders participated in a persona journey mapping workshop to inform development of the program prototype. The I-Can Manage program integrates evidence-based information and strategies for the self-management of treatment toxicities and health-promoting behaviors in 6 e-learning modules (lay termed “chapters”), starting with an orientation to self-management. Behavioral exercises, patient written and video stories, downloadable learning resources, and online completion of goals and action plans were integrated across chapters. Patient participants (n=5) with different cancers, gender, and age worked through the program in the human factors laboratory using a cognitive think-aloud process and all key stakeholders reviewed each chapter of the program and approved revisions. Results of the PSSUQ (mean total score: 3.75) completed following the cognitive think-aloud process (n=5) suggest patient satisfaction with the usability of I-Can Manage. ConclusionsThe I-Can Manage program has the potential for activating patients in self-management of cancer and treatment toxicities but requires testing in a larger randomized controlled trial.
- Published
- 2023
- Full Text
- View/download PDF
3. Implementation of medication reconciliation in outpatient cancer care
- Author
-
Ernie Mak, Lucy Ma, Vishal Kukreti, Melanie Powis, Ryan Kirkby, Monika K Krzyzanowska, Celina Dara, Alyssa Macedo, Saidah Hack, Lyndon Morley, and Hemangi Dave
- Subjects
Medicine (General) ,R5-920 - Abstract
Background Medication reconciliation (MedRec) is a process where providers work with patients to document and communicate comprehensive medication information by creating a complete medication list (best possible medication history (BPMH)) then reconciling it against what patient is actually taking to identify potential issues such as drug-drug interactions. We undertook an environmental scan of current MedRec practices in outpatient cancer care to inform a quality improvement project at our centre with the aim of 30% of patients having a BPMH or MedRec within 30 days of initiating treatment with systemic therapy.Methods We conducted semi-structured interviews with key stakeholders from 21 cancer centres across Canada, probing on current policies, and barriers and facilitators to MedRec. Guided by the findings of the scan, we then undertook a quality improvement project at our cancer centre, comprising six iterative improvement cycles.Results Most institutions interviewed had a process in place for collecting a BPMH (81%) and targeted patients initiating systemic therapy (59%); however, considerable practice variation was noted and completion of full MedRec was uncommon. Lack of resources, high patient volumes, lack of a common medical record spanning institutions and settings which limits access to medication records from external institutions and community pharmacies were identified as significant barriers. Despite navigating challenges related to the COVID-19 pandemic, we achieved 26.6% of eligible patients with a documented BPMH. However, uptake of full MedRec remained low whereby 4.7% of patients had a documented MedRec.Conclusions Realising improvements to completion of MedRec in outpatient cancer care is possible but takes considerable time and iteration as the process is complex. Resource allocation and information sharing remain major barriers which need to be addressed in order to observe meaningful improvements in MedRec.
- Published
- 2023
- Full Text
- View/download PDF
4. Promoting Self-management and Patient Activation Through eHealth: Protocol for a Systematic Literature Review and Meta-analysis
- Author
-
Saeed Moradian, Roma Maguire, Geoffrey Liu, Monika K Krzyzanowska, Marcus Butler, Chantal Cheung, Marisa Signorile, Nancy Gregorio, Shiva Ghasemi, and Doris Howell
- Subjects
Medicine ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
BackgroundMajor advances in different cancer treatment modalities have been made, and people are now living longer with cancer. However, patients with cancer experience a range of physical and psychological symptoms during and beyond cancer treatment. New models of care are needed to combat this rising challenge. A growing body of evidence supports the effectiveness of eHealth interventions in the delivery of supportive care to people living with the complexities of chronic health conditions. However, reviews on the effects of eHealth interventions are scarce in the field of cancer-supportive care, particularly for interventions with the aim of empowering patients to manage cancer treatment–related symptoms. For this reason, this protocol has been developed to guide a systematic review and meta-analysis to assess the effectiveness of eHealth interventions for supporting patients with cancer in managing cancer-related symptoms. ObjectiveThis systematic review with meta-analysis is conducted with the aim of identifying eHealth-based self-management intervention studies for adult patients with cancer and evaluating the efficacy of eHealth-based self-management tools and platforms in order to synthesize the empirical evidence on self-management and patient activation through eHealth. MethodsA systematic review with meta-analysis and methodological critique of randomized controlled trials is conducted following Cochrane Collaboration methods. Multiple data sources are used to identify all potential research sources for inclusion in the systematic review: (1) electronic databases such as MEDLINE, (2) forward reference searching, and (3) gray literature. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for conducting the review were followed. The PICOS (Population, Interventions, Comparators, Outcomes, and Study Design) framework is used to identify relevant studies. ResultsThe literature search yielded 10,202 publications. The title and abstract screening were completed in May 2022. Data will be summarized, and if possible, meta-analyses will be performed. It is expected to finalize this review by Winter 2023. ConclusionsThe results of this systematic review will provide the latest data on leveraging eHealth interventions and offering effective and sustainable eHealth care, both of which have the potential to improve quality and efficiency in cancer-related symptoms. Trial RegistrationPROSPERO 325582; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=325582 International Registered Report Identifier (IRRID)DERR1-10.2196/38758
- Published
- 2023
- Full Text
- View/download PDF
5. Lessons Learned: It Takes a Village to Understand Inter-Sectoral Care Using Administrative Data across Jurisdictions
- Author
-
Patti Ann Groome, Mary L McBride, Li Jiang, Cynthia Kendell, Kathleen M Decker, Eva Grunfeld, Monika K Krzyzanowska, and Marcy Winget
- Subjects
breast neoplasms ,health services research ,datasets as topic ,methods ,Demography. Population. Vital events ,HB848-3697 - Abstract
Cancer care is complex and exists within the broader healthcare system. The CanIMPACT team sought to enhance primary cancer care capacity and improve integration between primary and cancer specialist care, focusing on breast cancer. In Canada, all medically-necessary healthcare is publicly funded but overseen at the provincial/territorial level. The CanIMPACT Administrative Health Data Group’s (AHDG) role was to describe inter-sectoral care across five Canadian provinces: British Columbia, Alberta, Manitoba, Ontario and Nova Scotia. This paper describes the process used and challenges faced in creating four parallel administrative health datasets. We present the content of those datasets and population characteristics. We provide guidance for future research based on ‘lessons learned’. The AHDG conducted population-based comparisons of care for breast cancer patients diagnosed from 2007-2011. We created parallel provincial datasets using knowledge from data inventories, our previous work, and ongoing bi-weekly conference calls. Common dataset creation plans (DCPs) ensured data comparability and documentation of data differences. In general, the process had to be flexible and iterative as our understanding of the data and needs of the broader team evolved. Inter-sectoral data inconsistencies that we had to address occurred due to differences in: 1) healthcare systems, 2) data sources, 3) data elements and 4) variable definitions. Our parallel provincial datasets describe the breast cancer diagnostic, treatment and survivorship phases and address ten research objectives. Breast cancer patient demographics reflect inter-provincial general population differences. Across provinces, disease characteristics are similar but underlying health status and use of healthcare services differ. Describing healthcare across Canadian jurisdictions assesses whether our provincial healthcare systems are delivering similar high quality, timely, accessible care to all of our citizens. We have provided a description of our experience in trying to achieve this goal and include a list of ‘lessons learned’ and a study process checklist for future use.
- Published
- 2018
- Full Text
- View/download PDF
6. Cardiovascular toxicity of multi-tyrosine kinase inhibitors in advanced solid tumors: a population-based observational study.
- Author
-
Amirrtha Srikanthan, Josee-Lyne Ethier, Alberto Ocana, Bostjan Seruga, Monika K Krzyzanowska, and Eitan Amir
- Subjects
Medicine ,Science - Abstract
Treatment with small molecule tyrosine kinase inhibitors (TKIs) has improved survival in many cancers, yet has been associated with an increased risk of adverse events. Warnings of cardiovascular events are common in drug labels of many TKIs. Despite these warnings, cardiovascular toxicity of patients treated with TKIs remains unclear. Here, we evaluate the cardiovascular outcomes of advanced cancer patients treated with small molecule tyrosine kinase inhibitors.A population based cohort study was undertaken involving adults aged >18 years in Ontario, Canada, diagnosed with any advanced malignancy between 2006 and 2012. Data were extracted from linked administrative governmental databases. Adults with advanced cancer receiving TKIs were identified and followed throughout the time period. The main outcomes of interest were rates of hospitalization for ischemic heart disease (acute myocardial infarction and angina) or cerebrovascular accidents and death.1642 patients with a mean age of 62.5 years were studied; 1046 were treated with erlotinib, 166 with sorafenib and 430 with sunitinib. Over the 380 day median follow-up period (range 6-1970 days), 1.1% of all patients had ischemic heart events, 0.7% had cerebrovascular accidents and 72.1% died. Rates of cardiovascular events were similar to age and gender-matched individuals without cancer. In a subgroup analysis of treatment patients with a prior history of ischemic heart disease, 3.3% had ischemic heart events while 1.2% had cerebrovascular accidents.TKIs do not appear to increase the cause-specific hazard of ischemic heart disease and cerebrovascular accidents compared to age and gender-matched individuals without advanced cancer.
- Published
- 2015
- Full Text
- View/download PDF
7. Patterns of First-Line Systemic Therapy Delivery and Outcomes in Advanced Epithelial Ovarian Cancer in Ontario
- Author
-
Shiru L. Liu, Wing C. Chan, Geneviève Bouchard-Fortier, Stephanie Lheureux, Sarah E. Ferguson, and Monika K. Krzyzanowska
- Subjects
ovarian cancer ,bevacizumab ,real-world evidence ,health care utilization ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: First-line treatment of epithelial ovarian cancer (EOC) consists of a combination of cytoreductive surgery and platinum-based chemotherapy. Recently, targeted therapies such as bevacizumab have been shown to improve oncologic outcomes in a subset of a high-risk population. The objective of this study is to evaluate the patterns of practice and outcomes of first-line systemic treatment of advanced EOC, focusing on the adoption of bevacizumab. Methods: A population cohort study was conducted using administrative data in Ontario, Canada. Patients diagnosed with advanced stage non-mucinous EOC between 2014 and 2018 were identified. Datasets were linked to obtaining information on first-line treatment including surgery, systemic therapy, providers of care, systemic therapy facilities, and acute care utilization (emergency department (ED) visits and hospitalizations) during systemic treatment. Multivariate logistic regression was used to determine factors associated with systemic therapy utilization. Results: Among 3726 patients with advanced EOC, 2838 (76%) received chemotherapy: 1316 (47%) received neoadjuvant chemotherapy, 1060 (37%) underwent primary cytoreductive surgery followed by chemotherapy, and 462 (16%) received chemotherapy only. The median age was 67 (range: 20–100). Most chemotherapies were prescribed by gynecologic oncologists (60%) and in level 1 academic cancer centres (58%). Only 54 patients (3.1%) received bevacizumab in the first-line setting after its approval in Ontario in 2016. Bevacizumab was more likely to be administered by medical oncologists compared to gynecologic oncologists (OR 3.95, 95% CI 2.11–7.14). In total, 1561 (55%) and 1594 (56%) patients had at least one ED visit and/or hospitalization during systemic treatment, respectively. The most common reasons for ED visits were fever and bowel obstruction. Conclusion: Patterns of care for EOC in Ontario differed between care providers. The uptake of bevacizumab for first-line treatment of EOC was low. Acute care utilization related to EOC was high.
- Published
- 2022
- Full Text
- View/download PDF
8. Ambulatory Toxicity Management (AToM) Pilot: results of a pilot study of a pro-active, telephone-based intervention to improve toxicity management during chemotherapy for breast cancer
- Author
-
Monika K. Krzyzanowska, Cassandra MacKay, Heekyung Han, Maria Eberg, Sonal Gandhi, Nicole B. Laferriere, Melanie Powis, Doris Howell, Clare L. Atzema, Kelvin K. W. Chan, Vishal Kukreti, Sandra Mitchell, Marla Nayer, Mark Pasetka, Dafna Knittel-Keren, and Erin Redwood
- Subjects
Breast cancer ,Symptom management ,Chemotherapy toxicity ,Telephone case management ,Quality improvement ,Medicine (General) ,R5-920 - Abstract
Abstract Background Chemotherapy is associated with a significant risk of toxicity, which often peaks between ambulatory visits to the cancer centre. Remote symptom management support is a tool to optimize self-management and healthcare utilization, including emergency department visits and hospitalizations (ED+H) during chemotherapy. We performed a single-arm pilot study to evaluate the feasibility, acceptability, and potential impact of a telephone symptom management intervention on healthcare utilization during chemotherapy for early stage breast cancer (EBC). Methods Women starting adjuvant or neoadjuvant chemotherapy for EBC at two cancer centres in Ontario, Canada, received standardized, nurse-led calls to assess common toxicities at two time points following each chemotherapy administration. Feasibility outcomes included patient enrollment, retention, RN adherence to delivering calls per the study schedule, and resource use associated with calls; acceptability was evaluated based on patient and provider feedback. Impact on acute care utilization was evaluated post hoc by linking individual patient records to provincial data holdings to examine ED+H patterns among participating patients compared to contemporaneous controls. Results Between September 2013 and December 2014, 77 women were enrolled (mean age 55 years). Most commonly used regimens were AC-paclitaxel (58%) and FEC-docetaxel (16%); 78% of patients received primary granulocyte colony-stimulating factor prophylaxis. 83.8% of calls were delivered per schedule; mean call duration was 9 min. The intervention was well received by both patients and clinicians. Comparison of ED+H rates among study participants versus controls showed that there were fewer ED visits in intervention patients [incidence rate ratio (IRR) (95% CI) = 0.54 (0.36, 0.81)] but no difference in the rate of hospitalizations [IRR (95% CI) = 1.02 (0.59, 1.77)]. Main implementation challenges included identifying eligible patients, fitting the calls into existing clinical responsibilities, and effective communication to the patient’s clinical team. Conclusions Telephone-based pro-active toxicity management during chemotherapy is feasible, perceived as valuable by clinicians and patients, and may be associated with lower rates of acute care use. However, attention must be paid to workflow issues for scalability. Larger scale evaluation of this approach is in progress.
- Published
- 2019
- Full Text
- View/download PDF
9. Molecular profiling of advanced solid tumors and patient outcomes with genotype-matched clinical trials: the Princess Margaret IMPACT/COMPACT trial
- Author
-
Tracy L. Stockley, Amit M. Oza, Hal K. Berman, Natasha B. Leighl, Jennifer J. Knox, Frances A. Shepherd, Eric X. Chen, Monika K. Krzyzanowska, Neesha Dhani, Anthony M. Joshua, Ming-Sound Tsao, Stefano Serra, Blaise Clarke, Michael H. Roehrl, Tong Zhang, Mahadeo A. Sukhai, Nadia Califaretti, Mateya Trinkaus, Patricia Shaw, Theodorus van der Kwast, Lisa Wang, Carl Virtanen, Raymond H. Kim, Albiruni R. A. Razak, Aaron R. Hansen, Celeste Yu, Trevor J. Pugh, Suzanne Kamel-Reid, Lillian L. Siu, and Philippe L. Bedard
- Subjects
Molecular profiling ,DNA sequencing ,Clinical trials ,Solid tumors ,Precision medicine ,Medicine ,Genetics ,QH426-470 - Abstract
Abstract Background The clinical utility of molecular profiling of tumor tissue to guide treatment of patients with advanced solid tumors is unknown. Our objectives were to evaluate the frequency of genomic alterations, clinical “actionability” of somatic variants, enrollment in mutation-targeted or other clinical trials, and outcome of molecular profiling for advanced solid tumor patients at the Princess Margaret Cancer Centre (PM). Methods Patients with advanced solid tumors aged ≥18 years, good performance status, and archival tumor tissue available were prospectively consented. DNA from archival formalin-fixed paraffin-embedded tumor tissue was tested using a MALDI-TOF MS hotspot panel or a targeted next generation sequencing (NGS) panel. Somatic variants were classified according to clinical actionability and an annotated report included in the electronic medical record. Oncologists were provided with summary tables of their patients’ molecular profiling results and available mutation-specific clinical trials. Enrolment in genotype-matched versus genotype-unmatched clinical trials following release of profiling results and response by RECIST v1.1 criteria were evaluated. Results From March 2012 to July 2014, 1893 patients were enrolled and 1640 tested. After a median follow-up of 18 months, 245 patients (15 %) who were tested were subsequently treated on 277 therapeutic clinical trials, including 84 patients (5 %) on 89 genotype-matched trials. The overall response rate was higher in patients treated on genotype-matched trials (19 %) compared with genotype-unmatched trials (9 %; p
- Published
- 2016
- Full Text
- View/download PDF
10. Primary Care Continuity and Wait Times to Receiving Breast Cancer Chemotherapy: A Population-Based Retrospective Cohort Study Using CanIMPACT Data
- Author
-
Eva Grunfeld, Rahim Moineddin, Aisha Lofters, Rachel Lin Walsh, and Monika K. Krzyzanowska
- Subjects
Pediatrics ,medicine.medical_specialty ,Waiting Lists ,medicine.medical_treatment ,Population ,Breast Neoplasms ,Article ,wait times ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer chemotherapy ,Breast cancer ,breast cancer ,mental disorders ,Medicine ,Humans ,030212 general & internal medicine ,skin and connective tissue diseases ,education ,RC254-282 ,Retrospective Studies ,education.field_of_study ,business.industry ,Primary care physician ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Cancer ,Retrospective cohort study ,Continuity of Patient Care ,medicine.disease ,Confidence interval ,3. Good health ,primary health care ,030220 oncology & carcinogenesis ,Population study ,Female ,business ,population health - Abstract
(1) Background: Wait times to chemotherapy are associated with morbidity and mortality in breast cancer patients, however, it is unclear how primary care physician (PCP) continuity impacts these wait times, or whether this association is different in immigrants, who experience cancer care inequities. We assessed the association between PCP continuity and the contact-to-chemotherapy interval (wait time from when a patient first presents to healthcare to the first day of receiving breast cancer chemotherapy), with a specific look at the immigrant population. (2) Methods: Population-based, retrospective cohort study of women who were diagnosed with stage I–III breast cancer in Ontario who received surgery and adjuvant chemotherapy. We used quantile regression at the median and 90th percentile to quantify the effect of PCP continuity on the contact-to-chemotherapy interval, performing a separate analysis on the immigrant population. (3) Results: Among 12,781 breast cancer patients, including 1706 immigrants, the median contact-to-chemotherapy interval (126 days) was 3.21 days shorter (95% confidence interval (CI) 0.47–5.96) in symptom-detected patients with low PCP continuity, 10.68 days shorter (95% CI 5.36–16.00) in symptom-detected patients with no baseline PCP visits and 17.43 days longer (95% CI 0.90–34.76) in screen-detected immigrants with low PCP continuity compared to the same groups with high PCP continuity. (4) Conclusions: Higher PCP continuity was not associated with a change in the contact-to-chemotherapy interval for most of our study population, but was associated with a marginally longer interval in our symptom-detected population and a shorter contact-to-chemotherapy interval in screen-detected immigrants. This highlights the importance of PCP continuity among immigrants with positive screening results. Additionally, having no PCP visits at baseline was associated with a shorter contact-to-chemotherapy interval in symptom-detected patients.
- Published
- 2021
11. Estimating the optimal perioperative chemotherapy utilization rate for muscle‐invasive bladder cancer
- Author
-
Kelly Brennan, Yingwei Peng, Monika K. Krzyzanowska, Christopher M. Booth, William J. Mackillop, D. Robert Siemens, and Safiya Karim
- Subjects
0301 basic medicine ,Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Multivariate analysis ,Population ,Comorbidity ,lcsh:RC254-282 ,Perioperative Care ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Case mix index ,Internal medicine ,medicine ,Animals ,Humans ,Radiology, Nuclear Medicine and imaging ,Neoplasm Invasiveness ,benchmarking ,education ,Original Research ,Aged ,Aged, 80 and over ,education.field_of_study ,Bladder cancer ,business.industry ,Clinical Cancer Research ,Perioperative ,Middle Aged ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Cancer registry ,Disease Models, Animal ,030104 developmental biology ,Treatment Outcome ,Oncology ,Urinary Bladder Neoplasms ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Population study ,bladder cancer ,Female ,business ,Utilization rate ,neoadjuvant chemotherapy - Abstract
Background Identifying optimal chemotherapy (CT) utilization rates can drive improvements in quality of care. We report a benchmarking approach to estimate the optimal rate of perioperative CT for muscle‐invasive bladder cancer (MIBC). Methods The Ontario Cancer Registry and linked treated records were used to identify neoadjuvant and adjuvant CT rates among patients with MIBC during 2004‐2013. Monte Carlo simulation was used to estimate the proportion of observed rate variation that could be due to chance alone. The criterion‐based benchmarking approach was used to explore whether social and health‐system factors were associated with CT rates. We also used the “pared‐mean” approach to identify a benchmark population of hospitals with the highest treatment rates. Hospital CT rates were adjusted for case mix and simulated using a multi‐level multivariable model and a parametric bootstrapping approach. Results The study population included 2581 patients; perioperative CT was delivered to 31% (798/2581). Multivariate analysis showed that treatment was strongly associated with patient socioeconomic status and hospital teaching status. The benchmark rate was 36%. Unadjusted CT rates were significantly different across hospitals (range 0%‐52%, P, Identifying optimal chemotherapy (CT) utilization rates can drive improvements in quality of care. In this benchmarking study of neoadjuvant chemotherapy for muscle‐invasive bladder cancer (MIBC), we found that treatment was strongly associated with patient socioeconomic status and hospital teaching status. The benchmark rate of neoadjuvant chemotherapy for MIBC was 36%‐41%.
- Published
- 2019
12. Ambulatory Toxicity Management (AToM) Pilot: results of a pilot study of a pro-active, telephone-based intervention to improve toxicity management during chemotherapy for breast cancer
- Author
-
Vishal Kukreti, Clare L. Atzema, Melanie Lynn Powis, Doris Howell, Marla Nayer, Erin Redwood, Sandra Mitchell, Sonal Gandhi, Kelvin K. W. Chan, Mark Pasetka, Monika K. Krzyzanowska, Heekyung Han, Maria Eberg, Dafna Knittel-Keren, Cassandra MacKay, and Nicole Laferriere
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Medicine (miscellaneous) ,Telephone case management ,Rate ratio ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Acute care ,medicine ,030212 general & internal medicine ,Stage (cooking) ,Quality improvement ,Chemotherapy toxicity ,Chemotherapy ,lcsh:R5-920 ,business.industry ,Research ,Cancer ,Symptom management ,Emergency department ,medicine.disease ,Emergency medicine ,Ambulatory ,business ,lcsh:Medicine (General) ,030217 neurology & neurosurgery - Abstract
Background Chemotherapy is associated with a significant risk of toxicity, which often peaks between ambulatory visits to the cancer centre. Remote symptom management support is a tool to optimize self-management and healthcare utilization, including emergency department visits and hospitalizations (ED+H) during chemotherapy. We performed a single-arm pilot study to evaluate the feasibility, acceptability, and potential impact of a telephone symptom management intervention on healthcare utilization during chemotherapy for early stage breast cancer (EBC). Methods Women starting adjuvant or neoadjuvant chemotherapy for EBC at two cancer centres in Ontario, Canada, received standardized, nurse-led calls to assess common toxicities at two time points following each chemotherapy administration. Feasibility outcomes included patient enrollment, retention, RN adherence to delivering calls per the study schedule, and resource use associated with calls; acceptability was evaluated based on patient and provider feedback. Impact on acute care utilization was evaluated post hoc by linking individual patient records to provincial data holdings to examine ED+H patterns among participating patients compared to contemporaneous controls. Results Between September 2013 and December 2014, 77 women were enrolled (mean age 55 years). Most commonly used regimens were AC-paclitaxel (58%) and FEC-docetaxel (16%); 78% of patients received primary granulocyte colony-stimulating factor prophylaxis. 83.8% of calls were delivered per schedule; mean call duration was 9 min. The intervention was well received by both patients and clinicians. Comparison of ED+H rates among study participants versus controls showed that there were fewer ED visits in intervention patients [incidence rate ratio (IRR) (95% CI) = 0.54 (0.36, 0.81)] but no difference in the rate of hospitalizations [IRR (95% CI) = 1.02 (0.59, 1.77)]. Main implementation challenges included identifying eligible patients, fitting the calls into existing clinical responsibilities, and effective communication to the patient’s clinical team. Conclusions Telephone-based pro-active toxicity management during chemotherapy is feasible, perceived as valuable by clinicians and patients, and may be associated with lower rates of acute care use. However, attention must be paid to workflow issues for scalability. Larger scale evaluation of this approach is in progress. Electronic supplementary material The online version of this article (10.1186/s40814-019-0404-y) contains supplementary material, which is available to authorized users.
- Published
- 2019
13. Utilization Rates of Pancreatectomy, Radical Prostatectomy, and Nephrectomy in New York, Ontario, and New South Wales, 2011 to 2018
- Author
-
Hilary Pang, Bruce E. Landon, Adam G Elshaug, Peter Cram, Kelsey Chalmers, Bradley A. Erickson, Girish S. Kulkarni, Vicki Ling, Monika K. Krzyzanowska, and John Matelski
- Subjects
Male ,medicine.medical_treatment ,New York ,Nephrectomy ,Pancreatectomy ,Per capita ,medicine ,Humans ,Original Investigation ,Aged ,Retrospective Studies ,Ontario ,Prostatectomy ,business.industry ,Research ,Health Policy ,General Medicine ,Surgical procedures ,Middle Aged ,Online Only ,Social Class ,Female ,New South Wales ,business ,Procedures and Techniques Utilization ,Surgical patients ,Demography ,Cohort study - Abstract
Key Points Question Do utilization rates for pancreatectomy, radical prostatectomy, and nephrectomy differ between New York State (US), Ontario (Canada), and New South Wales (Australia), and do income-based differences in utilization vary between countries? Findings This cohort study of 115 428 surgical patients found significantly lower surgical utilization in Ontario than in New York and New South Wales. Residents of lower-income neighborhoods had lower rates of surgery than residents of higher-income neighborhoods in all countries; income-based differences were significantly smaller in Ontario than in New York and New South Wales. Meaning In this study, Ontario had lower surgical utilization rates and smaller differences in utilization between patients in high-income vs low-income neighborhoods, but income-based disparities were present in all jurisdictions., This cohort study compares population-level utilization of pancreatectomy, radical prostatectomy, and nephrectomy in New York (US), Ontario (Canada), and New South Wales (Australia) and how utilization differs for residents of lower- and higher-income neighborhoods., Importance Few studies have compared surgical utilization between countries or how rates may differ according to patients’ socioeconomic status. Objective To compare population-level utilization of 3 common nonemergent surgical procedures in New York State (US), Ontario (Canada), and New South Wales (Australia) and how utilization differs for residents of lower- and higher-income neighborhoods. Design, Setting, and Participants This cohort study included all adults aged 18 years and older who were hospitalized for pancreatectomy, radical prostatectomy, or nephrectomy between 2011 and 2016 in New York, between 2011 and 2018 in Ontario, and between 2013 and 2018 in New South Wales. Each patient’s address of residence was linked to 2016 census data to ascertain neighborhood income. Data were analyzed from August 2019 to November 2020. Main Outcomes and Measures Primary outcomes were (1) each jurisdiction’s per capita age- and sex-standardized utilization rates (procedures per 100 000 residents per year) for each surgery and (2) utilization rates among residents of lower- and higher-income neighborhoods. Results This study included 115 428 surgical patients (25 780 [22.3%] women); 5717, 21 752, and 24 617 patients in New York were hospitalized for pancreatectomy, radical prostatectomy, and nephrectomy, respectively; 4929, 19 125, and 16 916 patients in Ontario, respectively; and 2069, 13 499, and 6804 patients in New South Wales, respectively. Patients in New South Wales were older for all procedures (eg, radical prostatectomy, mean [SD] age in New South Wales, 64.8 [7.3] years; in New York, 62.7 [8.4] years; in Ontario, 62.8 [6.7] years; P
- Published
- 2021
14. Selecting, implementing and evaluating patient-reported outcome measures for routine clinical use in cancer: the Cancer Care Ontario approach
- Author
-
Monika K. Krzyzanowska, Zahra Ismail, Denise Bryant-Lukosius, Lesley Moody, Michael Brundage, Doris Howell, Lisa Barbera, Susan J. Bartlett, Nicole Montgomery, and Claire F. Snyder
- Subjects
medicine.medical_specialty ,Standardization ,Clinical care ,business.industry ,lcsh:Public aspects of medicine ,Research ,Health Informatics ,Usability ,Qualitative property ,lcsh:RA1-1270 ,Symptom management ,Prom ,Recommendations ,female genital diseases and pregnancy complications ,Test (assessment) ,Identification (information) ,Health Information Management ,Patient-reported outcome measures ,Agency (sociology) ,medicine ,Patient-reported outcome ,Medical physics ,business ,Psychology ,Routine care - Abstract
Background The use of Patient-Reported Outcome Measures (PROMs) in routine clinical care can help ensure symptoms are identified, acknowledged and addressed. In 2007, the provincial cancer agency, Cancer Care Ontario, began to implement routine symptom screening with the Edmonton Symptom Assessment System (ESAS) for ambulatory cancer patients. Having had a decade of experience with ESAS, the program developed a strategic interest in implementing new and/or additional measures. This article describes the development of a streamlined PROM selection and implementation evaluation process with core considerations. Methods Development of the PROM selection and implementation evaluation process involved analysis of quantitative and qualitative data as well as consensus building through a multi-stakeholder workshop. Core PROM selection considerations were developed through a literature scan, review and refinement by a panel of methodological experts and patient advisors, and testing via a test case. Core PROM implementation evaluation considerations were developed through analysis of PROM evaluation frameworks, and review and refinement by a committee of provincial implementation leads. Results Core PROM selection considerations were identified under three overarching themes: symptom coverage, usability and psychometric properties. The symptom coverage category assesses each PROM to determine how well the PROM items address the most prevalent and burdensome symptoms in the target patient population. The usability category aims to assess each measure on characteristics key to successful implementation in the clinical setting. The psychometric properties category assesses each PROM to ensure the data collected is credible, meaningful and interpretable. A scoring system was developed to rate PROM performance by assigning a grade of “weak”, “average” or “good” for each category. The process results in a summary matrix which illustrates the overall assessment of each PROM. Implementation evaluation considerations were identified under three overarching concepts: acceptability, outcomes, and sustainability. A consensus building exercise resulted in the further identification of patient, provider, and clinic specific indicators for each consideration. Conclusion To address the need for a systematic, evidence-based approach to selection, implementation and evaluation of PROMs in the clinical setting, Cancer Care Ontario defined a process with embedded core considerations to facilitate decision-making and encourage standardization.
- Published
- 2020
15. Feasibility randomised controlled trial of remote symptom chemotherapy toxicity monitoring using the Canadian adapted Advanced Symptom Management System (ASyMS-Can): a study protocol
- Author
-
Vishal Kukreti, Monika K. Krzyzanowska, Eitan Amir, Saeed Moradian, Geoffrey Liu, Doris Howell, Plinio P. Morita, and Roma Maguire
- Subjects
QA75 ,medicine.medical_specialty ,Telemedicine ,medicine.medical_treatment ,lcsh:Medicine ,Antineoplastic Agents ,world wide web technology ,law.invention ,RC0254 ,Quality of life (healthcare) ,Randomized controlled trial ,law ,Intervention (counseling) ,Neoplasms ,medicine ,Humans ,Prospective Studies ,Randomized Controlled Trials as Topic ,Protocol (science) ,Ontario ,Chemotherapy ,Symptom management ,business.industry ,lcsh:R ,Cancer ,General Medicine ,medicine.disease ,Telephone ,Oncology ,Research Design ,Emergency medicine ,adult oncology ,Feasibility Studies ,telemedicine ,Drug Monitoring ,Symptom Assessment ,business - Abstract
IntroductionTechnology is emerging as a solution to develop home-based, proactive ‘real-time’ symptom monitoring and management in cancer care. The Advanced Symptom Monitoring and Management System—Canada (ASyMS-Can) is a remote phone-based symptom management system that enables real-time remote monitoring of systemic chemotherapy toxicities.Methods and analysisThis study is an open-label, prospective, mixed-method, Phase II, 2-arm parallel group assignment (ASyMS-Can vs usual care) feasibility study in patients with cancer receiving systemic (neo-adjuvant or adjuvant) chemotherapy at Princess Margaret Cancer Centre. A total of 114 patients will be recruited in oncology clinics prior to initiation of chemotherapy. Patients in both arms will complete a demographic and a set of questionnaires at enrolment, mid and end of treatment. Patients in intervention arm will be provided with an encrypted, secure, preprogrammed ASyMS phone for symptom reporting daily for the first 14 days of each chemotherapy treatment cycle up to sixth cycle (16 weeks). Feasibility metrics (recruitment, retention and protocol adherence) and outcomes to assess impact of ASyMS—Can include symptom severity, emotional distress, quality of life and acceptability to patients and clinicians.Ethics and disseminationThe study has received ethical and institutional approvals from the University Health Network. Dissemination will include presentations at national/international conferences, and publications in peer-reviewed journals.Trial registration numberNCT03335189.
- Published
- 2020
16. A primer on the genetics of medullary thyroid cancer
- Author
-
V. Larouche, Carissa M. Thomas, Shereen Ezzat, Monika K. Krzyzanowska, and Amit Akirov
- Subjects
multiple endocrine neoplasia type 2 ,vandetanib ,endocrine system ,endocrine system diseases ,Multiple endocrine neoplasia type 2 ,Disease ,Review Article ,Vandetanib ,Proto-Oncogene Mas ,Germline ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Genetic Testing ,Thyroid Neoplasms ,Multiple endocrine neoplasia ,Thyroid cancer ,Genetic Association Studies ,Medullary thyroid cancer ,business.industry ,Thyroid ,Proto-Oncogene Proteins c-ret ,medicine.disease ,Carcinoma, Neuroendocrine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Mutation ,Cancer research ,business ,RET ,medicine.drug - Abstract
Medullary thyroid cancer is a rare type of neuroendocrine tumour that arises from the parafollicular cells (C cells) of the thyroid gland. It accounts for 3%&ndash, 5% of thyroid cancer cases. Close to 25% of cases are familial, and 75% are considered sporadic. Familial cases are associated with a germline RET mutation, 43%&ndash, 65% of sporadic cases harbour a somatic event in the gene. Germline RET mutations are associated with the autosomal-dominant inherited multiple endocrine neoplasia (men) 2a and 2b syndromes and the isolated familial medullary thyroid cancer syndrome. More than 100 RET codon mutations have been reported to date, with genotype&ndash, phenotype correlations that include the extent and aggressiveness of the medullary thyroid cancer and the presence of other features of the men2 syndromes. The latter include pheochromocytoma&ndash, paraganglioma, hyperparathyroidism, cutaneous lichen amyloidosis, and Hirschsprung disease.
- Published
- 2019
17. Additional germline findings from a tumor profiling program
- Author
-
Amit M. Oza, Raymond Jang, Lillian L. Siu, Kara Semotiuk, Philippe L. Bedard, Suzanne Kamel-Reid, Melyssa Aronson, Tracy Stockley, Jeanna McCuaig, Christine Elser, Monika K. Krzyzanowska, Abha A. Gupta, Lisa Wang, Neda Stjepanovic, Natasha B. Leighl, Raymond H. Kim, Lailah Ahmed, and Spring Holter
- Subjects
0301 basic medicine ,Oncology ,Male ,Germline ,Cohort Studies ,0302 clinical medicine ,Neoplasms ,Germline mutation ,Schwannomatosis ,Genetics (clinical) ,Aged, 80 and over ,medicine.diagnostic_test ,High-Throughput Nucleotide Sequencing ,Middle Aged ,Neoplastic syndromes ,Neoplasms/genetics ,Incidental findings ,030220 oncology & carcinogenesis ,Cohort ,Medical genetics ,Female ,Research Article ,Adult ,medicine.medical_specialty ,lcsh:Internal medicine ,Adolescent ,lcsh:QH426-470 ,03 medical and health sciences ,Young Adult ,Secondary findings ,Internal medicine ,Next generation sequencing ,Genetics ,medicine ,Humans ,Genetic Predisposition to Disease ,Genetic Testing ,lcsh:RC31-1245 ,Allele frequency ,Germ-Line Mutation ,Genetic testing ,Aged ,business.industry ,Hereditary Cancer ,medicine.disease ,Human genetics ,lcsh:Genetics ,030104 developmental biology ,business - Abstract
Background Matched tumor-normal sequencing, applied in precision cancer medicine, can identify unidentified germline Medically Actionable Variants (gMAVS) in cancer predisposition genes. We report patient preferences for the return of additional germline results, and describe various gMAV scenarios delivered through a clinical genetics service. Methods Tumor profiling was offered to 1960 advanced cancer patients, of which 1556 underwent tumor-normal sequencing with multigene hotspot panels containing 20 cancer predisposition genes. All patients were provided with an IRB-approved consent for return of additional gMAVs. Results Of the whole cohort 94% of patients consented to be informed of additional germline results and 5% declined, with no statistically significant differences based on age, sex, race or prior genetic testing. Eight patients were found to have gMAVs in a cancer predisposition gene. Five had previously unidentified gMAVs: three in TP53 (only one fulfilled Chompret’s Revised criteria for Li-Fraumeni Syndrome), one in SMARCB1 in the absence of schwannomatosis features and one a TP53 variant at low allele frequency suggesting an acquired event in blood. Conclusion Interest in germline findings is high among patients who undergo tumor profiling. Disclosure of previously unidentified gMAVs present multiple challenges, thus supporting the involvement of a clinical genetics service in all tumor profiling programs. Electronic supplementary material The online version of this article (10.1186/s12920-018-0383-5) contains supplementary material, which is available to authorized users.
- Published
- 2018
18. Characterization of Tumor Size Changes Over Time From the Phase 3 Study of Lenvatinib in Thyroid Cancer
- Author
-
Jaume Capdevila, Martin Schlumberger, Makoto Tahara, Bruce G. Robinson, James Song, Matthew H. Taylor, Lori J. Wirth, Steven I. Sherman, Corina E. Dutcus, Monika K. Krzyzanowska, and Sung Bae Kim
- Subjects
Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Clinical Biochemistry ,Phases of clinical research ,030209 endocrinology & metabolism ,Context (language use) ,Antineoplastic Agents ,Placebo ,Biochemistry ,Disease-Free Survival ,03 medical and health sciences ,chemistry.chemical_compound ,Young Adult ,0302 clinical medicine ,Endocrinology ,Double-Blind Method ,Internal medicine ,Outcome Assessment, Health Care ,medicine ,Humans ,Thyroid Neoplasms ,Thyroid cancer ,Aged ,Aged, 80 and over ,business.industry ,Phenylurea Compounds ,Biochemistry (medical) ,Cancer ,Original Articles ,Middle Aged ,medicine.disease ,Clinical trial ,chemistry ,Response Evaluation Criteria in Solid Tumors ,030220 oncology & carcinogenesis ,Quinolines ,Female ,business ,Lenvatinib ,Follow-Up Studies - Abstract
Context: Lenvatinib improved the progression-free survival (PFS) and overall response rate of patients with radioiodine-refractory differentiated thyroid cancer vs placebo in the Phase 3 Study of (E7080) Lenvatinib in Differentiated Cancer of the Thyroid (SELECT). Objective: The objective of the study was to characterize tumor size changes with lenvatinib treatment. Design: SELECT was a phase 3, randomized, double-blind, multicenter study. Setting: In this clinical trial, tumor assessments of lenvatinib (n = 261) and placebo-treated (n = 131) patients were performed by independent radiological review per Response Evaluation Criteria in Solid Tumors version, 1.1 at 8-week intervals. Patients: Patients with complete or partial response were defined as responders to lenvatinib (n = 169). Of the 92 nonresponders, 76 had at least one postbaseline tumor assessment and were included in this analysis. Interventions: Lenvatinib (24 mg once daily) or placebo in 28-day cycles until unacceptable toxicity, disease progression, or death. Main Outcome Measures: This was an exploratory analysis of key end points from SELECT, including PFS, overall response rate, and tumor reduction. Results: The median maximum percentage change in tumor size was −42.9% for patients receiving lenvatinib (responders, −51.9%; nonresponders, −20.2%). Tumor size reduction was most pronounced at first assessment (median, −24.7% at 8 wk after randomization); thereafter, the rate of change was slower but continuous (−1.3% per mo). In a multivariate model, percentage change in tumor size at the first assessment was a marginally significant positive predictor for PFS (P = .06). Conclusions: The change in tumor size conferred by lenvatinib was characterized by two phases: an initial, rapid decline, followed by slower, continuous shrinkage., In the phase 3 SELECT study, change in tumor size mediated by lenvatinib treatment occurred in 2 phases, with an initial rapid decline followed by slower continuous shrinkage.
- Published
- 2016
19. Genome analysis and data sharing informs timing of molecular events in pancreatic neuroendocrine tumour
- Author
-
Arnavaz Danesh, Adam C. Smith, Tiantian Li, S. Y. Cindy Yang, Rene Quevedo, Simron Singh, Jeff Bruce, Sylvia L. Asa, Cherry Have, Suzanne Kamel-Reid, Amanda Giesler, Tong Zhang, Lillian L. Siu, Monika K. Krzyzanowska, Benjamin Haibe-Kains, Youstina Hanna, Anna Spreafico, and Trevor J. Pugh
- Subjects
Whole genome sequencing ,Loss of heterozygosity ,Death-associated protein 6 ,Somatic cell ,MEN1 ,Computational biology ,Biology ,Exome ,Genome ,ATRX - Abstract
Neuroendocrine tumours (NETs) are rare, slow growing cancers that present in a diversity of tissues. To understand molecular underpinnings of gastrointestinal (GINET) and pancreatic NETs (PNETs), we profiled 45 tumours combining exome, RNA, and shallow whole genome sequencing, as well as fluorescent in situ hybridization. In addition to expected somatic mutations and copy number alterations, we found that PNETs contained a highly consistent copy neutral loss-of-heterozygosity (CN-LOH) profile affecting over half of the genome; a greater percentage than any cancer analyzed to date. Our data indicates that onset of extreme autozygosity may be progressive, associated with metastasis, and initially triggered by the loss ofDAXX/ATRX, and subsequent biallelic loss ofMEN1. We confirmed this molecular timing model using targeted clinical sequencing data from an additional 43 NETs made available by the AACR GENIE project. Against this background of CN-LOH, several chromosomal regions consistently retained heterozygosity, suggesting selection for crucial allele-specific components specific to PNET progression and potential new therapeutic targets.Statement of significanceWe have discovered that pancreatic neuroendocrine tumours contain a characteristic pattern of copy neutral loss-of-heterozygosity affecting the majority of the genome following mutations ofMEN1andATRX/DAXX. Against this background of loss-of-heterozygosity, specific genomic regions are consistently retained and may therefore contain vulnerable therapeutic targets for pancreatic neuroendocrine tumours.
- Published
- 2018
- Full Text
- View/download PDF
20. Use of physician services during the survivorship phase: a multi-province study of women diagnosed with breast cancer
- Author
-
Donna Turner, Cynthia Kendell, Patti A. Groome, K. Decker, Li Jiang, Mary L. McBride, Robin Urquhart, Marcy Winget, Monika K. Krzyzanowska, G. Porter, and Eva Grunfeld
- Subjects
medicine.medical_specialty ,Population ,Specialty ,Primary care ,follow-up care ,03 medical and health sciences ,primary care ,0302 clinical medicine ,Breast cancer ,Ambulatory care ,Survivorship curve ,medicine ,030212 general & internal medicine ,education ,education.field_of_study ,business.industry ,Cancer ,survivors ,Retrospective cohort study ,social sciences ,medicine.disease ,humanities ,3. Good health ,030220 oncology & carcinogenesis ,Family medicine ,Emergency medicine ,population characteristics ,Original Article ,business ,human activities - Abstract
Oncologists have traditionally been responsible for providing routine follow-up care for cancer survivors, in recent years, however, primary care providers (pcps) are taking a greater role in care during the follow-up period. In the present study, we used a longitudinal multi-province retrospective cohort study to examine how primary care and specialist care intersect in the delivery of breast cancer follow-up care. Various databases (registry, clinical, and administrative) were linked in each of four provinces: British Columbia, Manitoba, Ontario, and Nova Scotia. Population-based cohorts of breast cancer survivors were identified in each province. Physician visits were identified using billings or claims data and were classified as visits to primary care (total, breast cancer&ndash, specific, and other), oncology (medical oncology, radiation oncology, and surgery), and other specialties. The mean numbers of visits by physician type and specialty, or by combinations thereof, were examined. The mean numbers of visits for each follow-up year were also examined by physician type. The results showed that many women (>64%) in each province received care from both primary care and oncology providers during the follow-up period. The mean number of breast cancer&ndash, specific visits to primary care and visits to oncology declined with each follow-up year. Interprovincial variations were observed, with greater surgeon follow-up in Nova Scotia and greater primary care follow-up in British Columbia. Provincial differences could reflect variations in policies and recommendations, relevant initiatives, and resources or infrastructure to support pcp-led follow-up care. Optimizing the role of pcps in breast cancer follow-up care might require strategies to change attitudes about pcp-led follow-up and to better support pcps in providing survivorship care.
- Published
- 2017
21. Molecular profiling of advanced solid tumors and patient outcomes with genotype-matched clinical trials: the Princess Margaret IMPACT/COMPACT trial
- Author
-
Nadia Califaretti, Lillian L. Siu, Neesha C. Dhani, Mateya Trinkaus, Trevor J. Pugh, Carl Virtanen, Tong Zhang, Theodorus van der Kwast, Blaise A. Clarke, Eric X. Chen, Albiruni Ryan Abdul Razak, Natasha B. Leighl, Mahadeo A. Sukhai, Hal K. Berman, Michael H.A. Roehrl, Anthony M. Joshua, Patricia Shaw, Amit M. Oza, Ming-Sound Tsao, Monika K. Krzyzanowska, Suzanne Kamel-Reid, Aaron R. Hansen, Frances A. Shepherd, Lisa Wang, Raymond H. Kim, Jennifer J. Knox, Stefano Serra, Tracy Stockley, Philippe L. Bedard, and Celeste Yu
- Subjects
0301 basic medicine ,Oncology ,Male ,lcsh:Medicine ,Bioinformatics ,Molecular profiling ,0302 clinical medicine ,Clinical trials ,Gene Frequency ,Neoplasms ,Genotype ,Solid tumors ,Genetics(clinical) ,DNA sequencing ,Molecular Targeted Therapy ,Young adult ,Genetics (clinical) ,Aged, 80 and over ,Precision medicine ,High-Throughput Nucleotide Sequencing ,DNA, Neoplasm ,Middle Aged ,Immunohistochemistry ,Response Evaluation Criteria in Solid Tumors ,030220 oncology & carcinogenesis ,Molecular Medicine ,Female ,Early phase ,Adult ,medicine.medical_specialty ,Canada ,lcsh:QH426-470 ,Adolescent ,03 medical and health sciences ,Young Adult ,Internal medicine ,medicine ,Genetics ,Biomarkers, Tumor ,Humans ,Genetic Predisposition to Disease ,Allele frequency ,Molecular Biology ,Aged ,Performance status ,business.industry ,Research ,lcsh:R ,Clinical trial ,lcsh:Genetics ,030104 developmental biology ,Mutation ,business - Abstract
Background The clinical utility of molecular profiling of tumor tissue to guide treatment of patients with advanced solid tumors is unknown. Our objectives were to evaluate the frequency of genomic alterations, clinical “actionability” of somatic variants, enrollment in mutation-targeted or other clinical trials, and outcome of molecular profiling for advanced solid tumor patients at the Princess Margaret Cancer Centre (PM). Methods Patients with advanced solid tumors aged ≥18 years, good performance status, and archival tumor tissue available were prospectively consented. DNA from archival formalin-fixed paraffin-embedded tumor tissue was tested using a MALDI-TOF MS hotspot panel or a targeted next generation sequencing (NGS) panel. Somatic variants were classified according to clinical actionability and an annotated report included in the electronic medical record. Oncologists were provided with summary tables of their patients’ molecular profiling results and available mutation-specific clinical trials. Enrolment in genotype-matched versus genotype-unmatched clinical trials following release of profiling results and response by RECIST v1.1 criteria were evaluated. Results From March 2012 to July 2014, 1893 patients were enrolled and 1640 tested. After a median follow-up of 18 months, 245 patients (15 %) who were tested were subsequently treated on 277 therapeutic clinical trials, including 84 patients (5 %) on 89 genotype-matched trials. The overall response rate was higher in patients treated on genotype-matched trials (19 %) compared with genotype-unmatched trials (9 %; p
- Published
- 2016
22. Approach to fever assessment in ambulatory cancer patients receiving chemotherapy: a clinical practice guideline
- Author
-
Monika K. Krzyzanowska, C. Walker-Dilks, Clare L. Atzema, R. Gupta, Tom Kouroukis, K. McCann, A. Morris, and R. Halligan
- Subjects
medicine.medical_specialty ,Fever ,business.industry ,MEDLINE ,Cancer ,Retrospective cohort study ,Guideline ,medicine.disease ,chemotherapy ,Systemic therapy ,03 medical and health sciences ,0302 clinical medicine ,Systematic review ,febrile neutropenia ,Practice Guideline ,030220 oncology & carcinogenesis ,Medicine ,030212 general & internal medicine ,business ,Intensive care medicine ,Adverse effect ,Febrile neutropenia - Abstract
Background: This guideline was prepared by the Fever Assessment Guideline Development Group, a group organized by the Program in Evidence-Based Care at the request of the Cancer Care Ontario Systemic Treatment Program. The mandate was to develop a standardized approach (in terms of definitions, information, and education) for the assessment of fever in cancer patients receiving chemotherapy. Methods: The guideline development methods included a search for existing guidelines, literature searches in medline and embase for systematic reviews and primary studies, internal review by content and methodology experts, and external review by targeted experts and intended users. Results: The search identified eight guidelines that had partial relevance to the topic of the present guideline and thirty-eight primary studies. The studies were mostly noncomparative prospective or retrospective studies. Few studies directly addressed the topic of fever except as one among many symptoms or adverse effects associated with chemotherapy. The recommendations concerning fever definition are supported mainly by other existing guidelines. No evidence was found that directly pertained to the assessment of fever before a diagnosis of febrile neutropenia was made. However, some studies evaluated approaches to symptom management that included fever among the symptoms. Few studies directly addressed information needs and resources for managing fever in cancer patients. Conclusions: Fever in patients with cancer who are receiving systemic therapy is a common and potentially serious symptom that requires prompt assessment, but currently, evidence to inform best practices concerning when, where, and by whom that assessment is done is very limited.
- Published
- 2016
- Full Text
- View/download PDF
23. E-mail communication practices and preferences among patients and providers in a large comprehensive cancer center
- Author
-
Natalie Cook, Monika K. Krzyzanowska, Alice Chia-chi Wei, Aditi Dobriyal, Manjula Maganti, Jolie Ringash, and Michal Sheinis
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Younger age ,Adolescent ,Patients ,education ,MEDLINE ,Cancer Care Facilities ,Logistic regression ,Patient care ,Electronic mail ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Surveys and Questionnaires ,Health care ,Humans ,Medicine ,Center (algebra and category theory) ,030212 general & internal medicine ,Young adult ,Aged ,Aged, 80 and over ,Oncologists ,Physician-Patient Relations ,Electronic Mail ,Manchester Cancer Research Centre ,Oncology (nursing) ,business.industry ,Communication ,Health Policy ,ResearchInstitutes_Networks_Beacons/mcrc ,Cancer ,Patient Preference ,Middle Aged ,medicine.disease ,Oncology ,030220 oncology & carcinogenesis ,Family medicine ,Female ,business - Abstract
Purpose: Little is known about how electronic mail (e-mail) is currently used in oncology practice to facilitate patient care. The objective of our study was to understand the current e-mail practices and preferences of patients and physicians in a large comprehensive cancer center. Methods: Separate cross-sectional surveys were administered to patients and physicians (staff physicians and clinical fellows) at the Princess Margaret Cancer Centre. Logistic regression was used to identify factors associated with current e-mail use. Record review was performed to assess the impact of e-mail communication on care. Results: The survey was completed by 833 patients. E-mail contact with a member of the health care team was reported by 41% of respondents. The team members contacted included administrative assistants (52%), nurses (45%), specialist physicians (36%), and family physicians (18%). Patient factors associated with a higher likelihood of e-mail contact with the health care team included younger age, higher education, higher income, enrollment in a clinical trial, and receipt of multiple treatments. Eighty percent of physicians (n = 63 of 79) reported previous contact with a patient via e-mail. Physician factors associated with a greater likelihood of e-mail contact with patients included older age, more senior clinical position, and higher patient volume. Nine hundred sixty-two patient records were reviewed, with e-mail correspondence documented in only 9% of cases. Conclusion: E-mail is commonly used for patient care but is poorly documented. The use of e-mail in this setting can be developed with appropriate guidance; however, there may be concerns about widening the gap between certain groups of patients.
- Published
- 2016
24. Association of hospital and physician case volumes with cardiac monitoring and cardiotoxicity during adjuvant trastuzumab treatment for breast cancer: a retrospective cohort study
- Author
-
Kelvin K. W. Chan, George Tomlinson, Dennis T. Ko, Kelly Lien, Maureen E. Trudeau, Scott Gavura, Monika K. Krzyzanowska, Andrew T. Yan, Christine Brezden-Masley, Alexander Kumachev, Murray Krahn, Raveen Pal, Craig C. Earle, and Nicolas J. Chin-Yee
- Subjects
medicine.medical_specialty ,Cardiotoxicity ,education.field_of_study ,business.industry ,medicine.medical_treatment ,Research ,Population ,Retrospective cohort study ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Discontinuation ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Trastuzumab ,030220 oncology & carcinogenesis ,Heart failure ,Emergency medicine ,medicine ,Cardiac monitoring ,Intensive care medicine ,education ,business ,medicine.drug - Abstract
Background: Adjuvant trastuzumab is the standard of care for patients with HER2 overexpressing breast cancer, but use of trastuzumab may lead to cardiotoxicity. Our goal was to evaluate the relationship between hospital and physician case volume and cardiac outcomes in this population. Methods: In this retrospective cohort study, we identified all female patients in Ontario with a breast cancer diagnosis in 2003–2009 who underwent treatment with trastuzumab through a provincial drug-funding program and linked these patients to administrative databases to ascertain patient demographics, treating hospital and physician characteristics, admissions to hospital, cardiac risk factors, cardiac imaging and comorbidities. Insufficient cardiac monitoring was defined as per the Canadian Trastuzumab Working Group guideline. Cardiotoxicity was defined as receiving fewer than 16 of 18 doses of trastuzumab because of heart failure admission, heart failure diagnosis or discontinuation of the drug after cardiac imaging. We constructed hierarchical multivariable logistic regression models to evaluate the effect of annual hospital volume, cumulative physician volume and treatment period on cardiac monitoring and cardiotoxicity. Results: Of 3777 women treated by 214 oncologists at 68 hospitals, 918 (24.3%) had insufficient cardiac monitoring and cardiotoxicity developed in 640 (16.9%). Cardiotoxicity occurred in 389 (42.4%) and 251 (8.8%) patients in the insufficient- and sufficient-monitoring groups, respectively. Higher annual hospital and cumulative physician volumes, and more recent calendar period, were all independent predictors for decreased cardiotoxicity. Adjustment for rates of cardiac monitoring annulled the relationships between case volume and cardiotoxicity. Interpretation: Greater hospital and physician case volumes are associated with reduced rates of trastuzumab-related cardiotoxicity, most likely because of better cardiac monitoring at higher volume centres.
- Published
- 2016
25. Guidelines on the use of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal surface malignancy arising from colorectal or appendiceal neoplasms
- Author
-
Lloyd A. Mack, Erika Haase, Yarrow J. McConnell, Carman A. Giacomantonio, Walley J. Temple, Lucas Sideris, Pierre Dubé, J.A. McCart, Monika K. Krzyzanowska, A. Govindarajan, Calvin Law, Rami Younan, and Pierre Major
- Subjects
medicine.medical_specialty ,pseudomyxoma peritonei ,Peritoneal surface ,Colorectal cancer ,business.industry ,fungi ,Peritoneal Surface Malignancy ,appendiceal cancer ,colorectal cancer ,carcinomatosis ,medicine.disease ,Surgery ,Appendiceal neoplasms ,hyperthermic intraperitoneal chemotherapy ,Practice Guideline ,peritoneal metastasis ,medicine ,Pseudomyxoma peritonei ,cytoreductive surgery ,In patient ,Hyperthermic intraperitoneal chemotherapy ,Peritoneal surface malignancy ,Cytoreductive surgery ,business - Abstract
To meet the needs of patients, Canadian surgical and medical oncology leaders in the treatment of peritoneal surface malignancies (PSMS), together with patient representatives, formed the Canadian HIPEC Collaborative Group (CHICG). The group is dedicated to standardizing and improving the treatment of PSM in Canada so that access to treatment and, ultimately, the prognosis of Canadian patients with PSM are improved. Patients with resectable PSM arising from colorectal or appendiceal neoplasms should be reviewed by a multidisciplinary team including surgeons and medical oncologists with experience in treating patients with PSM. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy should be offered to appropriately selected patients and performed at experienced centres. The aim of this publication is to present guidelines that we recommend be applied across the country for the treatment of PSM.
- Published
- 2015
- Full Text
- View/download PDF
26. Phase II Efficacy and Pharmacogenomic Study of Selumetinib (AZD6244; ARRY-142886) in Iodine-131 Refractory Papillary Thyroid Carcinoma with or without Follicular Elements
- Author
-
D. Neil Hayes, Dominic T. Moore, Christine H. Chung, Barbara A. Murphy, Karen E. Weck, Ni Zhao, Michele C. Hayward, Ezra E.W. Cohen, Janelle M. Hoskins, Roger B. Cohen, Wendi G. O’Connor, Tawee Tanvetyanon, Jill Gilbert, Monika K. Krzyzanowska, Amy Lucas, Ranee Mehra, and Arif Sheikh
- Subjects
Oncology ,Adult ,Diarrhea ,Proto-Oncogene Proteins B-raf ,Male ,Cancer Research ,medicine.medical_specialty ,Genotype ,Kaplan-Meier Estimate ,Article ,Papillary thyroid cancer ,Iodine Radioisotopes ,Internal medicine ,Adenocarcinoma, Follicular ,medicine ,Clinical endpoint ,Humans ,Thyroid Neoplasms ,Thyroid cancer ,Fatigue ,Aged ,Aged, 80 and over ,business.industry ,Carcinoma ,Cancer ,Exanthema ,Middle Aged ,medicine.disease ,Carcinoma, Papillary ,Surgery ,Treatment Outcome ,Tolerability ,Response Evaluation Criteria in Solid Tumors ,Pharmacogenetics ,Thyroid Cancer, Papillary ,Mutation ,Selumetinib ,ras Proteins ,Benzimidazoles ,Female ,business ,Progressive disease - Abstract
Purpose: A multicenter, open-label, phase II trial was conducted to evaluate the efficacy, safety, and tolerability of selumetinib in iodine-refractory papillary thyroid cancer (IRPTC). Experimental Design: Patients with advanced IRPTC with or without follicular elements and documented disease progression within the preceding 12 months were eligible to receive selumetinib at a dose of 100 mg twice daily. The primary endpoint was objective response rate using Response Evaluation Criteria in Solid Tumors. Secondary endpoints were safety, overall survival, and progression-free survival (PFS). Tumor genotype including mutations in BRAF, NRAS, and HRAS was assessed. Results: Best responses in 32 evaluable patients out of 39 enrolled were 1 partial response (3%), 21 stable disease (54%), and 11 progressive disease (28%). Disease stability maintenance occurred for 16 weeks in 49%, 24 weeks in 36%. Median PFS was 32 weeks. BRAF V600E mutants (12 of 26 evaluated, 46%) had a longer median PFS compared with patients with BRAF wild-type (WT) tumors (33 versus 11 weeks, respectively, HR = 0.6, not significant, P = 0.3). The most common adverse events and grades 3 to 4 toxicities included rash, fatigue, diarrhea, and peripheral edema. Two pulmonary deaths occurred in the study and were judged unlikely to be related to the study drug. Conclusions: Selumetinib was well tolerated but the study was negative with regard to the primary outcome. Secondary analyses suggest that future studies of selumetinib and other mitogen-activated protein (MAP)/extracellular signal-regulated kinase (ERK; MEK) inhibitors in IRPTC should consider BRAF V600E mutation status in the trial design based on differential trends in outcome. Clin Cancer Res; 18(7); 2056–65. ©2012 AACR.
- Published
- 2012
- Full Text
- View/download PDF
27. Chemotherapy treatment decision-making experiences of older adults with cancer, their family members, oncologists and family physicians: a mixed methods study
- Author
-
Kara McWatters, Shabbir M.H. Alibhai, Margaret I. Fitch, Raymond Jang, Martine Puts, Ann E. Tourangeau, Monika K. Krzyzanowska, Katherine Lee, Michael Kulik, Mary Ellen MacDonald, Schroder Sattar, Natasha B. Leighl, Anthony M. Joshua, Eitan Amir, and Padraig Warde
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Pain medicine ,Decision Making ,Comorbidity ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,Health care ,medicine ,Humans ,Family ,030212 general & internal medicine ,Longitudinal Studies ,Aged ,Aged, 80 and over ,Oncologists ,Chemotherapy ,business.industry ,Nursing research ,Communication ,Age Factors ,Cancer ,Physicians, Family ,Functional status ,medicine.disease ,3. Good health ,Geriatric oncology ,Oncology ,030220 oncology & carcinogenesis ,Family medicine ,Mixed methods study ,Original Article ,Female ,Treatment decision making ,business - Abstract
Purpose Although comorbidities, frailty, and functional impairment are common in older adults (OA) with cancer, little is known about how these factors are considered during the treatment decision-making process by OAs, their families, and health care providers. Our aim was to better understand the treatment decision process from all these perspectives. Methods A mixed methods multi-perspective longitudinal study using semi-structured interviews and surveys with 29 OAs aged ≥70 years with advanced prostate, breast, colorectal, or lung cancer, 24 of their family members,13 oncologists, and 15 family physicians was conducted. The sample was stratified on age (70–79 and 80+). All interviews were analyzed using thematic analysis. Results There was no difference in the treatment decision-making experience based on age. Most OAs felt that they should have the final say in the treatment decision, but strongly valued their oncologists’ opinion. “Trust in my oncologist” and “chemotherapy as the last resort to prolong life” were the most important reasons to accept treatment. Families indicated a need to improve communication between them, the patient and the specialist, particularly around goals of treatment. Comorbidity and potential side-effects did not play a major role in the treatment decision-making for patients, families, or oncologists. Family physicians reported no involvement in decisions but desired to be more involved. Conclusion This first study using multiple perspectives showed neither frailty nor comorbidity played a role in the treatment decision-making process. Efforts to improve communication were identified as an opportunity that may enhance quality of care. Condensed abstract In a mixed methods study multiple perspective study with older adults with cancer, their family members, their oncologist and their family physician we explored the treatment decision making process and found that most older adults were satisfied with their decision. Comorbidity, functional status and frailty did not impact the older adult’s or their family members’ decision. Electronic supplementary material The online version of this article (doi:10.1007/s00520-016-3476-8) contains supplementary material, which is available to authorized users.
- Full Text
- View/download PDF
28. Impact of the Early Phase of the COVID-19 Pandemic on the Quality of Care for Colorectal and Anal Cancers at Comprehensive Cancer Centers on Two Continents
- Author
-
Erick F. Saldanha, Melanie Powis, Divya Sharma, Osvaldo Espin-Garcia, Saidah Hack, Felicia Cavalher, Maria Rita Costa, Maria Simoes, Huaqi Li, Abed Baiad, Kevin Chen, Zuhul Mohmand, Peter Nakhla, Samuel Aguiar, Rachel Riechelmann, and Monika K. Krzyzanowska
- Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
PURPOSEThe early phase of the COVID-19 pandemic affected cancer care globally. Evaluating the impact of the pandemic on the quality of cancer care delivery is crucial for understanding how changes in care delivery may influence outcomes. Our study compared care delivered during the early phase of the pandemic with the same period in the previous year at two institutions across continents (Princess Margaret Cancer Center [PM] in Canada and A.C. Camargo Cancer Center [AC] in Brazil).METHODSPatients newly diagnosed with colorectal or anal cancer between February and December 2019 and the same period in 2020 were analyzed. Sociodemographic and clinical characteristics and performance of individual indicators within and between centers and between the peri–COVID-19 and control cohorts were tested using Cohen's h test to assess the standardized differences between the two groups.RESULTSAmong 925 patients, distinct effects of the early COVID-19 pandemic on oncology services were observed. AC experienced a 50% reduction in patient consultations (98 v 197) versus a 12.5% reduction at PM (294 v 336). Similarly, AC experienced a higher proportion of stage IV disease presentations (42.9% v 29.9%; P = .015) and an increase in treatment delay (61.9% v 9.7%; P < .001) compared with prepandemic. At PM, a 10% increase in treatment interruption (32.4% v 22.3%; P < .001) and a higher rate of discontinuation of radiotherapy (9.4% v 1.1%; P < .001) were observed during the pandemic. Postsurgical readmission rates increased in both AC (20.9% v 2.6%; P < .001) and PM (10.5% v 3.6%; P < .01).CONCLUSIONThe early phase of the COVID-19 pandemic affected the quality of care delivery for colorectal and anal cancers at both centers. However, the magnitude of this impact was greater in Brazil.
- Published
- 2024
- Full Text
- View/download PDF
29. The Impact of the Pandemic on the Quality of Colorectal and Anal Cancer Care, and 2-Year Clinical Outcomes
- Author
-
Melanie Powis, Rinku Sutradhar, Simron Singh, Shabbir Alibhai, Saidah Hack, Abed Baiad, Kevin Chen, Huaqi Li, Zuhal Mohmand, and Monika K. Krzyzanowska
- Subjects
quality of care ,COVID-19 ,pandemic ,colorectal cancer ,anal cancer ,progression ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
We undertook a retrospective study to compare the quality of care delivered to a cohort of newly diagnosed adults with colon, rectal or anal cancer during the early phase of COVID-19 (02/20–12/20) relative to the same period in the year prior (the comparator cohort), and examine the impact of the pandemic on 2-year disease progression and all-cause mortality. We observed poorer performance on a number of quality measures, such as approximately three times as many patients in the COVID-19 cohort experienced 30-day post-surgical readmission (10.5% vs. 3.6%; SD:0.27). Despite these differences, we observed no statistically significant adjusted associations between COVID-19 and time to either all-cause mortality (HR: 0.88, 95% CI: 0.61–1.27, p = 0.50) or disease progression (HR: 1.16, 95% CI: 0.82–1.64, p = 0.41). However, there was a substantial reduction in new patient consults during the early phase of COVID-19 (12.2% decrease), which appeared to disproportionally impact patients who traditionally experience sociodemographic disparities in access to care, given that the COVID-19 cohort skewed younger and there were fewer patients from neighborhoods with the highest Housing and Dwelling, ands Age and Labour Force marginalization quintiles. Future work is needed to understand the more downstream effects of COVID-19 related changes on cancer care to inform planning for future disruptions in care.
- Published
- 2024
- Full Text
- View/download PDF
30. Involvement of low- and middle-income countries in randomized controlled trial publications in oncology
- Author
-
Shubarna Amin, Zarnie Lwin, Kimberly A. Fernandes, Monika K. Krzyzanowska, and Janice C. Wong
- Subjects
Oncology ,medicine.medical_specialty ,Low and middle income countries ,Alternative medicine ,law.invention ,Randomized controlled trial ,law ,Neoplasms ,Internal medicine ,Epidemiology ,medicine ,Humans ,Developing Countries ,Cancer ,Randomized Controlled Trials as Topic ,Quality of Life Research ,business.industry ,Research ,Public health ,Health Policy ,Publications ,Health services research ,Public Health, Environmental and Occupational Health ,Authorship ,Sponsorship ,Bibliometrics ,Randomized controlled trials ,Periodicals as Topic ,business - Abstract
Background We describe trends in participation by investigators from low- and middle-income countries (LMCs) in publications describing oncology randomized control trials (RCTs) over a decade. Methods We used Medline to identify RCTs published in English from 1998 to 2008 evaluating treatment in lung, breast, colorectal, stomach and liver cancers. Data on author affiliations, authorship roles, trial characteristics, funding and interventions were extracted from each article. Countries were stratified as low-, middle- or high-income using World Bank data. Interventions were categorized as requiring basic, limited, enhanced or maximal resources as per the Breast Health Global Initiative classification. Logistic regression was used to identify factors associated with authorship by investigators from LMCs. Results 454 publications were identified. Proportion of articles with at least one LMC author increased over time from 20% in 1998 to 29% in 2008 (p = 0.01), but almost all LMC authors were from middle-income countries. Proportion of articles with at least one LMC author was higher among articles that explicitly reported recruitment in at least one LMC vs those that did not (76% vs 13%). Among 87 articles (19%) that involved authors from LMCs, 17% had LMC authors as first or corresponding authors, and 67% evaluated interventions requiring enhanced or maximal resources. Factors associated with LMC authorship included industry funding (OR = 3.54, p = 0.0001), placebo comparator arm (OR = 2.57, p = 0.02) and palliative intent treatment (OR = 4.00, p = 0.0003). Conclusion An increasing number of publications describing oncology RCTs involve authors from LMC countries but primarily in non-leadership roles in industry-funded trials.
- Full Text
- View/download PDF
31. Early survival for patients newly diagnosed with cancer during COVID‐19 in Ontario, Canada: A population‐based cohort study
- Author
-
Rui Fu, Rinku Sutradhar, Qing Li, Pabiththa Kamalraj, Anna Dare, Timothy P. Hanna, Kelvin K. W. Chan, Jonathan C. Irish, Natalie Coburn, Julie Hallet, Simron Singh, Ambica Parmar, Craig C. Earle, Lauren Lapointe‐Shaw, Monika K. Krzyzanowska, Alexander V. Louie, Alyson Mahar, David R. Urbach, Daniel I. McIsaac, Danny Enepekides, David Gomez, Nicole J. Look Hong, Jill Tinmouth, and Antoine Eskander
- Subjects
cancer ,cancer detection ,cancer survivorship ,COVID‐19 ,oncology ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Little is known about the association between the COVID‐19 pandemic and early survival among newly diagnosed cancer patients. Methods This retrospective population‐based cohort study used linked administrative datasets from Ontario, Canada. Adults (≥18 years) who received a cancer diagnosis between March 15 and December 31, 2020, were included in a pandemic cohort, while those diagnosed during the same dates in 2018/2019 were included in a pre‐pandemic cohort. All patients were followed for one full year after the date of diagnosis. Cox proportional hazards regression models were used to assess survival in relation to the pandemic, patient characteristics at diagnosis, and the modality of first cancer treatment as a time‐varying covariate. Interaction terms were explored to measure the pandemic association with survival for each cancer type. Results Among 179,746 patients, 53,387 (29.7%) were in the pandemic cohort and 37,741 (21.0%) died over the first post‐diagnosis year. No association between the pandemic and survival was found when adjusting for patient characteristics at diagnosis (HR 0.99 [95% CI 0.96–1.01]), while marginally better survival was found for the pandemic cohort when the modality of treatment was additionally considered (HR 0.97 [95% CI 0.95–0.99]). When examining each cancer type, only a new melanoma diagnosis was associated with a worse survival in the pandemic cohort (HR 1.25 [95% CI 1.05–1.49]). Conclusions Among patients able to receive a cancer diagnosis during the pandemic, one‐year overall survival was not different than those diagnosed in the previous 2 years. This study highlights the complex nature of the COVID‐19 pandemic impact on cancer care.
- Published
- 2023
- Full Text
- View/download PDF
32. Patient Perceptions of the Impact of the COVID Pandemic on the Quality of Their Gastrointestinal Cancer Care
- Author
-
Melanie Powis MSc, PhD, Rinku Sutradhar PhD, Saidah Hack BSc, Shabbir M.H. Alibhai MD, MSc, Alejandro Berlin MD, MSc, Simron Singh MD, MPH, and Monika K. Krzyzanowska MD, MPH
- Subjects
Medicine (General) ,R5-920 - Abstract
We surveyed patients who had a received care for a gastrointestinal cancer between 03/2020 and 05/2021 to understand their perceptions of the impact of the Covid pandemic on cancer care delivery and quality of care. Three-hundred fifty-eight respondents provided evaluable responses (response rate: 17.3%). Approximately half of respondents (46.4%) perceived that they had experienced a pandemic-related cancer care modification; most changes were initiated by a clinician or the cancer center (44.6%). Relative to White patients those from Racialized Groups (OR: 1.91, 95% CI: 1.03-3.54) were more likely to report a cancer treatment change. Additionally, relative to patients in follow-up, those who were newly diagnosed (OR: 2.39; 95% CI: 1.21-4.71) were more likely to report a change. Compared to White patients, patients from Racialized Groups were approximately twice as likely to report perceiving that virtual visits during Covid negatively impacted the quality of their care (OR: 2.21; 95% CI: 0.96-5.08). These findings potentially reflect pre-existing systemic disparities in quality of and access to care, as well as differences in how care is experienced by patients from Racialized Groups.
- Published
- 2023
- Full Text
- View/download PDF
33. Health‐related quality‐of‐life analyses from a multicenter, randomized, double‐blind phase 2 study of patients with differentiated thyroid cancer treated with lenvatinib 18 or 24 mg/day
- Author
-
Matthew H. Taylor, Sophie Leboulleux, Yury Panaseykin, Bhavana Konda, Christelle de LaFouchardiere, Brett G. M. Hughes, Andrew G. Gianoukakis, Young Joo Park, Ilia Romanov, Monika K. Krzyzanowska, Diana Garbinsky, Bintu Sherif, Jie Janice Pan, Terri A. Binder, Nicholas Sauter, Ran Xie, and Marcia S. Brose
- Subjects
dose intensity ,HRQoL ,kinase inhibitor ,lenvatinib ,quality of life ,radioiodine‐refractory differentiated thyroid cancer ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background In the phase 2 double‐blind Study 211, a starting dose of lenvatinib 18 mg/day was compared with the approved starting dose of 24 mg/day in patients with radioiodine‐refractory differentiated thyroid cancer (RR‐DTC). Predefined criteria for noninferiority for efficacy in the 18 mg arm were not met; safety was similar in both arms. Impact of lenvatinib treatment on health‐related quality‐of‐life (HRQoL) was a secondary endpoint of Study 211. Methods Patients with RR‐DTC were randomly assigned to a blinded starting dose of lenvatinib 18 mg/day or 24 mg/day. HRQoL was assessed at baseline, every 8 weeks until Week 24, then every 16 weeks, and at the off‐treatment visit, using the EQ‐5D‐3L and FACT‐G instruments. Completion and compliance rates, mean change from baseline, and times to first and definitive deterioration were evaluated. Results Baseline EQ‐5D and FACT‐G scores, and overall changes from baseline, were comparable between patients in the lenvatinib 18 mg/day (n = 77) and 24 mg/day arms (n = 75). For the 18 mg versus 24 mg arms, least squares mean differences were −0.42 (95% CI −4.88, 4.03) for EQ‐5D‐VAS and 0.47 (95% CI −3.45, 4.39) for FACT‐G total. Time to first deterioration did not significantly favor either arm; EQ‐5D‐VAS HR [18 mg/24 mg] 0.93 (95% CI 0.61–1.40), EQ‐5D‐HUI HR [18 mg/24 mg] 0.68 (95% CI 0.44–1.05), FACT‐G total HR [18 mg/24 mg] 0.73 (95% CI 0.48–1.12). Time to definitive deterioration did not significantly favor either arm, though EQ‐5D‐VAS showed a trend in favor of the 24 mg arm (HR [18 mg/24 mg] 1.72; 95% CI 0.99–3.01); EQ‐5D‐HUI HR [18 mg/24 mg] was 0.96 (95% CI 0.57–1.63), FACT‐G total HR [18 mg/24 mg] was 0.72 (95% CI 0.43–1.21). Conclusions In Study 211, HRQoL for patients in the lenvatinib 18 mg/day arm was not statistically different from that of patients in the 24 mg/day arm. These data further support the use of the approved lenvatinib starting dose of 24 mg/day in patients with RR‐DTC. ClinicalTrials.gov Number NCT02702388.
- Published
- 2023
- Full Text
- View/download PDF
34. Cancer Patients First Treated with Chemotherapy: Are They More Likely to Receive Surgery in the Pandemic?
- Author
-
Rui Fu, Rinku Sutradhar, Anna Dare, Qing Li, Timothy P. Hanna, Kelvin K. W. Chan, Jonathan C. Irish, Natalie Coburn, Julie Hallet, Simron Singh, Ambica Parmar, Craig C. Earle, Lauren Lapointe-Shaw, Monika K. Krzyzanowska, Antonio Finelli, Alexander V. Louie, Ian J. Witterick, Alyson Mahar, David R. Urbach, Daniel I. McIsaac, Danny Enepekides, Nicole J. Look Hong, and Antoine Eskander
- Subjects
COVID-19 ,cancer ,chemotherapy ,cancer surgery ,health inequity ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Due to the ramping down of cancer surgery in early pandemic, many newly diagnosed patients received other treatments first. We aimed to quantify the pandemic-related shift in rate of surgery following chemotherapy. This is a retrospective population-based cohort study involving adults diagnosed with cancer between 3 January 2016 and 7 November 2020 in Ontario, Canada who received chemotherapy as first treatment within 6-months of diagnosis. Competing-risks regression models with interaction effects were used to quantify the association between COVID-19 period (receiving a cancer diagnosis before or on/after 15 March 2020) and receipt of surgical reSection 9-months after first chemotherapy. Among 51,653 patients, 8.5% (n = 19,558) of them ultimately underwent surgery 9-months after chemotherapy initiation. Receipt of surgery was higher during the pandemic than before (sHR 1.07, 95% CI 1.02–1.13). Material deprivation was independently associated with lower receipt of surgery (least vs. most deprived quintile: sHR 1.11, 95% CI 1.04–1.17), but did not change with the pandemic. The surgical rate increase was most pronounced for breast cancer (sHR 1.13, 95% CI 1.06–1.20). These pandemic-related shifts in cancer treatment requires further evaluations to understand the long-term consequences. Persistent material deprivation-related inequity in cancer surgical access needs to be addressed.
- Published
- 2022
- Full Text
- View/download PDF
35. Assessing the Impact of the COVID-19 Pandemic on Emergency Department Use for Patients Undergoing Cancer-Directed Surgeries
- Author
-
Antoine Eskander, Qing Li, Jiayue Yu, Julie Hallet, Natalie Coburn, Anna Dare, Kelvin K. W. Chan, Simron Singh, Ambica Parmar, Craig C. Earle, Lauren Lapointe-Shaw, Monika K. Krzyzanowska, Timothy P. Hanna, Antonio Finelli, Alexander V. Louie, Nicole Look-Hong, Jonathan C. Irish, Ian Witterick, Alyson Mahar, David R. Urbach, Danny Enepekides, Rinku Sutradhar, and on behalf of the Pandemic—Ontario Collaborative in Cancer Research (POCCR)
- Subjects
cancer ,surgery ,health services research ,quality of care ,COVID-19 ,emergency department ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Emergency department (ED) use is a concern for surgery patients, physicians and health administrators particularly during a pandemic. The objective of this study was to assess the impact of the pandemic on ED use following cancer-directed surgeries. This is a retrospective cohort study of patients undergoing cancer-directed surgeries comparing ED use from 7 January 2018 to 14 March 2020 (pre-pandemic) and 15 March 2020 to 27 June 2020 (pandemic) in Ontario, Canada. Logistic regression models were used to (1) determine the association between pandemic vs. pre-pandemic periods and the odds of an ED visit within 30 days after discharge from hospital for surgery and (2) to assess the odds of an ED visit being of high acuity (level 1 and 2 as per the Canadian Triage and Acuity Scale). Of our cohort of 499,008 cancer-directed surgeries, 468,879 occurred during the pre-pandemic period and 30,129 occurred during the pandemic period. Even though there was a substantial decrease in the general population ED rates, after covariate adjustment, there was no significant decrease in ED use among surgical patients (OR 1.002, 95% CI 0.957–1.048). However, the adjusted odds of an ED visit being of high acuity was 23% higher among surgeries occurring during the pandemic (OR 1.23, 95% CI 1.14–1.33). Although ED visits in the general population decreased substantially during the pandemic, the rate of ED visits did not decrease among those receiving cancer-directed surgery. Moreover, those presenting in the ED post-operatively during the pandemic had significantly higher levels of acuity.
- Published
- 2022
- Full Text
- View/download PDF
36. Estimating the optimal perioperative chemotherapy utilization rate for muscle‐invasive bladder cancer
- Author
-
Safiya Karim, William J. Mackillop, Kelly Brennan, Yingwei Peng, D. Robert Siemens, Monika K. Krzyzanowska, and Christopher M. Booth
- Subjects
benchmarking ,bladder cancer ,neoadjuvant chemotherapy ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Identifying optimal chemotherapy (CT) utilization rates can drive improvements in quality of care. We report a benchmarking approach to estimate the optimal rate of perioperative CT for muscle‐invasive bladder cancer (MIBC). Methods The Ontario Cancer Registry and linked treated records were used to identify neoadjuvant and adjuvant CT rates among patients with MIBC during 2004‐2013. Monte Carlo simulation was used to estimate the proportion of observed rate variation that could be due to chance alone. The criterion‐based benchmarking approach was used to explore whether social and health‐system factors were associated with CT rates. We also used the “pared‐mean” approach to identify a benchmark population of hospitals with the highest treatment rates. Hospital CT rates were adjusted for case mix and simulated using a multi‐level multivariable model and a parametric bootstrapping approach. Results The study population included 2581 patients; perioperative CT was delivered to 31% (798/2581). Multivariate analysis showed that treatment was strongly associated with patient socioeconomic status and hospital teaching status. The benchmark rate was 36%. Unadjusted CT rates were significantly different across hospitals (range 0%‐52%, P
- Published
- 2019
- Full Text
- View/download PDF
37. Estimating the optimal rate of adjuvant chemotherapy utilization for stage III colon cancer
- Author
-
Safiya Karim, Christopher M. Booth, Kelly Brennan, Yingwei Peng, D. Robert Siemens, Monika K. Krzyzanowska, and William J. Mackillop
- Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Identifying optimal chemotherapy utilization rates can drive improvements in quality of care. We report a benchmarking approach to estimate the optimal rate of adjuvant chemotherapy (ACT) for stage III colon cancer. Methods The Ontario Cancer Registry and linked treated records were used to identify ACT utilization. Monte Carlo simulation was used to estimate the proportion of ACT rate variation that could be due to chance alone. The criterion‐based benchmarking approach was used to explore whether socioeconomic or system‐level factors were associated with ACT. We also used the “pared‐mean” approach to identify a benchmark population of hospitals with the highest ACT rates. Results The study population included 2801 patients; ACT was delivered to 66% (1861/2801). Monte Carlo simulation suggested that the observed component of variation (15.6%) in ACT rates was within the 95% CI (11.5%‐17.3%) of what could be expected due to chance alone; the nonrandom component of ACT rate variation across hospitals was only 1.5%. There was no difference in hospital ACT rate by teaching status (P = .107), cancer center status (P = .362), or having medical oncology on site (P = .840). Unadjusted ACT rates varied across hospitals (range 44%‐91%, P = .017). The unadjusted benchmark ACT rate was 81% (95%CI 76%‐86%); utilization rate in non‐benchmark hospitals was 65% (95%CI 63%‐66%). However, after adjusting for case mix, the difference in ACT utilization between benchmark and non‐benchmark populations was significantly smaller. Conclusions We did not find any system‐level factors associated with the utilization of ACT. Our results suggest that the observed variation in hospital ACT rate is not significantly different from variation due to chance alone. Using the “pared‐mean” approach may significantly overestimate optimal treatment rates if case mix is not considered.
- Published
- 2019
- Full Text
- View/download PDF
38. Ambulatory Toxicity Management (AToM) in patients receiving adjuvant or neo-adjuvant chemotherapy for early stage breast cancer - a pragmatic cluster randomized trial protocol
- Author
-
Monika K. Krzyzanowska, Jim A. Julian, Melanie Powis, Doris Howell, Craig C. Earle, Katherine A. Enright, Nicole Mittmann, Maureen E. Trudeau, and Eva Grunfeld
- Subjects
Breast cancer ,Symptom management ,Chemotherapy toxicity ,Telephone case management ,Quality improvement ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Population-based studies suggest that emergency department visits and hospitalizations are common among patients receiving chemotherapy and that rates in routine practice are higher than expected from clinical trials. Chemotherapy-related toxicities are often predictable and, consequently, acute care visits may be preventable with adequate treatment planning and support between visits to the cancer centre. We will evaluate the impact of proactive telephone-based toxicity management on emergency department visits and hospitalizations in women with early stage breast cancer receiving chemotherapy. Methods In this pragmatic covariate constraint-based cluster randomized trial, 20 centres in Ontario, Canada are randomly allocated to either proactive telephone toxicity management (intervention) or routine care (control). The primary outcome is the cluster-level mean number of ED + H visits per patient evaluated using Ontario administrative healthcare data. Participants are all patients with early stage (I-III) breast cancer commencing adjuvant or neo-adjuvant chemotherapy at participating institutions during the intervention period. At least 25 patients at each centre participate in a patient reported outcomes sub-study involving the collection of standardized questionnaires to measure: severity of treatment toxicities, self-care, self-efficacy, quality of life, and coordination of care. Patients participating in the patient reported outcomes (PRO) sub-study are asked to provide written consent to link their PRO data to administrative data. Unit costs will be applied to each per person resource utilized, and a total cost per population and patient will be generated. An incremental cost-effectiveness analysis will be undertaken to compare the incremental costs and outcomes between the intervention and control groups from the health system perspective. Discussion This study evaluates the effectiveness of a proactive toxicity management intervention in a routine care setting. The use of administrative healthcare data to evaluate the primary outcome enables an evaluation in a real world setting and at a much larger scale than previous studies. Trial registration Clinicaltrials.gov, NCT02485678. Registered 30 June 2015.
- Published
- 2019
- Full Text
- View/download PDF
39. Additional germline findings from a tumor profiling program
- Author
-
Neda Stjepanovic, Tracy L. Stockley, Philippe L. Bedard, Jeanna M. McCuaig, Melyssa Aronson, Spring Holter, Kara Semotiuk, Natasha B. Leighl, Raymond Jang, Monika K. Krzyzanowska, Amit M. Oza, Abha Gupta, Christine Elser, Lailah Ahmed, Lisa Wang, Suzanne Kamel-Reid, Lillian L. Siu, and Raymond H. Kim
- Subjects
Germline mutation ,Neoplasms/genetics ,Neoplastic syndromes ,Hereditary Cancer ,Incidental findings ,Secondary findings ,Internal medicine ,RC31-1245 ,Genetics ,QH426-470 - Abstract
Abstract Background Matched tumor-normal sequencing, applied in precision cancer medicine, can identify unidentified germline Medically Actionable Variants (gMAVS) in cancer predisposition genes. We report patient preferences for the return of additional germline results, and describe various gMAV scenarios delivered through a clinical genetics service. Methods Tumor profiling was offered to 1960 advanced cancer patients, of which 1556 underwent tumor-normal sequencing with multigene hotspot panels containing 20 cancer predisposition genes. All patients were provided with an IRB-approved consent for return of additional gMAVs. Results Of the whole cohort 94% of patients consented to be informed of additional germline results and 5% declined, with no statistically significant differences based on age, sex, race or prior genetic testing. Eight patients were found to have gMAVs in a cancer predisposition gene. Five had previously unidentified gMAVs: three in TP53 (only one fulfilled Chompret’s Revised criteria for Li-Fraumeni Syndrome), one in SMARCB1 in the absence of schwannomatosis features and one a TP53 variant at low allele frequency suggesting an acquired event in blood. Conclusion Interest in germline findings is high among patients who undergo tumor profiling. Disclosure of previously unidentified gMAVs present multiple challenges, thus supporting the involvement of a clinical genetics service in all tumor profiling programs.
- Published
- 2018
- Full Text
- View/download PDF
40. Reply to F. Poizeau et al.
- Author
-
Eng L, Sutradhar R, and Krzyzanowska MK
- Published
- 2023
- Full Text
- View/download PDF
41. Setting Quality Improvement Priorities for Women Receiving Systemic Therapy for Early-Stage Breast Cancer by Using Population-Level Administrative Data.
- Author
-
Enright KA, Taback N, Powis ML, Gonzalez A, Yun L, Sutradhar R, Trudeau ME, Booth CM, and Krzyzanowska MK
- Subjects
- Aged, Breast Neoplasms epidemiology, Drug Therapy standards, Female, Humans, Middle Aged, Neoplasm Staging, Ontario epidemiology, Registries, Women's Health, Breast Neoplasms drug therapy, Health Priorities standards, Quality Improvement standards, Quality of Health Care standards
- Abstract
Purpose Routine evaluation of quality measures (QMs) can drive improvement in cancer systems by highlighting gaps in care. Targeting quality improvement at QMs that demonstrate substantial variation has the potential to make the largest impact at the population level. We developed an approach that uses both variation in performance and number of patients affected by the QM to set priorities for improving the quality of systemic therapy for women with early-stage breast cancer (EBC). Patients and Methods Patients with EBC diagnosed from 2006 to 2010 in Ontario, Canada, were identified in the Ontario Cancer Registry and linked deterministically to multiple health care databases. Individual QMs within a panel of 15 QMs previously developed to assess the quality of systemic therapy across four domains (access, treatment delivery, toxicity, and safety) were ranked on interinstitutional variation in performance (using interquartile range) and the number of patients who were affected; then the two rankings were averaged for a summative priority ranking. Results We identified 28,427 patients with EBC who were treated at 84 institutions. The use of computerized physician electronic order entry for chemotherapy, emergency room visits or hospitalizations during chemotherapy, and timely receipt of chemotherapy were identified as the QMs that had the largest potential to improve quality of care at a system level within this cohort. Conclusion A simple ranking system based on interinstitutional variation in performance and patient volume can be used to identify high-priority areas for quality improvement from a population perspective. This approach is generalizable to other health care systems that use QMs to drive improvement.
- Published
- 2017
- Full Text
- View/download PDF
42. Reply to K.K. Sahu et al.
- Author
-
Cook N and Krzyzanowska MK
- Published
- 2017
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.