Search

Taste changes and malnutrition are two important problems in patients with different types of cancer. This study was conducted to evaluate the relationship between malnutrition and subjective taste changes experienced by cancer patients receiving outpatient chemotherapy. The study used a cross-sectional design and was carried out with 1382 patients with cancer receiving outpatient chemotherapy. Of the patients, 63.1% experienced taste changes. It was determined that 8.8% of patients had malnutrition according to the Mini Nutritional Assessment. The mean scores of patients experiencing malnutrition and being at risk for malnutrition from all sub-dimensions of The Chemotherapy-induced Taste Alteration Scale (CiTAS) were found to be higher than the patient group evaluated to have normal nutrition. It was determined that a unit increase in the scores of the parageusia and phantogeusia subscales of the CiTAS increased the risk of malnutrition by 3.36 times (%95 CI= 2.68-4.02). In line with these results, we recommend that patients with cancer receiving chemotherapy should be routinely evaluated in terms of taste changes in clinical practice and that they should be followed up in terms of malnutrition in the presence of taste changes.

Outpatient Chemotherapy Appointment (OCA) planning and scheduling is a process of distributing appointments to available days and times to be handled by various resources through a multi-stage process. Proper OCAs planning and scheduling results in minimizing the length of stay of patients and staff overtime. The integrated consideration of the available capacity, resources planning, scheduling policy, drug preparation requirements, and resources-to-patients assignment can improve the Outpatient Chemotherapy Process’s (OCP’s) overall performance due to interdependencies. However, developing a comprehensive and stochastic decision support system in the OCP environment is complex. Thus, the multi-stages of OCP, stochastic durations, probability of uncertain events occurrence, patterns of patient arrivals, acuity levels of nurses, demand variety, and complex patient pathways are rarely addressed together. Therefore, this paper proposes a clustering and stochastic optimization methodology to handle the various challenges of OCA planning and scheduling. A Stochastic Discrete Simulation-Based Multi-Objective Optimization (SDSMO) model is developed and linked to clustering algorithms using an iterative sequential approach. The experimental results indicate the positive effect of clustering similar appointments on the performance measures and the computational time. The developed cluster-based stochastic optimization approaches showed superior performance compared with baseline and sequencing heuristics using data from a real Outpatient Chemotherapy Center (OCC).

Objective: The aim of the study is to evaluate the long-term changes in fatigue of cancer patients receiving outpatient chemotherapy after a disaster such as the Great Earthquake. Methods: From 2012 to 2014, we measured subjective fatigue, autonomic function, and physical activity with reference to the criteria for chronic fatigue syndrome. Results: The participants were 13, 9 males (69.2%) and 4 females (30.8%). The most common cancer among the participants was lung cancer 4 patients (30.8%). In 2012, eight patients (61.6%) received anti-cancer drugs and three (23.0%) received the drug by intravenous drip and oral administration. Physical fatigue (p = 0.004), mental fatigue (p = 0.002), comprehensive fatigue (p = 0.012), and comprehensive evaluations (p = 0.032) were significantly different. Significant differences in the autonomic nervous function were observed during the three years from 2012 to 2014 (log LF [p = 0.017], log HF [p = 0.023] and log LF/HF [p = 0.039]). Similar to Subjective fatigue, Significant differences in physical activity were observed during the three years from 2012 to 2014 (DA [p = 0.042], TST [p = 0.037], SE [p = 0.018], AW [p = 0.023] and Naps [p = 0.014]). Conclusions: The participants fatigue worsened at one time, but showed improvement over time. In the event of an emergency such as a disaster, it is necessary to evaluate the physical and mental condition based on objective indicators of cancer patients receiving anti-cancer drug treatment and provide nursing support.

This study aimed to determine response rates, overall survival (OS), event-free survival (EFS) and toxicity profile of an outpatient chemotherapy regimen based on gemcitabine and vinorelbine (GV) for relapsed childhood Hodgkin lymphoma (HL). This was a retrospective study that included 41 patients up to the age of 18 years with relapsed HL. Twelve patients (29%) had primary progressive disease (PPD), 6 (15%) had early relapse (ER) and 23 (56%) had late relapse (LR). The overall initial response rate was 83% (LR: 87%, ER: 83%, PPD: 75%.

Background The effect of pharmaceutical intervention to treat adverse events on quality of life (QOL) in outpatients receiving cancer chemotherapy is unclear. We investigated whether pharmaceutical intervention provided by pharmacists in collaboration with physicians improves QOL with outpatient cancer chemotherapy. Methods We conducted a single-center retrospective descriptive study of pharmaceutical intervention for patients receiving outpatient cancer chemotherapy at Gifu University Hospital between September 2017 and July 2020. We assessed patient QOL using the Japanese version of the EuroQol 5 Dimension5 Level (EQ-5D-5L). Adverse events were graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. We compared the EQ-5D-5L utility value and incidence of grade 2 or higher adverse events before and after pharmaceutical intervention. Results Our analysis included 151 patients who underwent 210 chemotherapy cycles. Pharmaceutical intervention significantly improved patients’ EQ-5D-5L utility values from 0.8197 to 0.8603 (P P = 0.016), peripheral neuropathy (pre-intervention 0.7798, post-intervention 0.7988, P = 0.032) and pain (pre-intervention 0.7625, post-intervention 0.8197, P = 0.035). Although not statistically significant, the incidence of grade 2 or higher adverse events, including nausea and vomiting, dermopathy, pain, oral mucositis, diarrhea and dysgeusia, tended to be lower post-intervention than pre-intervention. Conclusions Pharmaceutical intervention by pharmacists in collaboration with physicians may improve QOL in patients undergoing outpatient cancer chemotherapy.

Purpose Practicing self-care behaviors is important for patients with gastrointestinal cancer undergoing outpatient chemotherapy. Knowledge of personality traits may be useful in providing individualized support that can improve self-care behaviors. Therefore, we assessed the association between personality traits and self-care behaviors in these patients. Methods This cross-sectional study was conducted among patients who received intravenous chemotherapy at a designated regional cancer hospital between June 2020 and October 2020. A self-administered survey was conducted among these patients using the Japanese version of the Ten Item Personality Inventory and a 29-item questionnaire to assess self-care behaviors. Association between the scores of the personality traits and frequency of each self-care behavior was analyzed using the Spearman's rank correlation coefficient. Results In total, 53 responses were obtained from 57 participants, of which 52 valid responses were included in the analysis. Openness and conscientiousness were personality traits significantly associated with multiple self-care behaviors. High degree of openness, characterized by the ability to tackle new situations, had a moderately significant positive correlation with adjustment of exercise (ρ = 0.49, pρ = 0.40, pρ = 0.30, p=0.03) and confirmation of inspection results (ρ = 0.39, p

INTRODUCTION AND OBJECTIVE:Patients with ureteral tumors managed endoscopically often benefit from adjuvant immuno-chemotherapy and require interval upper tract surveillance with ureteroscopy. Howe...

Increasing number of cancer survivors besides effective medications increase the demand for cancer care services. Therefore, managers have to investigate new ways to enhance the operational performance of the outpatient chemotherapy clinics (OCCs). However, the management process is complex due to significant variability in treatment times as a result of the different cancer types and accordingly different chemotherapy protocols and scarce resources such as nurses, chemotherapy chairs/beds, and pharmacists. In this paper, we address two problems in OCCs. First, in the planning problem, the objective is assigning the optimum first day to start the treatment for a set of new patients, and computing the required number of nurses and pharmacists given the limited resources. Second, the operational problem of scheduling the patients’ appointments. In this problem, the objective is to set the best appointment schedules for all patients, new and existing to improve the operational performance of the clinic. As the two problems are highly interrelated, we propose a two-phase solution approach starting by a mixed integer programming model that assigns the starting day of treatment for new patients and finds the optimum number of needed nurses and pharmacists to fulfill two objectives. Then, in the second phase, a discrete event simulation model is used to generate patient appointment schedules that minimise the treatment delay for patients and the total completion times of treatments in each day under resources availability constraints, including two new constraints covering the drug availability and pharmacists working-hours. Finally, the proposed simulation model is applied for evaluating the operations performance of a current case study and finding the best scheduling rule for patient appointment times to achieve a minimum wait time in the OCC.

Objective: Breast cancer survivors are increasing in number among survivors of all types of cancer, and survivors returning to work are extremely important. The development of outpatient chemotherapy has increased the working population of patients undergoing cancer therapy. Consequently, a significant number of breast cancer survivors experience physical, psychological, and social problems. This study aimed to clarify differences in concerns among patients with breast cancer receiving outpatient chemotherapy according to their employment status. Methods: Twenty-eight patients with breast cancer undergoing outpatient chemotherapy were recruited. A questionnaire was used to survey the attributes, employment status, and levels of concern in these patients based on the Cancer-chemotherapy Concerns Rating Scale (CCRS). Data from three groups (employed full time, employed part-time, and unemployed) were analyzed using multiple comparison tests. Results: The patients’ mean age was (55.1 ± 9.9) years. According to the CCRS findings, the following three parameters differed between the three groups: scores for the items “I always think about my disease” (employed vs. unemployed, P = 0.005) and “I can’t work (housework/schoolwork)” (employed full time vs. part time, P = 0.045), and scores for the “self-existence” subscale (employed vs. unemployed, P = 0.024). Conclusions: This study revealed the characteristics of concerns in patients with breast cancer according to their employment status. Being able to continue working is considered to enhance the social health of these patients. Predicting concerns in employed patients will help gain perspective in early nursing interventions.

Purpose This pilot-controlled trial aimed to examine the feasibility and acceptability of hypnosis-derived communication (HC) administered by trained nurses during outpatient chemotherapy to optimize symptom management and emotional support — two important aspects of patient well-being in oncology. Methods The trial was conducted in two outpatient oncology units: (1) intervention site (usual care with HC), and (2) control site (usual care). Nurses at the intervention site were invited to take part in an 8-h training in HC. Participants’ self-ratings of symptoms and emotional support were gathered at predetermined time points during three consecutive outpatient visits using the Edmonton Symptom Assessment Scale and the Emotional Support Scale. Results Forty-nine patients (24 in the intervention group, 25 in the control group) with different cancer types/stages were recruited over a period of 3 weeks and completed the study. All nurses (N = 10) at the intervention site volunteered to complete the training and were able to include HC into their chemotherapy protocols (about ± 5 min/intervention). Compared to usual care, patients exposed to HC showed a significant reduction in physical symptoms during chemotherapy. In contrast, perception of emotional support did not show any significant effect of the intervention. Participants exposed to HC report that the intervention helped them relax and connect on a more personal level with the nurse during chemotherapy infusion. Conclusions Our results suggest that HC is feasible, acceptable, and beneficial for symptom management during outpatient chemotherapy. While future studies are needed, hypnosis techniques could facilitate meaningful contacts between cancer patients and clinicians in oncology. Trial registration Clinical Trial Identifier: NCT04173195, first posted on November 19, 2019

We previously reported that successive pharmaceutical care by oncology pharmacy specialists contributes to quality outpatient chemotherapy. However, there are a few reports regarding such care during immune checkpoint inhibitors (ICIs) treatment, despite increasing patients being treated with ICIs and the profile of immune-related adverse events being quite different from that of the adverse effects of cytotoxic agents. We retrospectively evaluated the effectiveness of continuous pharmaceutical care in outpatient ICI treatment, focusing especially on the period of providing pharmaceutical recommendations. The adoption rate, efficacy, and period of pharmaceutical interventions, such as prescription questions and pharmaceutical recommendations, were evaluated. A total of 3597 ICI administrations (366 patients) were evaluated. We performed 2625 face-to-face medication counseling. A total of 282 prescription questions and 147 pharmaceutical recommendations were conducted. Approximately 70% of the questions were regarding ordering of laboratory examination, and 86.5% of these questions were adopted. Pharmaceutical recommendations were categorized into medication recommendations (81.1%), examination recommendations (10.8%), and recommendation of expert consultation (8.1%). The adoption rate of pharmaceutical recommendations was 96.0, and 70% of the medication recommendations attenuated the symptoms. Finally, the provision rate of pharmaceutical recommendations was significantly higher in the first 3 months after ICI treatment initiation. We found that pharmaceutical care contributes to an improved quality of outpatient ICI treatment, and face-to-face pharmaceutical counseling up to 3 months after ICI treatment initiation is the most important.

Quality of life (QoL) is a particularly important issue for cancer patients. This study was designed to investigate the differences in QoL in esophageal squamous cell carcinoma (ESCC) patients who underwent inpatient chemotherapy (IPCT) or outpatient chemotherapy (OPCT). A total of 107 ESCC patients were enrolled, including 53 patients in the IPCT group and 54 patients in the OPCT group. The widely used and well-validated instruments European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 Items (EORTC QLQ-C30) and Oesophageal Cancer Module (EORTC QLQ-OES18) were used to examine the QoL of the two groups. In addition, the differences in adverse events (AEs) were evaluated. The results of QLQ C-30 analysis showed that mean global quality of life scores were similar between IPCT and OPCT groups, as were functional and symptom scales. There were no significant differences in the functional and symptom scales in the analysis of QLQ OES18 either. Most AEs of chemotherapy were grades 1&ndash, 2, and the majority of patients tolerated the side effects, no statistically significant difference in AEs between these two groups was mentioned. Our study suggests that the health-related QoL and adverse events in ESCC patients who received IPCT or OPCT are similar. OPCT is reasonable and safe in clinical practice.

Background Advanced cancer therapeutics have improved patient survival, leading to an increase in the number of patients who require long-term outpatient chemotherapy. However, the available schedule options for chemotherapy are generally limited to traditional business hours. Method In 2017, we surveyed 721 patients with cancer in Okayama, Japan, regarding their preferences for evening and weekend (Friday evening, Saturday, and Sunday) chemotherapy appointments. Results A preference for evening and weekend appointment options was indicated by 37% of the respondents. Patients who requested weekend chemotherapy were younger, female, with no spouse or partner, living alone, employed, and currently receiving treatment. Among these factors, age and employment status were significantly associated with a preference for weekend chemotherapy, according to multivariate analysis. Conclusion Our findings reveal a demand for evening and weekend outpatient chemotherapy, especially among young, employed patients.

© Equinox Publishing Ltd 2018. Holistic patient-centred care is the aim of health services in the United Kingdom delivered through the 6Cs. Chaplains can offer aspects of this through compassionate care of the patient, particularly when a person is facing a life-limiting prognosis. This study firstly evaluated patient awareness and use of chaplaincy services in two oncology settings; Inpatient and Outpatient. Outpatients had not previously been offered chaplaincy services. Secondly, the demand and needs for a chaplaincy intervention was investigated with patients who expressed a spiritual or religious belief and had received a chaplaincy visit. Results indicated that half of the patients seen in the first evaluation identified with a spiritual/ religious belief and both Outpatients and Inpatients had a similar demand for chaplaincy visits. Those receiving a chaplaincy visit before being evaluated generally requested further visits. Based on these results we have now established a chaplaincy visiting service in the Outpatient chemotherapy suites to try to match demands.

Background/aim Cholinergic syndrome frequently occurs within the first 24 h after irinotecan injection. We evaluated the prophylactic effect of scopolamine butylbromide on irinotecan-related cholinergic syndrome. Patients and methods Fifty-nine patients who received irinotecan-based regimens at our outpatient chemotherapy clinic between April 2013 and May 2014 were enrolled. Patients who developed irinotecan-related cholinergic syndrome were prophylactically administered scopolamine butylbromide at the next scheduled treatment. Risk factors for irinotecan-related cholinergic syndrome were determined using logistic regression analysis. Results Irinotecan-related cholinergic syndrome occurred in 50.8% of patients. Scopolamine butylbromide administration significantly reduced the incidence to 3.4% (P

It is important that pharmacists ensure safe chemotherapy implementation. In addition to inspecting chemotherapeutic prescriptions according to patient condition and drug-drug interactions, the management of chemotherapy-induced adverse effects and associated pharmaceutical intervention is one of the most important responsibilities of pharmacists in medical care teams. In May 2016, an oncology pharmacist was set responsible for the specialized, long-term, and successive pharmaceutical care, including instructions about appropriate use of medication at an outpatient chemotherapy center. We evaluated the effectiveness of the continuous pharmaceutical care. The number of medication counseling and associated pharmaceutical interventions increased with time. Specifically, the number of pharmaceutical interventions (prescription questions and pharmaceutical proposals) was 745 (459 and 286, respectively) in the surveillance period, which significantly increased compared to that observed within the same duration before posting an oncology pharmacist. The adoption rate was approximately 70% for prescription questions and 98% for pharmaceutical proposals. We also found that approximately 70% of the proposals attenuated the painful symptoms. Furthermore, approximately 60% of all pharmaceutical interventions were established after the third visit; in particular, approximately 20% of the pharmaceutical proposals were suggested after the sixth visit, indicating that continuous medication counseling results in an increase in pharmaceutical proposals. In conclusion, long-term and successive pharmaceutical care by oncology pharmacy specialists in outpatient chemotherapy contributes to a safe and less onerous chemotherapy implementation, as it has been highly adopted, is effective in many cases, and has been proven to be important for risk management in chemotherapy.

Background Collaboration between pharmacists, doctors, and nurses in outpatient treatment is beneficial; however, such services are limited in Japan due to the lack of a healthcare reimbursement fee for outpatient pharmacy services at outpatient clinic. Objective We evaluated the impact of a service in which clinical pharmacists collaborated with an oncologist at an outpatient clinic in the treatment of adverse drug reactions in outpatient cancer chemotherapy. Methods We performed a retrospective cohort study using patients’ medical records and treatment diaries. Subjects were patients who received outpatient chemotherapy via a clinical pharmacist collaboration service provided by six outpatient pharmacists and an oncologist at an outpatient clinic between June and August 2016. Results During the study period, the total number of outpatient services was 2508, with 2055 (81%) related to chemotherapy. The six outpatient pharmacists provided interventions to 498 of the 2055 cases (24%). Of the 498 interventions, 103 (20%), in addition to oncologist’s prescription, were suggested treatments for adverse drug reactions due to cancer chemotherapy. Oncologists approved a total of 82 prescription suggestions from pharmacists (79%) to 63 patients. Fifty-seven percent ( n = 47) of the adverse drug reactions were improved following the pharmacists’ suggested prescriptions. Conclusions This is the first study to clarify the benefits of outpatient pharmacy services in which pharmacists collaborate with oncologists at an outpatient clinic for the management of adverse drug reactions in cancer patients in Japan.

Introduction: Optimal scheduling and calendar management in an outpatient chemotherapy unit is a complex process that is driven by a need to focus on safety while accommodating a high degree of variability. Primary constraints are infusion times, staffing resources, chair availability, and unit hours. Methods: We undertook a process to analyze our existing management models across multiple practice settings in our health care system, then developed a model to optimize safety and efficiency. The model was tested in one of the community chemotherapy units. We assessed staffing violations as measured by nurse-to-patient ratios throughout the workday and at key points during treatment. Staffing violations were tracked before and after the implementation of the new model. Results: The new model reduced staffing violations by nearly 50% and required fewer chairs to treat the same number of patients for the selected clinic day. Actual implementation results indicated that the new model leveled the distribution of patients across the workday with an 18% reduction in maximum chair utilization and a 27% reduction in staffing violations. Subsequently, a positive impact on peak pharmacy workload reduced delays by as much as 35 minutes. Nursing staff satisfaction with the new model was positive. Conclusion: We conclude that the proposed optimization approach with regard to nursing resource assignment and workload balance throughout a day effectively improves patient service quality and staff satisfaction.

Background: Cancer and its therapy is commonly associated with a variety of side effects that impact eating behaviors that reduce nutritional intake. This review will outline potential causes of chemotherapy and radiation damage as well as approaches for the amelioration of the side effects of cancer during therapy. Methods: Information for clinicians, patients, and their caregivers about toxicity mitigation including nausea reduction, damage to epithelial structures such as skin and mucosa, organ toxicity, and education is reviewed. Results: How to anticipate, reduce, and prevent some toxicities encountered during chemotherapy and radiation is detailed with the goal to improve eating behaviors. Strategies for health care professionals, caregivers, and patients to consider include (a) the reduction in nausea and vomiting, (b) decreasing damage to the mucosa, (c) avoiding a catabolic state and muscle wasting (sarcopenia), and (d) developing therapeutic alliances with patients, caregivers, and oncologists. Conclusions: Although the reduction of side effects involves anticipatory guidance and proactive team effort (e.g., forward observation, electronic interactions, patient reported outcomes), toxicity reduction can be satisfying for not only the patient, but everyone involved in cancer care.

272 Background: Rule OP-35, which characterizes treatment-related complications of patients receiving outpatient chemotherapy that result in a potentially avoidable emergency department (ED) visit or hospitalization, was developed to encourage practices to build treatment models that reduce such events. However, defining visits as potentially avoidable based on symptoms may not capture the complexity of caring for oncology patients. We aim to evaluate the effectiveness of OP-35 in identifying preventable ED visits by real world standards at an academic institution. Methods: A retrospective analysis was performed reviewing ED visits at the Sidney Kimmel Cancer Center (SKCC) at Thomas Jefferson University for oncology patients from 10/1/2020 to 1/31/2021. Each patient received care at SKCC had received intravenous or oral chemotherapy in the preceding 30 days, and each encounter was classified as potentially avoidable by OP-35 criteria. Two investigators independently conducted chart reviews to determine whether these visits were potentially avoidable, recording whether the patient attempted to contact their care team prior to the ED encounter and assessing if the concern could have been managed in a timely manner in an outpatient setting. The two records were then compared, and the principal investigator served as an arbiter for determining if a visit was potentially avoidable in instances where the investigators disagreed. Results: We reviewed 144 total encounters and excluded events from patients with either acute leukemia or breast cancer on hormone therapy only, leaving 107 encounters for analysis. After evaluating the clinical circumstances, we determined that 29% of these ED encounters were potentially avoidable. Applying New York University Emergency Department Algorithm (NYU-EDA) criteria, 69% of encounters were considered potentially avoidable. Patients called for advice before seeking ED care in 53% of unavoidable encounters compared to 26% of potentially avoidable encounters. An additional 14% of visits deemed unavoidable were from patients sent directly from clinic. For potentially avoidable encounters, 60% of patients were discharged directly from the ED. In comparison, 8% of unavoidable encounters led to discharge from the ED. Pain was the most common reason for encounters and 53% of these visits were considered potentially avoidable. Conclusions: We found that approximately 30% of ED encounters deemed avoidable by OP-35 criteria were considered potentially avoidable following clinician review. In the majority of cases patients were referred to the ED following initial outpatient attempts at management. NYU-EDA criteria for preventability did not correlate with OP-35 nor clinician consensus regarding potentially avoidable encounters. More work remains in refining tools to identify potentially avoidable ED visits for oncology patients.

223 Background: Despite the recent introduction of the CMS metric, OP-35, which tracks 30-day inpatient admissions and ED visits after outpatient chemotherapy administration, the risk factors driving acute care utilization (ACU) in the head and neck cancer treatment setting are not yet well understood. Further characterization of these risk factors could allow for improved care quality and reduce preventable inpatient and ED admissions. Methods: This was a retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked cancer registry-claims database. The study cohort consisted of patients aged 66 years or older diagnosed with head and neck cancer between 2004-2015 who received outpatient chemotherapy within the first two years after diagnosis. Multivariable logistic regression modeling was utilized to characterize the risk factors associated with an inpatient or ED admission within 30 days after receiving chemotherapy. Results: Of the 2,236 eligible patients, 735 (32.9%) had at least one inpatient or ED admission within 30 days of receiving outpatient chemotherapy. On multivariable analysis, cancer of the oral cavity [odds ratio (OR) 1.43; 95% confidence interval (CI) 1.04-1.96] and oropharynx/hypopharynx [OR 1.34; 95% CI 1.06-1.70] were associated with an increased odds of ACU. Other factors associated with ACU included NCI comorbidity index [OR 1.10; 95% CI 1.03-1.18], prior ACU [OR 1.06; 95% CI 1.02-1.09], second cycle of chemotherapy relative to the first cycle [OR 0.38, 95% CI 0.29-0.50], and third or greater cycle of chemotherapy [OR 0.17; 95% CI 0.13-0.21]. Certain chemotherapeutic agents also modified risk: use of an angiogenesis inhibitor [OR 0.18; 95% CI 0.06-0.45], alkylating agent [OR 1.24; 95% 1.01-1.53], plant alkaloid [OR 1.63; 95% CI 1.25-2.10], or antimetabolite [OR 2.69; 95% CI 1.78-4.09]. The most common admission diagnosis was pain (n = 243; 33.1%) followed by dehydration (n = 167; 22.7%). Conclusions: Multiple clinical variables modify risk of acute care utilization after outpatient chemotherapy in the head and neck cancer setting, providing several potential avenues of intervention for providers.

Background: Japanese Red Cross Nagoya Daini Hospital provides medical care for COVID-19 as a designated type 1 medical institution for infectious diseases and provides safely anti-cancer drugs administration for cancer patients as a regional cancer treatment cooperation base hospital. Purposes and methods: Purposes of this questionnaire are to identify the psychological aspects of cancer patients under COVID-19 pandemic, the evaluation of in-hospital countermeasures, and the points for improvement. We conducted a questionnaire to cancer patients receiving chemotherapy. Objects: Two hundred and fifty-six patients who received chemotherapy at our outpatient chemotherapy center from August 14 to September 4, 2020. Results: Of the 256 patients, 253 agreed to fill out this questionnaire. One hundred and thirty-one patients (51.8%) were worried about visiting a medical institution. One hundred and fifty-six ones (61.7%) were worried about cancer treatment. On the other hand, two hundred and thirty-four ones (92.5%) had never wanted to quit their treatment. Two hundred and twenty-seven ones (89.7%) evaluated the countermeasures against COVID-19 taken by our hospital and did not consider options other than our hospital. The main answers to the question “What kind of information and consideration did you want to receive from the medical staff?” were as follows;(1) Patients are exposed to many information through media, so medical staff just answer individual questions. (2) No special information and consideration are required. (3) Countermeasures and prevention for COVID-19 are a matter of personal awareness. Others, there were several answers that it was difficult to understand how the in-hospital measures changed. Discussion: About half of the patients continued to receive the cancer treatment with anxiety. We confirmed that patients receiving chemotherapy were highly conscious of infection prevention. We will consider safer countermeasures based on these opinions.

Aim: to characterize and verify the fragility of the elderly in outpatient chemotherapy treatment in a university hospital of southern Brazil, and to identify the association between fragility and the following variables: chemotherapeutic effect, treatment time and selfreported diseases. Method: cross-sectional study conducted with 70 elderly in the chemotherapy outpatient, from August to September 2014 by means of Edmonton Frail Scale and characterization form. Results: fifty percent did not present fragility, 31.4% were apparently vulnerable and 18.6% had some level of fragility. Among the frail elderly, 15.7% had mild fragility, 1.4% moderate and 1.4% severe. The association between frailty and self-reported diseases, time of treatment and chemotherapeutic effects was not statistically significant. Conclusion: it was point to applicability of the scale to identify predisposing factors for the fragility syndrome and to enable preventive actions for the elderly in chemotherapeutic treatment

Purpose Ambulatory administration of chemotherapy provides benefit to patients and institutions alike. We hypothesized that transitioning rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (R-EPOCH) from an inpatient to ambulatory setting would reduce inpatient bed days and overall healthcare costs. The purpose of this effort was to create a guideline that would transition R-EPOCH to the ambulatory setting. To assess institutional benefit, we assessed inpatient bed days saved and financial impact. Methods A single center, retrospective analysis of inpatient R-EPOCH administration from January 2013 to December 2015 defined the need for medication use guidelines for ambulatory R-EPOCH administration. While this guideline targeted a reduction in inpatient bed days, it also created desired staff-and-patient education on R-EPOCH. Multidisciplinary collaboration enabled this comprehensive approach to outpatient chemotherapy administration. Results The 42 patients included received 147 cycles of R-EPOCH. Administration was primarily inpatient, amounting to 107 cycles and 799 inpatient days. Concurrently, 40 cycles of R-EPOCH were administered to 11 patients in the ambulatory setting. Only two patients received all cycles as outpatient; the other nine patients received chemotherapy in both settings. Financial analysis showed a 53% reduction in drug acquisition cost and 30% reduction in direct costs with ambulatory R-EPOCH administration. Based on our projection, after guideline implementation, 12 patients will be eligible for ambulatory R-EPOCH annually, resulting in a savings of 360 bed days and approximately $650,000 per year. Conclusion Transitioning R-EPOCH is a viable option to significantly decrease inpatient bed days and overall healthcare costs. Multidisciplinary collaboration is vital to successfully transitioning regimens to the ambulatory setting and to establishing consistent support for ambulatory administration.

Introduction Blood transfusion is an integral part of routine outpatient Haematology-Oncology care. Blood product administration requires the concerted effort of nursing and laboratory staff in accredited institutions. One of the challenges with scheduling transfusions is the unpredictability surrounding transfusion requirements and the amount of time required to administer blood products. This mismatch between capacity availability for ad hoc transfusions and clinical need has resulted in physicians pre-booking transfusion slots so patients can be transfused if needed. However, when patients do not require transfusions, their cancelled slots represent capacity which could have otherwise been used to administer chemotherapy. This problem is exacerbated in a pandemic, where demand for inpatient beds necessitates the transition of elective chemotherapy to the outpatient setting insofar as is possible. Aim We hypothesized that reducing the number of transfusion slots booked could help to save healthcare-related costs and improve capacity utilisation. We also sought to right-site blood transfusions away from the chemotherapy infusion unit and to an acute cancer care unit (ACCU). Methods On 1 May 2020, two simple workflow changes were made. First, we introduced a policy where transfusions could not be pre-booked. Physicians were reassured that their patients would be transfused before their patient's crossmatch sample expired and that urgent transfusions would be done on the same day. The only exceptions to this policy were regularly transfused patients (e.g. thalassaemia major patients on chronic transfusions) and infirm patients. Secondly, ad hoc blood transfusions were moved from the chemotherapy unit to the acute cancer care unit. Ad hoc transfusion timing was prioritised according to clinical need. Consecutive patients treated at the National University Cancer Institute, Singapore, from 1 July 2019 to 31 July 2020 were included. Scheduled appointments were extracted from the hospital's scheduling system and analysed. Patients who had appointments booked for blood product transfusions were included. Data was extracted from drug ordering systems to determine the number of blood products administered. Patients were divided into a historical control group (before 1 May) and a study group (after 1 May). The primary outcome measures were cancellation rate (defined as the number of cancellations over total number of slots booked for transfusion) and number of chair hours wasted. Secondary outcome measures included the number of patients who had to be admitted for blood transfusion due to lack of slot availability and cost savings reflected in unit chair hours made available. Categorical data were analysed by the chi-square test. Analysis was done with SPSS v22 (IBM, USA). Results Between 1 July 2019 and 31 July 2020, a total of 3144 slots were booked for transfusion. Each slot was booked for four hours. 1548 blood products were administered. In the control group, there were 1630 cancellations. This equated to 6520 hours of chemotherapy chair time (average of 652 hours/month). There were no nett cancellations in the study group, as total number transfused exceeded the number booked. Assuming the booking rate would have been similar without our intervention, the study resulted in 1956 unutilised chair hours saved. This reflects capacity created for administration of chemotherapy, and cost savings of 1956x, where x is the unit cost of one chair hour. The cancellation rate was 58.3% (1630 cancelled, 2800 booked) in the control group. This decreased to -9.9% in the study group (378 administered (i.e., no nett cancellations), 344 booked, p Conclusion Efficient utilisation brought about by two simple workflow changes can help to create capacity and save costs. Such strategies are especially critical in a pandemic, where healthcare resources are under major strain and existing capacity must be maximised. Disclosures No relevant conflicts of interest to declare.

Background Chemotherapy regimens historically have required admission of the patient to the hospital for extended infusions running over multiple days to complete each cycle of therapy. With the evolution of monitoring strategies readily available, a renaissance in patient care and healthcare cost utilization is necessary as transitioning the administration of these agents to the outpatient setting is seemingly achievable and is potentially more cost-effective. Purpose This evaluation sought to primarily measure cost-savings for an institution by transitioning inpatient chemotherapy regimens to the outpatient setting. Secondary outcomes evaluated the effect of this transition on overall patient length of stay, prevalence of adverse effects, and overall chemotherapy schedule adherence as a result of implementing transitions in sites of care. Barriers to receiving care in the outpatient setting were assessed by evaluating the acuity of performance status as well as distance from the hospital. Methods This single-center retrospective, quantitative chart and expense analysis evaluated patients receiving rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (R-EPOCH) or rituximab, ifosfamide, carboplatin, and etoposide (R-ICE) chemotherapy regimens based on treatment setting at a single institution. Included patients were treated at the University of Chicago Medical Center. Those receiving inpatient-only management as compared with patients who received therapy in outpatient settings were compared in a matched cohort analysis. The control group was matched from the period before transition of therapy was instituted between November 2014 and November 2015, with those patients transitioned to outpatient therapy (December 2015 to November 2016), using demographic, diagnostic, treatment, and clinical status data to assure group similarity. Mean cost of therapy was compared between inpatient and outpatient regimens. Descriptive and demographic categorical data were compared using the Fisher’s exact test. Continuous data were evaluated using the Student’s t test. A significance level of alpha Results The cost of R-EPOCH therapy represented a significant difference across groups. R-ICE therapy similarly saw significant cost differences between inpatient and outpatient groups. If this was made standard of care for qualifying patients a retrospective annualized estimation of $466,507.85 with R-EPOCH therapy and $205,977.60 for R-ICE therapy could have been saved if this was utilized for patients who previously received their therapy as an inpatient. Conclusion The population of patients cared for at the University of Chicago Medicine during this time-period qualified for outpatient treatment for those treated with R-EPOCH and R-ICE regimens with no significantly identifiable prohibitive barriers between groups. As no significant complications manifested, it is reasonable to continue transitioning patients receiving these regimens to the outpatient setting where appropriate. R-EPOCH and R-ICE therapies were shown to be reasonable outpatient therapy while providing significant cost-savings for the institution.

BACKGROUND Persons with multiple sclerosis are increasingly treated with intermediate- or high-dose chemotherapy and a hematopoietic cell autotransplant. This is often done in an inpatient setting using frozen blood cell grafts. OBJECTIVE Determine if chemotherapy and a hematopoietic cell autotransplant can be safely done in an outpatient setting using refrigerated, non-frozen grafts. METHODS We developed an autotransplant protocol actionable in an outpatient setting using a refrigerated, non-frozen blood graft collected after giving cyclophosphamide, 50 mg/kg/d × 2 days and filgrastim, 10 μg/kg/d. A second identical course was given 9 days later followed by infusion of blood cells stored at 4°C for 1-4 days. The co-primary outcomes were rates of granulocyte and platelet recovery and therapy-related mortality. RESULTS We treated 426 consecutive subjects. Median age was 47 years (range, 21-68 years). A total of 145 (34%) were male. Median graft refrigeration time was 1 day (range, 1-4 days). Median interval to granulocytes >0.5 × 10E + 9/L was 8 days (range, 2-12) and to platelets >20 × 10E + 9/L, 8 days (range, 1-12). Only 15 subjects (4%) were hospitalized, predominately for iatrogenic pneumothorax (N = 5) and neutropenic fever (N = 4). There was only 1 early death from infection. CONCLUSION Intermediate-dose chemotherapy and a hematopoietic cell autotransplant can be safely done in an outpatient setting using, refrigerated, non-frozen grafts.

Background Visual art and music have been found to improve the emotions and moods of patients and healthcare staff, and attendance of live performances has been shown to foster social interaction. Objectives The aim of the study was to explore the effects of a visual artist on patients and nursing staff in an outpatient chemotherapy treatment environment. Methods During an eight-week period, an artist painted in an outpatient chemotherapy treatment room, either interacting with patients (six weeks) or quietly painting while wearing headphones (two weeks). A total of 73 surveys were completed by patients and staff, providing quantitative and qualitative data about anxiety, distraction, enjoyment, and social interaction. Findings Patients evaluated the experience positively, whether the artist was interacting with them or not. However, according to patient- and staff-reported data, greater social interaction occurred during the interaction weeks. Nurses reported that the artist's presence made their job easier, with a stronger effect observed during the interaction weeks.

Purpose Patients scheduled for outpatient infusion sometimes may be deferred for treatment after arriving for their appointment. This can be the result of a secondary illness, not meeting required bloodwork counts, or other medical complications. The ability to generate high-quality predictions of patient deferrals can be highly valuable in managing clinical operations, such as scheduling patients, determining which drugs to make before patients arrive, and establishing the proper staffing for a given day. Methods In collaboration with the University of Michigan Comprehensive Cancer Center, we have developed a predictive model that uses patient-specific data to estimate the probability that a patient will defer or not show for treatment on a given day. This model incorporates demographic, treatment protocol, and prior appointment history data. We tested a wide range of predictive models including logistic regression, tree-based methods, neural networks, and various ensemble models. We then compared the performance of these models, evaluating both their prediction error and their complexity level. Results We have tested multiple classification models to determine which would best determine whether a patient will defer or not show for treatment on a given day. We found that a Bayesian additive regression tree model performs best with the University of Michigan Comprehensive Cancer Center data on the basis of out-of-sample area under the curve, Brier score, and F1 score. We emphasize that similar statistical procedures must be taken to reach a final model in alternative settings. Conclusion This article introduces the existence and selection process of a wide variety of statistical models for predicting patient deferrals for a specific clinical environment. With proper implementation, these models will enable clinicians and clinical managers to achieve the in-practice benefits of deferral predictions.

Purpose We describe the implementation process of a computerized physician order entry (CPOE) for outpatient chemotherapy at a Latin American hospital, with the intent of providing other institutions with general guidance and insight through our experience. Methods In 2012, under the direction of the Department of Medicine of the Instituto Nacional de Enfermedades Neoplásicas, a multidisciplinary team composed of oncologists, nurses, pharmacists, and informatics engineers was formed to develop software for a CPOE for chemotherapy within a preexistent homegrown electronic medical record system in various phases. This included mapping and redesigning processes in an entirely electronic format, integrating the needs of the user for the development of electronic order sets, developing a checkpoint and a warning system to minimize prescription errors, and finally, training all the staff in implementation of the system. Results A CPOE for outpatient chemotherapy was successfully implemented in 2016. We have successfully standardized 266 chemotherapy orders, including for both solid tumors and hematologic malignancies, on the basis of appropriate guidelines. The software is linked to laboratory results and allows entry of important details for the patient's safety, such as anthropometric information for an automatic dose calculation and ranges for safe prescription. In addition, it is linked to the nursing plan sheets. Finally, it is possible to assess and continuously monitor the complex process of chemotherapy prescription. Conclusion This is the first report of implementation of a CPOE for chemotherapy in our region. The system was designed by a multidisciplinary team with its own resources. Our experience demonstrates the feasibility of computerizing the chemotherapy prescription process, constituting a tangible example for other institutions with potential impact on patient care.

1511 Background: Acute care use is one of the largest drivers of cancer care costs. OP-35: Admissions and Emergency Department Visits for Patients Receiving Outpatient Chemotherapy is a CMS quality measure that will affect reimbursement based on unplanned inpatient admissions (IP) and emergency department (ED) visits. Targeted measures can reduce preventable acute care use but identifying which patients might benefit remains challenging. Prior predictive models have made use of a limited subset of the data available in the Electronic Health Record (EHR). We hypothesized dense, structured EHR data could be used to train machine learning algorithms to predict risk of preventable ED and IP visits. Methods: Patients treated at Stanford Health Care and affiliated community care sites between 2013 and 2015 who met inclusion criteria for OP-35 were selected from our EHR. Preventable ED or IP visits were identified using OP-35 criteria. Demographic, diagnosis, procedure, medication, laboratory, vital sign, and healthcare utilization data generated prior to chemotherapy treatment were obtained. A random split of 80% of the cohort was used to train a logistic regression with least absolute shrinkage and selection operator regularization (LASSO) model to predict risk for acute care events within the first 180 days of chemotherapy. The remaining 20% were used to measure model performance by the Area Under the Receiver Operator Curve (AUROC). Results: 8,439 patients were included, of whom 35% had one or more preventable event within 180 days of starting chemotherapy. Our LASSO model classified patients at risk for preventable ED or IP visits with an AUROC of 0.783 (95% CI: 0.761-0.806). Model performance was better for identifying risk for IP visits than ED visits. LASSO selected 125 of 760 possible features to use when classifying patients. These included prior acute care visits, cancer stage, race, laboratory values, and a diagnosis of depression. Key features for the model are shown in the table. Conclusions: Machine learning models trained on a large number of routinely collected clinical variables can identify patients at risk for acute care events with promising accuracy. These models have the potential to improve cancer care outcomes, patient experience, and costs by allowing for targeted preventative interventions. Future work will include prospective and external validation in other healthcare systems.[Table: see text]

Background Historically, at the site of the present study, chemotherapy orders were screened by a junior Grade 1/2 pharmacist. An audit in 2009 of pharmacy interventions when screening chemotherapy charts highlighted the need for a senior oncology pharmacist (SOP) to help improve the clinical service and patient safety. In October 2012 an integrated cancer care centre (ICCC) was opened where all outpatient chemotherapy was administered. The SOP was appointed and based in the ICCC. Aim To compare the number and significance of pharmacist interventions made when screening chemotherapy charts in the ICCC Pharmacy in 2013 with the results of a similar audit conducted in 2009 prior to the opening of the ICCC and the recruitment of a dedicated SOP. Methods Pharmacists prospectively recorded interventions and their outcome while screening outpatient chemotherapy charts in 2013. Interventions were separated into haematology and oncology specialties. Two ICCC pharmacists and the registrar of the corresponding specialty separately assessed the interventions, considering the consequence of impact and the likelihood of reoccurrence. Discrepancies were discussed and a decision reached. Results were compared with the previous audit in 2009. Results All interventions (2013) resulted in changed chemotherapy prescriptions. There were 90 pharmacist interventions over a 3-month period in 2013 compared with 201 pharmacist interventions over a 3-month period in 2009. The majority were low risk (2009: 54% (109/201); 2013: 62% (56/90); p = 0.126). There was no change in moderate or extreme risk interventions. There was a significant decrease in high-risk interventions from 2009 to 2013 (18% (37/201) vs 1% (1/90), respectively; p < 0.001). Conclusion The introduction of a dedicated SOP and an ICCC has coincided with a reduced number of high-risk pharmacist interventions. Better communication between physicians and pharmacy, and an increased pharmacist presence in the treatment centre, all potentially impact positively on patient safety.

Purpose To define the optimal model of care for patients receiving outpatient chemotherapy who experience a fever. Fever is a common symptom in patients receiving chemotherapy, but the approach to evaluation of fever is not standardized. Methods We conducted a search for existing guidelines and a systematic review of the primary literature from database inception to November 2015. Full-text reports and conference abstracts were considered for inclusion. The search focused on the following topics: the relationship between temperature and poor outcome; predictors for the development of febrile neutropenia (FN); the timing, location, and personnel involved in fever assessment; and the provision of information to patients receiving chemotherapy. Results Eight guidelines and 38 studies were included. None of the guidelines were directly relevant to the target population because they dealt primarily with the management of FN after diagnosis. The primary studies tended to include fever as one of many symptoms assessed in the setting of chemotherapy. Temperature level was a weak predictor of poor outcomes. We did not find validated prediction models for identifying patients at risk of FN among patients receiving chemotherapy. Several studies presented approaches to symptom management that included fever among the symptoms, but results were not mature enough to merit widespread adoption. Conclusion Despite the frequency and risks of fever in the setting of chemotherapy, there is limited evidence to define who needs urgent assessment, where the assessment should be performed, and how quickly. Future research in this area is greatly needed to inform new models of care.

Purpose The adequacy of pain management for individuals with cancer who receive outpatient chemotherapy is unclear. The primary objective of this study was to assess pain prevalence and intensity in such patients. The secondary objectives included assessment of pain management with the pain management index (PMI) and exploration of predictors of inadequate pain management. Methods Cancer patients who received outpatient chemotherapy were enrolled. Patients were required to complete questionnaires covering demographic data and including the Brief Pain Inventory and the Distress Thermometer and Impact Thermometer. The PMI score was determined twice with an interval of at least 3 weeks. Results Of the 740 patients enrolled in the study, 524 individuals (70.8%) completed all questionnaires. Totals of 282 patients (53.8%) and 264 patients (50.4%) reported pain at baseline and follow-up, respectively, with ∼14% of patients having moderate or severe pain at each assessment. Totals of 365 patients (69.7%) at baseline and 320 patients (61.1%) at follow-up reported pain or were prescribed analgesics, with the rate of inadequate pain management for these patients being 39.7 and 51.6%, respectively. Multivariable analysis for 418 patients (79.8%) who had pain or required analgesics at baseline or follow-up (or both) revealed that the most significant predictor of inadequate pain management was depressive state. Conclusions Pain in cancer patients receiving outpatient chemotherapy is prevalent and at risk for undertreatment. Pain management should be assessed on a regular basis and is likely to be improved by screening for depression.

Using SEER-Medicare linked data we identified elderly patients diagnosed with diffuse large B-cell lymphoma (DLBCL) between January 2000 and December 2007 who received second-line outpatient chemotherapy for relapsed or refractory disease. Second-line regimens were classified into three mutually exclusive groups: aggressive, conventional, and palliative. Of the 632 (426 relapsed, 206 refractory) patients in the cohort, 27.8% received aggressive second-line therapy, 39.1% received conventional therapy, and 33.1% received palliative therapy. There were no differences in survival by type of therapy received, either for relapsed or refractory patients, although the patient risk profile differed significantly. However, duration of remission, male gender, and anemia at diagnosis were important predictors in relapsed patients, and male gender, B-symptoms, comorbidity burden, and poverty status were important predictors in refractory patients. Survival in elderly patients receiving second-line therapy remains poor, and the 24-month cost of all care exceeds $97,000. Patients would benefit from improved treatment options.

Purpose: This cross-sectional study assessed the association between oncology outpatients' quality improvement preferences and health-related quality of life (HRQoL). Implementation of specific initiatives preferred by patients with lower HRQoL may be a strategic approach to enhancing care for potentially vulnerable patients. Methods: English-speaking adults were recruited from five outpatient chemotherapy clinics located in New South Wales, Australia. Using touch screen devices, participants selected up to 25 initiatives that would improve their experiences and completed the Functional Assessment of Cancer Therapy-General (FACT-G) survey. The logistic odds of selecting an initiative according to FACT-G scores were calculated to determine whether preferences were associated with HRQoL after controlling for potential confounders. Results: Of the 411 eligible outpatients approached to participate, 263 (64%) completed surveys. Commonly selected initiatives were up-to-date information on treatment and condition progress (19.8%), access to or information on financial assistance (18.3%), and reduced clinic wait times (17.5%). For those with relatively lower FACT-G scores, the adjusted odds of selecting five initiatives illustrated an increasing trend: convenient appointment scheduling systems (+23% [P = .002]), reduced wait times (+15% [P = .01]), information on medical emergencies (+14% [P = .04]), access to or information on financial assistance (+15% [P = .009]), help to maintain daily living activities (+18% [P = .007]). Conclusion: Two areas of improvement were commonly selected: easily accessible health services and information and support for self-management. Although the results suggest an association between a few quality improvement preferences and HRQoL, a wider spectrum of patient characteristics must be considered when targeting quality improvement to patient subgroups.

Purpose/Objectives:The purpose of this study was to demonstrate the relationship between self-care agency andquality of life (QOL) in cancer patients undergoing outpatient chemotherapy. Design: The study used a correlationalresearch design with cancer patients undergoing outpatient chemotherapy at a medical facility. M ethods:The subjects of the study were cancer patients from Facility A undergoing outpatient chemotherapy. A self-reportsurvey form was distributed to subjects and responses were returned by mail. The main variables of interestconsisted of(1)Honjo’s(2001)SCAQ to test chronic patients’self-care agency and (2)Cella’s(1993)FACT-G forQOL. Findings:The average age of subjects was 58.4, and the leading cancer types were breast cancer (38％) andlymphoma malignum (20％). The mean score(±SD) for each scale was 124.02± 13.56 on the SCAQ and 72.91±17.04 on the FACT-G. A significant correlation was found between the scores on these two scales (r＝.245, p.05). Conclusions: People with greater self-care agency have a higher level of QOL. The results suggest theimportance of nurses’support in helping to cultivate patients’self-care agency.