Search

The aim of this study is to examine the functional outcomes of ona-botulinum toxin A (BTX-A) injection into the external urethral sphincter (EUS) for female patients with nonneurogenic nonrelaxing sphincter as the underlying cause of voiding dysfunction (VD).A retrospective analysis was performed for all the patients with the urodynamic findings of higher than expected maximum urethral closure pressure (MUCP) who received their first injection during the study period. All patients were evaluated with preoperative videourodynamic study and urethral pressure profilometry and received 100 U of EUS BTX-A. Patients aged less than 18 years and those with neurogenic bladder were excluded. All patients were followed up with the free flow, postvoid residuals (PVR), and patient global impression of improvement (PGI-I) scale at 6 weeks and then at 3 monthly intervals.We identified 35 female patients with a mean age of 37.5 ± 15 years (range 18-72 years) with a mean follow-up of 20 months. More than 50% of patients had a history of prior surgical intervention and 28 (80%) patients were catheter dependent, a suprapubic catheterization, or clean intermittent self-catheterization. Mean MUCP was 97.1 ± 22 cm of water. After treatment with BTX-A, 21 (60%) patients were able to void per urethral (p = 0.02). The mean maximum flow rate (Qmax) improved from 8.8 to 11 mls/s and the mean PVR decreased from 200 to 149 mls (p lt; 0.05). On multivariate analysis, we identified high preoperative PVR, high preoperative actual MUCP, and previous surgical intervention (urethral dilatation, sacral neuromodulation, and pelvic surgery) as predictors of successful voiding restoration. The mean duration of response was 4.7 months, 46% of patients requested repeat injection, and 29% were established on maintenance injections. On the 5-point PGI-I score, 13 (37%), 12 (34%), and 10 (29%) patients reported good, some, and no improvement, respectively. Quality of life was also improved in 60% of patients. Two patients had transient stress urinary incontinence (for lt;6 weeks) and there were no significant long-lasting adverse events.EUS BTX-A is a valid treatment option for VD considering therapeutic options are limited. The patient must be made aware of the need for repeat treatments.

To report the management outcomes of men with ≤20-mm small testicular masses (STMs) and to identify clinical and histopathological factors associated with malignancy.A retrospective analysis of men managed at a single centre between January 2010 and December 2020 with a STM ≤20 mm in size was performed.Overall, 307 men with a median (interquartile range [IQR]) age of 36 (30-44) years were included. Of these, 161 (52.4%), 82 (26.7%), 62 (20.2%) and 2 men (0.7%) underwent surveillance with interval ultrasonography (USS), primary excisional testicular biopsy (TBx) or primary radical orchidectomy (RO), or were discharged, respectively. The median (IQR) surveillance duration was 6 (3-18) months. The majority of men who underwent surveillance had lesions5 mm (59.0%) and no lesion vascularity (67.1%) on USS. Thirty-three (20.5%) men undergoing surveillance had a TBx based on changes on interval USS or patient choice; seven (21.2%) were found to be malignant. The overall rate of malignancy in the surveillance cohort was 4.3%. The majority of men who underwent primary RO had lesions ≥10 mm (85.5%) and the presence of vascularity (61.7%) on USS. Nineteen men (23.2%) who underwent primary TBx (median lesion size 6 mm) had a malignancy confirmed on biopsy and underwent RO. A total of 88 men (28.7%) underwent RO, and malignancy was confirmed in 73 (83.0%) of them. The overall malignancy rate in the whole STM cohort was 23.8%. Malignant RO specimens had significantly larger lesion sizes (median [IQR] 11 [8-15] mm, vs benign: median [IQR] 8 [5-10] mm; P = 0.04).Small testicular masses can be stratified and managed based on lesion size and USS features. The overall malignancy rate in men with an STM was 23.8% (4.3% in the surveillance group). Surveillance should be considered in lesions10 mm in size, with a TBx or frozen-section examination offered prior to RO in order to preserve testicular function.

Background Two million non-emergency surgeries are being cancelled globally every week due to the COVID-19 pandemic, which will have a major impact on patients and healthcare systems. Methods During the peak of the pandemic in the United Kingdom, we set up a multicentre cancer network amongst 14 National Health Service institutions, performing urological, thoracic, gynaecological and general surgical urgent and cancer operations at a central COVID-19 cold site. This is a cohort study of 500 consecutive patients undergoing surgery in this network. The primary outcome was 30-day mortality from COVID-19. Secondary outcomes included all-cause mortality and post-operative complications at 30-days. Results 500 patients underwent surgery with median age 62.5 (IQR 51–71). 65% were male, 60% had a known diagnosis of cancer and 61% of surgeries were considered complex or major. No patient died from COVID-19 at 30-days. 30-day all-cause mortality was 3/500 (1%). 10 (2%) patients were diagnosed with COVID-19, 4 (1%) with confirmed laboratory diagnosis and 6 (1%) with probable COVID-19. 33/500 (7%) of patients developed Clavien-Dindo grade 3 or higher complications, with 1/33 (3%) occurring in a patient with COVID-19. Conclusion It is safe to continue cancer and urgent surgery during the COVID-19 pandemic with appropriate service reconfiguration., Highlights • Priority surgeries are being cancelled every week due to the COVID-19 pandemic. • A multicentre surgical referral network was set up as part of an NHS England approach to continuing safe surgery • The referral network consisted of 14 NHS trusts and surgery was performed at a single COVID-19 ‘cold site’. • After 500 surgeries performed, there was a 0% 30-day mortality from COVID-19. • It is safe to continue cancer and priority surgery during the COVID-19 pandemic with appropriate service reconfiguration.

Aim Bladder outflow in women (bladder outlet obstruction [BOO]) has no well-accepted defining diagnostic criteria. Various nomograms exist based on flow rates, pressure-flow data, and fluoroscopy. We have prospectively evaluated the Solomon-Greenwell bladder outflow obstruction nomogram (SG BOO nomogram) as a measurement of BOO resolution following targeted surgical intervention. Methods The routine posttreatment urodynamics of 21 unselected women with an original urodynamic diagnosis of BOO on fluoroscopy and the SG BOO nomogram (BOO boundary defined as Qmax > 2.2 Pdet.Qmax + 5) were reviewed. All women had symptomatic BOO secondary to anterior pelvic organ prolapse (aPOP), urethrovaginal fistula (UVF), previous stress urinary incontinence (SUI) surgery, urethral stricture (US), or urethral diverticulum (U Div). Following treatment, all presenting symptoms resolved and simple urodynamics were performed as part of routine follow-up. Results The urodynamic findings preoperatively and postoperatively showed statistically significant changes posttreatment in mean flow rate which increased from 9.38 to 14.71 mL/s, mean Pdet.Qmax which decreased from 38 to 18.38 cmH2 O, and mean SG BOO nomogram probability (PBOO) which reduced from PBOO = 0.68 to 0.08. Mean SG BOO nomogram PBOO was significantly reduced posttreatment in all individual categories except UVF where a nonsignificant reduction from PBOO = 0.55 to 0.05 occurred. Conclusions All urodynamic parameters significantly improve in women who become asymptomatic following surgical treatment of BOO. This improvement is best demonstrated by the change in probability of BOO according to the Solomon-Greenwell nomogram. These findings underline the validity of the Solomon-Greenwell female BOO nomogram for diagnosing and monitoring BOO in women.

The Michigan Oncology Quality Consortium (MOQC) is a continuous quality improvement collaborative seeking to improve oncology care in Michigan, including for patients taking oral chemotherapy. The aim of this study was to assess the relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics to inform future oncology care. A multicenter cross-sectional observational study was conducted using an online survey to examine patient activation (patient activation measure, PAM), health literacy, symptom burden (Edmonton Symptom Assessment System, ESAS), confidence to self-manage side effects (fatigue, nausea, and diarrhea), and adherence to oral oncolytics. Inclusion criteria were patients taking an oral oncolytic for at least 1 month. Bivariate analyses and logistic regression were performed to evaluate relationships between the variables. A total of 125 respondents, mean (SD) age 66.2 (13.6), 57.7% female, and 95.1% Caucasian completed the survey. The mean (SD) PAM score was 65.0 (18.0). Confidence to manage fatigue, nausea, and diarrhea was associated with higher activation, and confidence to self-manage fatigue and diarrhea were associated with higher health literacy. About 30% of participants reported some level of non-adherence to oral oncolytics, and those who experienced side effects (Fisher’s exact test p = 0.033) and with shorter length of therapy (t test p = 0.027) were significantly more likely to be non-adherent. These findings show that there is room for improvement across practices involved with MOQC with regard to supporting patients taking oral oncolytics. Patients will need to improve their activation levels, and oncology clinics will need to create new workflows in order to enhance self-care management ability for patients taking oral oncolytics.

Patients suffering from mental health illness have considerably more physical health disease burden than the rest of the population and are more likely to die 10 to 20 years younger compared with their peers. Diabetes, cardiovascular and respiratory disease have been recognised as contributing factors to premature death. Furthermore patients with severe mental illness undertake lower levels of physical activity. The aim of the project was therefore to address the inequalities in physical health that affect patients with mental health illness through designing and implementing a sustainable, transferable, patient-centred education and activity intervention. The objective of the project was to increase patient motivation to change behaviour as a result of physical health interventions by increasing patients' physical health understanding, motivation to change their physical health behaviour, motivation to do exercise and by reducing their anxiety. The method used was a prospective cohort study in four eighteen bed psychosis inpatient units. The units were across two large London hospitals in one Hospital Trust involving male and female inpatients with a range of mental health issues. The intervention was comprised of two components. The first component was a weekly 45 minute teaching group designed in collaboration with patients focusing on the key domains that affect the physical health of mental health patients. Four discussion domains (heart health, diabetes and weight, smoking and lung disease, cancer screening and substance misuse) were undertaken, with each cycle lasting four weeks. The second component was a weekly 45 minute exercise group ('normalisation activity') in collaboration with patients and the multidisciplinary team. The intervention was evaluated at the end of each cycle and four cycles in total took place. Weekly pre and post intervention measures were undertaken comprising of a self reported change in understanding, motivation to change physical health behaviours, confidence to change, anxiety and motivation to exercise. The result was a 26% improvement in self-reported understanding across the four domains following teaching. Furthermore patient anxiety reduced by on average 35%, self-reported motivation to change increased by 20%, motivation to do exercise by 26% and confidence to change by 16% as a result of the intervention. The authors conclude that a collaborative approach to education and activity between the Multidisciplinary Team (MDT) and service user results in sustained improvement in understanding of physical health, motivation to change behaviour and to do exercise. It also results in improved confidence and reduced anxiety.

Introduction Oesophageal adenocarcinoma is an increasingly common diagnosis and cause of death; risk factors include ‘Barrett's epithelium’ (BE). Endoscopic surveillance is most commonly used but is expensive. Other methods of surveillance have been suggested including nonendoscopic balloon cytology, but are handicapped by relying on cytological techniques; hence the need for a partner technology such as a biomarker. From earlier work we know the most commonly expressed oesophageal stress response proteins are SEP 53, SEP70 and anterior gradient-2 (AG-2). We set out to map the expression of these stress response proteins and explore their potential as prototype biomarkers of BE. Methods Patients (n=192) presenting to the endoscopy unit of a large teaching hospital with symptoms of gastro-oesophageal reflux disease or a known BE were recruited, endoscopically examined and the biopsies obtained were examined for heat shock protein expression. Results and discussion Normal controls and those with oesophagitis predominantly expressed SEP 53 (76.9/91.95%) and SEP 70 (79.48/89.65%). Although those with BE expressed AG-2; using this expression as a marker for BE, gives a sensitivity of 65.15% and specificity of 89.68% (positive predictive value of 76.78% and negative predictive value of 84.9%) and in gastro-oesophageal reflux disease a sensitivity of 65.15% and specificity of 90.80% (positive predictive value of 84.31% and negative predictive value of 77.45%). We confirmed that AG-2 is preferentially expressed in BE; suggesting its use would allow a screening tool with specificity of around 90%.

156 Background: The purpose of this study was to investigate the relationships between new patient volume per oncologist, the availability of a social worker, and the capacity to provide psychosocial care. Methods: Community practices within Michigan Oncology Quality Consortium (MOQC), a statewide quality collaborative, completed NCI’s 10-item Cancer Psychosocial Care Matrix (CPCM). The CPCM speaks to communication, assessment, coordination, training, and outcomes and quality, each on a separate Likert scale. Analyses describe the ability to meet psychosocial care and the availability of a social worker, new patients/full time oncologist, payer mix, and percent minorities. Results: To date,15 of 47 practices (32%) completed the CPCM. We report on 4 measures with sizeable variation between practices. Scores were the highest on the ability to communicate the importance of psychosocial care and implementing a plan (scale of 1 – 3; mean of 2.36, standard deviation, SD 0.72; mean of 1.79, SD 0.89). The lowest scores were related to linking patients with services and offering provider education (scale of 1 – 5: mean of 2.18, SD 1.08; mean of 2.20, SD 0.94). Linear regression showed an association with number of patients/oncologist and the ability to provide staff training of effective patient/provider communication and monitoring this activity’s impact. For every 100-person increase in the number of patients/oncologist, there was a -0.16 (p = 0.046) rating difference in staff training and a -0.25 (p = 0.006) rating difference to monitor the communication’s effect. A dedicated social worker was present in 3 practices. Regression analysis showed a relationship between a social worker and recognizing (p=0.02) and addressing psychosocial care (p

This article has been retracted by the publisher. For more information please see the statement here: https://www.cogentoa.com/article/10.1080/23311886.2017.1330439

6594Background: The aim was to assess medication adherence and confidence to self-manage side effects of oral oncolytic agents among cancer patients whose providers participate in the Michigan Onco...

255 Background: The Michigan Oncology Quality Consortium (MOQC) is a quality collaborative supported by Blue Cross Blue Shield of Michigan with the goal of improving cancer care in Michigan by using data gathered as part of the national Quality Oncology Practice Initiative (QOPI) program. In spring 2014, MOQC launched a statewide collaborative focused on advance care planning (ACP) with the following aim: to provide training and resources on how to engage patients in a discussion of goals, preferences, and priorities for care. Methods: The collaborative was comprised of three half day learning sessionsthat included an overview of legal and documentation requirements, and facilitator-lead role play with patient actors. Lean resources (templates, workflows) to support standard work in the clinic were disseminated. Eight oncology practices participated ranging in size from 1-25 physicians. ASCO QOPI data were analyzed pre and post collaborative in spring 2014 and spring 2015. Results: Improvement in QOPI performance from spring 2014 to 2015 on “hospice enrollment, palliative care referral/services, or documented discussion” (73.8% to 77.6%) and “for patients not referred, hospice or palliative care discussed within the last 2 months of life” (17.7% to 23.9%) was noted for participating practices (n = 8). Collaborative participants also compared favorably to all other MOQC practices (n = 47) in spring 2015 on “hospice enrollment, palliative care referral or documented discussion” (77.6% vs. 66.2%) (p < 0.001). Conclusions: Use of a collaborative education modelthat includes facilitator-lead role play and dissemination of lean resources to create standard work may be an efficient and effective approach to improve discussion and documentation of advance care planning.

89 Background: The rapid shift to oral oncolytic therapy presents challenges to oncology practitioners. The purpose of this study is to describe how participation in a statewide oral oncolytic improvement collaborative where best practices and resources were shared can readily impact quality of care as measured by national standards. Methods: The Michigan Oncology Quality Consortium (MOQC) hosted a series of learning collaborative sessions focused on topics and deployment of resources specific to oral oncolytic management and quality improvement. Participating practices performed pre/post self-assessments in Oct. 2013 and Apr. 2015 (n = 3). Concordance with national ASCO QOPI and ONS standards was compared, including documentation (5 measures), patient education (7 measures), and follow-up/monitoring (4 measures). A response scale of always, sometimes, and never was used. Specifically, practices were surveyed to assess which evidence-based MOQC resources were implemented: patient intake template, drug-specific self-management guides, start date mailer, medication calendar, primary care physician communication template, Edmonton Symptom Assessment Scale (ESAS), and patient adherence questionnaires. Results: Practice A showed improvement in documentation, patient education, and monitoring. This practice used the initial oral chemotherapy template, ESAS, patient education templates, and patient calendar (Table). Practice B implemented 6 resources and demonstrated improvements in 15 metrics. Practice C implemented 4 resources, namely patient-focused resources, to improve all patient education and monitoring metrics. Conclusions: Use of the collaborative model and supplying oncology teams with scientific evidence, standard workflows, and resources improves concordance with national standards of care. Large-scale deployment of this model program may provide a clinically efficient and effective mechanism to enhance widespread change. [Table: see text]

68 Background: The aim of this study was to assess patient confidence to self-manage common side effects of oral oncolytic agents among cancer patients whose providers participated in the Michigan Oncology Quality Consortium (MOQC). Methods: This was a cross-sectional study conducted between August and September 2015, enrolling a convenience sample of 125 patients currently taking oral oncolytics in 10 oncology practices who completed a brief online survey. Demographics, clinical information, health literacy (3 items) and Patient Activation Measure (PAM, 13 items) were assessed. The PAM instrument assesses patient self-reported knowledge, skills and confidence for self-management. Participants were also asked to rate on a scale 0-10 how confident they felt self-managing 3 common oral oncolytic side-effects: fatigue, nausea and diarrhea. Differences by age, gender, education level, health literacy, and PAM level were examined. Results: Respondents were 66.2 (SD, 13.6) years old and 57.7% were female. The mean length of oral oncolytic therapy was 12.9 (SD, 13.8) months and average number of medications was 5.9 (SD, 3.2). Approximately three-quarters of patients assessed had high levels of patient activation (41.5% level 3 and 32.5% level 4), with the remaining 26.0% having low involvement in their care (17.1% level 1 and 8.9% level 2). Confidence to manage fatigue was high for 79% of patients, moderate for 12.1% and low for 8.9%. Confidence to manage nausea and diarrhea was higher with 85.5% and 88.7% patients reporting high confidence, respectively, but 6.5% and 4.8% reporting low confidence to manage these two symptoms. When combining the confidence measures to manage each of the three symptoms, patients with higher health literacy (p = 0.001), higher PAM levels (p = 0.018) and older patients (p = 0.041) exhibited higher confidence at a statistically significant degree. Conclusions: Healthliteracy and PAM were associated with patient confidence to self-manage oral oncolytic side effects. Health literacy screening in clinical practice may be an efficient means to identify patients with low self-management confidence and determine needs of further education and support.

Purpose Tobacco use is not only associated with the development of cancer, but after a patient develops cancer, its continued use is associated with poorer cancer treatment outcomes. Despite this fact, most oncologists do not regularly provide tobacco cessation support. The purpose of this study was to implement an expedited process of patient identification and tobacco cessation for cancer patients. Methods The Michigan Oncology Quality Consortium (MOQC) collaborated with the Michigan Department of Community Health, Blue Cross and Blue Shield of Michigan, and the Michigan Cancer Consortium to enhance tobacco cessation support for cancer patients. A statewide tobacco cessation demonstration project using a lean engineering approach was developed to provide structured tobacco assessments, referral to state quitline resources, and provide tailored cessation support to cancer patients consisting of behavioral counseling and free pharmacotherapy where appropriate. These steps were rapidly deployed in over 30 locations including those in private oncology practices and cancer centers in the first year. Data were analyzed to evaluate participation, retention, and quit rates for cancer patients enrolled in the program. Results Previous reports have described high rates of patient contact and participation in the cessation program. In the 690 patients with at least 12 months since program enrollment, 200 (29%) participated in only 1 call, 313 (45%) participated in 1-2 follow-up calls, and 177 (26%) participated in 3 or more follow-up calls. Follow-up 30 day quit rate data was obtained in 198, 138, and 199 patients at 3, 6, and 12 months respectively. Self-reported quit rates remained largely consistent with 29.8% at 3 months, 27.5% at 6 months, and 30.2% at 12 months. Conclusions The MOQC demonstration project represents a model partnership between payors, clinicians, and statewide quitlines that maintained consistent and moderate quit rates in cancer patients. Large-scale deployment of this model program may provide a clinically efficient and effective mechanism to enhance widespread tobacco cessation efforts for cancer patients. Citation Format: Laura Petersen, Hilary Baca, Karen Brown, Jamie Lindsay, Sarah Mott, Jane Severson, Anna Schulze, Graham Warren. Rapid deployment of statewide tobacco cessation program for cancer patients. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3728. doi:10.1158/1538-7445.AM2015-3728