JCO oncology practice
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Little information exists on factors that predict opioid misuse in oncology. We adopted the Screener and Opioid Assessment for Patients With Pain-Short Form (SOAPP-SF) and toxicology testing to assess for opioid misuse risk. The primary objective was to (1) identify characteristics associated with a high-risk SOAPP-SF score and noncompliant toxicology test, and (2) determine SOAPP-SF utility to predict noncompliant toxicology tests. ⋯ Male sex, young age, and higher ESAS depression score were associated with a high SOAPP-SF score. Smoking habit was associated with an aberrant test. An SOAPP-SF of ≥ 3 (sensitivity, 0.74; specificity, 0.64), not ≥ 4, was predictive of an aberrant test; however, performance characteristics were decreased from those published by Inflexxion, for ≥ 4 (sensitivity, 0.86; specificity, 0.67). The specificity warrants caution in falsely labeling patients. The SOAPP-SF may aid in meeting National Comprehensive Cancer Network recommendations to screen oncology patients for opioid misuse.
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JCO oncology practice · Oct 2020
Management of Breast Cancer During the COVID-19 Pandemic: A Stage- and Subtype-Specific Approach.
The COVID-19 pandemic has rapidly changed delivery of cancer care. Many nonurgent surgeries are delayed to preserve hospital resources, and patient visits to health care settings are limited to reduce exposure to SARS-CoV-2. Providers must carefully weigh risks and benefits of delivering immunosuppressive therapy during the pandemic. ⋯ These algorithms emphasize medical oncology treatment decisions and demonstrate how we have operationalized the general treatment recommendations during the pandemic proposed by national groups, such as the COVID-19 Pandemic Breast Cancer Consortium. Our recommendations can be adapted by other institutions and medical oncology practices in accordance with local conditions and resources. Guidelines such as these will be important as we continue to balance treatment of breast cancer against risk of SARS-CoV-2 exposure and infection until approval of a vaccine.
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JCO oncology practice · Sep 2020
Effects of a Communication Intervention Randomized Controlled Trial to Enable Goals-of-Care Discussions.
Patients with advanced cancer often have a poor understanding of cancer incurability, which correlates with more aggressive treatment near the end of life (EOL). We sought to determine whether training oncologists to elicit patient values for goals-of-care (GoC) discussions will increase and improve these discussions. We explored its impact on use of aggressive care at EOL. ⋯ Use of a coaching model focused on teaching oncologists to elicit patient values improved that skill but did not increase prevalence or quality of GoC discussions among patients with advanced cancer. There was no impact on high care utilization at EOL.
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JCO oncology practice · Sep 2020
Hematology/Oncology Fellowship Emergency Restructuring in Response to the COVID-19 Pandemic-Henry Ford Hospital, Michigan.
The COVID-19 pandemic has wreaked havoc and created challenges in various subspecialty training programs, including hematology/oncology fellowship programs. The challenge of social distancing, providing care for those infected by COVID-19, continuing appropriate treatment of time-sensitive diseases, and the looming threat of health care worker infections required swift planning and restructuring of training programs. ⋯ While understanding that there is no one-size-fits-all, shared experiences can assist training programs to incorporate best practices and customize their programs to provide an active educational environment that balances patient care needs, didactics, scholarly activities, and wellbeing during the process of rapid changes and adaptation. We share our hematology/oncology fellowship program's restructuring approach in response to the COVID-19 pandemic.
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JCO oncology practice · Aug 2020
Oncology Fellow-Led Quality Improvement Project to Improve Rates of Palliative Care Utilization in Patients With Advanced Cancer.
ASCO guidelines recommend palliative care (PC) referral for patients with advanced or metastatic cancer. Despite this, implementation has considerable hurdles. First-year oncology fellows at our institution identified low rates of PC utilization in their longitudinal clinic as a metric needing improvement. ⋯ A multidisciplinary approach and classic quality improvement methodology improved PC use in patients with advanced cancer. The pilot succeeded given the small number of fellows, buy-in from stakeholders, and institutional and leadership support. Straightforward EMR interventions and ancillary staff use are effective in addressing underreferrals.