Pathology Consultation Clinic for Patients With Cancer: Meeting the Clinician Behind the Microscope

2021 ◽  
pp. OP.20.00948
Author(s):  
Eliya Shachar ◽  
Shira P. Hasson ◽  
Rochelle Fayngor ◽  
Ido Wolf ◽  
Dov Hershkovitz
Keyword(s):  
Treatment Plan ◽  
Clinic Visit ◽  
Molecular Testing ◽  
Oncology Patients ◽  
Genetic Sequencing ◽  
Patient Understanding ◽  
Patients With Cancer ◽  
Pathology Reports ◽  
Tissue Specimens ◽  
Consultation Services

PURPOSE: Traditionally, pathologists have been branded the doctor's doctor, with a position behind the microscope and limited interaction among patients, despite their rich understanding of disease development and ability to navigate personalized medicine in an era of dynamic molecular testing. METHODS: We piloted a unique patient-pathology consultation service, whereby pathologists review tissue specimens with oncology patients, facilitating a platform for heightening patient understanding of their disease and guiding additional genetic and molecular evaluation. We conducted a retrospective survey assessing patient experience. RESULTS: Fifty-nine patients participated in the patient-pathology clinic consultation, with a median age of 64 years and a female predominance (33, 55.9%). The majority of patients were treated for sarcomas (11, 18.6%), breast cancer (10, 17%), and GI tumors (10, 17%). Half of the participants consulted regarding a metastatic disease (28, 47.5%). Thirty patients (50.8%) were referred to additional workup, 11 patients (18.6%) to a second opinion, and 25 participants (42.4%) were counseled to complete genetic sequencing or additional molecular profiles on their pathologic samples. Twelve patients (20.3%) were referred for pathology revision within our institution. Three patients (5.1%) had a change in treatment plan resulting from the clinic visit. The majority (90%) would recommend the patient-pathology clinic to other oncology patients. CONCLUSION: To our knowledge, this is the largest study of patient-pathologist consultation services implemented at a single institution. Our work suggests that the program may provide effective patient understanding and reinforce the role of the pathologist as the patient's doctor. This work surfaced the concerns of patients, regarding their pathology reports, and demonstrated that the patient-pathology clinics are a valuable platform to address patients' distress regarding uncertainty of their diagnosis and an integral resource engaging directly with patients, driving additional evaluation and patient-targeted treatment.

scholarly journals Seroconversion rates following COVID-19 vaccination amongst patients with malignant disease- the impact of diagnosis and cancer-directed therapies

2021 ◽  
Author(s):  
Astha Thakkar ◽  
Jesus Gonzalez Lugo ◽  
Niyati Goradia ◽  
Radhika Gali ◽  
Lauren C. Shapiro ◽  
...  
Keyword(s):  
Passive Immunization ◽  
High Rate ◽  
Oncology Patients ◽  
Post Vaccination ◽  
Patients With Cancer ◽  
Immunization Strategies ◽  
Checkpoint Inhibitor Therapy ◽  
Hormonal Therapies ◽  
Anti Cd20 ◽  
The Impact

As COVID-19 has been shown to adversely affect patients with cancer, prophylactic strategies are critically needed. We determined the immunogenicity of COVID-19 vaccination in a cohort of cancer patients that had received full dosing with one of the FDA-approved COVID-19 vaccines. 201 oncology patients underwent anti-spike protein SARS-CoV-2 IgG testing post-vaccination and demonstrated a high rate of seroconversion (94%) overall. When compared to solid tumors (98%), a significantly lower rate of seroconversion was observed in patients with hematological malignancies (85%), particularly recipients of anti-CD20 therapies (70%) and stem cell transplantation (74%). Patients receiving immune checkpoint inhibitor therapy (97%) or hormonal therapies (100%) demonstrated high seroconversion post-vaccination. Patients with prior COVID-19 infection demonstrated higher anti-spike IgG titers post-vaccination. Relatively lower IgG titers were noted following vaccination with the adenoviral when compared to the mRNA-based vaccines. These data demonstrate generally high immunogenicity of COVID-19 vaccination in oncology patients and identify vulnerable cohorts that need novel vaccination or passive immunization strategies.

scholarly journals Evaluation of the Xpert MTB/RIF Performance on Tissues: Potential Impact on Airborne Infection Isolation at a Tertiary Cancer Care Center

2018 ◽  
Vol 39 (4) ◽  
pp. 462-466 ◽  
Author(s):  
Tracy McMillen ◽  
Shauna C. Usiak ◽  
Liang Hua Chen ◽  
Luz Gomez ◽  
Peter Ntiamoah ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Limit Of Detection ◽  
Tertiary Care ◽  
Ffpe Tissue ◽  
Cancer Center ◽  
Oncology Patients ◽  
Tissue Samples ◽  
Airborne Infection ◽  
Potential Impact ◽  
Tissue Specimens

OBJECTIVESIn this study, we sought to evaluate the performance of the Xpert MTB/RIF (Cepheid) assay for the detection of Mycobacterium tuberculosis (MTB) complex DNA on fresh and formalin-fixed, paraffin-embedded (FFPE) tissue specimens from oncology patients in an area with a low prevalence of tuberculosis. We also aimed to retrospectively assess the potential impact of Xpert MTB/RIF on the duration of airborne infection isolation (AII).SETTINGA 473-bed, tertiary-care cancer center in New York City.DESIGNA total of 203 tissue samples (101 FFPE and 102 fresh) were tested using Xpert MTB/RIF, including 133 pulmonary tissue samples (65.5%) and 70 extrapulmonary tissue samples (34.5%). Acid-fast bacilli (AFB) culture was used as the diagnostic gold standard. The limit of detection (LOD) and reproducibility were also evaluated for both samples types using contrived specimens. The potential impact of the Xpert MTB PCR assay on tissue samples from AII patients on AII duration was retrospectively assessed.RESULTSUsing the Xpert MTB/RIF for fresh tissue specimens, the sensitivity was 50% (95% CI, 1.3%–98.7%) and the specificity was 99% (95% CI, 94.5%–99.9%). For FFPE tissue specimens, the sensitivity was 100% (95% CI, 63.1%–100%) and the specificity was 98.3% (95% CI, 95.5%–100%. The LOD was 103 colony-forming units (CFU)/mL for both fresh and FFPE tissue specimens, and the Xpert MTB/RIF was 100% reproducible at concentrations 10 times that of the LOD. With an expected turnaround time of 24 hours, the Xpert MTB PCR could decrease the duration of AII from a median of 8 days to a median of 1 day.CONCLUSIONSThe Xpert MTB/RIF assay offers a valid option for ruling out Mycobacterium tuberculosis complex (MTBC) on tissue samples from oncology patients and for minimizing AII resource utilization.Infect Control Hosp Epidemiol 2018;39:462–466

Abstract T P276: Transient Ischemic Attack Clinic Drives Superior Patient Outcomes While Reducing Cost

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jim Woodard ◽  
Shelby Haschker
Keyword(s):  
Average Cost ◽  
Treatment Plan ◽  
Cost Effective ◽  
Clinic Visit ◽  
Fiscal Year ◽  
Time Interval ◽  
Short Time Interval ◽  
Emergency Rooms ◽  
High Satisfaction ◽  
Ischemic Attack

It is estimated that 40% of all individuals that experience a TIA will ultimately suffer a stroke. As many as 50% of these patients will have a stroke within one week post TIA. Given the short time interval between TIA symptomology and stroke onset, immediate treatment is warranted. Historically treatment of TIA patients has taken place in emergency rooms and as hospital inpatients. A TIA clinic was established in 2011 as an alternative option to traditional TIA treatment. This clinic was designed to expedite diagnosis and treatment while reducing cost. Utilizing the ABCD2 tool, emergency department clinicians, PCPs and ophthalmologists referred low risk patients to the clinic. Clinic patients were scheduled to be seen in the clinic within 24-48 hours. All testing, stroke/TIA education, neurological consultation and secondary treatment plan were completed during the clinic visit. To date, the clinic has evaluated 137 patients. There have been no reports of stroke 90-days post clinic visit. Stroke rates post TIA are estimated to be as high as 17% after 3 months. This data supports the TIA clinic’s success in secondary stroke prevention. Patients seen in the clinic reported high satisfaction scores with the clinic and the care they received. It was initially hypothesized that the TIA clinic would provide care in a more cost effective way. A cost analysis was performed comparing TIA clinic costs and the cost of treating patients admitted to the hospital. Using fiscal year 2014 data, the average cost for treating a patient in the clinic was $423. The average cost for admitting a patient to the hospital was $1,464 per patient. The TIA clinic has shown that patients can receive timely treatment in a setting that produces the highest clinical outcomes, maintains patient satisfaction and reduces cost by 70%.

#31: Risk Factors Associated with Mortality due to Multidrug-Resistant Organisms in Pediatric Oncology Patients with Febrile Neutropenia

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S15-S16
Author(s):  
Miguel A Minero ◽  
Asia Castro ◽  
Martha Avilés-Robles
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Pediatric Patients ◽  
Bloodstream Infections ◽  
Oncology Patients ◽  
Factors Associated ◽  
Patients With Cancer ◽  
The Impact

Abstract Background Infectious processes are frequent complications presented in pediatric patients with cancer. Currently, the indiscriminate use of antibiotics induces resistance to available treatments, creating the emergence of multi-drug-resistant organisms (MDROs). Due to the impact in morbidity and mortality secondary to MDRO infection, we aimed to identify risk factors associated with mortality in infections due to MDROs in pediatric patients with cancer. Methods Case–control study nested in a prospective cohort of pediatric oncology patients with febrile neutropenia (FN) at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from March 2015 to September 2017. MDRO was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Patients with FN episodes who died from an infection due to MDROs were defined as cases and patients with FN episodes of an infection due to MDROs who did not die were defined as controls. Mucositis, septic shock, PICU stay, and bacterial prophylaxis (Trimethoprim/Sulfamethoxazole) were compared between groups. Descriptive statistics was performed and Pearson χ 2 or Student’s t-test were used to compare risk factors between groups. Results A total of 929 FN episodes were documented, 44.4% episodes occurred in male patients, mean age was 7.9 years, with the population under 5 years being the most represented (68.2%). The most frequent diagnosis was acute lymphoblastic leukemia in 75% followed by rhabdomyosarcoma in 10.5% and acute myeloid leukemia in 9.6%. Prophylaxis (trimethoprim/sulfamethoxazole) was used in 86%, mucositis was present in 9.2% of episodes. 12.1% had septic shock and 4.7% were admitted to PICU. In 148 FN episodes (15.9%) a microorganism was identified, of these 50 (33.7%) were due to an MDROs. Urinary tract infection was the most frequent site (49%), followed by bloodstream infections (47%). K. pneumoniae was the most frequent MDRO in 22.8%, followed by E. coli in 19.2% and P. aeruginosa in 14%. Septic shock was presented in 26% of MDROs infections. Overall mortality was 1.94% and only 0.86% (8) were secondary to MDROs. Of patients with MDRO isolated mortality was 30% (15/50). Mortality associated with bloodstream infection due to MDROs was 25% compared with other source of MDROs infections (3%) (P = 0.01). Septic shock was present in 40% of patients with death due to MDROs infection (P = 0.001). Conclusions In our population of children with FN episodes who had an isolated microorganism, infection due to MDROs are high (33.7%) and MDROs infection-directed mortality was as high as 30%. Bloodstream infections and septic shock were risk factors associated with mortality due to MDROs.

scholarly journals Cardiovascular care of the oncology patient during COVID-19: An expert consensus document from the ACC Cardio-Oncology and Imaging Councils

2020 ◽  
Author(s):  
Lauren A Baldassarre ◽  
Eric H Yang ◽  
Richard K Cheng ◽  
Jeanne M DeCara ◽  
Susan Dent ◽  
...  
Keyword(s):  
Multimodality Imaging ◽  
Cardiovascular Complications ◽  
Expert Consensus ◽  
Oncology Patients ◽  
Oncology Patient ◽  
Cancer History ◽  
Patients With Cancer ◽  
Consensus Document ◽  
Increased Risk ◽  
Cardiovascular Care

Abstract In response to the coronavirus disease 2019 (COVID-19) pandemic, The Cardio-Oncology and Imaging Councils of the American College of Cardiology offers recommendations to clinicians regarding the cardiovascular care of cardio-oncology patients in this expert consensus statement. Cardio-oncology patients–individuals with an active or prior cancer history, and with or at risk of cardiovascular disease–are a rapidly growing population, who are both at increased risk of infection by COVID-19 and experiencing severe and/or lethal complications. Recommendations for optimizing screening and monitoring visits to detect cardiac dysfunction are discussed. In addition, judicious use of multimodality imaging and biomarkers are proposed to identify myocardial, valvular, vascular, pericardial involvement in cancer patients. The difficulties of diagnosing the etiology of cardiovascular complications in patients with cancer and COVID-19 are outlined, along with weighing the advantages against risks of exposure, with the modification of existing cardiovascular treatments and cardiotoxicity surveillance in patients with cancer during the COVID-19 pandemic.

scholarly journals Dissemination and Implementation of Palliative Care in Oncology

2020 ◽  
Vol 38 (9) ◽  
pp. 995-1001 ◽  
Author(s):  
Betty R. Ferrell ◽  
Vincent Chung ◽  
Marianna Koczywas ◽  
Thomas J. Smith
Keyword(s):  
Palliative Care ◽  
Models Of Care ◽  
Dissemination And Implementation ◽  
Community Practice ◽  
Future Directions ◽  
Patients With Cancer ◽  
Effective Dissemination ◽  
Oncology Care ◽  
Cancer Trajectory ◽  
Consultation Services

Palliative care began in academic centers with specialty consultation services, and its value to patients, families, and health systems has been evident. The demand for palliative care to be integrated throughout the cancer trajectory, combined with a limited palliative care workforce, means that new models of care are needed. This review discusses evidence regarding the need for integration of palliative care into routine oncology care and describes best practices recognized for dissemination of palliative care. The available evidence suggests that palliative care be widely adopted by clinicians in all oncology settings to benefit patients with cancer and their families. Efforts are needed to adapt and integrate palliative care into community practice. Limitations of these models are discussed, as are future directions to continue implementation efforts. The benefits of palliative care can only be realized through effective dissemination of these principles of care, with more primary palliative care delivered by oncology clinicians.

scholarly journals Survey of Fertility Preservation Options Available to Patients With Cancer Around the Globe

2020 ◽  
pp. 331-344 ◽  
Author(s):  
Alexandra S. Rashedi ◽  
Saskia F. de Roo ◽  
Lauren M. Ataman ◽  
Maxwell E. Edmonds ◽  
Adelino Amaral Silva ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Fertility Preservation ◽  
Treatment Plan ◽  
Quality Care ◽  
Global Scale ◽  
Process Improvements ◽  
Patients With Cancer ◽  
Survey Results ◽  
Successes And Challenges ◽  
Legal Barriers

Purpose Oncofertility focuses on providing fertility and endocrine-sparing options to patients who undergo life-preserving but gonadotoxic cancer treatment. The resources needed to meet patient demand often are fragmented along disciplinary lines. We quantify assets and gaps in oncofertility care on a global scale. Methods Survey-based questionnaires were provided to 191 members of the Oncofertility Consortium Global Partners Network, a National Institutes of Health–funded organization. Responses were analyzed to measure trends and regional subtleties about patient oncofertility experiences and to analyze barriers to care at sites that provide oncofertility services. Results Sixty-three responses were received (response rate, 25%), and 40 were analyzed from oncofertility centers in 28 countries. Thirty of 40 survey results (75%) showed that formal referral processes and psychological care are provided to patients at the majority of sites. Fourteen of 23 respondents (61%) stated that some fertility preservation services are not offered because of cultural and legal barriers. The growth of oncofertility and its capacity to improve the lives of cancer survivors around the globe relies on concentrated efforts to increase awareness, promote collaboration, share best practices, and advocate for research funding. Conclusion This survey reveals global and regional successes and challenges and provides insight into what is needed to advance the field and make the discussion of fertility preservation and endocrine health a standard component of the cancer treatment plan. As the field of oncofertility continues to develop around the globe, regular assessment of both international and regional barriers to quality care must continue to guide process improvements.

Content of Hematologic Malignancies Consultations: Good and Bad News From the HEMA-COMM Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 68-68
Author(s):  
Stephanie J. Lee ◽  
Amy Sullivan ◽  
Roberta E Goldman ◽  
Robin Matsuyama ◽  
Fausto R. Loberiza ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Preference ◽  
Conflicts Of Interest ◽  
Hematologic Malignancy ◽  
Treatment Plan ◽  
College Education ◽  
Patient Communication ◽  
Patient Understanding ◽  
Doctor Patient Communication ◽  
Life Threatening

Abstract Abstract 68 Introduction: Communications literature suggests that optimal doctor-patient communication in medical encounters should include several specific behaviors to enhance successful communication. Very little is known about how often hematologic malignancy subspecialists engage in these behaviors, but several studies have documented that patients are more optimistic about their prognoses than their physicians. We anticipated that a first consultation with a hematology-oncology subspecialist would provide an opportunity to study doctor-patient communication in a particularly intense situation, since the patient and physician are meeting for the first time, discussing a life-threatening disease, and usually confirming or deciding on a treatment plan. Methods and Subjects: We studied 236 patients having first consultations with 40 physicians at two academic institutions in the HEMA-COMM study. The HEMA-COMM study is an observational study designed to evaluate doctor-patient communication with data collected through patient and physician surveys, patient interviews, and audiotaping and coding of the consultations. Results: Median patient age was 55 years and 53% were men, 89% White, 78% married and 60% had at least a college education. Diagnoses included lymphoma (31%), acute leukemia (19%), myelodysplastic syndrome (17%), multiple myeloma (16%) and chronic leukemia (16%). Median age of physicians was 47 years and 85% were men. The median year of fellowship completion was 1992. Physicians estimated they saw a median of 8 new patients a month, 80% of whom were direct referrals. Results: Median duration of the consultations was 80 minutes. Coding of recorded consultations showed the frequency at which recommended communication behaviors occurred: discussion about purpose of the visit (78%), patient prior knowledge about disease (89%), patient preference for decision-making role (37%), patient understanding of presented information (31%), and patient preference for information (5%). Consultations addressed treatment recommendations (97%) and treatment impact on quality of life (52%), but rarely patient participation in recovery (1%). Qualitative prognostic information was provided in 97% of consultations and quantitative information in 90%, but “hedging” (suggestions that prognostic estimates do not apply to the individual) occurred in 23%. Overall, 64% of consultations included clear discussion of mortality risk without hedging and 49% included clear discussions of cure risk without hedging. The median number of patient questions was 23 (range 0-122). The percentage of patients with a treatment plan increased from 31% before the consultation to 79% after the consultation and 98% of patients were happy with their level of involvement in decision-making. Patients were satisfied with their consultations and 80% were very likely to recommend the consulting physician to other patients. Conclusion: Physicians could improve their verbal communication by assessing patients' preferences for information and decision-making roles, and checking for patient understanding during consultations. Approximately half of consultations in our study clearly addressed prognostic topics such as mortality and cure. These data form the basis for investigating factors which contribute to optimal doctor-patient communication about life-threatening disorders. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The gut microflora assay in patients with colorectal cancer: in feces or tissue samples?

2019 ◽  
Author(s):  
Sama Rezasoltani ◽  
Hossein Dabiri ◽  
Hamid Asadzadeh-Aghdaei ◽  
Abbas Akhavan Sepahi ◽  
Mohammad Hossein Modarressi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Gut Microbiota ◽  
Screening Tests ◽  
Microbial Composition ◽  
Tissue Samples ◽  
Bacterial Populations ◽  
Patients With Cancer ◽  
Advantages And Disadvantages ◽  
Identification Of Bacteria ◽  
Tissue Specimens

Gut microbiota is the complex community of microorganisms that live in the digestive tracts of humans and other animals, including insects. The relationship between gut microbiota and human health is mutualistic and altered bacterial composi- tions in fecal and mucosal specimens of colon in patients with cancer compared to healthy subjects were observed. Thereby, studying the gut microbiota, their interactions with the host and their alterations in colorectal cancer (CRC) patients could be helpful to diagnose and treat the disease in earlier stages. In CRC research, the most common samples are feces and tumor tissues. Interestingly, scientists have quite different views regarding gut microbiota composition of feces and tissues. Some believe bacterial populations in feces and mucosa are completely distinct and differ in composition and diversity while some others declare similar variations. Actually, both types of specimens have some advantages and disadvantages in survey of gut microbiota. Fecal samples serve as a noninvasive approach for screening tests while mucosal associated samples are more powerful for identification of bacteria with adenoma and CRC initiation and growth. Here we have discussed the advantages and disadvantages of two type of specimens in CRC investigations and also discussed the similarities and differences of microbial composition between stool and tissue specimens.

scholarly journals Perceptions and knowledge of oncology patients of covid-19 infection in a developing country

2020 ◽  
Author(s):  
Arwa Y Alami ◽  
Gadeer Abdeen ◽  
Rula El Sabbagh ◽  
Amneh Dabor
Keyword(s):  
Medical Treatment ◽  
Developing Country ◽  
Preventive Measures ◽  
Treatment Plan ◽  
Hand Washing ◽  
Risk Of Infection ◽  
Oncology Patients ◽  
Protective Measures ◽  
Phone Calls ◽  
Anticancer Treatment

Abstract PurposeTo assess knowledge, beliefs, and measures followed by oncology patients in a developing country during the pandemic covid-10.Methods A survey conducted by phone calls to a group of patients treated at a cancer hospital, answers were recorded by the investigators. Data were analysed descriptively.Results Two hundred and one oncology patients answered the survey, mean age was 51.49 years; 66.2% were females, 49.2% of them were on active anticancer treatment. All patients knew of covid-19, 91%believed that it was contagious but only 46.3% thought they could become infected. While 75.1% believed that coming to the hospital increased the risk of infection, only 33.3% preferred to postpone their treatment. Only a minority thought that they will not seek medical treatment if they were infected with covid-19. Most of the participants followed preventive measures such as hand washing and use of disinfectants. Patients were followed by phone calls instead of clinical visits and 85.6% were satisfied with it.Conclusion: Study showed that most oncology patients are aware of the covid-19 pandemic, methods of spread and risk of infection. Most of them followed protective measures and adhered to social distancing. Patients were satisfied with phone calls as a replacement to clinical visits during the pandemic and their treatment plan was followed.

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