Successes and Challenges of Implementing Teleprehabilitation for Onco-Surgical Candidates and Patients’ Experience: A Retrospective Pilot-Cohort Study

Purpose: This study aimed to document the successes and challenges of teleprehabilitation programs for cancer patients undergoing surgery.Method: This pilot-cohort study included adults scheduled for elective cancer surgery, referred to the prehabilitation clinic to engage in physical activity and received a teleprehabilitation program between August 1st 2020 and February 28th 2021. Using a technology platform that included a tablet and was wearable, data were acquired through virtual physical activity monitoring in addition to patient charts.Results: Ten patients (8 males and 2 females; mean age: 68.3 years, SD: 11.96) diagnosed with various thoraco-abdominal malignancies were included in the current descriptive study. The successes identified were related to recruitment and assessment, improvement in functional capacity, clinic scheduling and interventions, and optimal medical follow-up. The challenges identified were related to the adoption of the technologies by patients and the multidisciplinary team, the accurate acquisition of patient physical activity data, and the initial costs to acquire the new technologies. Patients were satisfied with the teleprehabilitation program (i.e., services delivered; average appreciation: 96%), and they perceived the technologies provided to be 90% user-friendly.Conclusion: The findings of the current study are paramount in view of the current international health paradigm changes prioritizing remote interventions facilitated through digital communication technologies. It provides important insight into the clinical application of telehealth in elderly populations, notably in the context of acute preoperative cancer care. This article may provide guidance for other cancer care facilities aiming to implement teleprehabilitation programs.

Telemonitorização de sintomas pós quimioterapia com dispositivos mobile: revisão integrativa da literatura

O objetivo desse estudo foi avaliar se há benefícios no telemonitoramento de sintomas pós quimioterapia com dispositivos mobile em comparação com modelo tradicional de visitas médicas intervalares no cuidado de pacientes oncológicos, de modo a propiciar ganhos em desfechos prioritários para paciente. Trata-se de uma revisão integrativa de artigos publicados no Pubmed e Scielo nos últimos cinco anos. Termos de busca incluíram cancer, neoplasia, neoplasms, oncology, medical oncology, cancer care facilities, oncology service, telemedicine, telemonitoring, teleoncology, mobile health, mhealth, m-health, e-health, ehealth, videogame, mobile game, mobile app, app-technology, chemotherapy, drug therapy, treatment, drug therapy. Foram incluídos estudos randomizados e controlados, publicados em língua inglesa, pacientes oncológicos expostos a quimioterapia, supervisionados remotamente das toxidades agudas induzidas por quimioterapia, com os dados inseridos por dispositivos mobile. Para extração de dados, dois revisores utilizaram ficha com campos de informação padronizados. Os estudos analisados após critérios de elegibilidade apontam melhor controle de sintomas e desfechos. Conclui-se que telemonitorar toxidade pós quimioterapia por meio de dispositivos mobile gera melhor controle de sintomas e reduz complicações.

A call for revamping the policy on import process of anticancer drugs in Pakistan

Madam, cancer therapy in Pakistan is a costly treatment financially exhausting patients and their caregivers. Due to the sky high costs of treatment, there is a lack of cancer care facilities in the country. The sale and regulation of anticancer drugs and biologics is controlled by the Drug Regulatory Authority Pakistan (DRAP). DRAP is responsible for granting No Objection Certificate (NOC) to import unregistered drugs either for the patient or the institutional use of a hospital, both subject to renewal. This process can take up from a minimum of 10 days to a maximum of 30 days, for an individual patient it may take up to 1 to 3 days. This was a task almost unachievable before the formation of DRAP. (1,2) In Pakistan, there have been challenges such as price hike in local medicines (3), anticancer drug shortages due to unavailability of active pharmaceutical ingredients (4) as well as COVID19 related raw material and drug availability (5). The average time for importing an unregistered drug from outside the country is about 4-6 weeks, which may be further delayed for months. Our discourse aims to bring attention to this issue, as delay in initiation or continuation of treatment significantly reduces the chances of the patient’s survival with time, which is something they do not have much of We propose the following steps as part of making this process easier for the stakeholders and patients alike: Reduce the time of import of unregistered drugs to 1 week (revamp import process/fast-track) Decentralize authority to provincial DRAP to reduce the burden Once an unregistered drug is imported, it should be registered in the list of special status drugs to fasten future process Facilitate the cancer centers on procurement of import medicines. Hospitals who face inventory challenges- should be able to easily borrow an imported medicine item from a nearby hospital where it is available. Exempt custom duties and taxes on import of such medicines Encourage local manufacturing of generic drugs Abolish regularity duties on import of raw material of said medicines for the manufacturer of such generic drugs Allow multiple sources of drug import Trainee program for DRAP officials dealing with biologics Derive an online process/portal to communicate and update patients and hospitals for delays and implement procedures to deal with such issues (6). Continuous...

VERIFICATION OF AVAILABILITY OF THE HEALTH CARE CLUSTER IN THE BAIKAL REGION

Кластерный подход, разработанный М. Портером, позволяет выполнить верификацию наличия кластера в сфере охраны здоровья в регионе. Авторы в своем исследовании доказали наличие данного кластера в Байкальском регионе. В статье также представлена разработанная для кластера SWOT-матрица и кратко описана модель организации онкологической помощи в рамках кластера в сфере охраны здоровья в Байкальском регионе. The cluster approach, developed by M. Porter, gives an opportunity to verify the availability of the health care cluster in a region. The authors within the framework of their research proved the availability of such a cluster in the Baikal region. The SWOT-matrix developed especially for the cluster is presented in the article, as well as the model of organizing the cancer care facilities within the framework of the health care cluster in the Baikal region is briefly described.

Cancer Care Facilities Nurses Experience of Infection Control

Purpose: The purpose of this study was to explore cancer center nurses experience of infection control.Methods: From March 26 to 2019 to May 1, 2019 data were collected through focus group interviews and in-depth interviews. Data collected though interviews and field notes were analyzed using Colaizzi's phenomenological method. Participants were 12 registered nurses and 2 head nurses.Results: Fifteen themes emerged from four themes clusters. 1) Encountering barriers to infection control. 2) Infection control is still difficult. 3) Complaints about Infection Control Department exist. 4) Need to consider strategies for improving infection control.Conclusion: The results of the study indicate that in order to facilitate infection control and increase the compliance rate of the guidelines, it is necessary to develop a program to increase the individual's competency associated with infection control and the elimination of negative factors. Further, mediation of external factors related to the hospital environment is necessary.

Using Evidence to Design Cancer Care Facilities

The nuts and bolts of planning and designing cancer care facilities—the physical space, the social systems, the clinical and nonclinical workflows, and all of the patient-facing services—directly influence the quality of clinical care and the overall patient experience. Cancer facilities should be conceived and constructed on the basis of evidence-based design thinking and implementation, complemented by input from key stakeholders such as patients, families, and clinicians. Specifically, facilities should be designed to improve the patient experience, offer options for urgent care, maximize infection control, support and streamline the work of multidisciplinary teams, integrate research and teaching, incorporate palliative care, and look beyond mere diagnosis and treatment to patient wellness—all tailored to each cancer center’s patient population and logistical and financial constraints. From conception to completion to iterative reevaluation, motivated institutions can learn to make their own facilities reflect the excellence in cancer care that they aim to deliver to patients.

Precision lung cancer survivorship care: Accrual to the Kentucky LEADS Collaborative Lung Cancer Survivorship Care Program.

144 Background: Recent innovations in lung cancer care create an urgent need to generate survivorship care interventions that target lung cancer survivors and tailor content and services to this unique community. In addition to suffering significant distress and symptom burden, individuals diagnosed with lung cancer suffer the additional burden of stigma and bias and may not receive optimal social support. The Kentucky LEADS Collaborative Lung Cancer Survivorship Care Program adopts a precision survivorship approach by combining shared decision making and motivational interviewing to address specific threats to quality of life experienced by an individual facing lung cancer. Methods: A single-arm trial was conducted at nine cancer care facilities across Kentucky to assess intervention feasibility, acceptability, and preliminary efficacy. Eligible participants included individuals diagnosed with lung cancer who did not evince acute psychiatric or substance abuse issues. Upon consent, participants completed a baseline survey (T1) and medical data was extracted from the electronic record. Participants also completed the survey following intervention completion (T2) and six months post-baseline (T3). Analyses evaluate accrual and completion rates as well as participant demographics. Results: Over an approximately 12-month accrual period, nine sites accrued 142 participants. Three sites exceeded the accrual goal of 20. Of the participants accrued, 138 (97%) completed T1, 84 (58%) completed T2, 74 (52%) completed T3, and 70 (49%) provided complete data. The majority of participants were female (64%), the mean age was 63.4 (9.3) years, and nearly all participants were white/non-Hispanic (96%). Most participants had a high school degree or less (52%), described household incomes of $35K or less, but nearly all reported carrying health insurance (98%). Conclusions: The Kentucky LEADS program offers an intriguing approach to engaging lung cancer survivors by incorporating precision care strategies that may circumvent some of the more common challenges to reaching individuals diagnosed with lung cancer. Clinical trial information: NCT02989974.

Assessing cancer programs' financial resources for rural cancer patients.

165 Background: The National Cancer Institute (NCI) has identified rural cancer control as a research priority. Rural patients may have greater cancer-related financial burdens due to high travel costs, low insurance coverage, and less flexible work schedules. To better understand geographic differences in cancer-related financial toxicity from an organizational perspective, we interviewed staff from a range of cancer treatment settings in counties across the rural-urban continuum. The goal was to qualitatively assess the financial resources available to cancer patients, particularly those residing in rural areas. Methods: Seven research teams within the Cancer Prevention and Research Control Network interviewed personnel providing financial navigation services across four types of cancer care facilities and three urban/rural classifications. Interviews were audio-recorded and transcribed. We identified themes using inductive content analysis. A total of 28 interviews were collected across 7 states and preliminary results have been generated from 20 interviews. Results: Study participants identified transportation and housing costs as primary financial stressors for rural patients. A few personnel from centers in urban counties did not observe clear differences in experiences of financial toxicity between rural and urban patients. No personnel mentioned resources that are long-term or specifically for rural patients. Gas cards and temporary housing are often provided to help rural and urban patients access treatment. Insufficient staffing is a barrier to addressing patients’ financial concerns in rural and urban centers. Urban institutions, particularly NCI-designated facilities, employ more cancer-specific financial navigators than rural institutions. Conclusions: Patients across the rural-urban continuum experience financial hardship, but rural patients may be disproportionately affected by transportation and housing costs. Improving transportation and housing support may improve their ability to access treatment. Financial navigation practices within states vary; thus, patients and cancer centers may benefit from more streamlined approaches to address financial needs for all cancer patients.