RESUMO
BACKGROUND: Postoperative complications are an independent predictor of poor survival across several tumors. However, there is limited literature on the association between postoperative morbidity and long-term survival following total laryngectomy (TL) for cancer. METHODS: We conducted a retrospective review of all TL patients at a single institution from 2008 to 2013. Demographic and clinical data were collected and analyzed, including postsurgical outcomes, which were classified using the Clavien-Dindo system. Multivariable Cox regression analyses were performed to identify factors associated with overall survival (OS) and disease-free survival (DFS). RESULTS: A total of 362 patients were identified. The mean age was 64 years, and the majority of patients were male (81%). The median follow-up interval was 21 months. Fifty-seven percent of patients had received preoperative radiation, and 40% had received preoperative chemotherapy. Fifty-seven percent of patients underwent salvage TL, and 60% underwent advanced reconstruction (45% free flap and 15% pedicled flap). A total of 136 patients (37.6%) developed postoperative complications, 92 (25.4%) of which were major. Multivariable modeling demonstrated that postoperative complications independently predicted shorter OS (hazard ratio [HR], 1.50; 95% CI, 1.16-1.96; P = .002) and DFS (HR, 1.36; 95% CI, 1.05-1.76; P = .021). Other independent negative predictors of OS and DFS included positive lymph node status, preoperative chemotherapy, comorbidity grade, and delayed adjuvant therapy. Severity of complication and reason for TL (salvage vs primary) were not shown to be predictive of OS or DFS. CONCLUSION: Postoperative complications are associated with worse long-term OS and DFS relative to uncomplicated cases. Patient optimization and timely management of postoperative complications may play a critical role in long-term survival.
Assuntos
Laringectomia/efeitos adversos , Serviço Hospitalar de Oncologia/normas , Protocolos Clínicos , Humanos , Laringectomia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Texas , Fatores de Tempo , Estados UnidosAssuntos
COVID-19 , Neoplasias Colorretais/cirurgia , Serviço Hospitalar de Oncologia/normas , Qualidade da Assistência à Saúde , Idoso , COVID-19/epidemiologia , Infecção Hospitalar/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Singapura/epidemiologiaAssuntos
COVID-19/prevenção & controle , Medicina Baseada em Evidências , Serviço Hospitalar de Oncologia/organização & administração , Serviço Hospitalar de Oncologia/normas , COVID-19/epidemiologia , COVID-19/transmissão , Humanos , Pandemias , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Mídias Sociais , IncertezaAssuntos
COVID-19/prevenção & controle , Protocolos Clínicos , Neoplasias/cirurgia , Serviço Hospitalar de Oncologia/organização & administração , Cuidados Pré-Operatórios , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/transmissão , Teste para COVID-19 , Hospitalização , Humanos , Serviço Hospitalar de Oncologia/normas , Pandemias , SARS-CoV-2Assuntos
COVID-19/prevenção & controle , Infecção Hospitalar/prevenção & controle , Neoplasias/cirurgia , Serviço Hospitalar de Oncologia/organização & administração , COVID-19/epidemiologia , COVID-19/transmissão , Inglaterra/epidemiologia , Humanos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Serviço Hospitalar de Oncologia/normas , Pandemias , SARS-CoV-2RESUMO
BACKGROUND: Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient's profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life. METHODS: The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011-2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral). RESULTS: Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level > 35 g/l. The median [1st-3rd quartile] IP was 0.39 [0.16-0.72], ranging between 0.53 [0.20-0.79] (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 [0.07-0.56] (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units. CONCLUSIONS: The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances.
Assuntos
Tomada de Decisão Compartilhada , Serviço Hospitalar de Oncologia/normas , Encaminhamento e Consulta/normas , Fatores de Tempo , Idoso , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/normas , Prestação Integrada de Cuidados de Saúde/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/classificação , Neoplasias/terapia , Serviço Hospitalar de Oncologia/organização & administração , Serviço Hospitalar de Oncologia/tendências , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Cuidados Paliativos/tendências , Encaminhamento e Consulta/tendências , Estudos Retrospectivos , Assistência Terminal/organização & administração , Assistência Terminal/normas , Assistência Terminal/tendênciasRESUMO
BACKGROUND: Palliative care (PC) is increasingly recognized as essential for oncology care, and several academic societies strongly recommend integrating oncology and palliative care (IOP) in daily practice. Similarly, the Japanese government encouraged the implementation of IOP through the Cancer Control Act of 2007; however, its detailed progress remains unclear. Therefore, this cross-sectional nationwide survey was conducted to investigate the current status and hospital executive physicians' perception of IOP. METHODS: The questionnaire was developed based on IOP indicators with international consensus. It was distributed to executive physicians at all government-designated cancer hospitals (DCHs, n = 399) and matched non-DCHs (n = 478) in November 2017 and the results were compared. RESULTS: In total, 269 (67.4%) DCHs and 259 (54.2%) non-DCHs responded. The number of PC resources in DCHs was significantly higher than those in non-DCHs (e.g., full-time PC physicians and nurses, 52.8% vs. 14.0%, p < 0.001; availability of outpatient PC service ≥3 days per week, 47.6% vs. 20.7%, p < 0.001). Routine symptom screening was more frequently performed in DCHs than in non-DCHs (65.1% vs. 34.7%, p < 0.001). Automatic trigger for PC referral availability was limited (e.g., referral using time trigger, 14.9% vs. 15.3%, p = 0.700). Education and research opportunities were seriously limited in both types of hospitals. Most executive physicians regarded IOP as beneficial for their patients (95.9% vs. 94.7%, p = 0.163) and were willing to facilitate an early referral to PC services (54.7% vs. 60.0%, p < 0.569); however, the majority faced challenges to increase the number of full-time PC staff, and < 30% were planning to increase the staff members. CONCLUSIONS: This survey highlighted a considerable number of IOP indicators met, particularly in DCHs probably due to the government policy. Further efforts are needed to address the serious research/educational gaps.
Assuntos
Prestação Integrada de Cuidados de Saúde/tendências , Serviço Hospitalar de Oncologia/tendências , Cuidados Paliativos/métodos , Estudos Transversais , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/normas , Humanos , Japão , Serviço Hospitalar de Oncologia/normas , Cuidados Paliativos/normas , Cuidados Paliativos/tendências , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Central Venous Catheters (CVCs) are placed in pediatric patients that require frequent and/or long-term access for intravenous treatments and increase the risk for Central line-associated bloodstream infections (CLABSIs). The specific aims of the study were to evaluate adherence to the intervention components and rates of Central Line Associated Bloodstream Infections (CLABSIs) over five years. METHODS: Implementation occurred on the acute care and hematology-oncology pediatric units of a quaternary health care setting in Southern California. Adherence rates were quantified using a CVC audit sheet and CLABSI rates were obtained quarterly before, and at year 1, 2, 3, 4, 5 of implementation. RESULTS: CLABSI rates for both pediatric units decreased over the five-year period. Adherence rates were 90% to 100% on the different features of the intervention; the lowest was adherence to Patient Protective Equipment (PPE). A total of 41 incidents of hospital-acquired CLABSIs were reported the year prior to the Bug Buster Committee, which decreased steadily to 9 incidents after implementation. The quarterly CLABSI rates in the Pediatric Acute Care ranged from 2.8 to 6.6/1,000 catheter days and in Pediatric Hematology-Oncology from 2.1 to 4.3/1,000 catheter days the year prior to implementation. CONCLUSIONS: While adherence for staff remains high, parent/family adherence was low. We recommend including in the multi-level intervention, procedures targeting parent adherence such as patient education handouts, reviewing content on admission, placing signs on doors indicating PPE requirements, and promptly providing PPE to non-adherent family members.
Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/normas , Hospitais Pediátricos/normas , Serviço Hospitalar de Oncologia/normas , Assistência Ambulatorial/estatística & dados numéricos , Bacteriemia/prevenção & controle , California , Cateteres Venosos Centrais/normas , Criança , Infecção Hospitalar/prevenção & controle , Feminino , Humanos , Masculino , Neoplasias/terapia , Melhoria de QualidadeRESUMO
One of the largest change operations to take place in South Australia was the moving of the Royal Adelaide Hospital (RAH) to its new site in 2017. Change can influence workplace effectiveness and staff satisfaction and morale. Understanding the stages of change, staff experience and carefully managing the process is important. This paper aims to describe the successful move of the radiation therapy department at the RAH to its new site, focusing on the staff experience and management strategies to ensure the success of the move. A four-stage model of change was used to guide understand, manage and reflect upon the transition of the RAH radiation therapy department to a new site. Key change events and management strategies are described and aligned with the four stages of change. The move to the new site was a great success with a transition period working across two sites enabling a slower ramp up of activity at the new site supporting staff and patients in adjusting to the new environment. The four-stage model of change assisted in the smooth implementation of a transition plan for radiation oncology. At the RAH, innovation and development are encouraged, along with management having a comprehensive understanding of organisational change enabling the radiation oncology department to successfully navigate rapid change.
Assuntos
Gestão de Mudança , Serviço Hospitalar de Oncologia/organização & administração , Radio-Oncologistas/organização & administração , Serviço Hospitalar de Radiologia/organização & administração , Serviço Hospitalar de Oncologia/normas , Radio-Oncologistas/normas , Serviço Hospitalar de Radiologia/normas , Austrália do SulRESUMO
Traditional quality assurance processes provide significant opportunities for positive disruption. Doctor of Nursing Practice (DNP) students are well positioned to apply program learning to large-scale change in complex organizations. This article presents an innovative approach for creating a point-of-care interdisciplinary approach to address high fall risk frequencies in ambulatory oncology clinics using complexity leadership principles. Processes for nurse executives to consider for replication of this approach for other challenging clinical situations are suggested using the emerging competence of DNP educated nurses. Adults with cancer who are older than 65 years are at a higher risk for falls than older adults without cancer. Oncology providers and nurses are not routinely screening, documenting, and preventing falls. A fall injury in an older adult with cancer may not only delay or impact cancer treatment but also result in hospitalization, loss of function, and/or death. Increasing awareness of the impact of falls and implementing change within a large ambulatory health care organization requires an interdisciplinary team approach. Complexity theory supports nonlinear change initiated at the grassroots level to create a dynamic movement to bring forth emergence and adaptation. The use of the Centers for Disease Control and Prevention STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative will enable oncology professionals to screen, assess, and intervene by collaborating, communicating, and coordinating with other health care specialists to introduce a fall prevention quality improvement system process. Nurse executives need to know about STEADI.
Assuntos
Acidentes por Quedas/prevenção & controle , Indicadores de Qualidade em Assistência à Saúde/normas , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Geriatria/métodos , Geriatria/normas , Humanos , Masculino , Serviço Hospitalar de Oncologia/organização & administração , Serviço Hospitalar de Oncologia/normas , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Melhoria de Qualidade/tendências , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricosRESUMO
BACKGROUND: Dose banding parenteral chemotherapy has the potential to optimise aseptic unit capacity and reduce drug expenditure without compromising the service provided. METHODS: Dose banding tables from NHS England were implemented into the electronic chemotherapy prescribing system. Compliance to the dose bands was analysed and submitted quarterly. Analysis of drug expenditure, drug use and cost per milligram data was also collected. RESULTS: Expenditure on the 17 drugs identified in the 2016/17 dose standardisation CQUIN reduced by approximately £100,000 per month over the CQUIN despite an increase in the number of prescribed doses of these drugs. At the beginning of the year, the percentage of work compounded in house was 60%, which was reduced to 51% of total workload at the end of the year due to outsourcing commonly prescribed doses from commercial pharmaceutical aseptic manufacturers. CONCLUSION: Dose banding parenteral chemotherapy is an efficient cost-saving strategy which also can help to increase the capacity of the aseptic unit.
Assuntos
Antineoplásicos/normas , Análise Custo-Benefício/métodos , Prescrição Eletrônica/normas , Infusões Parenterais/normas , Serviço Hospitalar de Oncologia/normas , Centros de Atenção Terciária/normas , Antineoplásicos/administração & dosagem , Antineoplásicos/economia , Relação Dose-Resposta a Droga , Prescrição Eletrônica/economia , Humanos , Infusões Parenterais/economia , Serviço Hospitalar de Oncologia/economia , Centros de Atenção Terciária/economiaRESUMO
BACKGROUND: An opportunity was identified to compare perceptions of the occurrence and types of missed care at a comprehensive cancer center. PURPOSE: The purpose was to evaluate the difference in perceived occurrence and types of missed care between medical, surgical, and hematologic oncology units in the context of a newly implemented patient care delivery system, Primary Team Nursing (PTN). METHODS: A descriptive, repeated-measures design was used. The MISSCARE survey was distributed electronically to 580 staff members across 6 inpatient units. RESULTS: Frequently perceived elements of missed nursing care were ambulation, turning every 2 hours, and care conference attendance. At the time of study implementation, surgical units reported 0.24 higher scores than medical units (P = .017); hematology units reported 0.26 lower scores than surgical units (P = .005). PTN status did not affect MISSCARE scores (P = .525). CONCLUSIONS: Study findings suggest that perceived missed care in a comprehensive cancer center is similar to that in other hospital settings.
Assuntos
Cuidados de Enfermagem , Percepção , Especialidades de Enfermagem , Oncologia Cirúrgica , Hospitais , Humanos , Equipe de Enfermagem , Serviço Hospitalar de Oncologia/normas , Inquéritos e Questionários , Estados UnidosRESUMO
INTRODUCTION: Workplace violence (WPV) is defined as any act in which a person is abused, threatened, intimidated, or assaulted during their employment. Despite an absence of published evidence, radiation therapists (RTs) are considered a "low-risk" profession for WPV. The aim of this research was to determine the incidence, severity, and impact of WPV on RTs perpetrated by patients and/or their caregivers. MATERIALS AND METHODS: A cross-sectional online questionnaire, based on established components of WPV, was distributed via e-mail to all RTs in a large, urban cancer clinic. The questionnaire was divided into the five categories of WPV and asked about the frequency, severity, perpetrator, location, and impact of WPV. RESULTS: Seventy-eight responses were received from a department of 165 RTs (47% response rate). Fifty-nine RTs reported experiencing at least one verbal abuse event during their career. Twenty-five reported experiencing a verbal threat at least once, 46 reported at least one occasion of harassing behaviour, and 18 experienced a threatening action at least once. Five RTs reported suffering from at least one physical assault. The majority of this WPV took place on the treatment unit, with the patient as the perpetrator, and was not reported by the RT. High numbers of RTs reported suffering from stress (35), frustration (34), and anxiety (29) as a consequence of WPV. CONCLUSIONS: The close, longitudinal relationship between RTs and cancer patients puts RTs at considerable risk of experiencing multiple WPV events during their career. WPV is infrequently reported by RTs, perhaps linked to the belief that excellent patient care requires you to accept and excuse poor behaviour by patients. Prevention programs and de-escalation training are needed for RTs, but short-term measures such as shift or unit changes may prevent multiple WPV exposures which are associated with an increased risk of emotional and psychological sequelae.
Assuntos
Neoplasias/radioterapia , Relações Médico-Paciente , Radiologistas/psicologia , Violência no Trabalho/estatística & dados numéricos , Cuidadores/psicologia , Estudos Transversais , Atenção à Saúde , Humanos , Notificação de Abuso , Estresse Ocupacional/epidemiologia , Estresse Ocupacional/etiologia , Serviço Hospitalar de Oncologia/normas , Ontário/epidemiologia , Radiologistas/estatística & dados numéricos , Inquéritos e Questionários , Violência no Trabalho/psicologiaRESUMO
OBJECTIVE: To explore motives and experiences of patients with incurable cancer who are looking across the border for second opinions or treatments or are considering to do so. DESIGN: Qualitative, semi-structured interview study. METHOD: A total of 24 patients with incurable cancer from two Dutch hospitals were interviewed by phone. All interviews were coded independently by two researchers and then analysed inductively, without any pre-specified theoretical framework. RESULTS: Patients were looking for second opinions or treatments because they found it very difficult to accept a sudden diagnosis of incurable disease. They experienced little guidance during this transition. Patients felt they were not offered any treatment options because of imperative protocols. Many patients were in great need of some form of hope. There were often high expectations - unrealistic or not - of the possibilities abroad. Oncologists' reactions to patients' choices were very diverse. While disapproving reactions were unable to influence patients' choices, well-substantiated arguments were sometimes successful in influencing patients' choices. CONCLUSION: More guidance seems advisable for some patients to help them deal with a diagnosis of incurable disease. Dutch oncologists might be able to offer alternative forms of hope to these patients, who have a great need for this. If physicians speak with patients about what a treatment abroad may or may not be able to provide, this might benefit patients.
Assuntos
Turismo Médico/psicologia , Neoplasias/psicologia , Serviço Hospitalar de Oncologia/normas , Encaminhamento e Consulta , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Países Baixos , Relações Médico-Paciente , Pesquisa QualitativaRESUMO
OBJECTIVE: to create a multidisciplinary conducts manual for tracheostomies in adult and pediatric patients in the Amazonas State Oncology Control Center Foundation. METHODS: we developed a protocol using the modified Delphi method, which consisted in the application of two series of questionnaires to 20 professionals of the unit. RESULTS: thirteen professionals completed the two steps. In the first stage, there was consensus in 53 out of 92 questions (57.6%). The questions that obtained consensus formed the text of the second stage, divided into eight chapters and evaluated by marking the answers offered on a Linkert scale. All the chapters presented in the second stage obtained consensus, meaning that the sum of the answers "agree" and "fully agree" were above 70%. CONCLUSION: using the data obtained in the consensus, we elaborated a tracheostomy conduct protocol and a care guidelines manual for the patients and their caregivers.
OBJETIVO: criar um manual de rotina multidisciplinar de condutas em traqueostomias para pacientes adultos e pediátricos da Fundação Centro de Controle de Oncologia do Estado do Amazonas. MÉTODOS: o protocolo foi desenvolvido por meio do método Delphi modificado, que consistiu na aplicação de duas séries de questionários a 20 profissionais da unidade. RESULTADOS: treze profissionais concluíram as duas etapas. Na primeira etapa, 53 de 92 questões apresentadas obtiveram consenso (57,6%). Estas sentenças que obtiveram consenso formaram o texto da segunda etapa, que foi dividido em oito capítulos que foram avaliados por meio da marcação de respostas oferecidas em uma escala Linkert. Todos os capítulos apresentados na segunda etapa obtiveram consenso, significando que a soma das respostas concordo e concordo plenamente foram todas acima de 70%. CONCLUSÃO: utilizando os dados obtidos no consenso, foi elaborado um protocolo de condutas em traqueostomias e um manual de orientações de cuidados para os pacientes e seus cuidadores.
Assuntos
Guias de Prática Clínica como Assunto/normas , Inquéritos e Questionários/normas , Traqueostomia/normas , Brasil , Protocolos Clínicos/normas , Consenso , Técnica Delphi , Humanos , Serviço Hospitalar de Oncologia/normas , Traqueostomia/métodosRESUMO
PURPOSE: To analyze and describe health professionals' attitudes and perspectives on the complexities of cancer survivorship and rehabilitation needs assessment in a shared cancer care context. METHOD: The design and methodology for this study was Interpretive Description and the analysis was informed by Symbolic Interactionism as the theoretical framework. Between April and December 2015 an ethnographic fieldwork was carried out by the first author in haematological wards at two Danish hospitals and in two primary care settings conducting cancer survivorship care programs. Participants were 41 health professionals working with needs assessment. RESULTS: The findings revealed an understanding of the health professionals' attitudes and perspectives and were distinguishable in relation to three structural conditions associated with the dimensions of survivorship care: Patient Context, Workplace Priorities and Practice Culture. Despite shared beliefs that needs assessment was essential to ensure survivorship care, the differential conditions surrounding the hospital and the primary care settting impeded the wider idea of formalized needs assessment, creating barriers to a seamless link between the sectors. CONCLUSIONS: Meaningful resolution of these disjunctures will require broad solutions, recognizing that the organization of healthcare into disconnected systems, with their different conditions, history, habits and traditions, will certainly plague the "transition" problems in healthcare unless a wider perspective is taken. Thoughtful and informed clinicians working with decision makers and those who know the evidence and can interpret systems in context can certainly bring better options to light in order to develop high quality survivorship care that will support patients throughout their cancer trajectory.
Assuntos
Sobreviventes de Câncer/psicologia , Sobreviventes de Câncer/estatística & dados numéricos , Pessoal de Saúde/psicologia , Serviço Hospitalar de Oncologia/normas , Atenção Primária à Saúde/normas , Centros de Reabilitação/normas , Adulto , Atitude do Pessoal de Saúde , Tomada de Decisões , Dinamarca , Feminino , Guias como Assunto , Política de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das NecessidadesAssuntos
Serviço Hospitalar de Cardiologia/normas , Cardiologia , Doenças Cardiovasculares/terapia , Gerenciamento Clínico , Oncologia , Neoplasias/terapia , Serviço Hospitalar de Oncologia/normas , Doenças Cardiovasculares/etiologia , Humanos , Neoplasias/complicações , Equipe de Assistência ao PacienteRESUMO
This study aimed to ascertain the systemic barriers encountered by oncology health professionals (HPs) working with patients from ethnic minorities to guide the development of a communication skills training programme. Twelve medical and five radiation oncologists and 21 oncology nurses were invited to participate in this qualitative study. Participants were interviewed individually or in a focus group about their experiences working with people from minority backgrounds. All interviews were transcribed verbatim and analysed thematically. HPs encountered language and communication barriers in their interactions with patients and their families, which were perceived to impact negatively on the quality and amount of information and support provided. There was a shortage of, and poor processes for engaging, interpreters and some HPs were concerned about the accuracy of interpretation. HPs expressed a need for training in cultural awareness and communication skills with a preference for face-to-face delivery. A lack of funding, a culture of "learning on the job", and time constraints were systemic barriers to training. Oncologists and oncology nurses encounter complex challenges in clinical interactions with minority patients and their families, including difficulties working with interpreters. Formal training programmes targeted to the development of culturally competent communication skills are required.