Incidence and management of arthralgias in breast cancer patients treated with aromatase inhibitors in an outpatient oncology clinic.

PURPOSE: Aromatase inhibitors (AIs) are routinely used as first-line adjuvant treatment of breast cancer in postmenopausal women with hormone receptor positive tumors. The current recommended length of treatment with an AI is 5 years. Arthralgias have been frequently cited as the primary reason for discontinuation of AI therapy. Various treatment strategies are proposed in literature, but a standardized treatment algorithm has not been established. The initial purpose of this study was to describe the incidence and management of AI-induced arthralgias in patients treated at Kellogg Cancer Center (KCC). Further evaluation led to the development and the implementation of a treatment algorithm and electronic medical record (EMR) documentation tools. METHODS: The retrospective chart review included 206 adult patients with hormone receptor positive breast cancer who were receiving adjuvant therapy with an AI. A multidisciplinary treatment team consisting of pharmacists, collaborative practice nurses, and physicians met to develop a standardized treatment algorithm and corresponding EMR documentation tool. The treatment algorithm and documentation tool were developed after the study to better monitor and proactively treat patients with AI-induced arthralgias. RESULTS/ CONCLUSIONS: The overall incidence of arthralgias at KCC was 48% (n = 98/206). Of these patients, 32% were documented as having arthralgias within the first 6 months of therapy initiation. Patients who reported AI-induced arthralgias were younger than patients who did not report AI-induced arthralgias (61 vs. 65 years, p = 0.002). There was no statistical difference in the incidence of arthralgias in patients with a history of chemotherapy (including taxane therapy) compared to those who did not receive chemotherapy (p = 0.352). Of patients presenting with AI-induced arthralgias, 41% did not have physician-managed treatment documented in the EMR. A standardized treatment algorithm and electronic chart documentation tools were then developed by the multidisciplinary team.

Outcomes of computerized physician order entry in an electronic health record after implementation in an outpatient oncology setting.

PURPOSE: Computerized physician order entry (CPOE) in electronic health records (EHR) has been recognized as an important tool in optimal health care provision that can reduce errors and improve safety. The objective of this study is to describe documentation completeness and user satisfaction of medical charts before and after implementation of an outpatient oncology EHR/ CPOE system in a hospital-based outpatient cancer center within three treatment sites. METHODS: This study is a retrospective chart review of 90 patients who received one of the following regimens between 1999 and 2006: FOLFOX, AC, carboplatin + paclitaxel, ABVD, cisplatin + etoposide, R-CHOP, and clinical trials. Documentation completeness scores were assigned to each chart based on the number of documented data points found out of the total data points assessed. EHR/CPOE documentation completeness was compared with completeness of paper charts orders of the same regimens. A user satisfaction survey of the paper chart and EHR/CPOE system was conducted among the physicians, nurses, and pharmacists who worked with both systems. RESULTS: The mean percentage of identified data points successfully found in the EHR/CPOE charts was 93% versus 67% in the paper charts (P < .001). Regimen complexity did not alter the number of data points found. The survey response rate was 64%, and the results showed that satisfaction was statistically significant in favor of the EHR/CPOE system. CONCLUSION: Using EHR/CPOE systems improves completeness of medical record and chemotherapy order documentation and improves user satisfaction with the medical record system. EHR/CPOE requires constant vigilance and maintenance to optimize patient safety.

Influence of dental status on nutritional status of geriatric patients in a convalescent and rehabilitation hospital.

PURPOSE: To investigate 6 dental statuses as risk factors for malnutrition in geriatric patients admitted to a convalescent and rehabilitation hospital. MATERIALS AND METHODS: One hundred twenty (59 men and 61 women) geriatric patients admitted to a convalescent and rehabilitation hospital were recruited. Three biochemical and hematologic parameters (albumin, hemoglobin, and lymphocyte count) were used for analysis. Malnutrition was defined as Body Mass Index (BMI) below 18.5 and albumin level under 35 g/L. The number of natural or prosthetic teeth in the dentate patients, and the presence of one or both dentures in the edentate patients, were recorded. Risk factors associated with malnutrition were investigated, namely: (1) edentulism among all patients, (2) edentulism without a set of complete dentures among all patients, (3) edentulism without a set of complete dentures among the edentate patients, (4) decreased number (< 6) of occluding pairs of natural or prosthetic teeth among the dentate patients, (5) decreased number (< 5) of posterior occluding pairs of natural or prosthetic teeth among the dentate patients, and (6) absence of posterior occluding pairs of natural or prosthetic teeth among the dentate patients. One-way ANOVA and Bonferroni multiple comparisons were used to determine if significant differences in the anthropometric, biochemical, and hematologic parameters existed between the patients with different dental statuses. The odds ratio and significance of 6 dental statuses as risk factors of malnutrition were calculated (P = .05). RESULTS: BMI, albumin, and hemoglobin levels of the malnourished patients were significantly lower than those of nourished patients (P < .05). Lymphocyte count was not significantly different between the 2 patient groups (P > .05). The status of edentate patients without a set of complete dentures compared with other edentate and dentate patients was the only independent risk factor (P < .05) in the 6 statuses studied. CONCLUSION: Primary healthcare workers caring for hospitalized geriatric patients should identify edentate patients without a set of complete dentures for the possibility of malnutrition.