Limited data exist on when to offer naloxone to cancer patients on opioid therapy.
We assessed patient and clinician attitudes on naloxone education (done via surveys at initial and follow up visits) ...and prescribing rates (via chart reviews) at a single ambulatory palliative care practice. Pharmacy records assessed naloxone dispense rates.
During a three-month period, all new patients receiving opioid therapy were offered naloxone. Standardized educational materials on opioid safety and naloxone use were created and shared by clinical team.
Naloxone prescribing rates increased from 5% to 66%. 92% (n = 23) of clinicians reported education/prescribing took ≤ five minutes, and 100% reported either a positive or neutral impact on the encounter. A total of 81% (n = 25) of patients reported no increased worry about opioid use, 68% (n = 21) felt safer with naloxone, and 97% rated the encounter as neutral or positive. 88% (n = 37) of prescriptions were dispensed and 67% of patients (n = 16) paid <$10.
Opioid safety education and naloxone prescribing can be done quickly and is well-received by clinicians and patients.
Randomized controlled trials (RCTs) have demonstrated a survival benefit for adjuvant platinum-based chemotherapy after resection of locoregional non-small cell lung cancer (NSCLC). The relative ...benefits and harms and optimal approach to treatment for NSCLC patients who have major comorbidities (chronic obstructive pulmonary disease COPD, coronary artery disease CAD, and congestive heart failure CHF) are unclear, however.
We used a simulation model to run in-silico comparative trials of adjuvant chemotherapy versus observation in locoregional NSCLC in patients with comorbidities. The model estimated quality-adjusted life years (QALYs) gained by each treatment strategy stratified by age, comorbidity, and stage. The model was parameterized using outcomes and quality-of-life data from RCTs and primary analyses from large cancer databases.
Adjuvant chemotherapy was associated with clinically significant QALY gains for all patient age/stage combinations with COPD except for patients >80 years old with Stage IB and IIA cancers. For patients with CHF and Stage IB and IIA disease, adjuvant chemotherapy was not advantageous; in contrast, it was associated with QALY gains for more advanced stages for younger patients with CHF. For stages IIB and IIIA NSCLC, most patient groups benefited from adjuvant chemotherapy. However, In general, patients with multiple comorbidities benefited less from adjuvant chemotherapy than those with single comorbidities and women with comorbidities in older age categories benefited more from adjuvant chemotherapy than their male counterparts.
Older, multimorbid patients may derive QALY gains from adjuvant chemotherapy after NSCLC surgery. These results help extend existing clinical trial data to specific unstudied, high-risk populations and may reduce the uncertainty regarding adjuvant chemotherapy use in these patients.
Prior studies have shown an anticancer effect of metformin in patients with breast and colorectal cancer. It is unclear, however, whether metformin has a mortality benefit in lung cancer.
To compare ...overall survival of patients with diabetes with stage IV non-small cell lung cancer (NSCLC) taking metformin versus those not on metformin.
Using data from the Surveillance, Epidemiology, and End Results registry linked to Medicare claims, we identified 750 patients with diabetes 65-80 years of age diagnosed with stage IV NSCLC between 2007 and 2009. We used propensity score methods to assess the association of metformin use with overall survival while controlling for potential confounders.
Overall, 61% of patients were on metformin at the time of lung cancer diagnosis. Median survival in the metformin group was 5 months, compared with 3 months in patients not treated with metformin (P < 0.001). Propensity score analyses showed that metformin use was associated with a statistically significant improvement in survival (hazard ratio, 0.80; 95% confidence interval, 0.71-0.89), after controlling for sociodemographics, diabetes severity, other diabetes medications, cancer characteristics, and treatment.
Metformin is associated with improved survival among patients with diabetes with stage IV NSCLC, suggesting a potential anticancer effect. Further research should evaluate plausible biologic mechanisms and test the effect of metformin in prospective clinical trials.
Given a shortage of specialty palliative care clinicians and geographic variation in availability, telemedicine has been proposed as one way to improve access to palliative care services for patients ...with cancer. However, the enduring digital divide raises questions about whether unequal access will exacerbate healthcare disparities.
To examine factors associated with utilization of telemedicine as compared to in-person visits by patients with cancer in the ambulatory palliative care setting.
We collected data on patients seen in Supportive Oncology clinic by palliative care clinicians with an in-person or telemedicine visit from March 1 to December 30, 2020. A logistic regression with generalized estimating equation was fit to assess the association between visit type and patient characteristics.
A total of 491 patients and 1783 visits were identified, including 1061 (60%) in-person visits and 722 (40%) telemedicine visits. Female patients were significantly more likely to utilize telemedicine than male patients (OR 1.46; 95% CI 1.11–1.90). Spanish-speaking patients (OR 0.32, 95% CI 0.17–0.61), those without insurance (OR 0.28, 95% CI 0.15–0.52), and those without an activated patient portal (Inactivated: OR 0.46, 95% CI 0.26–0.82; Pending Activation: OR 0.29, 95% CI 0.18–0.48) were less likely to utilize telemedicine.
Our study reveals disparities in telemedicine utilization in the ambulatory palliative care setting for patients with cancer who are male, Spanish-speaking, uninsured, or do not have an activated patient portal. In the wake of the COVID-19 pandemic, we can better meet the palliative care needs of patients with cancer through telemedicine only if equity is kept at the forefront of our discussions.
Although lobectomy is considered the standard surgical treatment for stage IA non–small-cell lung cancer (NSCLC), wedge resection or segmentectomy are frequently performed on patients who are not ...lobectomy candidates. The objective of this study was to compare survival among patients with stage IA NSCLC, who are undergoing these procedures.
Using the Surveillance, Epidemiology and End Results registry, we identified 3525 patients. We used logistic regression to determine propensity scores for patients undergoing segmentectomy, based on the patient’s preoperative characteristics. Overall and lung cancer-specific survival of patients treated with wedge resection versus segmentectomy was compared after adjusting, stratifying, or matching patients based on propensity score.
Overall, 704 patients (20%) underwent segmentectomy. Analyses, adjusting for propensity scores, showed that segmentectomy was associated with significant improvement in overall (hazard ratio: 0.80, 95% confidence interval: 0.69–0.93) and lung cancer-specific survival (hazard ratio: 0.72, 95% confidence interval: 0.59–0.88) compared with wedge resection. Similar results were obtained when stratifying and matching by propensity score and when limiting analysis to patients with tumors sized less than or equal to 2 cm, or aged 70 years or younger.
These results suggest that segmentectomy should be the preferred technique for limited resection of patients with stage IA NSCLC. The study findings should be confirmed in prospective studies.
High quality communication is essential to older adults’ medical decision-making, quality of life, and adjustment to serious illness. Studies have demonstrated that Geritalk, a two day (16 hours ...total) in-person communication skills training improves self-assessed preparedness, skill acquisition, and sustained practice of communication skills. Due to the COVID-19 pandemic, Geritalk was adapted to a virtual format (four days, 10 hours total).
Our study evaluated the change in participants’ self-assessed preparedness for serious illness communication before and after the virtual course and satisfaction with the course, and compared these findings to responses from a prior in-person Geritalk course.
Geriatrics and Palliative Medicine fellows at three urban academic medical centers completed surveys, which employed five-point Likert scales, before and after the virtual course to assess satisfaction with the course and preparedness for serious illness communication.
Of the 20 virtual Geritalk participants, 17 (85%) completed the pre-course assessment, and 14 (70%) completed the post-course assessment. Overall, satisfaction with the course was high (mean 4.9 on a 5‐point scale). Compared to in-person Geritalk participants, virtual course participants reported comparable and significant (P < 0.01) improvements in mean self-reported preparedness across all surveyed communication skills.
We show that a virtual communication skills training is feasible and effective. Our findings suggest that the innovative virtual Geritalk course has the potential to increase access to communication skills training, improve serious illness communication skills, and in improve the quality of care received by older adults with serious illness.
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