Barry V. Fortner

Sleep and quality of life in breast cancer patients.

This study described sleep in a heterogeneous sample of breast cancer patients using the Pittsburgh Sleep Quality Index (PSQI) and examined the relation between sleep disturbance and health-related quality of life as measured by the Rand 36-Item Health Survey. Chemotherapy and radiation therapy were explored as predictors of sleep disturbance in breast cancer patients, and the sleep characteristics of breast cancer patients were compared to the sleep characteristics of a sample of medical patients with general medical conditions. Results showed that 61% of breast cancer patients had significant sleep problems. Sleep was characterized by reduced total sleep time with sleep frequently being disturbed by pain, nocturia, feeling too hot, and coughing or snoring loudly. Despite the frequency of significant sleep disturbance, pharmacological and cognitive-behavioral treatments of sleep problems were observed to be inadequate. Limited evidence was found for the role of chemotherapy and radiation therapy in the sleep disturbance of breast cancer patients, and the general pattern of sleep disturbance in breast cancer patients was not significantly different than that observed in medical patients with general medical conditions. Breast cancer patients having significant sleep problems had greater deficits in many areas of health-related quality of life. The implications of the findings and study limitations are discussed.

Description and Predictors of Direct and Indirect Costs of Pain Reported by Cancer Patients

The purpose of this study was to describe direct and indirect costs associated with pain in cancer patients and to examine potential predictors of these costs. The study surveyed cancer outpatients about direct costs resulting from pain-related hospitalizations, emergency department visits, physician office visits, and use of analgesic medications and indirect costs related to money spent on pain-related transportation, complementary methods to improve pain management, educational materials, over-the counter medication, domestic support, and childcare. Furthermore, the study examined age, marital status, race, income level, pain severity, pain interference, and presence of breakthrough pain as predictors of direct and indirect costs. Three hundred and seventy-three cancer outpatients were sampled. One hundred and forty-four cancer patients (39%) reported experiencing cancer-related pain and completed the study questionnaires. Seventy-six percent (76%) of the patients had experienced at least one pain-related cost, resulting in an average monthly direct cost of US

Evaluation of a tablet PC technology to screen and educate oncology patients.

891/month per patient. Sixty-nine percent (69%) of patients had experienced some type of direct medical cost due to pain, resulting in an average total direct pain-related cost of US

The Zero Acceptance of Pain (ZAP) Quality Improvement Project: evaluation of pain severity, pain interference, global quality of life, and pain-related costs.

825/month per patient. Fifty-seven percent (57%) of patients reported incurring at least one indirect pain-related expense for an average indirect cost of US

Implications of IV monoclonal antibody infusion reaction for the patient, caregiver, and practice: results of a multicenter study

61/month per patient. Higher pain intensity, greater pain interference, and presence of breakthrough pain predicted higher direct and indirect medical expenses. Younger age and lower income level also predicted higher direct medical expenses.

Costs of human resources in delivering cancer chemotherapy and managing chemotherapy-induced neutropenia in community practice

Study GoalThe aim of the study was to evaluate The Patient Assessment, Care and Education (PACE) System™—an electronic patient symptom screening and reporting system for oncology. Specifically, the study determined provider and patient opinions of The PACE System™ and documented evidence as to whether symptom assessment rates increased after this system was implemented.Materials and methodsNinety-two providers (i.e., physicians, nurse practitioners, and physician assistants) at 16 community oncology clinics were surveyed about their experiences with The PACE System™. In addition, 100 patients at two community oncology clinics were surveyed about their perceptions of The PACE System™. Finally, at two oncology clinics, 100 patient charts were abstracted in the year before implementation of The PACE System™, and 100 patient charts were abstracted in the year after its implementation to evaluate changes in symptom assessment rates.Main resultsProviders seemed to value the system. In particular, they reported that the screening and reporting system helped them to identify, track, and document the patients’ most important symptoms. The patient survey indicated that the majority of patients at the two sites found the system easy to use and generally helpful and would recommend it to others. The chart review indicated that assessment rates for depression, fatigue, and pain increased after The PACE System™ was implemented.ConclusionsThe PACE System™ appears to be a promising approach to addressing the widespread problem of under-identification and under-treatment of symptoms in patients receiving cancer treatment.

The AIM Higher Initiative: new procedures implemented for assessment, information, and management of chemotherapy toxicities in community oncology clinics.

The Zero Acceptance of Pain (ZAP) Quality Improvement Project was a multi-site effort to improve the lives of outpatients with cancer pain by enhancing the clinical practice of pain assessment and management. Independent samples of patients completed self-report measures of severity of pain, pain interference, global quality of life, pain treatment satisfaction, general medical treatment satisfaction, pain attitudes, and pain-related medical costs before and after the implementation of ZAP. Results suggested that ZAP decreased the severity of recent pain, decreased interference of pain on daily functioning, and improved satisfaction with pain treatment and attitudes about addiction to opioid medication. Direct medical costs consisting of pain-related hospitalizations, emergency department visits, and physician office visits were greatly reduced. In summary, the findings of this study support the idea that clinic-based efforts to improve the practice of pain management are effective in improving the lives of cancer patients who are experiencing pain.

Baseline evaluation of the aim higher initiative : Establishing the mark from which to measure

Goals of workTargeted monoclonal antibodies (MoAbs) have become a promising treatment option for patients with cancer. However, there is a risk of developing infusion reactions (IRs) with MoAbs. This study was conducted to evaluate the impact of IRs on staff time and costs among patients receiving an initial infusion of cetuximab (Erbitux®) and rituximab (Rituxan®).Patients and methodsA prospective multicenter study involving time and motion and activity sampling methods was conducted among patients with cancer receiving their first outpatient infusion of cetuximab or rituximab. Patients were observed from initiation of MoAb infusion to the end of the clinic visit. IRs were classified as absent, mild/moderate, and severe/life threatening. Staff time and costs were estimated for preparation and administration of MoAb, other chemotherapy agents, and for management of IRs. Resource costs were compared across IR groups within each MoAb.Main resultsAmong 161 patients enrolled, 32% of 71 patients on cetuximab and 39% of 90 patients on rituximab experienced IRs. Treatment of patients who experienced IRs required more staff time (31–80% more time) and resulted in higher human resource costs (increase of 17–65 US dollars) than patients who did not experience IRs.ConclusionsIRs following cetuximab and rituximab administration are common and are associated with measurably increased costs of care. The frequency of IRs suggests the importance of identifying clinical guidelines for intervention and management.

Symptom Burden for Patients with Metastatic Colorectal Cancer Treated with First-Line FOLFOX or FOLFIRI with and Without Bevacizumab in the Community Setting

Research on the costs of delivering cancer chemotherapy has typically focused on drug administration, but assessing the overall costs must also consider the human resources necessary. Furthermore, supportive care, such as using colonystimulating factors to manage chemotherapy-induced neutropenia, can greatly affect the costs of care. This study evaluated the human resource costs associated with delivering chemotherapy and managing chemotherapy-induced neutropenia in the community oncology setting. A model of medical visits associated with 21-day chemotherapy regimens and common approaches to managing neutropenia was defined. Four hundred medical professionals at 20 community oncology practices in the United States completed a semistructured interview to provide data on practice patterns and the time and costs of performing medical tasks. The results indicate that chemotherapy- and neutropenia-related medical visits require substantial human resource time and costs. The human resource cost of a single treatment with pegfilgrastim or filgrastim was equivalent, but, because of the greater number of visits required with filgrastim, the total time and costs with pegfilgrastim (2.4 hours and

Greater physical and psychological symptom burden in patients with grade 3/4 chemotherapy-induced neutropenia.

57.30) were less than those with filgrastim (14.8 hours and