Sherri Rauenzahn

Opioid management of pain: the impact of the prescription opioid abuse epidemic.

Purpose of reviewThe greater emphasis on pain control over the last decade has been accompanied by increased opioid prescriptions and an epidemic of opioid abuse. This review examines the financial, regulatory, and clinical practice impact of the epidemic, the factors contributing to its growth, and strategies that may counter this public health crisis. Recent findingsDespite the call for urgent practice change and the introduction of new initiatives such as electronic prescription monitoring and additional education programs for providers and patients, the evidence for improved outcomes are limited. There are also concerns that some patients may suffer from underprescribing as an unintended consequence of more stringent state and federal regulations. There is consensus that some form of universal precautions should be adopted for all patients, including those being treated for cancer-related pain, in order to better identify and manage those at risk of opioid abuse. SummaryThe opioid prescription abuse epidemic has precipitated calls for increased regulation. Clinicians can improve patient care and diminish opioid abuse by identifying patient risk factors, increasing vigilance and structure for those at risk, and providing interdisciplinary care for any patients coping in a maladaptive manner.

Predictors and Impact of Thirty-Day Readmission on Patient Outcomes and Health Care Costs after Reduced-Toxicity Conditioning Allogeneic Hematopoietic Cell Transplantation

Thirty-day readmission (30-DR) has become an important quality-of-care measure. Allogeneic hematopoietic cell transplantation (allo-HCT) presents a medical setting with higher readmission rates. We analyzed factors affecting 30-DR and its impact on patient outcomes and on health care costs in 91 patients who underwent reduced-toxicity conditioning (RTC) allo-HCT with fludarabine and busulfan. The patient cohort was divided into 2: the readmission group (R-gp) or the no-readmission group (NR-gp). Overall, 38% (n = 35) required readmission with a median time to readmission of 14 days. In multivariate analysis, only documented infection during the index admission predicted 30-DR, P = .01. With a median follow-up of 18 months (range, 1 to 69) for surviving patients, the 2-year overall survival was 49% and 58% in the R-gp and NR-gp respectively, P = .48. The 1-year nonrelapse mortality in R-gp and NR-gp was 18% and 13% respectively, P = .43. The median post-transplantation hospital charges in the R-gp and NR-gp were

Acute Myeloid Leukemia Presenting as Acute Appendicitis

85,115 (range,

Long-term outcomes after thiotepa-based high-dose therapy (HDT) and autologous hematopoietic cell transplantation (auto-HCT) in non-Hodgkin lymphoma (NHL)

32,015 to

Integrating Palliative Care Services in Ambulatory Oncology: An Application of the Edmonton Symptom Assessment System

242,519) and

Integrating palliative care services in oncology clinics: An application of the Edmonton Symptom Assessment System (ESAS).

45,083 (range,

Disparities in access to palliative care services among cancer patients in south Texas.

10,715 to

Urine drug screen findings among ambulatory oncology patients in a supportive care clinic.

485,456), P = .0002. In conclusion, only documented infections during the index hospitalization influenced 30-DR after RTC allo-HCT. Although 30-DR did not adversely affect mortality or survival, it was associated with significantly increased 100-day post-transplantation hospital charges, thus supporting its role as a quality-of-care measure in allo-HCT patients.

Long Term Outcomes of Autologous Hematopoietic Cell Transplant (AHCT) Following Thiotepa-Based High-Dose Therapy (HDT) in Patients with Non-Hodgkin Lymphoma (NHL)

Appendicitis in leukemic patients is uncommon but associated with increased mortality. Additionally, leukemic cell infiltration of the appendix is extremely rare. While appendectomy is the treatment of choice for these patients, diagnosis and management of leukemia have a greater impact on remission and survival. A 59-year-old Caucasian female was admitted to the surgical service with acute right lower quadrant pain, nausea, and anorexia. She was noted to have leukocytosis, anemia, and thrombocytopenia. Abdominal imaging demonstrated appendicitis with retroperitoneal and mesenteric lymphadenopathy for which she underwent laparoscopic appendectomy. Peripheral smear, bone marrow biopsy, and surgical pathology of the appendix demonstrated acute myeloid leukemia (AML) with nonsuppurative appendicitis. In the setting of AML, prior cases described the development of appendicitis with active chemotherapy. Of these cases, less than ten patients had leukemic infiltration of the appendix, leading to leukostasis and nonsuppurative appendicitis. Acute appendicitis with leukemic infiltration as the initial manifestation of AML has only been described in two other cases in the literature with an average associated morbidity of 32.6 days. The prompt management in this case of appendicitis and AML resulted in an overall survival of 185 days.

Palliating oncologists: A pilot study on primary palliative care development in hematology-oncology trainee outpatient clinics.

Autologous hematopoietic cell transplantation (auto-HCT) is considered the standard approach for relapsed or refractory non-Hodgkin lymphoma (NHL).1 The therapeutic rationale for auto-HCT is the delivery of myeloablative doses of chemotherapy and/or radiation without overlapping toxicities, thus increasing the response of the resistant lymphoma cells. Relapse/progression of lymphoma and to a lesser extent non-relapse mortality (NRM) remain limitations to treatment success. Although several conditioning regimens are available, including the commonly utilized BEAM (carmustine, etoposide, cytarabine, melphalan)2 and CBV (cyclophosphamide, carmustine, etoposide),3 there is no general consensus regarding a standard conditioning approach in lymphoproliferative disorders.