Billings Clinic Cancer Center

Billings, United States

Billings Clinic Cancer Center

Billings, United States

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PubMed | Norton Healthcare, Providence Portland Medical Center, Mercy Cancer Center, Penrose Cancer Center and 8 more.
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2017

8 Background: The Institute of Medicine advised that cancer survivors and their primary care providers receive survivorship care plans (SCPs) to summarize cancer treatment and plan ongoing care. However, the use of SCPs remains limited.Oncology providers at 14 National Cancer Institute Community Cancer Centers Program (NCCCP) hospitals completed a survey regarding their perceptions of SCPs, including barriers to implementation, strategies for implementation, the role of oncology providers, and the importance of topics in SCPs (diagnosis, treatment, recommended ongoing care, and the aspects of ongoing care that the oncology practice will provide).Among 245 providers (70% response rate), a minority reported ever providing an SCP or any of its components to patients. The most widely reported barriers were personnel to creating SCPs and time (69% and 64% of respondents, respectively). The most widely endorsed strategy among those using SCPs was the use of a template with pre-specified fields; 94% of those who used templates found them helpful. For each topic of an SCP, while 87%-89% of oncology providers felt it was very important for primary care providers to receive the information, only 58%-65% of respondents felt it was very important for patients to receive the information. Further, 33%-38% of respondents had mixed feelings about whether it was oncology providers responsibility to provide SCPs.Practices need additional resources to overcome barriers to implementing SCPs. We found resistance toward SCPs, particularly the perceived value for the survivor and the idea that oncology providers are responsible for SCP dissemination.


Brant J.M.,Billings Clinic Cancer Center | Brant J.M.,University of Utah | Beck S.,University of Utah | Dudley W.N.,University of North Carolina | And 3 more authors.
Cancer Nursing | Year: 2011

Background: Cancer survivorship following cancer treatment is uncertain as physical and psychological sequelae related to the disease or its treatment may persist. However, little is known about the experience of symptoms after treatment. Objectives: The purposes of this study were to (1) examine postchemotherapy (post-CTX) symptom trajectories in cancer survivors and (2) determine whether demographic characteristics predicted symptom trajectories. METHODS: One hundred patients who recently completed CTX for lung cancer, colorectal cancer, or lymphoma rated symptoms on an electronic patient care monitor system prior to ambulatory care visits. Latent growth curve analyses were conducted to examine the trajectories of pain, fatigue, sleep disturbance, distress, and depression for 16 months after initial CTX. Results: Symptoms were present at the first follow-up visit following CTX (P < .0001) and persisted over 16 months. The depression trajectory was predicted by sex: males showed a convex curvilinear growth trajectory, whereas females showed a concave trajectory (P < .05). Higher distress was predicted by younger age (P < .05). Conclusions: Psychological and physical symptoms persisted over the 16-month period following CTX for the entire sample. Sex differences in coping could partially explain the different trajectories of growth for depression, but further studies are warranted. Younger patients may be more vulnerable for distress during this posttreatment phase. Implications for Practice: The posttreatment surveillance plan for cancer survivors should include a comprehensive assessment of psychological and physical symptoms. Persistence of symptoms can be expected in some patients, and supportive interventions should be tailored according to symptom reports. Copyright © 2010 Lippincott Williams & Wilkins.


Salz T.,Sloan Kettering Cancer Center | McCabe M.S.,Sloan Kettering Cancer Center | Onstad E.E.,Sloan Kettering Cancer Center | Baxi S.S.,Sloan Kettering Cancer Center | And 12 more authors.
Cancer | Year: 2014

BACKGROUND The Institute of Medicine recommended that survivors of cancer and their primary care providers receive survivorship care plans (SCPs) to summarize cancer treatment and plan ongoing care. However, the use of SCPs remains limited. METHODS Oncology providers at 14 National Cancer Institute Community Cancer Centers Program hospitals completed a survey regarding their perceptions of SCPs, including barriers to implementation, strategies for implementation, the role of oncology providers, and the importance of topics in SCPs (diagnosis, treatment, recommended ongoing care, and the aspects of ongoing care that the oncology practice will provide). RESULTS Among 245 providers (response rate of 70%), 52% reported ever providing any component of an SCP to patients. The most widely reported barriers were lack of personnel and time to create SCPs (69% and 64% of respondents, respectively). The most widely endorsed strategy among those using SCPs was the use of a template with prespecified fields; 94% of those who used templates found them helpful. For each topic of an SCP, although 87% to 89% of oncology providers believed it was very important for primary care providers to receive the information, only 58% to 65% of respondents believed it was very important for patients to receive the information. Furthermore, 33% to 38% of respondents reported mixed feelings regarding whether it was the responsibility of oncology providers to provide SCPs. CONCLUSIONS Practices need additional resources to overcome barriers to implementing SCPs. We found resistance toward SCPs, particularly the perceived value for the survivor and the idea that oncology providers are responsible for SCP dissemination. © 2013 American Cancer Society.


Forsythe L.P.,U.S. National Cancer Institute | Forsythe L.P.,Patient-Centered Outcomes Research Institute | Rowland J.H.,U.S. National Cancer Institute | Padgett L.,U.S. National Cancer Institute | And 4 more authors.
Psycho-Oncology | Year: 2013

Objective Although the Institute of Medicine provided a vision for effective psychosocial care for cancer survivors, limited guidance exists regarding the essential components of comprehensive care or progressive steps for implementing each component. This paper describes the development of a unique tool for assessing capacity to provide quality psychosocial care to cancer survivors and the results of the first implementation of this tool in community settings. Methods The psychosocial working group of the National Cancer Institute Community Cancer Centers Program (NCCCP) developed the Cancer Psychosocial Care Matrix assessment tool. All NCCCP sites (n = 30, enrolled in 2007 and 2010) completed the matrix indicating their capacity for providing psychosocial care at entry into NCCCP ('baseline') after 2 years of NCCCP participation (2007 sites only) and within the coming year ('future aspirations'). Results At baseline, matrix responses reflected few or no systematic processes in place for most components of comprehensive psychosocial care. However, reported capacity to deliver specific components improved at 2 years post-NCCCP entry for the 2007 sites and in all NCCCP sites' future aspirations. Conclusions With growing demand on cancer centers to meet new metrics of quality care, the psychosocial matrix can help centers systematically identify and develop steps to address gap areas in their capacity to meet these new standards. The Cancer Psychosocial Care Matrix appears to enable evaluation of psychosocial programs, may promote intentions to improve psychosocial services, and can facilitate communication of 'best practices' among cancer centers. Copyright © 2013 John Wiley & Sons, Ltd. Copyright © 2013 John Wiley & Sons, Ltd.


Langford A.T.,University of Michigan | Resnicow K.,University of Michigan | Dimond E.P.,U.S. National Cancer Institute | Denicoff A.M.,U.S. National Cancer Institute | And 6 more authors.
Cancer | Year: 2014

BACKGROUND This study examined racial/ethnic differences among patients in clinical trial (CT) enrollment, refusal rates, ineligibility, and desire to participate in research within the National Cancer Institute's Community Cancer Centers Program (NCCCP) Clinical Trial Screening and Accrual Log. METHODS Data from 4509 log entries were evaluated in this study. Four logistic regression models were run using physical/medical conditions, enrollment into a CT, patient eligible but declined a CT, and no desire to participate in research as dependent variables. RESULTS Age ≥ 65 years (OR = 1.51, 95% CI = 1.28-1.79), males (OR = 2.28, 95% CI = 1.92-2.71), and non-Hispanic black race (OR = 1.53, 95% CI = 1.2-1.96) were significantly associated with more physical/medical conditions. Age ≥ 65 years was significantly associated with lower CT enrollment (OR = 0.83, 95% CI = 0.7-0.98). Males (OR = 0.78, 95% CI = 0.65-0.94) and a higher grade level score for consent form readability (OR = 0.9, 95% CI = 0.83-0.97) were significantly associated with lower refusal rates. Consent page length ≥ 20 was significantly associated with lower odds of "no desire to participate in research" among CT decliners (OR = 0.75, 95% CI = 0.58-0.98). CONCLUSIONS There were no racial/ethnic differences in CT enrollment, refusal rates, or "no desire to participate in research" as the reason given for CT refusal. Higher odds of physical/medical conditions were associated with older age, males, and non-Hispanic blacks. Better management of physical/medical conditions before and during treatment may increase the pool of eligible patients for CTs. Future work should examine the role of comorbidities, sex, age, and consent form characteristics on CT participation. Cancer 2014;120:877-884. © 2013 American Cancer Society. There were no racial/ethnic differences in clinical trial (CT) enrollment, refusal rates, or "no desire to participate in research" as the reason given for CT refusal; however, higher odds of physical/medical conditions were associated with older age, males, and non-Hispanic blacks. Better management of physical/medical conditions before and during treatment may increase the pool of eligible patients for CTs. © 2013 American Cancer Society.


Das M.,Stanford University | Riess J.W.,Stanford University | Frankel P.,City of Hope Cancer Center | Schwartz E.,Stanford University | And 8 more authors.
Lung Cancer | Year: 2012

Purpose: To utilize a novel circulating tumor cell (CTC) technology to quantify ERCC1 expression on CTCs and determine whether ERCC1 expression levels predict efficacy of platinum-based chemotherapy in patients with metastatic non-small-cell lung cancer (NSCLC). Experimental design: ERCC1 expression was measured in 17 metastatic NSCLC patients who received platinum-based therapy and had ≥2 intact CTCs with acceptable ERCC1 expression assay results. ERCC1 levels were determined from average expression on individual CTCs in each sample. Progression-free survival (PFS) was calculated from the date of therapy initiation. Results: PFS decreased with increasing ERCC1 expression (p<0.04, F-test, linear regression). Lack of ERCC1 expression was associated with longer PFS (266 days versus 172 days, log-rank, p<0.02) in a Kaplan-Meier analysis using ERCC expression level of 1 as a cutoff (range 0-30). The difference in survival was statistically significant with a hazard ratio of 4.20 (95% CI 1.25-14.1, p<0.02, log-rank). PFS was also observed to decrease with increased cytokeratin (CK) expression (p<0.01 long-rank (Cox regression) and F-test (linear regression)). The hazard ratio is 4.38 (95% CI 1.76-10.9) for each log-change in CK value until progression was noted on imaging. Conclusion: Low expression of ERCC1 on CTCs correlates with PFS in patients with metastatic NSCLC receiving platinum-based therapy. © 2012 Elsevier Ireland Ltd.


Wendel M.,Scripps Research Institute | Bazhenova L.,University of California at San Diego | Boshuizen R.,Netherlands Cancer Institute | Kolatkar A.,Scripps Research Institute | And 11 more authors.
Physical Biology | Year: 2012

Circulating tumor cell (CTC) counts are an established prognostic marker in metastatic prostate, breast and colorectal cancer, and recent data suggest a similar role in late stage non-small cell lung cancer (NSCLC). However, due to sensitivity constraints in current enrichment-based CTC detection technologies, there are few published data about CTC prevalence rates and morphologic heterogeneity in early-stage NSCLC, or the correlation of CTCs with disease progression and their usability for clinical staging. We investigated CTC counts, morphology and aggregation in early stage, locally advanced and metastatic NSCLC patients by using a fluid-phase biopsy approach that identifies CTCs without relying on surface-receptor-based enrichment and presents them in sufficiently high definition (HD) to satisfy diagnostic pathology image quality requirements. HD-CTCs were analyzed in blood samples from 78 chemotherapy-nave NSCLC patients. 73% of the total population had a positive HD-CTC count (>0 CTC in 1 mL of blood) with a median of 4.4 HD-CTCs mL 1 (range 0515.6) and a mean of 44.7 (95.2) HD-CTCs mL 1. No significant difference in the medians of HD-CTC counts was detected between stage IV (n = 31, range 0178.2), stage III (n = 34, range 0515.6) and stages I/II (n = 13, range 0442.3). Furthermore, HD-CTCs exhibited a uniformity in terms of molecular and physical characteristics such as fluorescent cytokeratin intensity, nuclear size, frequency of apoptosis and aggregate formation across the spectrum of staging. Our results demonstrate that despite stringent morphologic inclusion criteria for the definition of HD-CTCs, the HD-CTC assay shows high sensitivity in the detection and characterization of both early- and late-stage lung cancer CTCs. Extensive studies are warranted to investigate the prognostic value of CTC profiling in early-stage lung cancer. This finding has implications for the design of extensive studies examining screening, therapy and surveillance in lung cancer patients. © 2012 IOP Publishing Ltd.


Nieva J.,Billings Clinic Cancer Center | Wendel M.,Scripps Research Institute | Luttgen M.S.,Scripps Research Institute | Marrinucci D.,Scripps Research Institute | And 9 more authors.
Physical Biology | Year: 2012

Sampling circulating tumor cells (CTCs) from peripheral blood is ideally accomplished using assays that detect high numbers of cells and preserve them for downstream characterization. We sought to evaluate a method using enrichment free fluorescent labeling of CTCs followed by automated digital microscopy in patients with non-small cell lung cancer. Twenty-eight patients with non-small cell lung cancer and hematogenously seeded metastasis were analyzed with multiple blood draws. We detected CTCs in 68% of analyzed samples and found a propensity for increased CTC detection as the disease progressed in individual patients. CTCs were present at a median concentration of 1.6 CTCs ml -1 of analyzed blood in the patient population. Higher numbers of detected CTCs were associated with an unfavorable prognosis. © 2012 IOP Publishing Ltd.


Nieva J.J.,Billings Clinic Cancer Center | Kuhn P.,Scripps Research Institute
Future Oncology | Year: 2012

Cancer is currently diagnosed and treated based on the results of a tissue biopsy of the primary tumor or a metastasis using invasive techniques such as surgical resection or needle biopsy. New technology for retrieving cancer cells from the circulation, developed in the last 5 years, has made it possible to obtain a 'fluid biopsy from the bloodstream without the need for an invasive procedure. This technological development makes it possible to diagnose and manage cancer from a blood test rather than from a traditional biopsy. It also allows the repeated sampling of cancer cells from a patient, making it possible, in a practical manner, to interrogate the disease repeatedly in order to understand the mechanisms by which cancer cells evolve within a given individual. The ability to obtain cancer cells repeatedly also has the potential to substantially advance drug development by enabling early ex vivo validation of both targets and early-stage compounds, as well as creating new efficiencies in the drug development process during clinical trials. © 2012 Future Medicine Ltd.


Brant J.M.,Billings Clinic Cancer Center
Asian Pacific Journal of Cancer Prevention | Year: 2010

Pain is a significant problem in patients with cancer. Pain occurs in approximately 50% of patients at some point during the disease process and in up to 75% of patients with advanced cancer. Total pain impacts quality of life domains including physical, psychological, social, and spiritual realms. Unfortunately, pain is underappreciated and undermanaged throughout the world. Lack of knowledge among healthcare professionals, inadequate pain assessment, fears of addiction, and beliefs that pain is an inevitable component of cancer are common barriers. Education about comprehensive pain assessment and optimal management strategies and discussions about belief systems regarding pain can assist to bridge the gap between suffering and comfort. Self-report is the gold standard for pain assessment. Gathering information about the location(s), intensity, quality and temporal factors is essential. Intensity should be quantified on a rating scale to determine the amount of pain and the degree of relief from interventions. Quality can be used to diagnose the specific pain syndrome. Temporal factors provide input about how the pain is experienced over time and can offer input into the pain management plan of care. For patients who cannot self-report pain, non-verbal assessment tools are available to aid in assessment. The World Health Organization's Analgesic Ladder provides a template for the management of cancer pain. For step 1, pain can be managed with nonsteroidal anti-inflammatory drugs (NSAIDS) and other nonopioid analgesics. As pain persists or increases, step 2 involves managing pain with select opioids for mild to moderate pain along with NSAIDS and nonopioid analgesics. Step 3 of the ladder is applicable to many cancer pain syndromes, and includes opioids for moderate to severe pain in conjunction with NSAIDS and nonopioids. This 3 step approach can be 80-90% effective. This polypharmaceutical employed with behavioral complimentary techniques are often employed to interrupt pain along the physiological pathways during transduction, transmission, perception, and modulation. Severe cancer pain that is not managed with the Step 3 approach, deserves special attention and unique strategies for control. When pain control is inadequate or if side effects are intolerable, a change of opioid or a change in the route of administration is recommended. Intraspinal analgesics can be trialed in patients who have intractable pain or intolerable side effects with systemic opioids. This route is especially helpful in neuropathic pain syndromes located at the trunk level or below. Opioid doses in all patients with intractable pain should be titrated judiciously for optimal relief with a balance of toxicity management. Other strategies for intractable pain should be investigated including nerve blocks and neuroablation. The overall goal for patients is to attain comfort with minimal side effects and optimal quality of life.

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