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Kligler B.,Beth Israel Deaconess Medical Center | Homel P.,Beth Israel Deaconess Medical Center | Harrison L.B.,Continuum Cancer Centers of New York | Levenson H.D.,Beth Israel Deaconess Medical Center | And 2 more authors.
American Journal of Managed Care | Year: 2011

Objectives: To evaluate the cost impact of an integrative medicine intervention on an inpatient oncology service. Study Design: This study used nonrandomized, nonequivalent groups. A baseline sample of inpatient oncology patients at Beth Israel Medical Center admitted to the medical oncology unit before implementation of the Urban Zen Initiative were compared with patients admitted after the Urban Zen Initiative was in place. Methods: The Urban Zen Initiative incorporated yoga therapy, holistic nursing techniques, and a "healing environment" into routine inpatient oncology care. Length of stay and medication use data were extracted from Beth Israel's decision support electronic database. We compared length of stay, total medication costs, and costs of as-needed medications for both groups: the baseline sample of inpatient oncology patients and patients exposed to the Urban Zen healing environment initiative. Results: We had complete cost data on 85 patients in our baseline group and 72 in our intervention group. We found no difference in length of stay between the 2 groups. We found a significant decrease in use of antiemetic, anxiolytic, and hypnotic medication costs as well as a decrease in total medication costs in the Urban Zen sample compared with the baseline group. Conclusions: An integrative medicine approach including yoga therapy, holistic nursing, and a healing environment in the inpatient setting can decrease use of medications, resulting in substantial cost savings for hospitals in the care of oncology patients.


Talcott J.A.,United Health Centers | Talcott J.A.,Continuum Cancer Centers of New York | Talcott J.A.,Harvard University | Manola J.,Dana-Farber Cancer Institute | And 9 more authors.
BJU International | Year: 2014

Objective To describe a successful quality improvement process that arose from unexpected differences in control groups' short-term patient-reported outcomes (PROs) within a comparative effectiveness study of a prostate brachytherapy technique intended to reduce urinary morbidity. Patients and Methods Patients planning prostate brachytherapy at one of three institutions were enrolled in a prospective cohort study. Patients were surveyed using a validated instrument to assess treatment-related toxicity before treatment and at pre-specified intervals. Unexpectedly, urinary PROs were worse in one of two standard brachytherapy technique control populations (US-BT1 and US-BT2). Therefore, we collaboratively reviewed treatment procedures, identified a discrepancy in technique, made a corrective modification, and evaluated the change. Results The patient groups were demographically and clinically similar. In the first preliminary analysis, US-BT2 patients reported significantly more short-term post-treatment urinary symptoms than US-BT1 patients. The study's treating physicians reviewed the US-BT1 and US-BT2 treatment protocols and found that they differed in whether they used an indwelling urinary catheter. After adopting the US-BT1 approach, short-term urinary morbidity in US-BT2 patients decreased significantly. Brachytherapy procedures were otherwise unchanged. Conclusion Many procedures in cancer treatments are not evaluated, resulting in practice variation and suboptimal outcomes. Patients, the primary medical consumers, provide little direct input in evaluations of their care. We used PROs, a sensitive and valid measure of treatment-related toxicity, for quality assessment and quality improvement (QA/QI) of prostate brachytherapy. This serendipitous patient-centred QA/QI process may be a useful model for empirically evaluating complex cancer treatment procedures and for screening for substandard care. © 2013 The Authors. BJU International © 2013 BJU International.


Shao T.,Beth Israel Deaconess Medical Center | Shao T.,Continuum Cancer Centers of New York | Klein P.,Beth Israel Deaconess Medical Center | Klein P.,Continuum Cancer Centers of New York | And 3 more authors.
Oncologist | Year: 2012

In addition to its role in calcium homeostasis and bone health, vitaminDhas also been reported to have anticancer activities against many cancer types, including breast cancer. The discovery that breast epithelial cells possess the same enzymatic system as the kidney, allowing local manufacture of active vitamin D from circulating precursors, makes the effect of vitamin D in breast cancer biologically plausible. Preclinical and ecologic studies have suggested a role for vitamin D in breast cancer prevention. Inverse associations have also been shown between serum 25-hydroxyvitamin D level (25(OH)D) and breast cancer development, risk for breast cancer recurrence, and mortality in women with early-stage breast cancer. Clinical trials of vitamin D supplementation, however, have yielded inconsistent results. Regardless of whether or not vitamin D helps prevent breast cancer or its recurrence, vitamin D deficiency in the U.S. population is very common, and the adverse impact on bone health, a particular concern for breast cancer survivors, makes it important to understand vitamin D physiology and to recognize and treat vitamin D deficiency. In this review, we discuss vitaminDmetabolism and its mechanism of action.Wesummarize the current evidence of the relationship between vitamin D and breast cancer, highlight ongoing research in this area, and discuss optimal dosing of vitamin D for breast cancer prevention. © AlphaMed Press.


Dy I.A.,St Lukes Roosevelt Hospital Center | Dy I.A.,Continuum Cancer Centers of New York | Wiernik P.H.,St Lukes Roosevelt Hospital Center | Wiernik P.H.,Continuum Cancer Centers of New York
Seminars in Thrombosis and Hemostasis | Year: 2012

The syndrome of cocaine-levamisole thrombotic vasculopathy is a tetrad of cutaneous manifestations, arthralgia, leukopenia, and positive antineutrophil cytoplasmic antigen (ANCA). Cocaine is cut with levamisole to potentiate its euphoric effects. However, along with this are the adverse reactions of levamisole such as fatal agranulocytosis, flu-like symptoms, and cutaneous thrombotic vasculopathy. High index of suspicion is needed for its diagnosis. This article will review on its toxicities, especially its prothrombotic effects. Copyright © 2012 by Thieme Medical Publishers, Inc.


Serra D.,Continuum Cancer Centers of New York | Robertson Parris C.,Continuum Cancer Centers of New York | Carper E.,Continuum Cancer Centers of New York | Homel P.,Maimonides Medical Center | And 3 more authors.
Clinical Journal of Oncology Nursing | Year: 2012

Guided imagery is an established intervention in integrative oncology. This study was initiated to evaluate the impact of guided imagery on patients undergoing radiation therapy for breast cancer. Eligible patients receiving guided imagery sessions were monitored via biofeedback before and after each session. Monitored measures included blood pressure, respiration rate, pulse rate, and skin temperature. In addition, the EuroQoL Group's EQ-5D questionnaire was used for subjective assessment and patient feedback was collected at the end of radiation therapy through a satisfaction survey. Measured parameters revealed statistically significant improvement from baseline, with decreases noted in respiration rate and pulse rate as well as systolic and diastolic blood pressure. Skin temperature increased, indicating more peripheral capillary flow secondary to a decrease in the sympathetic response. Overall, 86% of participants described the guided imagery sessions as helpful, and 100% said they would recommend the intervention to others. The results of this study illustrate the positive impact of guided imagery as measured through subjective and objective parameters. Improving the overall care for patients with breast cancer supports the value of incorporating practices of integrative oncology into standard practice. © Oncology Nursing Society.


Fleishman S.B.,Continuum Cancer Centers of New York | Homel P.,Continuum Cancer Centers of New York | Homel P.,Maimonides Medical Center | Chen M.R.,Continuum Cancer Centers of New York | And 4 more authors.
Journal of Community and Supportive Oncology | Year: 2015

Background: Animal-assisted visits (AAVs) are commonplace in cancer centers, but there is little evidence of their usefulness. Objective: To test the efficacy of AAVs in improving the quality of life in patients with head and neck cancer receiving combined chemotherapy-radiation therapy. Methods: 42 patients consented to daily AAVs during the time they received therapy for head and neck cancer. The Functional Assessment of Cancer Therapy-General Scale (FACT-G) was administered at baseline, week 3, and week 7 (at the end of therapy), and the Satisfaction With The AAV Intervention instrument, an 18-item scale adapted from the Pet Attitude Scale. Results: 37 patients completed at least baseline and 1 follow-up assessment for a single group analysis of change over time. Means for FACT-G subscales showed significant declines in Physical Well-Being (PWB, P < .001) and Functional Well-Being (FWB, P = .003). In contrast, Social Well-Being increased (SWB, P = .03). Controlling for declines in PWB at each time point, increases in Emotional Well-Being (EWB) were also significant (P = .004). Limitations Scheduling and patient preference prevented conducting a randomized trial. Conclusion FACT-G analysis showed significant increase in SWB and EWB despite high symptom burden and clinically evident and expected declines in PWB and FWB. Mean scores for satisfaction related to psychological symptoms, liking animals/pets, and contact with animals were consistently higher than neutral score or Unsure (all P < .001). Satisfaction related to physical symptoms was not significantly different from neutral. Though self-selected for an affinity to pets, patients endorsed a high level of satisfaction, which supports the usefulness of the intervention. © 2015 Frontline Medical Communications.


Dutcher J.P.,Continuum Cancer Centers of New York
Oncology (Williston Park, N.Y.) | Year: 2012

Three emerging trends have occurred recently in renal cell carcinoma (RCC). First, over the last several decades there has been a marked increase in the diagnosis of RCC, with a corresponding decrease in the typical tumor size, resulting in an increased interest in less invasive approaches to primary tumor treatment. Second, while conventional radiotherapy plays a limited palliative role due to the relative radio-resistance of RCC, advances in immobilization and image guidance have led several investigators to consider stereotactic radiotherapy techniques (SRT) to overcome this resistance, with impressive results in the metastatic setting. In addition, preliminary use of SRT to treat the primary RCC tumor is underway. Thirdly, although RCC is resistant to conventional chemotherapy agents, exciting recent advances have emerged in the treatment of clear cell RCC, with the development of targeted agents in addition to immunotherapy-based treatments. In the current critical review we discuss these emerging trends in localized and systemic treatment as well as possible interesting combinations of the two modalities. Finally, we discuss the role of the new systemic agents in non-clear cell RCC.


Reeve B.B.,University of North Carolina at Chapel Hill | Chen R.C.,University of North Carolina at Chapel Hill | Moore D.T.,University of North Carolina at Chapel Hill | Deal A.M.,University of North Carolina at Chapel Hill | And 4 more authors.
BJU International | Year: 2014

Objective To improve and individualise estimates of treatment outcomes for men diagnosed with prostate cancer, we examined the impact of baseline comorbidity on health-related quality of life (HRQL) outcomes in an analysis of two pooled, prospective cohort studies.Patients and Methods We studied 697 patients from three academic hospitals who received radical prostatectomy (RP), external beam radiation therapy (EBRT), or brachytherapy (BT). Measures of patient-reported bowel, urinary, and sexual symptoms along with physical and mental health were prospectively collected before treatment and 3, 12, 24, and 36 months after treatment. We assessed baseline comorbidity by the validated Index of Co-Existent Disease (ICED), abstracted from medical records. Regression mixed-models were built for each treatment group and HRQL outcome controlling for baseline age, education, marital status, risk group and patient-reported general health.Results About 71% of patients had one or more comorbid conditions at baseline. After adjusting for covariates, we found baseline comorbidity was independently associated with poorer sexual function after BT (P = 0.04) and RP (P = 0.03) but not EBRT (P = 0.35). Physical health was significantly worse for men receiving BT with more comorbidities (P = 0.02). Baseline comorbid conditions were not associated with urinary incontinence or bowel functioning.Conclusions Comorbidity at baseline is significantly associated with poorer sexual function after prostate BT or RP. This information may help patients and their physicians anticipate outcomes after surgical and radiation treatments. © 2014 The Authors.


Wiernik P.H.,Continuum Cancer Centers of New York
Expert Opinion on Pharmacotherapy | Year: 2013

Introduction: Lenalidomide, a thalidomide analog, is representative of a new class of antineoplastic drugs which has been especially effective in certain hematologic malignancies such as myeloma and myelodysplasia. Lenalidomide has anti-inflammatory, anti-angiogenic and immunomodulatory properties, and targets tumor cells by direct cytotoxicity and, indirectly by interfering with several components of the tumor microenvironment [1]. Lenalidomide retains antitumor activity equal to or greater than the parent compound, thalidomide, but with less toxicity [2]. Areas covered: This paper summarizes what is known about the mechanisms of action of lenalidomide, and recent clinical results in lymphoma and chronic lymphocytic leukemia. A literature review was accomplished by searching the PubMed database for papers in English. Publications from 2000 through November 2012 were analyzed. Search terms used were lenalidomide, lymphoma, chronic lymphocytic leukemia, and Hodgkin's lymphoma. A manual search of conference proceedings from the previous 5 years of the American Society of Clinical Oncology, American Society of Hematology, America Association of Cancer Research, and the European Hematology Association was also conducted. Relevant references in chosen papers were also considered. Expert opinion: The data suggest that lenalidomide will play a major role in the management of certain lymphoid neoplasms such as B-cell lymphoma, chronic lymphocytic leukemia and, perhaps, T-cell lymphoma. © 2013 Informa UK, Ltd.


PubMed | Continuum Cancer Centers of New York
Type: Journal Article | Journal: The Journal of community and supportive oncology | Year: 2015

Animal-assisted visits (AAVs) are commonplace in cancer centers, but there is little evidence of their usefulness.To test the efficacy of AAVs in improving the quality of life in patients with head and neck cancer receiving combined chemotherapy-radiation therapy.42 patients consented to daily AAVs during the time they received therapy for head and neck cancer. The Functional Assessment of Cancer Therapy-General Scale (FACT-G) was administered at baseline, week 3, and week 7 (at the end of therapy), and the Satisfaction With The AAV Intervention instrument, an 18-item scale adapted from the Pet Attitude Scale.37 patients completed at least baseline and 1 follow-up assessment for a single group analysis of change over time. Means for Fact-G subscales showed significant declines in Physical Well-Being (PWB, P < .001) and Functional Well-Being (FWB, P = .003). In contrast, Social Well-Being increased (SWB, P = .03). Controlling for declines in PWB at each time point, increases in Emotional Well-Being (EWB) were also significant (P = .004).Scheduling and patient preference prevented conducting a randomized trial.FACT-G analysis showed significant increase in SWB and EWB despite high symptom burden and clinically evident and expected declines in PWB and FWB. Mean scores for satisfaction related to psychological symptoms, liking animals/pets, and contact with animals were consistently higher than neutral score or Unsure (all, P < .001). Satisfaction related to physical symptoms was not significantly different from neutral. Though self-selected for an affinity to pets, patients endorsed a high level of satisfaction, which supports the usefulness of this intervention.

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