1
|
Cogan JC, Accordino MK, Beauchemin MP, Spivack JH, Ulene SR, Elkin EB, Melamed A, Taback B, Wright JD, Hershman DL. Efficacy of a password-protected, pill-dispensing device with mail return capacity to enhance disposal of unused opioids after cancer surgery. Cancer 2022; 128:3392-3399. [PMID: 35819926 DOI: 10.1002/cncr.34384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/22/2022] [Accepted: 06/15/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Opioid misuse is a public health crisis, and unused postoperative opioids are an important source. Although 70% of pills prescribed go unused, only 9% are discarded. This study evaluated whether an inexpensive pill-dispensing device with mail return capacity could enhance disposal of unused opioids after cancer surgery. METHODS A prospective pilot study was conducted among adult patients who underwent major cancer-related surgery. Patients received opioid prescriptions in a mechanical device (Addinex) linked to a smartphone application (app). The app provided passwords on a prescriber-defined schedule. Patients could enter a password into the device and receive a pill if the prescribed time had elapsed. Patients were instructed to return the device and any unused pills in a disposal mailer. The primary end point was feasibility of device return, defined as ≥50% of patients returning the device within 6 weeks of surgery. Also explored was total pill use and return as well as patient satisfaction. RESULTS Among 30 patients enrolled, the majority (n = 24, 80%) returned the device, and 17 (57%) returned it within 6 weeks of surgery. In total, 567 opioid pills were prescribed and 170 (30%) were used. Of 397 excess pills, 332 (84% of unused pills, 59% of all pills prescribed) were disposed of by mail. Among 19 patients who obtained opioids from the device, most (n = 14, 74%) felt the benefits of the device justified the added steps involved. CONCLUSIONS Use of an inexpensive pill-dispensing device with mail return capacity is a feasible strategy to enhance disposal of unused postoperative opioids.
Collapse
Affiliation(s)
- Jacob C Cogan
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Melissa K Accordino
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Melissa P Beauchemin
- Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA.,Columbia University School of Nursing, New York, New York, USA
| | - John H Spivack
- Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,Joseph L. Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Sophie R Ulene
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Elena B Elkin
- Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,Joseph L. Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Bret Taback
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA.,Joseph L. Mailman School of Public Health, Columbia University, New York, New York, USA
| |
Collapse
|
2
|
Accordino MK, Spivack JH, Ulene S, Honan E, Trivedi MS, Crew KD, Harden E, Law C, Hershman DL. Abstract P4-11-33: Continuous glucose monitoring and hyperglycemia during chemotherapy for early-stage breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p4-11-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: There are a growing number of breast cancer (BC) survivors who are at risk for short and long-term treatment-related toxicities. BC survivors may be at higher risk of developing diabetes mellitus (DM), and chemotherapy may potentiate this risk due to concurrent corticosteroid use. DM is associated with both short and long-term treatment toxicities and worse BC outcomes. The prevalence of hyperglycemia (HG) during chemotherapy for early-stage BC (ESBC), and the association between HG during chemotherapy and treatment-related toxicities is unknown. Methods: We are conducting a single-arm pilot study to evaluate the prevalence of hyperglycemia among patients with ESBC during chemotherapy (NCT04473378). Patients are eligible if ≥18 years old, initiating chemotherapy with corticosteroid use, not receiving systemic steroids except as supportive care for chemotherapy, and known DM is allowed if patients are not treated with insulin. Within 7 days of chemotherapy initiation, the Freestyle Libre Pro (Abbott Diabetes Care) continuous glucose monitoring system is applied to the posterior arm of each participant. Patches are reapplied every 2-3 weeks and worn continuously until chemotherapy completion (duration per regimen). The Freestyle Libre Pro monitors interstitial glucose every 15 minutes via subcutaneous sensor filaments adhered to the skin without a finger prick. Data is downloaded using a wireless scan of the sensor by a reader. The primary endpoints are: 1) the prevalence of HG, defined as the number of participants who have ≥1 glucose value (fasting or non-fasting) of ≥140 mg/dL at any point from chemotherapy initiation to completion; 2) Among participants who develop HG, the proportion of time in which they have HG, measured as the number of hyperglycemic values (glucose value of ≥140 mg/dL) divided by the total number of glucose values recorded in an individual for the duration of chemotherapy. Secondary endpoints include the prevalence of impaired glucose tolerance (hemoglobin A1c [HgbA1c] ≥5.7%) prior to chemotherapy initiation in patients without a history of DM, and changes in glucose biomarkers (HgbA1c, fructosamine, and serum creatinine) during treatment. Results: Between December 2020 and April 2021, 7 patients were enrolled, with evaluable data for 5 patients. At baseline median age was 60 (range, 37-74) and median BMI was 33.0 (range, 24.6-41.6). Chemotherapy regimens were: docetaxel/cyclophosphamide (40%); docetaxel/cyclophosphamide/trastuzumab/pertuzumab (20%); weekly paclitaxel (20%); and paclitaxel followed by doxorubicin/cyclophosphamide (20%). All patients (100%) developed hyperglycemia. Of 18,768 sensor readings (281,265 minutes) the proportion of time participants were hyperglycemic (≥140 mg/dL) during the period of adjuvant/neoadjuvant chemotherapy was 22.1%, and the mean time from first corticosteroid administration to first hyperglycemic episode was 7.6 hours. Of three patients with no history of DM (including one patient with glucose intolerance), the proportion of time spent hyperglycemic (≥140 mg/dL) was 9.9% (range, 1.7-13.8%), and the mean daily glucose was 106.7 mg/dL (SD 10.3). Of the two patients with DM, the proportion of time spent hyperglycemic was 70.2% (range, 67.2-79.5%) and the mean daily glucose was 171.7 mg/dL (SD 3.1). Changes in glucose biomarkers will be presented with the full cohort. Conclusion: Hperglycemia during chemotherapy occurred in 100% of the cohort, including those without a history of DM or glucose intolerance. It is currently unknown if HG during chemotherapy is a modifiable risk factor for short and long-term BC treatment toxicities including neuropathy. Understanding glucose trends in this setting will help determine a successful intervention for HG during chemotherapy which may reduce short and long-term treatment toxicities.
Citation Format: Melissa K Accordino, John H Spivack, Sophie Ulene, Erin Honan, Meghna S Trivedi, Katherine D Crew, Erik Harden, Cynthia Law, Dawn L Hershman. Continuous glucose monitoring and hyperglycemia during chemotherapy for early-stage breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-33.
Collapse
Affiliation(s)
| | | | - Sophie Ulene
- Columbia University Medical Center, New York, NY
| | - Erin Honan
- Columbia University Medical Center, New York, NY
| | | | | | - Erik Harden
- Columbia University Medical Center, New York, NY
| | - Cynthia Law
- Columbia University Medical Center, New York, NY
| | | |
Collapse
|
3
|
Berger Y, Spivack JH, Heskel M, Aycart SN, Labow DM, Sarpel U. Extrahepatic metastasectomy for hepatocellular carcinoma: Predictors of long-term survival. J Surg Oncol 2017; 115:505-506. [PMID: 28334437 DOI: 10.1002/jso.24555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Yaniv Berger
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John H Spivack
- Department of Population, Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marina Heskel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha N Aycart
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel M Labow
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Umut Sarpel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
4
|
Spivack JH, Cheng B. Estimating odds ratios under a case-background design with an application to a study of Sorafenib accessibility. Ann Appl Stat 2016. [DOI: 10.1214/16-aoas972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
5
|
Berger Y, Spivack JH, Heskel M, Aycart SN, Labow DM, Sarpel U. Extrahepatic metastasectomy for hepatocellular carcinoma: Predictors of long-term survival. J Surg Oncol 2016; 114:469-74. [PMID: 27334650 DOI: 10.1002/jso.24340] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/11/2016] [Indexed: 12/16/2022]
Abstract
INTRODUCTION We report our institutional experience with extrahepatic metastasectomy (EM) in a cohort of hepatocellular carcinoma (HCC) patients with focus on predictors of survival. METHODS All patients diagnosed with metastatic HCC from 2001 to 2014 were retrospectively reviewed to identify those who underwent EM with therapeutic intent. Associations among multiple clinicopathological variables and survival after EM were analyzed by univariate and multivariate analyses. RESULTS Out of 440 metastatic HCC cases, we identified 85 patients (mean age 58.8 ± 11.7 years, 81.2% males) who underwent lung (n = 36), peritoneal (n = 22), lymph node (n = 19), musculoskeletal (n = 18), and adrenal (n = 9) metastasectomy. Most patients (84.7%) underwent metachronous EM following primary liver resection or transplantation. The median follow-up period was 20.9 months, during which 55 patients (64.7%) died. The 1-/2-/5-year overall survival rates after EM were 77.4, 53.1, and 25.1%, respectively. On multivariate analysis, number of metastases resected >2 correlated independently with poor survival (HR = 2.058, P = 0.0099). EM patients had superior median survival compared to all (n = 194) metastatic HCC patients treated with sorafenib without EM during the study period (27.2 vs. 7.4 months, P < 0.001). CONCLUSION Long-term survival may be achieved in highly selected HCC patients following EM. The presence of greater than two extrahepatic lesions correlates independently with poor survival. J. Surg. Oncol. 2016;114:469-474. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Yaniv Berger
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John H Spivack
- Department of Population, Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marina Heskel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha N Aycart
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel M Labow
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Umut Sarpel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
6
|
Sarpel U, Spivack JH, Berger Y, Heskel M, Aycart SN, Sweeney R, Edwards MP, Labow DM, Kim E. The effect of locoregional therapies in patients with advanced hepatocellular carcinoma treated with sorafenib. HPB (Oxford) 2016; 18:411-8. [PMID: 27154804 PMCID: PMC4857060 DOI: 10.1016/j.hpb.2016.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS It is unknown whether the addition of locoregional therapies (LRTx) to sorafenib improves prognosis over sorafenib alone in patients with advanced hepatocellular carcinoma (HCC). The aim of this study was to assess the effect of LRTx in this population. METHODS A retrospective analysis was performed of patients with advanced HCC as defined by extrahepatic metastasis, lymphadenopathy >2 cm, or gross vascular invasion. Sorafenib therapy was required for inclusion. Survival of patients who received LRTx after progression to advanced stage was compared to those who did not receive LRTx. RESULTS Using an intention to treat analysis of 312 eligible patients, a propensity weighted proportional hazards model demonstrated LRTx as a predictor of survival (HR = 0.505, 95% CI: 0.407-0.628; P < 0.001). The greatest benefit was seen in patients with the largest tumor burden (HR = 0.305, 95% CI: 0.236-0.393; P < 0.01). Median survival in the sorafenib arm was 143 days (95% CI: 118-161) vs. 247 days (95% CI: 220-289) in the sorafenib plus LRTx arm (P < 0.001). CONCLUSIONS These results demonstrate a survival benefit with the addition of LRTx to sorafenib for patients with advanced HCC. These findings should prompt a prospective clinical trial to further assess the role of LRTx in patients with advanced HCC.
Collapse
Affiliation(s)
- Umut Sarpel
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Correspondence Umut Sarpel, Division of Surgical Oncology, 19 East 98th St, New York, NY 10029, USA. Tel: +1 212 241 2891. Fax: +1 212 241 1572.
| | - John H. Spivack
- Department of Population, Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yaniv Berger
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marina Heskel
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha N. Aycart
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Sweeney
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martin P. Edwards
- Department of Radiology, Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel M. Labow
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Edward Kim
- Department of Radiology, Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
7
|
Vitale MA, Vanbeek C, Spivack JH, Cheng B, Geller JA. Pharmacologic reversal of warfarin-associated coagulopathy in geriatric patients with hip fractures: a retrospective study of thromboembolic events, postoperative complications, and time to surgery. Geriatr Orthop Surg Rehabil 2013; 2:128-34. [PMID: 23569682 DOI: 10.1177/2151458511417434] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Patients with acute hip fractures who are on maintenance warfarin for anticoagulation present a significant challenge and their management remains controversial. The purpose of this study was to assess thromboembolic and systemic complications associated with pharmacological reversal of warfarin-associated coagulopathy in a population of geriatric patients with hip fractures. METHODS This retrospective cohort study identified patients with operative hip fractures on oral warfarin therapy who had an international normalized ratio (INR) >1.50 on admission (N = 93) approximately over a 13-year span. The control group consisted of patients whose warfarin was held upon admission without further intervention preoperatively (n = 23). The treatment group consisted of patients who underwent pharmacologic reversal of elevated INR with vitamin K and/or fresh frozen plasma (FFP) in addition to holding warfarin (n = 70). Primary outcomes included thromboembolic and other complications as well as mortality within 3 months of presentation. Time to surgery was a secondary outcome. RESULTS The 3-month mortality rate was 4% in the pharmacological intervention group and 17% in the watch-and-wait group; this difference trended toward statistical significance (P = .06). There were no significant differences in the likelihoods of other thromboembolic or nonthromboembolic complications between groups. While the difference in mean time to surgery was not significantly different overall between groups, this difference was significant in a subgroup of patients with higher baseline INRs (n = 46, INR >2.17), with a mean difference of 4.0 fewer days until surgery in the pharmacological intervention group (P < .01). CONCLUSIONS Pharmacological reversal of warfarin-associated coagulopathy with a combination of vitamin K and FFP appears to be a safe way to optimize patients for operative fixation of hip fractures and is associated with a shorter delay to surgery in patients with more elevated INRs preoperatively. LEVEL OF EVIDENCE retrospective cohort study (level III).
Collapse
Affiliation(s)
- Mark A Vitale
- Center for Hip and Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Medical Center, Columbia University, New York, NY, USA
| | | | | | | | | |
Collapse
|