Colabroy, Donna, RN, MSN, OCN, CCM

Fry, Benjamin

Kratz, Melissa, RN, MSN, AOCN

Skandan, Savitri, MD

Sopka, Dennis, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Research Scholars Poster Presentation A Retrospective Review of Outcomes Associated With Treatment Modalities Utilized In The Management of Diffuse Large B Cell Non-Hodgkin's Lymphoma Benjamin Fry Donna Colabroy RN, MSN, OCN, CCM Melissa Kratz RN, MSN, AOCN Dennis Sopka MD Savitri Skandan MD Follow this and additional works at: https://scholarlyworks.lvhn.org/research-scholars-posters  Part of the Oncology Commons This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. Lehigh Valley Health Network, Allentown, Pennsylvania• Diffuse Large B-Cell Lymphoma (DLBCL) is the most common aggressive Non-Hodgkin’s Lymphoma subtype1• National Comprehensive Cancer Network (NCCN) issues peer-reviewed guidelines for DLBCL treatment2• National Cancer Institute (NCI) publishes Surveillance, Epidemiology, and End Results (SEER) statistics for DLBCL3References1. Treatment for Aggressive NHL Subtypes. (2015, February 26). Retrieved July 22, 2020, from https://www.lls.org/lymphoma/non-hodgkin-lymphoma/treatment/treatment-for-aggressive-nhl-subtypes2. Zelenetz, A., Et. Al. (2020, July 9). NCCN Clinical Practice Guidelines in Oncology: B Cell Lymphomas. Retrieved July 22, 2020, from https://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf3. SEER Cancer Stat Facts: Diffuse Large B-Cell Lymphoma. National Cancer Institute. Bethesda, MD. Retrieved July 22, 2020, from https://seer.cancer.gov/statfacts/html/dlbcl.htmlIntroductionConclusionsRecommendationsA Retrospective Review of Outcomes Associated With Treatment Modalities Utilized in the Management of Diffuse Large B-Cell Non-Hodgkin's LymphomaBenjamin Fry, Donna Colabroy MSN RN AOCNS, Melissa Kratz MSN RN AOCNS, Dennis Sopka MD, Savitri Skandan MDMethodsResultsObjectives• Determine if workup and treatment for DLBCL rendered at LVHN was in compliance with NCCN guidelines• Compare LVHN’s DLBCL population trends to those published by the NCI• Retrospective chart review of 269 DLBCL patients identified by LVHN’s Tumor Registry from 2014 to 2018• Utilized EPIC and Mosaiq to access electronic medical records (EMR) to record:– Demographic information – Chemotherapy regimen– Baseline:• Lugano staging (I, II, III, IV)• Viral testing results• Lactate dehydrogenase measurement• B symptom presence• PET scan completion status• Echocardiogram/MUGA completion status• Removed 88 patients from initial dataset due to:– Initial treatment at another hospital – 41 (46.6%)– Treatment by pediatrics unit – 3 (3.4%)– Patient declined treatment or entered hospice without treatment – 14 (15.9%)– DLBCL was primary CNS disease – 22 (25.0%)– Patient expired before treatment could be initiated – 8 (9.1%)• Determined compliance based on NCCN guidelines2 for first-line chemotherapy and workup procediures16/16 (100%) 23/31 (74.2%) 19/28 (67.9%) 24/40 (60.0%)Figure 1.3-Year Survival Rate Breakdown by Clinical Stage at Diagnosis*NCCN Treatment Guidelines Compliance*Stages at Dx Compliant Patients Total PatientsTotal % ComplianceI & II 61 67 91.0%III & IV 84 93 90.3%NCCN Workup Guidelines Compliance*IPI Score Compliant Patients Total PatientsTotal % ComplianceIncluded 27 181 14.9%Omitted 128 181 70.7%Survival Rate ComparisonSource Time-ScaleTotal % Per Stage at DxI II III IV OverallLVHN* 3-years 100% 74.2% 67.9% 60.0% 72.4%NCI SEER3 5-years 73.3% 72.7% 63.7% 52.7% 63.8%*Compliance = Documented LDH, ECOG, ± B Symptoms, PET Scan, Hepatitis B test, ECHO/MUGA [+anthracycline] *Compliance = First treatment modality followed NCCN flowchart 3 for selection based on stage group at diagnosis• Comparison to SEER statistics:– LVHN’s 3-year survival rates exceed all corresponding 5-year metrics provided by SEER– DLBCL outcomes are at or exceeding national average• Though, direct comparison is difficult due to different time-scales• NCCN workup:– Found a general absence of documented IPI scores• Led to a low overall workup compliance (14.9%)• However, IPI is a prognostic index and doesn’t have large impact on care plan– When omitted, 70.7% of workups are compliant• NCCN treatment:– Overall treatment compliance was 145/150 (90.6%)• Deviations from compliance can be explained case-to-case• Overall:– LVHN is compliant with NCCN guidelines and provides a high standard of care for its DLBCL patients.• In 2 years, recalculate survival rates per stage to have direct comparison to 5-year SEER statistics• Emphasize better documentation of IPI score in EMR– IPI scores have been documented as general prognostic statements such as “high risk”• Can be converted to numerical score, however nothing differentiates these statements from a general prognosis  – NCCN occasionally uses IPI to select chemotherapy regimen• IPI should be consistently documented to ensure proper careTable 1.Table 2.Table 3.21/35 (60.0%)21/37 (56.8%)26/37 (70.3%)29/37 (78.4%)31/35 (88.6%)Figure 2.NCCN Workup Compliance By Year (IPI Score Omitted)*Calculations in Table 1. and Figure 1. omit patients from 2018 that are not yet 3 years out from diagnosis.

A Retrospective Review of Outcomes Associated With Treatment Modalities Utilized In The Management of Diffuse Large B Cell Non-Hodgkin\u27s Lymphoma

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A Retrospective Review of Outcomes Associated With Treatment Modalities Utilized In The Management of Diffuse Large B Cell Non-Hodgkin\u27s Lymphoma

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