Browsing by Autor "Paula Gratal"

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CDK4/6 inhibitors for metastatic breast cancer in routine clinical practice in Spain: survey of patterns of use and oncologists’ perceptions
(Springer Science+Business Media, 2025) Fernando Moreno; Vega Iranzo; I. Álvarez; Antonio Antón; José Ignacio Chacón; Joaquín Gavilá; Michael S. Martin; Pedro Sánchez‐Rovira; Paula Gratal; M J Fernández González
Enhanced documentation of capecitabine adherence in stage II–III colorectal cancer: A quality improvement initiative at the University Hospital of Navarra.
(Lippincott Williams & Wilkins, 2025) Ibón Gurruchaga; Elena Mata; Carlos Burriel; Álvaro Rogado; Paula Gratal; Ruth Vera; Jesús García‐Foncillas
470 Background: Adherence to oral chemotherapy is critical to achieving optimal treatment outcomes. In stage II–III colorectal cancer, poor documentation of capecitabine intake limits the ability to evaluate compliance and manage toxicity. During Q1 2024, fewer than 25% of treatment cycles at the University Hospital of Navarra included adherence data in the medical record. This project, developed within the 2024 ASCO Quality Training Program in collaboration with Fundación ECO, aimed to improve the documentation rate to at least 75%. Methods: Over six months, a stepwise, multidisciplinary intervention was implemented. Oncology professionals were trained on the importance of documenting adherence, and patients received education on correct capecitabine intake. The electronic health record (EHR) was updated with a dedicated field to record adherence at each treatment cycle. At treatment initiation, patients completed the 8-item Morisky Medication Adherence Scale (MMAS-8) to assess risk of nonadherence. A patient-friendly compliance chart was also distributed for self-monitoring. Monthly tracking of adherence documentation was performed before and after each intervention. Results: Initial adherence documentation was under 25%. After staff education and EHR updates, it increased to 80.16%. Following the incorporation of the MMAS-8 tool and compliance chart, adherence documentation further improved to 89.12%, surpassing the 75% target. Conclusions: This initiative significantly enhanced the documentation of capecitabine adherence, supporting safer and more effective use of oral chemotherapy. The integration of EHR tools, structured patient engagement, and staff education proved effective. The project highlights the impact of systematic quality improvement and reinforces the value of collaboration through programs like the ASCO QTP and Fundación ECO. Adherence documentation rate during intervention phases. Phase Adherence Documentation (%) Baseline (Q1 2024) <25% After staff training + EHR update 80.16% After MMAS-8 + compliance chart 89.12%
Quality improvement project to optimize the management of immune-related toxicity in hospitalized patients receiving immunotherapy.
(Lippincott Williams & Wilkins, 2025) Jorge Soler; C. Ruiz; Inmaculada Roig; Sylvaine Cases; Alfredo Sánchez; Álvaro Rogado; Paula Gratal; Jesús García‐Foncillas
475 Background: As part of the 2024 Quality Training Program (QTP) held in Madrid, we developed a quality improvement project aimed at enhancing the management of immune-related adverse events (irAEs) in patients requiring hospitalization. The increasing use of immune checkpoint inhibitors has shifted the pattern of oncology admissions, with a notable rise in hospitalizations due to irAEs. Our objective was to reduce irAE-related hospital admissions by at least 15% through structured intervention using QTP methodology. Methods: We conducted a retrospective review of all hospital admissions from March to May 2024, identifying those due to irAEs. A baseline stratification by toxicity type was performed. Using a cause-effect diagram and Pareto analysis, the primary contributing factors were identified as suboptimal pre-treatment evaluation and inadequate clinical management of irAEs. A process flowchart revealed three potential intervention points: (1) oncologist training in irAE management, (2) pre-treatment immunology consultation, and (3) emergency department staff education. A prioritization matrix indicated that implementing an immunology consultation was the most feasible and impactful intervention. Prospective data were collected from September to November 2024, during which all patients scheduled for immunotherapy were referred to a dedicated immunology consult to assess toxicity risk via clinical and laboratory parameters. Results: Baseline data showed 30 irAE-related hospitalizations out of 577 immunotherapy treatments. After implementing the intervention, admissions slightly decreased to 27 out of 597 treatments. (See table). Conclusions: Although the 15% reduction target was not achieved, a modest decrease in irAE-related admissions was observed. Contributing limitations included a short intervention period and the absence of a standardized immunology consultation protocol. Future cycles of Plan-Do-Study-Act (PDSA) should focus on refining the consultation process and exploring complementary strategies such as emergency department staff training. Immune-related toxicity admissions before and after intervention. Month Total IT Treatments Total Oncology Admissions IT-Related Admissions March 183 97 10 April 193 102 11 May 201 83 9 Pre-intervention Total 577 282 30 September 198 104 9 October 203 121 8 November 196 92 10 Post-intervention Total 597 317 27