We are pleased to announce the successful applicants of our inaugural 2023 QUICC Research Grant Competition. This year two quality improvement grants were selected by the review panel to be supported over the next year. Congratulations to the following teams and we look forward to seeing your results advance cancer care for the patients in our local community!
1. Cancer Nephrotoxin Stewardship: A Program to Reduce Acute Kidney Injury in Patients Receiving Cancer Therapy.
Team: Dr. Samuel Silver (PI), Dr. Mihaela Mates, Dr. Andrew Robinson, Ms. Kaitlin Cormier, Ms. Nancy Guo, Dr. Bethany Monteith, Dr. Annette Hay, Mr. Rod Albrough, Mr. Patrick Norman.
Acute kidney injury (AKI) is a rapid decline in kidney function that affects up to 1 in 5 patients undergoing cancer therapy. In Ontario, 1 in 4 patients will die within one year of a hospitalization with AKI, with cancer as the leading cause of death. These poor outcomes in patients with AKI may be related to older age and “renalism”, where interventions are under-utilized in patients with kidney disease out of misplaced concerns that the harms exceed the benefits. “Renalism” may be reflected by delays or omission of cancer therapies due to concerns of recurrent AKI, nephrotoxicity or reduced kidney clearance. However, several risk factors for drug-related AKI are potentially modifiable, and this has been successfully demonstrated in the pediatric cancer population. A similar nephrotoxin prevention program could be adapted for our regional adult cancer patient population.
To address this health inequity, Dr. Silver’s team will first perform a retrospective chart abstraction to identify the proportion of patients in the prior year at high-risk for AKI. Then they will prospectively administer an AKI trigger tool for the next year in the hopes of increasing the number of patients identified at risk early, allowing the nephrology team to consult with oncology and primary care teams. Ultimately, their goal is to develop nephrotoxin stewardship pathways that reduce rates of AKI in adult patients receiving high-risk cancer treatment by 30% and increase the proportion of patients that safely receive their oncology team’s preferred cancer therapy, while avoiding treatment delays from kidney dysfunction.
2. Implementing systematic screening for risk for aberrant opioid use behavior in the Palliative Care Oncology Clinic at the Cancer Centre of Southeastern Ontario (CCSEO): a quality improvement initiative.
Team: Dr. Jean Mathews (PI), Dr. Michael Brundage, Dr. Leonie Herx, Dr. Aynharan Sinnarajah, Dr. Danielle Kain.
Canada is in the midst of an opioid crisis, with increasing opioid overdoses and opioid-related deaths. We have the second-highest rate per capita of opioid prescribing in the world. There is a pervasive belief that patients with cancer will not be impacted by this crisis, though recent evidence suggests that they are also at risk of aberrant opioid use behaviors. One in five cancer patients may be at risk of opioid use disorder, defined as problematic patterns of opioid use resulting in clinically significant impairment or distress.
To address this safely issue in our region, Dr. Mathew’s team will first determine the proportion of KHSC palliative care patients at risk for aberrant opioid use. Then they will prospectively implement and evaluate the utility of the Opioid Risk Tool (ORT) screening tool. In addition, they will be examining the feasibility and acceptability of implementing systematic screening for aberrant opioid use from both the perspective of palliative care patients with cancer and their healthcare providers.
Funding for these QUICC projects has been provided in partnership with University Hospitals Kingston Foundation.