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A total of 2299 new cancer patients were referred to the Northern Israel Oncology Center in 1974 and in 1980. The stage of disease, delay in diagnosis, the responsibility for the delay, and the survival of those referred in 1974 were investigated. At the time of diagnosis, 39% of the patients had localized disease, 34% had locally advanced disease, and 23% had metastatic disease. In 52% of the patients there was no delay in diagnosis. No correlation was found in the group as a whole between the stage of disease and delay in diagnosis. Only in the breast cancer group without delay in diagnosis, however, were there significantly more patients at an early stage than at an advanced stage of disease. At each stage of disease, responsibility for the delay was shared about equally between the patients and the physicians, except in advanced breast cancer, where the patients were more often responsible for the delay. The survival rate was higher in patients in whom the disease was diagnosed earlier. It was also higher at each clinical stage (Stages I and II) in patients who had no delay than in those with delay in diagnosis. The survival rate was higher in patients who were themselves responsible for the delay in diagnosis than in patients whose physicians were responsible for the delay. In 1980, less diagnoses were delayed in fewer patients than in 1974 (42% versus 65%). Responsibility for the delay in 1980 lay equally with the patients and with the physicians, but when compared to 1974, the physicians' responsibility and administrative delay were less. Campaigns for early diagnosis are advocated.

Seventy-three patients with Dukes' B2 and C colorectal cancer were randomized to adjuvant therapy after radical surgery. One group was treated with chemotherapy either alone or in combination with radiotherapy (RC). The second group was treated by chemotherapy (with or without radiotherapy) plus MER/BCG (RCM). In patients with Dukes' C disease, the survival at 54 months and the disease-free interval up to 24 months were significantly better in the RCM than in the RC subgroup. There were no significant differences in the survival and disease-free interval between RC- and RCM-treated patients with Dukes' B2 disease. Entry of additional patients and further follow-up are needed before we can decide whether the combination of RCM increases the cure rate in Dukes' C cancer or merely delays recurrence and prolongs survival.

Introduction Patients with hematological malignancies often require inpatient chemotherapy treatment to administer continuous infusion of chemotherapy drugs and allow better monitoring. Inpatient setting includes multiple caregivers with different level of expertise - physicians, nursing staff, pharmacy and administrators. Many patients are seen by their hematologist in an outpatient clinic where the chemotherapy plan is written. The patient is then admitted to the inpatient floor for therapy. However in many hospitals there are 2 different electronic medical record systems that don't necessarily communicate properly. In addition, the inpatient setting utilizes more health care resources and is undoubtedly more expensive than the ambulatory care. In this paper we describe an integrative process of establishing safer and better care to hematological patients admitted for inpatient chemotherapy. Methods A multidisciplinary team was established incorporating physicians, nurses, pharmacists and IT. We conducted focused observations and mapped the process. Failure Mode Effect Analysis (FMEA) was preformed to identify the most important issues needing intervention. An integrated electronic medical record interface was generated to enable online streaming of communication between different entities in the hospital - inpatient floor, outpatient clinic and pharmacy. We established a dedicated time out of the process. To assess the impact of our work we reviewed charts of randomly selected 18 patients who received inpatient chemotherapy prior to the interventions and continued to monitor records post intervention for the following indicators: 1. Percent of patients who received pre-chemo medications and fluids as prescribed by the hematologist; 2. The difference between a patient's weight on the chemotherapy orders and the actual patient weight as measured on admission; 3. The time difference variability between the planned administration time and the actual administration time of chemotherapy drugs. Results Prior to intervention, 20% of the pre-chemotherapy orders such as anti-emetics or fluids were not done according to the hematologist's request. Following the intervention, 100% of pre-chemotherapy orders were preformed accurately and timely. In 24% of patients' cases there was more than 10% difference between the weight used for chemotherapy orders and weight on admission. No significant difference was noted following intervention. In 50% of cases there was more than 2 hrs delay in chemotherapy administration on the following day. Following intervention there was no incidence of more than 2 hrs delay in chemotherapy administration. These interventions resulted in a significant decrease in hospital stay (7.4 vs. 4.7 days). Conclusions The Multidisciplinary team's approach is critical in a complex process as inpatient chemotherapy administration. FMEA is an essential tool to assess the severity of different failures of a complex process to prioritize interventions. Integrated electronic medical records interface helps improving communication between different providers and results in a better and safer patient care as well as reduces health care costs. Disclosures No relevant conflicts of interest to declare.