bluuebunny/crossref_metadata_2025 huggingface dataset:
The nurses perspective of the effectiveness and value of the respiratory distress observation scale.
Authors: Scheper Kerstin
Published: February 2017

139

Background: The nurses on the oncology unit at Overlook Medical Center have been using the Respiratory Distress Observation Scale (RDOS) since September 2013 to assess and manage respiratory distress and dyspnea at end of life for our cognitively impaired patients. The gold standard for managing dyspnea has been the ability of the patient to self-report. Cognitive impairment may interfere with the assessment of respiratory distress and dyspnea leading to under recognition and under or over medication of symptoms. Methods: A nurse focus group was formed and elicited discussion, information, and opinion of the implementation and effectiveness of the RDOS on the medical oncology unit. The nurses were tasked with identifying if the RDOS improved their ability to assess and manage respiratory symptoms for this patient population. The group consisted of eight nurses from the oncology unit who shared a passion for end of life care, but varied in levels of expertise and years of experience. The participants answered nine open-ended questions relating to the implementation and effectiveness of the RDOS, its use in communicating with patient’s family, and their experiences with end of life care both on their unit and throughout the hospital. Approximately fifty six patients were evaluated with the RDOS by these nurses prior to the focus group meeting. Results: All participants stated the RDOS was easy, took two minutes to perform and has improved their ability to assess and manage dyspnea while enhancing their ability to effectively communicate with physicians. All were passionate in their belief that the RDOS is a tool that validates their decision to medicate and facilitates educating families that may be resistant to pharmacological intervention. Conclusions: Our focus group results were similar to research findings identifying the RDOS as effective in managing dyspnea. The group advocated its use and support implementation of the RDOS house wide. The group produced useful information and elicited candid discussion on its ability to favorably impact care.
Provision of specialized palliative care in a multiprofessional network.
Authors: Papke Jens Hermann
Published: February 2017

144

Background: In Germany specialised palliative care in outpatient setting is financed by health insurances since 2007. Home Care Sachsen e.V. is a specialised palliative care provider working with two palliative care teams including qualified nurses, physicians and social workers in closely cooperation with general practitioners and nursing services. We report about the results of our work in a rural area around Dresden in Saxony, Germany. Methods: Our data were collected prospectively with PalliDoc software. Results: Between 2011 – 2013 Home Care Sachsen e.V. served for 1,572 pts (888 m, 684 f); 93% with an oncologic disease. Median age was 71 y, Karnofsky index was 40%, median caring time 27 days. In this time, 25% of our pts had one stay in hospital, 8% two and 4% three and more. 63% had no stays in hospital. At least 1,271 pts. died: 65% at home; 9% in nursing homes and hospices; 15% in palliative care units and 11% in hospital. Conclusions: Mean home death rate of oncologic pts without intervention in Germany is about 44% (Papke J, Koch R: Places of Death from Cancer in a Rural Location. Onkologie (2007) 30, 105-08). This proportion could be enhanced considerably with outpatient palliative care. Providing of specialised palliative care with a multiprofessional team is effective to increase the rate of dying at home and to fulfill one of the strongest wishes of pts in a palliative situation.
Utilizing Eastern Cooperative Oncology Group (ECOG) performance status scores to prevent harm with chemotherapy at the end of life.
Authors: Newhart Eve , Karlan Beth , Shane Rita , Patel Vipul , Rosen Bradley T. , Audeh M. William , Figlin Robert A.
Published: February 2017

146

Background: According to ASCO’s “top five” list of non evidence-based cancer treatments and procedures, the use of chemotherapy in solid tumor patients with evidence of poor performance status is at the top of the list. The Dartmouth Atlas report revealed a significant overuse of chemotherapy at the end of life (EOL), and Cedars-Sinai was identified as an outlier with regards to this practice. Methods: Cedars-Sinai’s interdisciplinary cancer quality committee designed a new initiative to eliminate the ineffective administration of chemotherapy. Each patient’s ECOG score, entered by a nurse or physician, was used as an appropriateness screen by pharmacists before they released chemotherapy in both the outpatient and inpatient settings. If a patient did not qualify for chemotherapy based on an ECOG score of 3 or greater, the pharmacist contacted the prescribing oncologist to discuss the case. Ultimately the oncologist had the final say as to whether the patient received chemotherapy. Data was collected on ECOG scores, number of patients screened and identified as being at risk, oncologists’ responses to being notified, and whether chemotherapy was ultimately administered. Results: Available data collected on the % of orders with ECOG scores, since February of 2014 is shown in the Table. Conclusions: Data and conclusions regarding oncologists’ responses to being notified, and whether chemotherapy was ultimately administered, and harm thus prevented, is currently being compiled and will be presented at the conference. [Table: see text]
Influence of palliative care consult on radiation therapy utilization for metastatic cancer patients within the last six months.
Authors: Schuster Jessica Moore , Tam Karman , Skoro Nevena , Cassel Brian , Anscher Mitchell Steven , Moghanaki Drew
Published: February 2017

149

Background: Palliative care encounters (PCE) have been demonstrated to reduce resource utilization and costs within an inpatient setting. Little is known about influence PCE on delivery of radiation therapy (RT). We hypothesize that terminally ill cancer patients completing PCE would have increased utilization of palliative RT (PRT) with decreased fractions and overall costs. Methods: Retrospective review of 3,128 cancer patients that had at least one hospital contact within 6 months prior to death. Data from single academic institution decedent database, hospital billing claims, and radiation oncology electronic medical record (RO EMR) was combined into one database that could be queried. Results: From January 2009 to June 2011, 417 patients with soft tissue/bone/not other specified (NOS) excluding brain metastatic disease and at least one palliative contact within 6 months prior to death were identified. Palliative contact: PRT or palliative care consult or admission (PCE). 232 patients completed 321 RT courses (87% palliative, 8% curative, and 5% unknown). 18% of PRT was delivered in 1 fraction, 30% in 2-5, 4% in 6-9, 36% in 10, and 12% > 10 fractions. PRT and PCE were both completed in 48% (33% before, 13% during and 54% after delivery of RT). PCE prior to PRT vs. PCE none/during/after PRT were more likely to result in 5 or fewer PRT treatments (62% vs. 40%, p=0.0309) and there was a trend for increased delivery of single fraction PRT (18 vs. 15%). Based on timing of PCE, no increase in PRT courses per patient and no overall cost reduction was observed beyond direct cost reduction by reducing PRT fractions. Other non-significant factors included sex, race, and payer type. Majority of PCE were within 30 days prior to death 52% vs. only 44% of PRT. Conclusions: Relationship between PCE and PRT is complex and are likely compounded by factors not accounted for in this study. Despite these limitations, PCE prior to delivery of PRT correlates to reduced treatment numbers. This report highlights that overall referrals for palliative services could be integrated into comprehensive cancer much earlier and in a more multi-disciplinary way.
Fostering patients and families during end-of-life care.
Authors: Tufaro Michelle , Devries Jim
Published: February 2017

150

Background: Hunterdon Palliative Care Program is a service owned and run by Hunterdon Medical Center, a non-profit, Magnet-recognized, community hospital of 178 beds for the residents of Hunterdon County in New Jersey. The program strives to provide the highest quality patient and family-centered care for seriously ill and terminal patients. Our goals include respect for patient autonomy, values and personal decisions, as well as minimizing of symptom distress, optimizing supportive interventions and services for patients and their families. The individual need of each patient is determined by an interdisciplinary process that includes the ongoing clarification of goals of care. In order to achieve this we have developed several tools to capture the unique needs of each patient and encourage a daily interdisciplinary process. Methods: Three tools were developed to incorporate and utilize the expertise of each individual team member which includes physicians, nurse practitioner, social worker, chaplain and a reiki master. Results: The tools are currently being used by all in-patient palliative care patients. The psych-social-spiritual assessment and care plan sheets are completed within 24 hours of the initial consultation. The documents are placed on the chart next to the written consult. Daily rounding sheets are placed in the progress notes section of the chart. All members of the patient’s treatment team are encouraged to utilize the forms. Both the care plan note and the daily rounding sheet include a section for input from other disciplines. A hot pink strip is located at the bottom of each sheet to make it easy for others to identify forms for integration into additional patient care plans. Conclusions: The Palliative Care Program was awarded Certification by The Joint Commission, with no recommendations for improvement! The interdisciplinary approach to a patient’s end of life needs was sited as "superior" for clinical documentation with special attention to the psycho-social spiritual assessment as a “best practice” standard.
Patients' and family caregivers' (FC) quality of life (QOL) and mood during hospitalization for hematopoietic stem cell transplantation (HCT).
Authors: El-Jawahri Areej , Traeger Lara , Eusebio Justin , Kuzmuk Kailyn , Vandusen Harry , Shin Jennifer , Greer Joseph A. , Pirl William F. , Ballen Karen K. , Spitzer Thomas R. , Graubert Timothy A. , McAfee Steven L. , Dey Bimalangshu , Jackson Vicki A. , Chen Yi-Bin Albert , Temel Jennifer S.
Published: February 2017

160

Background: While the long-term outcomes of HCT survivors have been described, the acute impact of hospitalization for HCT on patients’ and FC QOL and mood has received little attention. Methods: We conducted a longitudinal study of patients (and FC) hospitalized for HCT. At baseline (6 days pre-HCT), day+1, and day+8 of HCT, we assessed QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation FACT-BMT), fatigue (FACT-Fatigue), and mood (Hospital Anxiety and Depression Scale HADS). We used the SF-36 to examine FC QOL [physical component scale (PCS), and mental component scale (MCS)]. Using multivariable linear mixed models, we examined predictors of QOL changes during hospitalization. Results: We enrolled 97% of consecutively eligible patients undergoing autologous (n=30), myeloablative (n=30) or reduced intensity (n=30) allogeneic HCT. Patients’ QOL markedly declined and fatigue increased throughout hospitalization (Table). The proportion of patients meeting criteria for depression (HADS-D > 7) more than doubled from baseline to day+8 (15.6% to 37.8%, P < 0.0001) whereas the proportion of patients with anxiety remained stable (22.2%, P = 0.8). Depression (β= -2.24, F=42.2, p < 0.0001) and anxiety (β= -0.63, F=4.4, p = 0.03) at baseline independently predict worse QOL throughout hospitalization. The FC QOL declined during patient’s hospitalization (PCS: 83.1 to 79.6, P= 0.03, MCS: 71.6 to 67.4, P = 0.04). Conclusions: Patients undergoing HCT reported a rapid and steep deterioration in QOL along with substantially worse fatigue and depression during hospitalization. Greater decrements in QOL were predicted by depression and anxiety highlighting the importance of assessing pre-HCT psychiatric morbidity. [Table: see text]
Quality of life (QoL) in patients with malignant dysphagia: An international randomized trial comparing radiotherapy alone (RT) versus chemoradiotherapy (CRT)—TROG03.01 NCICCTG ES2.
Authors: Wong Rebecca , Au Heather-Jane , Ding Keyue , Harvey Jennifer A , Stephens Sonya , O'Callaghan Christopher J. , Kneebone Andrew , Ngan Sam , Ward Iain G. , Roy Rajarshi , Sullivan Thomas Richard , Nijjar Tirath , Biagi James Joseph , Penniment Michael Gordon
Published: February 2017

163

Background: The dominant symptom for pts with esophageal cancer is dysphagia. Palliative radiotherapy is commonly employed for symptom relief. We report the effect on QoL in our study comparing a 2-3 week course of RT alone vs the same RT with a single cycle of concomitant CT. Methods: 220 pts with malignant dysphagia were randomized to receive RT (30-35Gy in 10-15 fr) (n=109) ± concomitant CT (5FU and cisplatin D1-4) cycle. The primary outcome was dysphagia relief. QoL was evaluated using EORTC QLQ30/OES18 at baseline, wk 9, 13 and mthly x1yr. Group mean scores were compared between arms using Wilcoxon Rank-Sum test. Proportion of pts with improved, stable or worsened QoL (≥10 point change at any time compared with baseline) using chi square and MH chi-square test (for trend), while time to dysphagia improvement was compared using K-M estimates. Results: QoL compliance ranged from 77% (169/220) at baseline to 62% (36/58) at mth12 and was similar between groups. Baseline mean scores were equivalent between arms with the exception of physical [79 (SD19) CRT vs. 83.84 (SD19) RT; p=0.016] and role domains [61 (SD34) CRT vs. 72 (SD32) RT; p = 0.01]. There was no significant difference in QoL between the arms. The proportion of pts with improvement in the dysphagia domain was 50% CRT vs 64% RT (ns) while the time to improvement was 2.6m CRT vs 2.3m RT (ns). The eating domain was improved in 68% CRT and 74% RT (ns) while global QoL was 46% in both arms. Other symptom domains/items that were improved in more than half of the pts included 62% in pain and 52% in appetite. Functional domain improvements were moderate ranging from 41% emotional, 39% role, 38% social, 28% cognitive to 18% physical (average of scores in both arms). Conclusions: QoL data showed improvement in domains associated with nutritional intake for 50-70% of pts depending on the symptom measured. This was accompanied by moderate improvement in functional domains. No significant benefit was observed when CT was added to RT alone. Clinical trial information: NCT00193882.
A combined treatment approach for cachexia and cancer-related anemia in advanced cancer patients: A randomized placebo-controlled trial.
Authors: Madeddu Clelia , Gramignano Giulia , Tanca Luciana , Cherchi Maria Cristina , Floris Carlo Aurelio , Macciò Antonio
Published: February 2017

189

Background: Cancer progression is characterized by specific energy metabolism alterations and by symptoms including fatigue, anorexia, nausea, depression, which results in cachexia syndrome and compromised quality of life (QL). This condition is often associated to anemia (cancer-related anemia, CRA), which negatively impacts patient QL and disease outcome. Methods: Adult advanced cancer patients with cachexia (i.e., weight loss > 5% in the previous 6 months) and CRA were randomly assigned (1:1 by computer generated list) to receive 3 months of a combined approach consisting of celecoxib (200 mg/day), L-carnitine (2 g/day), curcumin (Meriva) (4 g/day) and lactoferrin (200 mg/day) or placebo. The rationale for selecting these agents was: L-carnitine for modulating cell energy metabolism; celecoxib for counteracting inflammation, which is a key feature of cachexia; curcumin for its antiinflammatory and antioxidant action, without disregarding its action on the NF-kB and JAK-STAT pathway and the related synthesis of proinflammatory cytokines; lactoferrin for its ability to regulate iron metabolism in anemic cancer patients. Primary endpoints were improvement of lean body mass (LBM), appetite, fatigue and anemia. Additionally, we assessed the impact of treatment on the main metabolic/inflammatory and iron metabolism parameters: C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, leptin, reactive oxygen species (ROS), glutathione peroxidase, serum iron, ferritin, hepcidin and erythropoietin (EPO). Results: From January 2013 to March 2014, 66 patients have been enrolled. The combination arm was more effective than placebo arm in improving body weight, LBM, appetite, fatigue, and anemia. Among secondary parameters IL-6, TNF-α, CRP, ROS, ferritin, hepcidin and EPO decreased, while leptin increased significantly in the combination arm. No significant changes were observed in the placebo arm. Conclusions: To date a standard effective treatment of cancer cachexia is lacking. Our combined multitargeted approach was able to improve the nutritional and immunometabolic alterations of cachexia, ameliorate patient QL and correct CRA.
Guiding lay navigation using the distress thermometer.
Authors: Rocque Gabrielle Betty , Taylor Richard A. , Kvale Elizabeth Ann , Acemgil Aras , Demark-Wahnefried Wendy , Meneses Karen , Martin Michelle , Lisovicz Nedra , Pisu Maria , Fouad Mona , Partridge Edward E.
Published: February 2017

195

Background: The Commission on Cancer will require distress evaluation in 2015, given growing emphasis on psychosocial care. We report on a novel use of the distress thermometers (DTs) to frame navigator-patient interactions. Methods: Thirty-eight lay (non-clinical) navigators were trained to utilize a comprehensive distress thermometer to evaluate patients in the Patient Care Connect program (PCCP). The PCCP is a 12-center network throughout AL, MS, GA, FL and TN that serves Medicare patients ≥ 65 with cancer. During patient interactions, navigators assess causes of distress and requests for intervention (barrier). Scores ≥ 4/10 trigger intervention. Navigators report symptom-related barriers to providers for proactive management and address non-clinical barriers by empowering patients to connect to available resources. Results: Of the first 3,000 patients with DTs, pain (n=367), fatigue (n=304), and mobility issues (n=217) were the most common sources of distress. Although pain was common, only 32% requested intervention. Intervention was most often requested for distress related to knowledge deficits about treatment (75%), transportation (69%), and insurance/financial (67%). Patients requested intervention in 32.8% of assessments. Over 90% of all barriers were resolved. Conclusions: The PCCP uses the DT as an integral navigation screening across multiple health systems of varying size and structure. This approach provides continuity and structure to extend the workforce using lay navigators. Use of the DT allows for identification of quality of life, informational, and logistical barriers to care. Monitoring patients using navigator administered DTs is a promising tool for future application across multiple health systems. Additionally, data collected by the DT can be used to identify themes in distress for further research and to design comprehensive interventional programs. The project described was supported by Grant Number 1C1CMS331023 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this abstract are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.
Palliating oncologists: A pilot study on primary palliative care development in hematology-oncology trainee outpatient clinics.
Authors: Alesi Erin R. , Rauenzahn Sherri , Lyckholm Laurel
Published: February 2017

21

Background: Primary Palliative Care (PPC) denotes basic PC competencies; whereas secondary PC (SPC) denotes consultant expertise. PPC competency includes basic symptom assessment/management; fundamental communication skills; and identification of patients for SPC. ASCO recommends early concurrent PC in advanced cancer/high symptom burden as it improves quality of life, symptom management, and care satisfaction. Because PC need exceeds availability of SPC providers, PPC proficiency by oncologists is essential. To enhance Hematology-Oncology (HO) fellows’ clinical experience through more effective PC training/utilization, we piloted an integrated fellows’ pre-clinic conference. Methods: HO fellows’ pre-clinic conferences were divided into intervention and control groups. Over 8 weeks, the PC fellow participated in interdisciplinary discussion for 2 weekly 1-hour conferences. The PC fellow provided PPC education via brief formal and informal didactics and identified patients for SPC referral. All HO fellows were surveyed before and after the intervention to assess comfort level with PPC and SPC referral. The survey used Likert-type scales and short-answer questions. Results: All HO fellows (N=10) voluntarily participated: 6 in the intervention group (IG), and 4 in the control group (CG). The IG demonstrated clearly enhanced comfort level with managing symptoms by improving in 100% of PPC categories after the intervention compared to 27% in the CG. Referral to SPC also increased in the IG, while it decreased in the CG. All HO fellows in the IG liked the PC integration, wanted to continue it, and wanted SPC availability in their future practice. Conclusions: This integration not only enhanced HO fellows’ PPC training and increased referral to SPC; it also fostered a partnership between HO and PC providers early in their careers. Such collaborative efforts are likely to improve long-term comprehensive cancer care as well as patient and provider satisfaction. Further study is merited and should include multiple centers and patient evaluations.
Good usage of epoetin alpha biosimilar: A subanalysis of the orheo study.
Authors: Michallet Mauricette , Soubeyran Pierre , Luporsi Elisabeth , Kurtz Jean-Emmanuel , Albrand Helene
Published: February 2017

217

Background: Chemotherapy-induced anaemia (CIA) is a frequent complication of patients with cancer. The ORHEO (place of biOsimilaRs in the therapeutic management of anaemia secondary to chemotherapy in HaEmatology and Oncology) study was a post-marketing, observational, multicentre study conducted in France that evaluated the changes in haemoglobin (Hb) level in patients with solid tumours, lymphoma or myeloma, treated with an epoetin alfa biosimilar (EAB) (Retacrit, Hospira Inc.). In this subanalysis of the ORHEO study, we compare the usage of EAB in relation to the dosage recommendations of the European Organisation for Research and Treatment of Cancer (EORTC) guidelines, regarding two criteria: efficacy and safety profile. Methods: Patients with CIA receiving chemotherapy for solid tumours (breast, lung, colorectal), lymphoma or myeloma, and prescribed EAB were monitored at the start of the EAB therapy (D0), at 3 months (M3) and 6 months (M6). Hb response was defined as achievement of target Hb without blood transfusions in the preceding 3 weeks and during treatment or Hb ≥10 g/dL orHb increase ≥1 g/dL since inclusion. The prescribed dosage of EAB according to body weight and the tolerability of EAB at that recommended dosage were analysed at each time point. Results: Data from 2310 patients were analysed. Throughout the study 43.8% of patients received the recommended dose of EAB as determined by their weight. Overall, the percentage of responders was 81.6% at M3 and 86.5% at M6. Responses to treatment (meeting predefined Hb target levels) at M6 were similar whether or not EAB was prescribed at the recommended dose throughout the study. A similar proportion of patients receiving the recommended dose of EAB reported adverse events (AEs) at M6 compared with patients who did not receive the recommended dose (9.9% vs 9.0%). Overall, the incidence of thromboembolic events was 3.5% over the duration of the study (M3 2.4%; M6 1.5%). Conclusions: Of the 2310 patients with CIA included in this analysis, less than half (43.8%) received the recommended dose of EAB over the six-month course of the study. The majority of patients had a similar response to therapy regardless of dose. The frequency of overall AEs at M6 did not vary depending on dose. Clinical trial information: NCT02140736.
Derivation and validation of a risk model for emergency department palliative care needs assessment using the Screen for Palliative and End-of-Life Care Needs in the Emergency Department (SPEED).
Authors: Moulia Danielle , Binney Zachary O. , Quest Tammie E. , DeSandre Paul , Vanairsdale Sharon , Janssens A. Cecile
Published: February 2017

22

Background: A key setting for the provision of palliative care is the emergency department (ED) where important decisions regarding treatment and next site of care are determined; however identifying patients who would benefit from a palliative care consult is an ongoing challenge. The (SPEED) is a 5-question tool that assesses unmet palliative care needs. Methods: We performed a retrospective derivation and temporal validation of a risk model for a palliative care event (PCE) among cancer patients with an ED visit and subsequent hospital admission using data available upon arrival, including data from the SPEED tool. A PCE was defined as a palliative care consult, discharge to hospice, or in-hospital death. We developed a multivariate logistic regression model to predict PCEs. We assessed model performance using a receiver operating characteristic curve and visual inspection of quintile plots. Results: Eleven factors were identified as predictive of a PCE, including SPEED score, proxy SPEED informer, age, EMS arrival, emergent or immediate ED acuity, the number of ED visits within the last 90 days, metastatic cancer, cardiac arrhythmias, coagulopathy, depression and weight loss. In validation, the risk model had an area under the curve of 0.72 and calibration showed an underestimation of risk in the second and third quintiles. Conclusions: A risk model based on SPEED score has been successfully derived, but needs a larger dataset for proper validation. If the predictive ability of the model is confirmed, a risk model can efficiently identify cancer patients arriving to the ED who may benefit from early initiation of a palliative care consult.
Relationships among patients’ ability to identify their cancer stage, knowledge of care options, and management of transitions.
Authors: Hinchey Jenna , Goldberg Jessica , Linsky Sarah , Linsky Rebecca , Jeon Sangchoon , Schulman-Green Dena
Published: February 2017

224

Background: Discrepancies may exist between what oncologists communicate and what patients understand about their cancer stage. We explored women’s ability to correctly identify their stage of breast cancer among a sample of women recently diagnosed with nonmetastatic (Stage I-III) disease. Methods: As part of a cancer self-management study, we asked women with non-metastatic breast cancer to identify their stage of disease. Participants’ responses were compared to their electronic medical record (EMR) for validation. We calculated descriptive statistics and used logistic regression to examine relationships between knowledge of stage, demographic and clinical variables, and study outcomes (Control Preferences Scale- CPS, Knowledge of Care Options Test- KOCO, Measurement of Transitions Scale- MOT, Medical Communication Competence Scale- MCCS, Chronic Disease Self-Efficacy Scale- CDSE, Uncertainty in Illness Scale- MUIS-C, and Hospital Anxiety and Depression Scale- HADS). Results: Participants (n= 100) had a mean age of 52.3 years (range 27-72). Per the EMR, 19 participants (19%) had Stage I breast cancer, 57 (57%) had Stage II, and 24 (24%) had Stage III. Twenty-nine participants (29%) were unable to correctly identify their stage of cancer. Of this group, 11 (39.3%) provided vague responses, 11 (39.3%) reported an incorrect stage, and 7 (25%) did not know/want to know their stage. Younger age (p=.0412) and earlier cancer stage (p=.0136) were predictive of correctly identifying cancer stage. Participants who at baseline had a greater knowledge of care options were more likely to correctly identify their cancer stage (KOCO, p=.0482). Those who correctly identified their cancer stage were better able to manage transitions over time (MOT, p=.0564) than those unable to identify their stage. Conclusions: Women who cannot correctly identify their cancer stage may neither understand its implications nor effectively participate in cancer self-management. Conversations about cancer stage should be revisited to ensure patients’ understanding. Future research should include women with Stage IV breast cancer to more completely investigate ability to identify cancer stage.
Cancer patients’ awareness and role in family-based medical decision-making mode in Confucian area.
Authors: Li Xing , Dong Min , Wen Jing-yun , Wei Li , Ma Xiao-kun , Xing Yan-Fang , Wu Xiang-yuan , Lin Qu
Published: February 2017

227

Background: Medical decision making of Chinese patients was family based, which was criticized for the latent moral risk. However, few studies have systematically illustrated the risks of the mode. We aimed to illustrate the determinant of patients’ role in decision making. Methods: A total of 644 adult cancer patients were included in this study between September 1, 2013 and December 31, 2013 from 13 leading general hospitals across China. A questionnaire was give to the oncologists in charge to evaluate each patient concerning the interaction between family and cancer patients, patients’ awareness of disease and participation in medical decision making in mainland China. In this study, the family statuses of patients were ranked as superordinate (one who was the major decision maker in family), equality (one discussed important issues with family members), and subordinate (those who usually don’t be involved in significant family issues). Results: Among the 644 cancer patients, only 125 (19.4%) patients made decision themselves. 291 (45.2%) patients delegated decision making to their family. The rest of 228 (35.4%) patients were involved in decision making. Patients with nonlocal insurance, which meant they traveled to the major cities for advanced medication, were inclined to let their family members make decision for them. Patients’ family status significantly determined their participation in medical decision making. Patients, as superordinate family members, tend to play a positive role in medical decision. By contrast, patients with subordinate role in family continued to play a passive role in medical decision making. Violation of medical recommendation increased according to the severity of patients’ prognosis. The reasons of violation were mainly financial problems. Distrust to doctors presented in merely about 5% of the cases. And conflicts between family members were extremely scarce. Bad news was always hidden from patients, especially for those with incurable disease. Conclusions: Medical decision making of Chinese cancer patients was family based. Patients’ awareness of disease and participation in medical decision making relied on their family status and family financial situation.
Feasibility of prophylactic haloperidol to prevent delirium in cancer patients.
Authors: Weckmann Michelle , Nguyen Christopher
Published: February 2017

232

Background: Approximately 2.5 million cancer patients are hospitalized annually and 25-40% of them will suffer from delirium; yet the majority of delirium is not diagnosed or treated. Delirium rates vary by age and reason for hospitalization and can be as high as 70% in hematopoietic stem cell transplant (HSCT) patients post-transplantation. Delirium can have devastating short and long-term complications and research is ongoing to see if it can be prevented. This study aims to: 1) demonstrate the feasibility of using prophylactic haloperidol in HSCT patients; 2) determine the side effects of oral haloperidol in HSCT patients; and 3) explore the hypothesis that prophylactic haloperidol will reduce the rate of delirium following HCST. Methods: All cognitively intact HSCT patients at a large academic institution were approached for study inclusion. Patients with delirium at time of screening or antipsychotic use in the previous 30 days were excluded. All participants received 5 mg oral haloperidol the night prior to transplant and nightly for 2 weeks post-transplant. Participants were seen daily to evaluate for side effects and every other day to evaluate for delirium using the Delirium Rating Scale (DRS-98). Results: Of the 19 patients who enrolled: 5 withdrew; 9 completed the full (2 week) study; and 5 completed a portion of the study. 22% (2 of 9) patients developed delirium (compared to a historical rate of 43% on our unit). Haloperidol was well tolerated with no evidence of major side effects (1 report of mild restlessness and 1 patient had transient evidence of sedation). Conclusions: Oral haloperidol was well tolerated in HSCT patients. While this study was not designed to detect differences in delirium incidence it provides promising evidence that prophylactic haloperidol may decrease delirium post-HSCT.
Pilot feasibility study: Eliciting provider and patient perspectives to help African American families cope with parental cancer.
Authors: Young Faith , Davey Maureen
Published: February 2017

233

Background: 1.2 million African American (AA) parents/guardians of school age children may be diagnosed with cancer in 2014. AAs have a disproportionate burden and mortality from solid tumor cancers. However, AAs are poorly represented in distress intervention studies, and psychosocial oncology support services may not be designed for culturally diverse populations. The goal of this pilot study was to gather feasibility data from a sample of AA medical providers and from a sample of 100 cancer patients. This approach aided development of effective structures and procedures to recruit AA cancer patients/guardians raising school-age children for a culturally sensitive family intervention program. Methods: We developed a focus group guide for AA medical providers to define best practices for recruiting AA cancer patients into an intervention program. The focus group of AA providers (4 oncologists, 3 primary care, and 3 family practitioners) first reviewed the treatment manual for cultural content. We then conducted an anonymous patient needs assessment, broadly sampling cancer patients from outpatient and inpatient settings (n=100). Results: Providers and patients identified transportation support, refreshments, and onsite care for young children as important. Both groups recommended targeting AA parents/guardians within the first months of diagnosis, when coping with a cancer diagnosis is acute. Parents/guardians who had current concerns about their children more often reported an interest in family support, and patients felt that a location other than the cancer center would be most comfortable for their children. Conclusions: Effective treatments to help children and adolescents cope with the impact of parental cancer are critical, particularly those targeting low-income AA populations. The provider focus group and patient needs assessment identified recruitment barriers in anticipation of a randomized control trial designed to address family distress after parental cancer diagnosis. This approach has the potential to impact the nature of treatment support options available to a group that is overrepresented and underserved by existing interventions.
Receiving a cancer diagnosis: Interview of random and not ill population.
Authors: De Paula Bruno Henrique Rala , Millen Eduardo Camargo , Almeida Rodrigo , Almeida Fernando C. O.
Published: February 2017

235

Background: In clinical practice the way you communicate a diagnosis is very important, especially because the reaction of patients is unexpected. Studies performed in order to check for trends or predictors that news produces no harmful effects and possibly to generate further patient adherence. However studies are focused on evaluate sick patients or their family members, referring to the need to evaluate a random population which is the distribution of opinions as the patient arrives at the doctor's office. Methods: Were interviewed 1,191 people randomly by medical students, on the streets of Volta Redonda city, RJ, between January and December 2010 after the exclusion criteria were tabulated 1,181 questionnaires. Results: 8.13% of responders would not like to be told that they had cancer. 27.51% believe that there is a reason not to tell the patient the diagnosis, and the reasons were: 40% psychological effects ; very committed clinical status 18.46%, embarrassment or discrimination 12.92%; mercy 9.23% and other opinions 19.38%. Cases of cancer in family were 48.01% and 74.11% of those the patient was not informed and the relative judged important the patient knowledge about their condition. Predominance of the way we should tell the patient his diagnosis according to the responders was 41.06% (patient, family and doctor in a moment), 29.46% (only doctor and patient) and 24.80% (the family knowing the diagnosis informing your loved sick in a second time). When asked if they should start cancer treatment before telling the patient to 8.89% of respondents said yes. And 68.57% of people believe to be beneficial to start treatment before telling the patient his diagnosis, said they think their next of kin should be informed that he has cancer. Conclusions: Receiving a cancer diagnosis is not easy for some individuals. Depending on who has cancer, person or a relative, some individuals are more likely to dissent opinion on whether to inform or not the diagnosis. There was a tendency to prefer the diagnosis is communicated by the doctor to the patient with family present. Finally there might be a correlation between the respondents believe that it is important to start treatment before giving the diagnosis to a relative.
An algorithm to identify delivery of palliative radiation therapy using health care claims data: A proof of concept application of data visualization tools in the prostate cancer (PCa) setting.
Authors: Onukwugha Ebere , Gardner James F. , Jayasekera Jinani , Malik Sana , Hussain Arif , Mullins C. Daniel , Valderrama Adriana , Seal Brian S. , Kwok Young
Published: February 2017

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Background: Studies using healthcare claims data to investigate the burden of skeletal-related events employ various approaches to identify radiation to the bone (RttB) because billing codes available in claims data do not distinguish RttB from radiation to the prostate gland. We investigated the use of Eventflow data visualization software to identify components of a claims-based algorithm for RttB. Methods: We analyzed data for PCa cases identified in the Surveillance, Epidemiology, and End Results (SEER) registry data linked with Medicare claims. We identified two cohorts of individuals diagnosed between 2005 and 2009 and receiving radiation therapy, C1: diagnosed with incident bone metastasis (BM) according to SEER data; C2: diagnosed with incident stage IV M0 PCa. We defined radiation episodes of care from claims for external beam radiation therapy, radiopharmaceutical therapy, intensity modulated radiotherapy and stereotactic radiosurgery. Eventflow was used to compare cohorts and identify criteria for identifying RttB using claims data. Results: Application of inclusion criteria resulted in 1,491 individuals: 999 in C1 and 492 in C2. Median follow up was 596 days in C1 and 882 days in C2. Average age was 77 years in C1 and 73 years in C2. The median time to radiation therapy was 133 days in C1 compared to 171 days in C2. When requiring a BM diagnosis code on the radiation claim, the median time was 160 days in C1 compared to 514 days in C2. The median time to a fracture was 107 days in C1 compared to 369 days in C2. The median time to bone surgery was 183 days in C1 compared to 447 days in C2. The median time to spinal cord compression was 154 days in C1 compared to 375 days in C2. A BM diagnosis code concurrent with the radiation episode and radiation episodes less than or equal to 4 weeks in length were more common among C1 compared to C2. Conclusions: Analysis of data visualization output indicates that incorporating a bone metastasis code on claims concurrent with a radiation episode of care or the information regarding the length of the radiation episode will be useful for identifying receipt of palliative radiation using claims data.
A systematic and interdisciplinary approach to the measurement of outcomes over the disease trajectory in a unique specialized cachexia clinic.
Authors: di Tomasso Jonathan , Ciutto Lorella , Cesare Sabrina , Uscatescu Irina , Yu-Chueh Kevin , Olders Henry , Aubin Nathalie , Kelly Mary Lou , Jelowicki Marta , Laroui Rabiaa , O'Grady Rosemary , Borod Manuel , Kilgour Robert , Vigano Antonio Angelo Luciano
Published: February 2017

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Background: Cancer cachexia affects 60-80% of advanced cancer patients and leads to weight loss, worsening functional status, and increased mortality. Thus, specialized clinics are needed to measure nutritional and functional trajectories over time in this population. Recently, the McGill University Health Centre has developed a systematic, standardized and interdisciplinary approach for the profiling and management of cancer cachexia. Methods: Patients with advanced cancer were recruited and categorized as cachetic. The following information was collected at baseline and at three follow-up visits: hand grip strength measured by Jamar dynamometer, the Edmonton Symptom Assessment System (ESAS) and the abridged Patient Generated Subjective Global Assessment (aPG-SGA) questionnaires. Results: Fifty-nine patients were eligible for this study yet only 24 completed 3 follow-ups and were included. There were 15 men and 9 women, mean age 65.7 years. Five patients had locally advanced disease and 19 had metastatic disease. The table contains results for handgrip strength, ESAS and aPG-SGA scores. Conclusions: Following baseline assessment and treatment, patients were noted to have a significant improvement in the aPG-SGA total score. Handgrip strength was maintained throughout the follow up period. ESAS appetite and fatigue exhibited a positive trend but did not achieve significance over time. This work suggests the benefits of an interdisciplinary cachexia clinic for the maintenance of nutritional and functional status in patients with cancer cachexia as well as possible improvements in quality of life. [Table: see text]
Early palliative care on an inpatient oncology unit: Impact of a novel co-rounding partnership on patient and health system outcomes.
Authors: Riedel Richard F. , Slusser Kim , Power Steve , Jones Christopher A. , LeBlanc Thomas William , Kamal Arif , Desai Devi , Allen Deborah , Galanos Anthony N
Published: February 2017

3

Background: Early palliative care (PC) improves outcomes for outpatients with advanced cancer, but its impact on an inpatient oncology unit is unknown. We implemented a novel inpatient medical oncology (ONC) and PC co-rounding partnership on September 1, 2011 at Duke University Hospital. Here we report its impact on patient and health system outcomes during its first year of implementation. Methods: We extracted patient data including demographics, cancer diagnosis, disease status, length of stay (LOS), ICU transfer rate, discharge disposition, time to ER return, time to readmission, and 7- and 30-day ER return and readmission rates (RR). Pre- and post-intervention cohorts were defined as all patients admitted or transferred to the solid tumor inpatient service from September 1, 2009-June 30, 2010 and September 1, 2011-June 30, 2012, respectively. Nursing and physician surveys assessed satisfaction. We used descriptive statistics, Student’s t-test, and Fisher’s exact test for analyses. Results: The pre- and post-intervention analysis cohorts included 731 and 783 patients respectively, representing 2,353 encounters. Cohorts were similar in baseline characteristics, including mean age (61 vs. 62; p=0.07), gender (male: 51% vs. 48%; p=0.22), race (white: 68% vs. 71%; p=0.39), insurance coverage (Medicare: 49% vs. 51%; p=0.96), and disease status (recurrent/metastatic: 73% vs. 74%; p=0.6). Post-intervention patients had a statistically significant decrease in mean LOS (p=0.02) from 4.51 days (95% CI 4.3-4.73) to 4.17 days (95% CI 3.97-4.37), and statistically significant improvements in 7- and 30-day readmission rates, representing a 15% (p=0.03) and 23% (p=0.05) improvement, respectively. We observed a trend for increasing hospice referral (p=0.09) and a 15% decrease in ICU transfers. Physicians and nurses universally favored the model. Conclusions: A fully-integrated, inpatient co-rounding partnership between PC and ONC resulted in statistically significant improvements in key health system-related outcomes and indicators of quality cancer care.
Analysis of palliative care studies with joint models for quality-of-life measures and survival.
Authors: Tosteson Tor D , Li Zhigang , Yang Qian , Frost H. Robert , Bakitas Marie
Published: February 2017

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Background: In palliative care studies, the primary outcomes are often health related quality of life measures (HRLQ). Randomized trials and prospective cohorts typically recruit patients with advanced stage of disease and follow them until death or end of the study. During this time, HRLQ measures are collected at regular intervals. The typical analysis involves comparing the means of two or more intervention or exposure groups at specific times from entry into the study. An important feature of such studies is that, by design, some patients, but not all, are likely to die during the course of the study. For instance, in the Dartmouth ENABLE II study (Bakitas et al., 2009), 60% of patients died during the study. This feature affects the interpretation of the conventional analysis of palliative care trials and suggests the need for specialized methods of analysis. Methods: We have developed a “terminal decline model” for palliative care trials that, by jointly modeling the time until death and the HRQL measures, leads to flexible interpretation and efficient analysis of the trial data (Li, Tosteson, Bakitas, 2012). Importantly, it allows the estimation of the quality of life in the months preceding death, and specifically incorporates data for patients not dying during the study. At the same time, it permits the efficient estimation and interpretation of HRQL effects as measured in the conventional analysis as the difference in HRQL at specified times from enrollment conditional on being alive. Finally, it allows the estimation of the HRQL weighted survival or quality adjusted life years (QALY). Results: Based on the terminal decline model, survival distributions are shown affect the conventional estimates of HRQL trends in palliative care trials. A direct estimate for quality of life at specified times prior to death is provided. The methods are illustrated with ENABLE II data as an approach for improving the conduct of palliative care studies. Conclusions: Proper interpretation of palliative care studies requires consideration of the joint distribution of quality of life measures and survival as in the terminal decline model.