bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety of biosimilar filgrastim in patients undergoing neutropenia-inducing chemotherapy: Next study.
Authors: Maloisel Frederic , Leprêtre Stephane , Kamioner Didier , Berthou Christian , Albrand Helene
Published: February 2017

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Background: Febrile neutropenia (FN) is a serious, frequent complication of cytotoxic chemotherapy (CT). Biosimilar filgrastim (Nivestim, Hospira Inc.) is a granulocyte-colony stimulating factor (G-CSF) licensed for the treatment of neutropenia and FN induced by myelosuppressive CT. The NEXT (Nivestim safety profile in patients [pts] treated with cytotoxic CT in real-life clinical practice) study aimed to assess the safety of biosimilar filgrastim in pts undergoing CT for malignancies (excluding chronic myeloproliferative and myelodysplastic syndrome) and receiving biosimilar filgrastim as prophylaxis, or as curative treatment. Methods: NEXT was a prospective, non-interventional, longitudinal, multicentre study conducted in France. Recorded data included pt demographic and clinical characteristics, biosimilar filgrastim treatment-related data on efficacy and safety, such as adverse events (AEs), including FN. Pts were monitored for 1–6 CT cycles with three visits at inclusion, during treatment, and following CT. Results: Overall, 2114 pts were enrolled in the study. Of these, 2,102 pts were analysed (50.2% male). Mean age ± SD was 63.5 ± 12.7 years. 75% of pts had solid tumours and 25% had haematological malignancies. The majority (98.2%) of pts received prophylactic biosimilar filgrastim and 1.8% for curative intent. At inclusion, 92.5% of patients had no prior FN; 34.4% had prior CT; 20.2% had prior G-CSF therapy. During the study 20.4% of pts experienced ≥1 AE; AEs were reported most frequently in pts with acute leukaemia (40.0%), lymphoma (21.9%) and solid tumours (21.1%). 12.7% of pts reported bone, muscular or chest pain. 4.9% of pts experienced FN and 3.1% had an infection. Conclusions: Biosimilar filgrastim (Nivestim) was effective and well-tolerated in both the prophylactic and curative setting in pts undergoing CT for solid tumours and haematological malignancies. Biosimilar filgrastim seems to be as efficacious and as well tolerated compared with the reference filgrastim (Neupogen, Amgen) regarding retrospective data. Clinical trial information: NCT01574235.
Prognostic understanding, quality of life (QOL), and mood in patients undergoing hematopoietic stem cell transplantation (HCT).
Authors: El-Jawahri Areej , Traeger Lara , Eusebio Justin , Kuzmuk Kailyn , Vandusen Harry , Shin Jennifer , Gallagher Emily R. , 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

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Background: In advanced cancers, patients’ prognostic perceptions influence their medical decisions. However, little is known about how patients with hematologic malignancies undergoing HCT and their family caregivers (FC) understand their prognosis. We examined prognostic perception in these patients during hospitalization for HCT and its relationship with QOL and mood. Methods: We conducted a longitudinal study of patients (and FC) hospitalized for HCT. At baseline (6 days pre-HCT), we used a 10-item questionnaire to measure patients’ and FC information preferences, and perception of prognosis. Using 2-items, we also asked oncologists regarding the patients’ prognosis. At day-6, day+1, day+8 of HCT, we assessed QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation FACT-BMT), and mood (Hospital Anxiety and Depression Scale). We examined the relationship between patients’ prognostic perception and their QOL and mood during hospitalization for HCT using multivariable linear mixed models. Results: We enrolled 97% of consecutively eligible patients undergoing autologous (n=30), myeloablative (n=30) or reduced intensity (n=30) allogeneic HCT. Most patients (80/90, 88.9%) and FC (41/47, 87.1%) believed that it is ‘extremely’ or ‘very’ important to know about prognosis. However, the majority of patients (66/85, 77.6%) and FC (33/46, 71.7%) reported an inaccurate and more optimistic perception of the patients’ prognosis compared to the oncologist (P < 0.0001). Patients with accurate prognostic understanding reported lower QOL (P = 0.03) and worse depressive symptoms (P = 0.04) with a steeper increase in depression (P = 0.006) over time compared to patients with an inaccurate optimistic prognostic perception. Conclusions: The majority of patients and FC reported inaccurate and more optimistic perception of prognosis compared with the oncologist. Patients with an accurate perception of their prognosis had lower QOL, higher depression, and a steeper increase in depression during hospitalization for HCT. Interventions are needed to improve prognostic understanding while providing adequate psychosocial support during HCT.
Improving management of breathlessness in lung cancer.
Authors: MacDonald James John , Temel Jennifer S. , Viscosi Elene , Vaughn Jeanne Griffin , Traeger Lara , McDonnell Theresa Margaret , Pirl William F. , Greer Joseph A.
Published: February 2017

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Background: Dyspnea is a common and debilitating symptom of advanced lung cancer that interferes with quality of life (QOL). Though few evidence-based treatments for dyspnea exist, there is support for non-pharmacological interventions that include elements of cognitive-behavioral therapy (CBT). The purpose of this study was to pilot a brief nurse-delivered CBT intervention for dyspnea in patients with lung cancer, assessing feasibility and effect. Methods: For this single-group, nonrandomized pilot trial, 20 patients receiving outpatient chemotherapy for advanced lung cancer (ECOG Performance Status 0-2) and reporting dyspnea participated in a two-session CBT intervention. We enrolled a convenience sample of patients referred by their medical oncologists based on self-reported dyspnea. Two nurse practitioners taught the participants breathing and relaxation techniques within the infusion clinic and encouraged home practice. Patients completed measures of dyspnea (Modified Medical Research Council Dyspnea Scale [MMRCDS]), QOL (Functional Assessment of Cancer Therapy-Lung [FACT-L] and Trial Outcome Index [TOI]), and depression symptoms (Hospital Anxiety and Depression Scale depression subscale [HADS-D]) at baseline and within 6 weeks after enrollment. We used dependent-samples t-tests to analyze treatment effect on dyspnea and QOL and sign test to analyze depressions symptoms. Results: Of the 20 patients (50% Female; Mean Age=64.80 years) enrolled in the study, 85% (17) completed post-assessment. We observed significant improvement in MMRCDS (p=.001), FACT –L (p=.029), and FACT-TOI (p=.008) scores from baseline to post-assessment. The proportion of patients reporting depression symptoms (e.g. HADS-D >7) decreased from 50% (n=10/20) to 12 % (n=2/17) (p=.016). Conclusions: In this sample of patients with advanced lung cancer and dyspnea, we observed a high completion rate for the 2-session CBT intervention. Patients also showed improvements in dyspnea, QOL, and mood. Follow-up randomized controlled trials are needed to examine the efficacy of brief CBT interventions for dyspnea. Clinical trial information: NCT01937637.
Relationship between the cancer-specific comprehensive score for financial toxicity (COST), patient-reported outcome, and health-related quality of life (HRQOL) in patients with advanced cancers.
Authors: De Souza Jonas A. , Yap Bonnie J. , Hlubocky Fay J. , Daugherty Christopher
Published: February 2017

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Background: Financial toxicity is an important Patient Reported Outcome (PRO). Its relationship with HRQOL has not been previously described. Therefore, we report the relationship between financial toxicity and HRQOL in patients with advanced cancers. Methods: HRQOL was measured by the EORTC QLC-C30 global health status and its functional scales. Financial toxicity was assessed by the COST (COmprehensive Score for financial Toxicity), a cancer-specific PRO measure developed in 155 patients with advanced cancers. The Personal Financial Wellness Scale (PFW), a non-cancer specific financial measure, as well as the EORTC perceived financial impact (FI), were used to assess convergent validity. The Marlowe-Crowne Social Desirability Scale and the Brief Profile of Mood States were included to demonstrate divergent validity (i.e., no significant relationship should exist between self-reported financial toxicity and social desirability and total mood disturbance). Spearman’s correlation coefficients were used to assess the strength of relationships. Results: Fifty patients were assessed. All participants were diagnosed with advanced cancers, were receiving treatment at the time of participation, and had received treatment for at least 3 months. A negative correlation existed between the COST and HRQOL as measured by the EORTC (r = -0.32, p < 0.05). The highest correlation was found between COST and the EORTC Emotional Functioning Scale (r = - 0.34, p < 0.05). The COST had high correlations with the PFW scale (r = 0.86, p<0.0001) and FI (r = 0.74, p < 0.0001), indicating convergent validity. The association between financial toxicity and social desirability and mood states were not statistically significant (r = 0.16, p = 0.28 and 0.20, p = 0.15, respectively), indicating divergent validity. Conclusions: Results demonstrate an inverse relationship between patient-reported HRQOL and financial toxicity, suggesting that higher financial toxicity is associated with worse HRQOL in this small sample of patients. There was no correlation between COST and social desirability and mood disturbances, as expected.
Work and financial disparities among adult cancer survivors in the United States.
Authors: Whitney Robin L. , Bell Janice , Reed Sarah , Davis Andra , Lash Rebecca Salisbury , Kim Katherine , Copenhaver David , Bold Richard J. , Joseph Jill G.
Published: February 2017

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Background: The prevalence of cancer in the US continues to increase, with 18.1 million projected survivors by 2020. Few recent population-based studies have examined cancer-related work and financial disparities in this growing population. Methods: Cancer-related work modifications (e.g., changing to a flexible schedule or less demanding job, early or delayed retirement, extended or unpaid time off) and financial difficulties (e.g., debt, worry about medical bills, bankruptcy) were examined in the 2011 Medical Expenditures Panel Survey Experiences with Cancer Survivorship Supplement (n=1,592). Survey-weighted logistic regression was used to model the odds of having any work modification or financial difficulty and negative binomial regression to model counts of these outcomes as functions of survivorship status (i.e., active treatment, <5 years post-treatment, and ≥5 post-treatment=reference) and socio-demographic covariates. Results are generalizable to the civilian, non-institutionalized US population. Results: Among survivors, 27% reported at least one financial difficulty and 37% reported making work modifications due to cancer. Significant predictors of work modifications included: active treatment (OR 2.9; 95% CI 1.7-4.9), with 40% more modifications than those ≥5 years post-treatment; females (OR 1.5; 95% CI 1.1-2.2), with 30% more modifications; and race/ethnicity other than white (OR 1.7; 95% CI 1.1-2.6,), with 54% more modifications. Significant predictors of financial difficulties included: active treatment (OR 3.2; 95% CI 2.1-5.0), with 92% more difficulties; age <65 years (OR 2.4; 95% CI 1.7-3.3), with 130% more difficulties; no insurance (OR 2.4; 95% CI 1.3-4.4), with 67% more difficulties; and race/ethnicity other than white (OR 1.6; 95% CI 1.1-2.3), with 41% more difficulties. Conclusions: Significant work and financial disparities exist among US cancer survivors, particularly women, younger survivors, racial/ethnic minorities, and those without insurance. Active treatment predicted these concerns, but did not fully account for observed disparities. Screening and support for work and financial concerns is needed across the survivorship trajectory, with particular attention to groups at risk.
Extended impact of an embedded palliative care program in a community cancer center.
Authors: Kalisiak Angela , Glenn Lyn A. , Weinmeister Mark
Published: February 2017

24

Background: High-level evidence has demonstrated that earlier palliative care (PC) improves outcomes for patients with advanced cancers, but a limited PC workforce and lack of outpatient resources remain barriers to access. In 2010, a productive intersection of oncologist-driven response to new evidence and Providence Cancer Center assessment of end of life care quality metrics resulted in funding of an outpatient Oncology Palliative Care Program (OPCP). An initial NP/LCSW team began concurrent PC for advanced lung and pancreas carcinoma patients in a specialty clinic setting in 2011. Scope of service was expanded to include other diagnoses in 2012. Early positive outcomes and oncology team feedback led to Cancer Center funding of a second PC team at a separate service site in August 2013; the OPCP simultaneously transitioned to an embedded care model. Methods: Retrospective chart review of patient deaths for all Providence Medical Group (PMG) Cancer Center patients not served by OPCP; review of OPCP referral data since adoption of embedded model (n= 177). Quarterly quality metrics included: % patients on hospice at time of death; % patients with evidence of an Advance Care Planning (ACP) discussion documented in the electronic medical record (EMR); and % patients receiving chemotherapy at end of life. Results: A significant improvement in the % PMG oncology patients with evidence of an ACP discussion occurred from 2010 baseline of 59.5% to 74.5% in 2013 (z=4.03, p<.001). In addition, % patients receiving chemotherapy in the last 14 days of life decreased from 5.9% in 2010 to 2.7% in 2013 (z=1.9; p<.05). For patients referred to the OPCP, referral diagnoses evolved from 100% lung and pancreas carcinoma to 34 % lung and pancreas carcinoma and 66 % other diagnoses. Conclusions: Incremental growth of the Providence OPCP has demonstrated successful expansion to diagnoses beyond end stage lung carcinoma. Improvement in end of life care quality metrics for oncology patients not served by the program (perhaps by elevating "generalist" PC skills) may be an additional benefit and value of a highly visible embedded PC team in a community cancer center, particularly with respect to modeling best practice of early goals of care discussions and ACP.
Providers' concordance with survivorship clinical algorithms.
Authors: Zandstra Frances Ann , Palos Guadalupe R. , Russell Ludivine , Gilmore Katherine Ramsey , Flores Jacklyn J. , Ozeri Delrose , Rodriguez Maria Alma
Published: February 2017

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Background: The utility of algorithms to guide clinical practice related to long-term survivorship care is unclear. In 2012, lymphoma survivorship algorithms for Hodgkin’s and Large B-Cell were developed as part of an institutional clinical practice initiative to enhance survivors’ outcomes. Here we describe providers’ concordance with minimum standards recommended in the survivorship lymphoma algorithm. Methods: Concordance, the primary outcome, was defined as whether minimum recommendations, summarized in the lymphoma algorithms, were provided during a survivorship visit. Concordance was measured using a “yes/no” response format assessing whether a provider’s recommendations were consistent with algorithms’ minimum standards including: 1) physical examination, 2) laboratory and imaging testing, 3) cancer screening procedures, and 4) health promotion education. Data were abstracted from electronic medical records and Passports (summary care plans). Secondary outcomes were number of survivors seen and Passports issued. All data included in these analyses were de-identified. Results: 63 survivors were seen in the Lymphoma Survivorship Clinic from 05/01 to 09/30/2012 and all received Passports. A provider tailored the plan to each survivor’s needs and counseled the individual on disease surveillance, life-style changes, screening recommendations, and specific procedures to assess for recurrence/late treatment effects. Results indicated 100% of survivors received a physical exam, including cardiovascular screening. Similar rates were also achieved for CBC testing, chest X-rays, and counseling survivors on screening recommendations relevant to: breast, cervical, colorectal and prostate cancers. Other counseling rates included 97% for skin exam recommendations and 100% for maintaining adult vaccinations. Finally, providers’ concordance with assessment of survivors’ psychosocial distress was 100%. Conclusions: Based on concordance results, providers met the minimum recommendations listed in the lymphoma algorithms. Future research is needed to assess the impact of providers’ use of algorithms on survivors’ outcomes and feasibility of replicating concordance analyses in other clinical care settings.
Support services of head and neck cancer survivors at 3 months post-treatment.
Authors: Quispe Jean Marie , Martens Kellie , Geller Jessica , Raben David , Kilbourn Kristin
Published: February 2017

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Background: Support services offer a multi-disciplinary approach to improve quality of life (QOL) in head and neck cancer (HNC) survivors. This study assessed support services of HNC survivors treated at a University-based cancer center. Methods: HNC survivors (N=115) who completed three-month post-treatment self-report questionnaires were recruited from three radiation oncology clinics. Questionnaires assessed emotional and physical symptoms, QOL, and use and interest in support services. Symptoms were assessed individually on a 5-point Likert scale. Utilization and interest of support services were assessed with yes/no scales while helpfulness of utilization was assessed on a 5-point Likert scale. Spearman correlation analyses were conducted in SPSS v22. Results: Participants’ were mostly male (77%) and Caucasian (79%), with a mean age of 58.71 years (SD=11.05), and 36% had stage III/IV cancer. The majority of participants (93.7%) agreed they received adequate support, yet, interest in classes/education (7.8%), integrative medicine (7.0%) and support groups (6.1%) were endorsed. Surprisingly, interest in these support services was associated with lower ratings of total symptoms: classes/education (r = -.48), integrative medicine (r = -.41) and support groups (r = -.55). More than half of participants utilized at least one support service (67.83%) with the most frequent including: nutritionist/dietitian (55.7%), social worker/navigator (21.0%) and cancer information line (15.7%). Utilization of some services was associated with lower ratings of individual symptoms: social worker/navigator and problems swallowing (r = -.31), fatigue (r = -.27) and pain (r = -.24); and cancer information line and weight loss (r = -.30). Meanwhile, overall helpfulness of support services (M = 2.37, SD = 1.51) was rated between “somewhat” and “quite a bit” helpful. Conclusions: This study suggests a relationship between utilization and interest in support services and symptom ratings. Notably, those who report more physical and emotional symptoms may be less likely to report interest in support services. This may be due to an inability to access support services because of lack of transportation, poor social living conditions, etc.
A pilot study on an idiographic assessment of quality of life in patients enrolled in phase I clinical trials.
Authors: Hou June YiJuan , Kaur Gurpreet , Klobocista Merieme , Zechmeister Jenna R. , Kuo Dennis Yi-Shin , Rapkin Bruce D. , Goldberg Gary L. , Nevadunsky Nicole Suzanne
Published: February 2017

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Background: Patient centered quality of life (QOL) is pivotal in treatment decision making for poor prognoses and recurrent solid tumors. Data regarding the best methods of QOL assessment for patients receiving chemotherapy for high risk cancers and enrolled in Phase I trials are sparse. We therefore piloted a QOL assessment that incorporated a validated metric as well as a novel “idiographic” questionnaire. Methods: Twenty-five women with high risk gynecologic malignancies (defined as < 30% five year survival) and 10 patients enrolled in Phase I clinical trials were recruited after IRB approval was obtained. Patients’ answers to the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire 30 (QLQ-30) and “idiographic” QOL assessment were recorded and decoded. Raw scores of the QLQ-30 were standardized using linear transformation. Statistical analysis was performed using Mann-Whitney U and Chi-square testing with SPSS software. Results: Idiographic assessment resulted in 100 goal statements in 17 domains from patients in Phase I trials as compared to 260 goals in 20 domains from patients with high risk gynecologic malignancies. There were no differences in goal attainment or satisfaction with attainment between groups. There was a trend toward increased number of autonomy directed goals in the high risk group versus Phase I participants (23% vs. 11%, p=0.07) Median scores on functional (71 high risk vs. 84 Phase I) and global health status (58 high risk vs. 67 Phase I) scales were not different between the two groups. However, higher symptom burden was reported by the high risk group as compared to the median Phase I score (51 vs. 27, p<0.01) Conclusions: There is a complex relationship between treatment decision-making and QOL for patients diagnosed with poor prognoses cancers. Further research is needed to better define QOL indicators and the impact of treatment on patient centered QOL.
Early palliative care involvement for children with cancer.
Authors: Mahmood Laila , Dozier Ann , Dolan James , Casey Denise , Korones David Nathan
Published: February 2017

26

Background: Although the overall survival of children with cancer exceeds 80%, these children experience significant physical, emotional, social and spiritual suffering. That suffering is even more profound for the 20% of children who succumb to their disease. We therefore conducted a prospective study to assess the feasibility and impact of early palliative care involvement for children with high risk malignancies. Objective: To determine if early palliative care involvement for high risk pediatric oncology patients is feasible, acceptable to patients, families and oncology teams, and helps with symptom management and communication. Methods: This was a prospective survey-based study. Children with cancer treated at University of Rochester were eligible to participate if they had a high risk malignancy, defined as (1) having a newly-diagnosed malignancy with an estimated overall survival of < 50%, (2) requiring hematopoietic stem cell transplantation (HSCT), and/or (3) any relapsed, recurrent or progressive cancer. Parents of these children or children >18YO were surveyed upon study entry, and 3 and 6 months later to assess the impact of early and ongoing pediatric palliative care involvement. Results: 20/25 eligible patients received a palliative care consultation at diagnosis; 16 families participated in the study. Six children had a newly diagnosed high risk malignancy, nine had recurrent disease and one child had a HSCT. Median age of the children was 5 years (0.1-20 year).The most frequent symptoms at the time of study entry were pain (75%), nausea/vomiting (69%), constipation (44%), and fatigue (44%). 75%, 73%, 43% and 43% reported successful treatment of pain, nausea/vomiting, constipation, and fatigue respectively. The proportion of children with each symptom decreased at 3 months except for fatigue. There was high satisfaction with the oncology and pediatric palliative care teams at baseline and 3 and 6 months. No families or oncologists declined an early palliative care consultation. Conclusions: Our results suggest that an early palliative care consultation is feasible for high risk children with cancer and that the palliative care team can work successfully with the primary oncology team to foster symptom control and communication.
Integration of oncology palliative care in a regional health care system.
Authors: Edelen Connie , Koesel Nicole
Published: February 2017

34

Background: Early incorporation of palliative medicine in cancer care has been shown to be associated with improved symptom control, quality of life, and patient and family satisfaction however integration in the outpatient setting remains deficient nationwide. Regional healthcare systems carry the additional challenge of providing consistent quality care across a diverse geographic area. We performed a retrospective review of oncology palliative care utilization in a regional healthcare system following the implementation of a fully integrated model of palliative care. Methods: In 2012, Levine Cancer Institute (LCI) and Carolinas Palliative Care collaborated to establish palliative care access across its 12-site regional cancer center. This was a transition from a vendor service to a fully embedded clinic at multiple LCI locations. The new model offered full time outpatient multidisciplinary services in addition to an inpatient oncology palliative care consult service. Standardization of care and early integration were augmented by the creation of symptom management guidelines and tumor treatment pathways with built in recommendations for palliative/supportive care. Results: New oncology palliative care referrals increased from 150 annually to over 475 in the first 12 months. The top diagnoses were lung (16%), breast (11%), and head and neck cancer (7.2%) with pain and symptom management as the primary reason for consultation. Ten symptom management pathways have been published for regional utilization, enabling primary palliative care and serving as a trigger for palliative specialist consultation. A toolkit was created to identify operational needs, clinical tools, and staffing at each site. Conclusions: The growth of oncology palliative care utilization by 317% demonstrates the success of a fully embedded program. This multidisciplinary model is being standardized across regional sites to ensure access to primary and secondary palliative care. Additional clinic sites and the application of telemedicine for rural areas are in development. Future research is needed to document outcomes associated with palliative care integration across the cancer trajectory in a regional healthcare system.
Integrating early palliative care into cancer care: A qualitative analysis of implementation models, barriers, and strategies in community settings.
Authors: Padgett Lynne Slaughter , Davis Mary Helen , Tallen Colleen , Jdaydani Andrew , Carrigan Angela
Published: February 2017

36

Background: There is a paucity of research providing evaluation of implementation strategies contributing to provision of high quality early palliative care. Data from the NCI Community Cancer Centers Program (NCCCP) offers insight into ways in which patients, providers, and systems negotiate the provision of early palliative care in the community setting. The purpose of this project was to test the implementation of early palliative care programs for patients diagnosed with a high lethality cancer in participating NCCCP centers. Methods: Thirteen of 21 NCCCP sites elected to participate. Data on project activities and progress was gathered quarterly between July 2012 and June 2014. Qualitative data were evaluated using inductive and deductive methods and models of care, barriers and strategies were identified. Results: Models of care described included group education visits for patients and caregivers, outpatient clinics, and electronic consultation referral triggers. Irrespective of the model of care, sites reported barriers at the patient, provider and system levels. Barriers included reluctance by both patients and providers to consider palliative care services due to the perception of "giving up," and inadequate staffing and clinic space were also cited as systemic barriers. Strategies for facilitating implementation included integrating palliative care staff into existing cancer center programs (e.g., multi-disciplinary clinics), electronic referrals, and utilizing navigation services, as well as a variety of programs targeted to increase oncologist "buy-in." Conclusions: These results provide guidance for both researchers and clinicians in designing future multi-level interventions to facilitate the delivery of early palliative care, and the importance of identifying and utilizing provider and system resources in program design, development and promotion. Provider buy-in is an essential factor, but patient and system resources are equally important components of a successful implementation strategy.
Association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of end-of-life care: An investigation of cancer decedents in a cancer-designated hospital in Japan.
Authors: Amano Koji , Tatara Ryohei , Katayama Hirofumi , Uno Teruaki , Takagi Ibuki
Published: February 2017

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Background: Palliative care has a positive effect on many clinical outcomes, yet most referrals to palliative care have occurred late. End-of-life (EOL) cancer care has become increasingly aggressive. There have been no studies investigating the association between early palliative care referrals and aggressive EOL care in Japan. Methods: This study was designed to explore the association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of EOL care by investigating cancer decedents. A retrospective cohort study in a cancer designated hospital in Japan. This study examined 266 consecutive cancer decedents. Inclusion criteria were as follows: (1) adults and (2) patients who died from cancer or causes related to cancer. Patients who died from causes unrelated to cancer were excluded. A total of 265 patients met the criteria. We explored the association between early referrals (>3 months before death) and inpatient hospice utilization and the relationship between the timing of referrals and aggressive EOL care measured by a composite score adapted from Earle et al. Results: Patients were divided into an early referral group (n=54) and a control group (n=211). The rate of inpatient hospice utilization was significantly higher in the early referral group (74% vs. 47%, P<0.001). While each of six indicators of aggressiveness of EOL care did not differ significantly, the composite score was significantly lower in the early referral group (1.91 ± 0.59 vs. 2.14 ± 0.78, P=0.040). Conclusions: Early palliative referrals were associated with more inpatient hospice utilization and less aggressive EOL care.
Palliative care screening tool: Does utilization promote early integration of palliative care for inpatient oncology patients?
Authors: Farnan Michelle , Smeltz Erica , Glod Susan , Parson Nancy , Kreher Margaret
Published: February 2017

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Background: Early integration of specialty Palliative Care (PC) in cancer patients improves quality of life and lowers medical costs. Engaging cancer patients early remains challenging. A checklist approach that evaluates type of malignancy, comorbidities, functional status, uncontrolled symptoms, readmission rates, and psychosocial/spiritual distress may prompt consultation to the PC team. We evaluated a palliative care screening tool’s (PCST) effect on promoting early PC consultation for oncology inpatients. Methods: A modified version of the Center to Advance Palliative Care screening tool was utilized by our hospital as part of the admission assessment. Registered nurses completed the PCST within 24 hours of admission for all adults. A PCST score of 3 or higher prompted staff to suggest a PC consult. A retrospective chart review of oncology patients who received a PC consult was performed to assess whether the screening tool score within 24 hours of admission impacted timing of a consult order. Effective tool utilization was considered to be a consult order within 36 hours of a high risk screen score. Results: From January through March 2014, 215 cancer patients screened with the PCST were found to have a score of 3 or higher. Seventy seven percent scored a 3 or higher, and PC consultation occurred in 16% of that patient cohort. Twenty three percent of PC consults occurred in patients scoring less than 3. The average number of days from admission to PC consult was 6 days. Conclusions: Using a PCST did not trigger PC consultation for inpatient cancer patients. Thirty four percent of the screened patients died during that admission, indicating a dramatic change in status from admission or ineffective prognostication, both barriers to early integration of PC. Our work suggests that a screening tool alone, even in a center with a well-embedded PC program, is not a sufficient means of effectively integrating PC into a patient’s hospital stay. Further work to identify patient characteristics that lead to consultation in both high and low risk patients is necessary.
Impact of palliative care clinic (PCC) referrals on pain control in genitourinary (GU) cancer patients: Retrospective analysis at Roswell Park Cancer Institute (RPCI).
Authors: Gupta Neha , Gandhi Shipra , Anwar Sidra , Wang Katy , Satchidanand Yashodhara
Published: February 2017

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Background: Many cancer patients (pts) with GU cancer suffer from uncontrolled pain, and may benefit from more focused palliative care. We assessed the frequency and impact of specialist PCC referrals on pain management of our GU Medical oncology clinic (GUMOC) pts. Methods: 239 consecutive pts were collected from a retrospective review of GUMOC records from 12/1/2013 to 2/28/2014. This group of pts was used to assess the frequency of PCC referral. Pts were divided into two arms- Arm A= GUMOC pts referred to PCC; Arm B: GUMOC pts not referred to PCC. To be able to detect a 15% between the two arms at 95% significance, 37 additional pts (who were already being seen at GUMOC) were collected from retrospective review of PCC records over 9/1/2013 to 2/28/2014. Total 276 pts were divided into Arm A (n=49), Arm B (n=227 pts). Data for baseline pain score and 4-week follow up pain scores were collected. A palliative care screening tool (retrieved from Center to Advance Palliative care [CAPC] website) was used to assign palliative care screening score (PCSS) to all study pts. Chi square test and T-test were used for statistical analysis. Results: Out of the 239 initially collected GUMOC pts, 5% were referred to PCC. 10% (n=24) had PCSS score of ≥ 4, and 33% pts with PCSS ≥ 4 were referred to PCC. Arm A had worse baseline symptoms, ECOG status and more advanced cancer stage. 4-week pain score follow up revealed significant improvement in Arm A -2.74 vs. Arm B -0.13 (p<0.01). Conclusions: GU cancer pts who are referred to PCC from medical oncology clinic have significant decrease in pain symptoms. Frequency of PCC consultation is still low in comprehensive cancer institutes, and not in congruence with the available palliative care screening tools criteria suggested by CAPC. Standardized tools should be developed to guide PCC referrals, and routine use of these tools will significantly help in pain control by seeking specialist palliative care.
Integration of specialist palliative care services into a multidisciplinary adolescent and young adult (AYA) oncology team.
Authors: Hughes Rachel Elizabeth , Thompson Kate
Published: February 2017

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Background: Palliative care is recommended alongside standard oncological care for patients with advanced cancer or high symptom burden (Smith TJ, Temin S, et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. Journal of Clinical Oncology. 2012;30(8)880-7.). AYA oncology patients are distinguished by several age-specific developmental and biopsychosocial factors, resulting in a unique impact profile (Wein S, Pery S, Zer A. Role of palliative care in adolescent and young adult oncology. J Clin Oncol. 2010;28:4819-4824). Methods: To examine the benefits of multidisciplinary AYA care, a palliative care fellow was incorporated into an existing AYA oncology team in Australia, for a 12 month period. This role facilitated assessment/management of symptoms, general health issues, treatment toxicity, end of life care and bereavement support. Results: Between 2012 and 2013, of 83 new patients were referred to the AYA oncology service, 27 (32.5%) were referred the palliative care fellow. Notably, 37% of patients referred were receiving curative intent treatment. 10 patients (37%) were referred at diagnosis for symptom management. Pain was the most frequent reason for referral (n=17 63%). A total of 7 patients (26%) were referred for advanced disease/terminal care. Conclusions: Evaluation demonstrates that onsite availability of palliative care services is acceptable, facilitates early referral and has encouraged collaborative, AYA multidisciplinary care. A significant additional finding has been recognition of the demand for symptom management of patients early in their cancer experience. Further development and evaluation of AYA specific palliative care is warranted.
The impact of tailored nutrition intervention and dietary counseling on body weight in female cancer cachexia patients in India.
Authors: Kapoor Neha , Tewfik Ihab , Naufahu Jane , Tewfik Sundus , Garg Rakesh , Bhatnagar Sushma
Published: February 2017

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Background: The prevalence of malnutrition, amongst cancer palliative patients, is 81%. As cancer progresses, patients’ develop malnutrition owing to metabolic changes and ill-effects of treatment. The aim of this study was to improve nutritional status of female cancer patients and their quality of life by counseling and providing nutrient rich natural food (IAtta). Methods: Female cancer patients (n=45) attending palliative care clinic (AIIMS, New Delhi); with symptoms of cachexia were randomly distributed into control (Group one, n=23) and intervention group (Group two, n=22). Both groups were provided with nutritional counseling while the intervention group also received 100grams of IAtta, to be consumed daily for three months. Anthropometric measurements [weight, muscle mass, percentage body fat (%BF) and mid upper arm circumference (MUAC)], dietary intake (two day dietary recall) and quality of life (European Organisation for Research and Treatment of Cancer-Quality of Life C30 Questionnaire) were assessed at baseline and after three months. Data was analysed using paired t-test and Wilcoxon signed-rank test on the variables assessed. P-value < 0.05 was considered statistically significant at 95% confidence interval. Results: Patients in group one had significantly decreased body weight (p= 0.001), muscle mass (p= 0.021), MUAC (p= 0.005) and %BF (p= 0.001) by end of three months. While patients in group two reported significant improvement in fatigue (p= 0.001) and appetite loss score (p= 0.002) under quality of life domains. Conclusions: Nutritional counseling along with IAtta food supplementation helps in stabilising weight and improves quality of life of cancer cachexia patients undergoing palliative care treatment. Clinical trial information: RP- 02/17.06.2013. [Table: see text]
Early palliative care: Recognizing the patient in need of palliative care and proactive palliative care planning with the GP as coordinator—An RCT.
Authors: Engels Yvonne , Groot Marieke de , Thoonsen Bregje , Verhagen Stans , Vissers Kris , Weel Chris van
Published: February 2017

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Background: In the Netherlands, many patients that might profit of palliative care don't receive it or don't receive it until the terminal phase. GPs in the Netherlands consider palliative care as an important task, but they don't feel confident to recognize the patients in need of palliative care and to provide it in a structured way. For that reason, we performed an RCT in which GPs in the intervention condition received training in recognozing the palliative patient and in early palliative care provision. Methods: Randomized controlled cluster trial (intention to treat) with GP as cluster. GPs in the intervention group received a 5-hours training in early recognition of the palliative patient, with the help of the RADPAC tool, and in proactive palliative care planning. They were invited to identify the patients in need of palliative care and provide the care as learned in the training. Primary outcome: number of out-of-hours contacts with the out-of-hours service, as measured retrospectively by analysing all patients that died during the intervention period of one year. Secondary outcomes: number of hospitalizations and place of death, also collected retrospectively. Results: Within one month, 159 GPs showed their interest to participate. Per responding GP, a mean number of 7 patients died during the intervention period. About 45% of the patients died at home, in both study groups. We did not find differences in out-of-hours contacts, hospitalizations and place of death between intervention and control group. Conclusions: We did not find differences between intervention and control group. As learning to identify the palliative patients was part of the intervention, we were not able to collect patient-related outcomes in the control group. This might explain why we did not find significant effects of early palliative care, in contrast to findings of Temel et al, and Zimmermann et al. and Bakitas et al. For that reason, we recommend to measure quality of life as primary outcome. Clinical trial information: NTR2815.
Identifying palliative care beds to contribute to the integration of early palliative care (EPC) into the inpatient, private practice oncology setting in Brittany (France).
Authors: Parot-Monpetit Anny , Monpetit Erik
Published: February 2017

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Background: In France, since 2002, Identified Palliative Care Beds (LISP) has contributed to the diversification and development of Palliative Care. They are identified in acute unit with significant PC activity and estimated at 5000 in 2011. In our Brittany private hospital, since fall 2008, 8 Beds are dedicated to PC in the solid tumour oncology unit (47 beds) and allowed EPC integrated to oncologic care for inpatients. Our model incorporated a PC physician as a second attending on service alongside the rounding oncologist. Time for discussions with oncologists is optimized and warranted decisions about providing adequate information to the patient and the continuation of treatments, specific or not. We thought to better define the added value of Identified PC Beds. Methods: Because more financial and educational resources are attributed to Identified Beds by health authorities to offer a true interdisciplinary approach, a specific annual evaluation is required. We analysed 7 quantitative components and the number of claimed letters about the unit between 2008 and 2013. Results: The table show an increased PC activity no reduced to terminal care (increase Home Hospice Care, decrease death) and better provider satisfaction with oncology care. Conclusions: The French concept of Identified PC Beds, in our experience, may improve early integrated PC into the inpatients and quality of care. The co management of patients with advanced cancer by oncologists and palliative care physicians is the key. Formal study of our Identified PC Beds model is warranted. [Table: see text]
Building a patient-centered model: Palliative medicine and cancer care.
Authors: Ramchandran Kavitha , Galligan Derek , Tribett Erika L , Valentine Melissa , Selig Meryl , Blayney Douglas W. , Asch Steven M
Published: February 2017

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Background: Palliative medicine (PM) improves outcomes for cancer patients. Still, there is limited evidence around components of an efficient, patient-centered model for integrating PM into oncologic care. While PM is committed to aligning with a patient's goals of care, very few programs incorporate their input into design or evaluation. The aim of this project is to combine best practice in PM with perspectives of patients, families and providers to develop an empathic PM service. We hypothesize that collaboration with stakeholders and user experience experts will result in a feasible, impactful and translatable model of care that aligns with patient and family goals. Methods: We are conducting semi-structured interviews with 30 patients, family members and 30 oncologists. Patient interviews assess needs and coping mechanisms. Provider interviews assess perceptions and experiences around PM. We will conduct observations to understand how patients and providers interact and how current protocols are operationalized. Data will be coded and analyzed for major themes. An expert panel of patients, family members, health care providers and design experts will assimilate the data and make recommendations for the prototype care model design. The model will be piloted and evaluated in fall 2014. Outcome metrics include patient satisfaction, symptom management, utilization, mortality, and others identified during development. Data from the pilot will inform intervention improvements in preparation for a large-scale, 12- month pilot in an outpatient PM clinic. Results: Preliminary work includes the development of a novel patient and family interview protocol that integrates cutting-edge research on PM with best practices for conducting empathic interviews. We will present initial results from these interviews at the symposium, as well as our iterative design process. Conclusions: This project integrates data on patient and family experience with known best practices to develop a patient-centered model for palliative cancer care. The development process and potential outcomes hold significant promise for the design of patient and provider-centered care models, especially those related to chronic and serious illnesses.
Impact of mindfulness training on avoidant coping and advance care planning.
Authors: Johns Shelley A. , Beck-Coon Kathleen , Schmidt Karen , Stump Timothy E. , Bernat Jennifer Kim , Torke Alexia M. , Helft Paul R.
Published: February 2017

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Background: Timely end-of-life (EOL) discussions and advance care planning (ACP) are crucial to quality cancer care; however, patients, family caregivers (CGs), and oncologists often avoid these tender conversations. When EOL discussions are avoided, patients are more likely to receive non-beneficial treatment near death and CGs are more likely to experience psychiatric disturbance. Mindfulness meditation facilitates emotional regulation and may enhance adaptive coping necessary for EOL discussions and ACP. Methods: Mindfully Optimizing Delivery of End-of-Life (MODEL) Care is a within-group pilot study developed to train patients with advanced-stage solid malignancies and their CGs (n=13 dyads) in present-moment awareness and non-reactive coping through a variety of mindfulness practices. Eligible patients met a threshold for avoidant coping and had not completed a Physician Orders for Scope of Treatment (POST) form documenting care preferences. Cognitive avoidance and quality of life (QoL) for patients and CGs were assessed from baseline (T1) to post-intervention (T2) and 1-month follow-up (T3) with standardized response mean (SRM) effect sizes. ACP from T1 to T3 was assessed descriptively. Results: Moderate decreases in cancer-related avoidance were found for patients (SRM=-0.47) and CGs (SRM=-0.59) T1 to T2, while T1 to T3 effects were small for patients (SRM=-0.31) and large for CGs (SRM=-1.12). At T1, no patient had completed a POST form; by T3, 50% reported completing one and 40% were preparing to do so soon. At T1, 23% of patients reported having had a ‘goals of care’ discussion with their oncologist, with 82% doing so by T3. At T1, 46% of patients reported having discussed ‘goals of care’ with their CGs, with 100% doing so by T3. Large improvements in QoL were found at both time points for patients and CGs (SRMs ranging from 0.85 to 1.21). Conclusions: Mindfulness was associated with mostly moderate reductions in avoidant coping and large improvements in QoL for patients and caregivers, with notable ACP progress for patients.