bluuebunny/crossref_metadata_2025 huggingface dataset:
Preparation of hydrophobic fabrics and effect of fluorine monomers on surface properties
Authors: Liang Liping , J Lis Arias Manuel , Lou Zixuan , Mao Qiaole , Ye Chang , Meng Xu
Published: November 2019

Preparation of hydrophobic cotton fabric based on the self-assembly method was proposed. The cotton fabric was modified with 3-(methacryloyloxy)propyltrimethoxysilane and grafted with trifluoroethyl methacrylate and dodecafluoroheptyl methacrylate through free radical polymerization reaction. The objective of this research work was to investigate the effect of fluorine monomer with different chemical structure deposited on cotton fabric on the hydrophobic property. The chemical structure, surface topography, and surface wettability of the fabrics were characterized by Fourier transform infrared spectroscopy, scanning electron microscopy, and water contact angle experiments, respectively. The results showed that the as-prepared fabrics exhibited water contact angle of above 140°. It was noticed that the fluorocarbon chain length of a modifier and its chemical structure could strongly affect the hydrophobic property of the modified fabrics, and the increase in fluorine atoms caused an increase in the water contact angle values.
Analysis of fatigue behavior of welded joints in orthotropic bridge deck using traction structural stress
Authors: Yang Haibo , Qian Hongliang , Wang Ping , Dong Pingsha
Published: November 2019

In this study, the fatigue behavior of welded joints in an orthotropic steel bridge is simulated and analyzed. The traction structural stress method is proven to be more accurate and effective, and the predicted results agree well with the test results compared to traditional assessment methods, including the nominal stress, hot-spot stress, and effective notch stress methods. The traction structural stress concentration factor curves of welded joints under cyclic tensile and bending moment loading are obtained. The accuracy and validity of finite-element simulation methods for welded joints in orthotropic steel bridge are verified by comparing simulation results with full-scale tests results. Equivalent nominal stresses predicted by the master S–N curve method based on traction structural stress results agree well with the fatigue test results with small standard deviation. The fatigue behavior of orthotropic steel bridge analysis specifications Eurocode3 and GB50017 is combined with the traction structural stress method using unified traction structural stress concentration factor curves. This approach provides practical guidance for the fatigue behavior design of orthotropic steel bridges.
A method to construct a reference model for model reference adaptive control
Authors: Su Shi-jie , Zhu Yuan-yuan , Wang Hai-rong , Yun Chen
Published: November 2019

Model reference adaptive control takes the output of a reference model as the target and ensures that the actual output is consistent with the target. In this scenario, the reference model determines the performance of the control system. Constructing a reference model with specific performance is challenging, and most researchers construct the reference model by experience. As alternative frameworks, we propose two novel reference model construction methods, namely, zero-pole method and frequency response method. The zero-pole method establishes a nonlinear optimization model to ensure that the added zeros and poles are as far away from the imaginary axis as possible. In the case where this cannot be done, the frequency response method matches the system frequency response of the reference model and the given model to the extent possible using a nonlinear optimization model. Experimental results are presented to confirm that both methods can construct a reference model based on a given transfer function. Deviations in response between the reference models constructed using the two methods and the given model are compared, and the reasons for higher accuracy of the frequency response method are discussed.
Variations in the adoption and use of mobile social apps in everyday lives in urban and rural China
Authors: Yan Pu , Schroeder Ralph
Published: November 2019

China has in recent years seen the rapid adoption of multifunctional social networking applications such as WeChat. This paper aims to explore if China’s social stratification has influenced the adoption and use of mobile social apps and if social apps such as WeChat can help to bridge the digital divide by providing urban and rural users equal access to diverse information and communication resources. The study is based on 4 months of fieldwork in the Henan Province of central China and combines quantitative data from surveys and qualitative data from semistructured interviews and focus groups. We found that there still exists a digital gap in the adoption and use of mobile social apps such as WeChat between rural and urban China, but such differences are also associated with demographic variables such as age, gender, and education level. Meanwhile, we found that WeChat has become more than a communication tool; it has also played an essential role in everyday problem-solving and information seeking for both rural and urban users. Our qualitative interviews and focus group studies reveal how WeChat influences various aspects of daily life in developing areas in China. We argue that although some divides in information seeking are being overcome, other new divides are emerging.
CD56 as a marker of an ILC1-like population with NK cell properties that is functionally impaired in AML
Authors: Salomé Bérengère , Gomez-Cadena Alejandra , Loyon Romain , Suffiotti Madeleine , Salvestrini Valentina , Wyss Tania , Vanoni Giulia , Ruan Dan Fu , Rossi Marianna , Tozzo Alessandra , Tentorio Paolo , Bruni Elena , Riether Carsten , Jacobsen Eva-Maria , Jandus Peter , Conrad Curdin , Hoenig Manfred , Schulz Ansgar , Michaud Katarzyna , Della Porta Matteo Giovanni , Salvatore Silvia , Ho Ping-Chih , Gfeller David , Ochsenbein Adrian , Mavilio Domenico , Curti Antonio , Marcenaro Emanuela , Steinle Alexander , Horowitz Amir , Romero Pedro , Trabanelli Sara , Jandus Camilla
Published: November 2019

Key Points

Human ILC1-like cells kill tumors in a KIR-independent manner. The cytotoxicity of human ILC1-like cells is impaired in AML at diagnosis but is restored in remission.
Gut-derived Enterococcus faecium from ulcerative colitis patients promotes colitis in a genetically susceptible mouse host
Authors: Seishima Jun , Iida Noriho , Kitamura Kazuya , Yutani Masahiro , Wang Ziyu , Seki Akihiro , Yamashita Taro , Sakai Yoshio , Honda Masao , Yamashita Tatsuya , Kagaya Takashi , Shirota Yukihiro , Fujinaga Yukako , Mizukoshi Eishiro , Kaneko Shuichi
Published: November 2019

Background

Recent metagenomic analyses have revealed dysbiosis of the gut microbiota of ulcerative colitis (UC) patients. However, the impacts of this dysbiosis are not fully understood, particularly at the strain level.

Results

We perform whole-genome shotgun sequencing of fecal DNA extracts from 13 healthy donors and 16 UC and 8 Crohn’s disease (CD) patients. The microbiota of UC and CD patients is taxonomically and functionally divergent from that of healthy donors, with E. faecium being the most differentially abundant species between the two microbial communities. Transplantation of feces from UC or CD patients into Il10−/− mice promotes pathological inflammation and cytokine expression in the mouse colon, although distinct cytokine expression profiles are observed between UC and CD. Unlike isolates derived from healthy donors, E. faecium isolates from the feces of UC patients, along with E. faecium strain ATCC 19434, promotes colitis and colonic cytokine expression. Inflammatory E. faecium strains, including ATCC 19434 and a UC-derived strain, cluster separately from commercially available probiotic strains based on whole-genome shotgun sequencing analysis. The presence of E. faecium in fecal samples is associated with large disease extent and the need for multiple medications in UC patients.

Conclusions

E. faecium strains derived from UC patients display an inflammatory genotype that causes colitis.
Towards optimization of entomopathogenic nematodes for more service in the biological control of insect pests
Authors: Abd-Elgawad Mahfouz M. M.
Published: November 2019

Cost and reliability have hindered entomopathogenic nematodes (EPNs) from realizing their full market size. Research approaches continually evolve in response to these issues. They address EPN basics, but other issues are less recognized among masses working on these biocontrol agents. So, this review emphasizes on the due but less recognized roles to optimize EPN research and get better findings in nematode realm. Being almost impossible for nematologists to act united, they need to use standardized procedures which allow future reviews to be analytical and may build on them. Current atypical sampling procedures of EPNs may lead to erratic results. Comparable sampling may better enable grasping the interaction between EPN distribution and agricultural management to develop more swiftly field application techniques and can introduce EPNs’ populations to a more even distribution designed to enhance their efficacy. Functional sampling should be expanded. Furthermore, EPNs should be included in integrated pest management programs in ways that make them complimentary or superior to chemical pesticides. Further modeling of EPNs’ populations should be tried. The few transgenic methods applied in EPNs should be followed up to address non-stability of selected beneficial traits and markers of beneficial genes. Awareness-raising of more growers, cooperatives, and extensions of EPNs as bio-insecticides for both plant and livestock pests should be attempted in earnest via broad and deep training. We should better communicate and apply the positive trends and standardization in EPNs’ research. Required but less known services to optimize research in the nematode realm should further be addressed.
Timing of adjuvant chemotherapy initiation and colon cancer survival.
Authors: Gehr Aaron , Lu Yan , Ghabach Bassam , Narra Kalyani , Neerukonda Latha Sri , Bullock Jolonda , Ojha Rohit P.
Published: November 2019

119

Background: The National Quality Forum endorsed initiation of adjuvant chemotherapy within 120 days of diagnosis for stage III colon cancer patients aged < 80 years. Nevertheless, no trials were conducted to establish this 120-day threshold and observational studies used to justify this threshold may be sensitive to recently identified sources of bias. Therefore, we aimed to assess the effect of initiating adjuvant chemotherapy within 120 days on survival among patients with stage III colon cancer. Methods: We used institutional registry data from the JPS Center for Cancer Care (JPS), an accredited Comprehensive Community Cancer Program. Eligible patients were adults aged < 80 years, diagnosed with first primary stage III colon cancer between 2011 and 2015, and received at least part of their first course treatment at JPS. Overall survival was defined as time from cancer diagnosis to death, loss to follow-up, or end of study. We emulated a pragmatic trial and estimated the intention to treat 36-month restricted mean survival difference and 95% confidence limits (CL) for initiating adjuvant chemotherapy within 120 days using a marginal structural model with stabilized inverse probability of treatment weights to reduce confounding bias. Results: Our study population comprised 62 patients, of whom 61% were aged 55 – 64 years, 58% were females, 61% were racial/ethnic minorities, 69% were uninsured, and 61% initiated adjuvant chemotherapy within 120 days after cancer diagnosis. The mean survival after 36 months of follow-up was 31 months (95% CL: 27, 34) for patients who initiated and 31 months (95% CL: 28, 34) for patients who did not initiate adjuvant chemotherapy within 120 days (mean survival difference = -0.10 months, 95% CL: -3.6, 3.4). Conclusions: Our results suggest no meaningful difference in overall survival between initiating or not initiating adjuvant treatment within 120 days of diagnosis for patients with stage III colon cancer, but our estimates are compatible with either a 3-month survival benefit or harm. A larger sample size may provide greater certainty whether the 120-day threshold is a questionable quality measure, as observed in our study.
Pain management in patients undergoing treatment for head and neck cancer with opiate use disorder on medication-assisted treatment.
Authors: Guyer Dana , Birnbaum Ariel E. , Leonard Kara Lynne , Yu Esther
Published: November 2019

120

Background: Buprenorphine, a partial agonist at the mu opiate receptor, is an effective pain medication and use has increased for patients with cancer pain, especially those with concurrent opiate use disorder (OUD). Substance use disorder is common in head and neck cancer patients since alcohol and tobacco are predisposing factors. Definitive chemoradiation (chemoRT) for head and neck cancer is a difficult treatment with a high burden of symptoms, including mucositis pain, dysphagia and odynophagia. Patients undergoing concurrent chemoRT routinely require systemic opiates to manage pain and tolerate treatment. This is a review of our institution’s experience using buprenorphine and methadone for pain management in patients with OUD during chemoRT for head and neck cancer. Methods: We reviewed all cases seen in the Lifespan Cancer Institute head and neck cancer multidisciplinary clinic between July 2018 and June 2019. Approximately 40% of patients had a history of opiate use disorder and one-fifth of those were on medication-assisted treatment with buprenorphine or methadone. The charts of patients with OUD were reviewed with respect to history of buprenorphine or methadone use, pain scores during chemoRT, effectiveness of pain medications during chemoRT, and change of pain medication during treatment. Results: 5 patients on buprenorphine and 4 patients on methadone underwent treatment with chemoRT for head and neck cancer. Despite effectiveness for pain with other cancer patients, we did not find that buprenorphine was an effective opiate for patients undergoing chemoRT for head and neck cancer. All patients on buprenorphine had to be rotated off to another opiate (generally methadone) to achieve adequate pain relief. Median time to pain medication change was 3 weeks (range: prior to starting to week 5/7). The patients on methadone generally were able to tolerate treatment with minor adjustments to their methadone. Conclusions: The ceiling effect of buprenorphine that makes it effective for OUD is a barrier to managing the severe pain from chemoRT for head and neck cancer, while methadone is effective for both pain control and maintenance of sobriety during a taxing treatment.
Generalizability of national survival estimates to adolescent and young adults with cancer at an urban safety-net institution.
Authors: Gehr Aaron , Lu Yan , Ghabach Bassam , Ojha Rohit P.
Published: November 2019

140

Background: Survival estimates for adolescent and young adults (AYAs) with cancer in the US are largely derived from the Surveillance, Epidemiology, and End Results (SEER) program, which does not include certain geographic areas with diverse populations such as Texas. The generalizability of these estimates to other populations is unknown but may be useful for identifying high-risk populations. Therefore, we aimed to assess the generalizability of survival estimates for AYAs with cancer in SEER to AYAs with cancer at an urban safety-net institution in Texas. Methods: We used data from the SEER program and the JPS Oncology and Infusion Center, an accredited Comprehensive Community Cancer Program. Eligible individuals in both populations were aged 18 – 39 years and diagnosed with a first primary cancer between 2008 and 2015. We computed entropy-balanced weights to adjust the baseline distribution of age, gender, race/ethnicity, insurance status, marital status, cancer type, and stage of the SEER population to our safety-net population. We used these weights to compute Kaplan-Meier estimates of expected survival for our safety-net population. We subsequently estimated the absolute survival difference between expected and observed (i.e. actual) survival and corresponding 95% confidence limits (CL). Results: Our safety-net population comprised 833 AYAs with cancer, of whom 60% were female, 62% were racial/ethnic minorities, and 66% were uninsured at diagnosis. The most common cancers were hematologic (17%), female genital (16%), thyroid (11%), and breast (11%). Metastasis was observed at diagnosis for 24% of AYAs. The expected 5-year survival for the safety-net population based on SEER data was 77%, whereas observed survival was 68%, which equated to an absolute survival difference of 9.5% (95% CL: 5.3%, 14%) after 5 years. Conclusions: Our results suggest that survival estimates of AYAs with cancer in SEER may not be generalizable to AYAs with cancer at an urban safety-net institution in Texas. Lack of generalizability may be relevant to other populations not represented in SEER. The reasons for poor survival of AYAs with cancer at safety-net institutions should be explored.
Problems following treatment for cancer: Building a picture and pathways for Manchester Cancer (UK) 2015-2018.
Authors: Higham Claire Emily , Wilby Lindsey , O'Rourke Claire , Makin Wendy
Published: November 2019

145

Background: Greater Manchester Cancer (GMC) is the cancer program for Greater Manchester’s (GM) devolved health and social care system. 13 tumor-specific (TPB’s) and 7 cross-cutting (inc Living With and Beyond Cancer (LWBCPB)) pathway boards were formed to support this. Aims:The LWBCPB tasked the TPB’s to describe late consequences of treatment, define current care pathways/resources and highlight service gaps. Methods: Questionnaires were sent to all TPB’s. Returned questionnaires (11/13) from 2015-18 were analysed quantitatively (Excel) and qualitatively (Nvivo). Results: Frequent cross cutting long term effects were fatigue(9/11 TPB’s), psychological distress(7/11), sexual dysfunction(6/11), memory loss(5/11), neuropathy(5/11). Management strategies were described; eg, for fatigue; specific workshops(11/11), verbal +/- written advice(7/11), referral to other HCP(6/11). Tumour specific long term effects included a mix of clinical and psychosocial issues; with all TPB’s providing information to patients; only 6/11 to Primary Care. Limited evidence was given for active screening for long term effects. Resources offered included national websites, charities, local services and support groups. For specific clinical issues eg cardiac; referral was mainly to local services; despite identification of clinicians with an interest in LWBC offering specialist services within GM. Lack of resource was the commonly cited reason for absence of care pathways. Identified gaps in current approaches to management were; lack of access to specific resources(11/11) (psychology(7/11), specialist nurse(2/11), hospice care(2/11); inequity of access to resources(7/11); need for specific pathways and referral guidance(3/11). Conclusions: Long term consequences of cancer treatments are cross-cutting. GMC PB’s are an opportunity to use these baseline data to define and implement locally appropriate LWBC pathways including optimal referral, screening and communication with primary care.
Unintended consequences of screening for anxiety and depression among survivors of pediatric, adolescent, and young adult (P-AYA) cancer.
Authors: Jacobs Linda A. , Blauch Abigail N. , Pucci Donna A. , Palmer Steven C
Published: November 2019

148

Background: Screening for psychosocial issues has been mandated to identify survivors in need of assistance and improve outcomes. Although screening identifies some individuals at risk for difficulties, many who screen positively ultimately decline intervention. Moreover, screening has the potential to "miss" patients who desire intervention but screen negatively for psychosocial need. We explored these issues among a sample of adult survivors of P-AYA cancer. Methods: Survivors of P-AYA cancer > 2 years from end of treatment completed an assessment including the Hospital Anxiety and Depression Scale (HADS) and desire for assistance with Anxiety and Depression following a survivorship visit. HADS subscale scores of > 8 indicated at least mild symptoms. Results: Participants (N = 237) were predominately white (89%), college educated (76%), single (63%), and had an annual income of > $60,000 (69%). A plurality had diagnoses of leukemia (30%) or Hodgkin's lymphoma (29%) treated 17 years previously. Treatment included surgery (35%), chemotherapy (91%), XRT (59%), and BMT (17%). Anxiety (M = 6.02; SD = 3.07) and depression (M = 2.54; SD = 2.85) scores were low and below the cutpoint of 8 (all t < -7.8; p < .001 ), although 21% and 9% screened positively for anxiety or depression, respectively. Screening positive for anxiety was associated with a desire for intervention (X2 = 20.77; p < .001 ), while screening positively for depression was not (p > 0.05). Among those screening positively for anxiety, 50% desired intervention, while among those screening positively for depression only 38% desired intervention. Moreover, among those desiring intervention for anxiety or depression, 36% and 68% screened negatively for symptoms, respectively. Conclusions: Many P-AYA survivors screening positively for anxiety or depression do not desire intervention. As well, screening would exclude between 36%-68% of those desiring intervention, representing a missed opportunity to potentially improve outcomes. Screening without assessing desire for intervention likely over identifies individuals who do not desire help while missing a relatively large number of those who do wish for assistance.
Perceptions of prognosis and goals of care in patients receiving radiation therapy.
Authors: Roldan Claudia Sofia , Chen Jie Jane , Nichipor Alexandra N. , Balboni Tracy A. , Krishnan Monica Shalini , Revette Anna , Chen Aileen B. , Hertan Lauren Michelle
Published: November 2019

30

Background: We aimed to gain insight into the experiences and perceptions of patients with advanced metastatic cancer surrounding palliative radiation therapy (RT). Methods: In-depth structured interviews were conducted from 9/2016 to 10/2018 with 17 patients with bone or lung metastases receiving their first course of palliative RT. Patient answers about understandings of goals of care and disease prognosis were recorded and analyzed through qualitative content analysis. Medical records were reviewed to obtain demographic and clinical data. Results: The median age of patients was 64 years (range: 21-82). The median survival from time of metastatic diagnosis was 17.6 months (range: 1-46). When asked about goals of RT, qualitative analysis revealed that half (53%) linked receiving palliative RT to improving their quality of life, however 35% believed RT would completely get rid of their tumor. Words that were used commonly throughout patient answers included alleviating pain (41%), cure (29%), and reducing tumor growth (24%). All patients reported they received their information about goals of care from their medical teams. When asked about prognosis, 53% said prognosis had been discussed with them, whereas 76.5% said they were interested in information about prognosis. When asked “What do you believe lies ahead?,” about half (47%) expressed uncertainty about the future, while others (41%) were focused on the next steps in treatment. In the patients interested in learning more about their prognosis, there was a strong preference for this information to come from their medical teams. Conclusions: More than half of patients accurately identified the goal of RT as improving their quality of life, however some patients believed that the palliative RT would cure their tumor. This highlights the ongoing gap in patient provider communication and the need for improvement in this area. Inaccurate perceptions of goals of treatment and prognosis may motivate some patients to pursue unnecessarily aggressive treatments, which could affect quality of life without improving survival. Referrals to radiation oncologists present a potential opportunity to reopen discussions on goals of care and prognosis to adjust patient expectations.
Shared decision making about opioid therapy for cancer patients: Do patients and providers take the same factors into consideration?
Authors: Silveira Maria J. , Giannitrapani Karleen F , Fereydooni Soraya , Azarfar Azin , Glassman Peter , Becker William , Lorenz Karl
Published: November 2019

32

Background: Many patients with cancerpain are appropriately managed on long-term opioid therapy (LTOT), but are at similar risk of overdose and addiction as are patients with non-cancer pain. Whether to commence opioids for cancer pain is often a shared decision between patient and provider. Little is known about this process. Methods: Semi-structured interviews with 20 cancer patients on LTOT and 20 interdisciplinary providers who prescribe LTOT from two VA medical centers. Transcripts were coded and analyzed using constant comparison to find common themes. Results: Providers and patients largely weighed the risks and benefits of LTOT similarly, except in the case of cancer patients with past/present substance use disorder (SUD). In those cases, providers felt the risks outweighed the benefits, while patients felt the benefits outweighed the risks. Generally, patients considered pain relief their overarching concern. Other factors that impacted their risk/benefit calculus included: personal/family experience with opioids and the opinions of trusted providers. Only rarely did patients defer decision making to providers. Factors that impacted the risk/benefit calculus of providers included: disease status, patient goals, patient characteristics, and providers' past experiences/biases. Of note, patients with past opioid exposure generally viewed their experience with opioids as positive, and usually anchored their risk assessment for opioids relative to those of chemotherapy. Patients also expressed that they would prefer to spend less physician time discussing LTOT and more time discussing cancer treatment instead. Conclusions: Patients and providers often agree on when it is appropriate to use LTOT for cancer pain. In cases where they disagree, providers are well advised to explore and address patients’ fears about the adequacy of pain management without opioids, as well as their lived experience with opioids. Patients are comfortable having such discussions with physician extenders in order to reserve face-to-face physician time to discuss cancer treatment instead.
Predictors of transfer to different facility at discharge in patients admitted with metastatic solid malignancy: Five-year National Inpatient Sample (NIS) database analysis.
Authors: Singh Sunny R K , Malapati Sindhu Janarthanam , Kumar Rohit , Thanikachalam Kannan , Alkhatib Yaser
Published: November 2019

38

Background: Improvement in cancer treatment has led to an increase in prevalence of metastatic malignancy (met-Ca) with a rise in healthcare utilization secondary to this. We aim to identify predictive factors for transfer at discharge to another non-acute facility, such as nursing home and sub-acute rehab. Methods: This is a retrospective cohort analysis of NIS database (from years 2010 to 2014.) Inclusion criteria was any admission of adults (≥18 years) with met-Ca (identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes.) Patients transferred in from a different acute care hospital or another type of health facility were excluded. Primary outcome was transfer upon discharge to a different facility (transfer out) excluding acute care hospital. Statistical analysis was done using STATA. Results: There were 3,204,631 admissions with met-Ca, 15.3% (n= 490,735) had transfer out. Of these, 50.6% were females, 69.6% Caucasians and mean age was 70.9 years. On multivariate regression analysis, African Americans had higher odds for transfer out versus Caucasians (OR 1.06 p <0.005). Admission type- weekend vs weekday and elective vs non elective were also associated with this outcome (OR 1.08 p<0.005 and OR 0.56 p<0.005). Odds ratio for other predictors are shown below (p value <0.005 for all). Conclusions: Age, race, increased length of stay, cancer type, hospital size and teaching status, admission type and insurance type had a significant predictive value for transfer out after discharge in patients with met-Ca. A future area of exploration is the development of a scoring system to predict risk of transfer to a different facility at discharge- this will allow early mobilization of resources for these patients with complex healthcare needs. [Table: see text]
Capturing patient advance directives status in a community oncology practice using an electronic patient-reported outcomes (ePRO) system.
Authors: Buzaglo Joanne S. , Skinner Karen , Stepanski Edward , Decker Veronica , Schwartzberg Lee S.
Published: November 2019

5

Background: The American Society of Clinical Oncology recommends that providers encourage early advance care planning with their patients; yet, many cancer patients do not have advance directives (ADs). A potential reason for low AD rates is inadequate communication between the provider and patient. To address this gap, we developed an outpatient clinic AD initiative for any stage cancer patients via an ePRO system. The AD module was designed to ensure patients are aware of ADs and to assess whether or not the patient had ADs, specifically a Living Will and/or a durable power of attorney and their interest in receiving information about ADs. The study purpose was to assess patient AD status at the patient’s initial visit to an oncology clinic. Methods: This study used a retrospective, observational design that involved use of PRO data collected via the Patient Care Monitor (PCM), a web-based ePRO system linked to electronic medical record data. All study data were collected as part of routine clinical care. All patients at an initial visit to an oncology clinic completed the PCM survey, including the AD module, via a handheld e-tablet. Results: Overall, 18,239 patients completed the AD module (mean age 62; 32% male/68% female; 55% married; 60% White, 36% Black). One third of all patients (30%) reported having an AD at the time of the initial visit to the oncology clinic, specifically 11% indicated having a Living Will and 19% a durable power of attorney. The remaining two-thirds (70%) indicated either NOT having an AD (58%) or not knowing if they had an AD (12%). Patients with ADs were more likely to be older (M= 69 v. 59 yrs) and White (77% v 20% Black) ps < .0001. Of the patients without ADs, 10% requested more information on ADs. These patients were more likely to be older (M= 61 v. 58 yrs), female (68% v 32%), Black (54% v 40% White) and non-married/non-partnered (53% v 47%); ps < .005. Conclusions: This study demonstrates that the majority of patients do not have ADs at the time of an initial visit to a community-based oncology practice. Using an ePRO system can be an innovative and non-threatening way to identify unmet needs of patients and link them to resources for developing advance directives.
Timing of referral for palliative radiation therapy and length of hospital stay.
Authors: Nagatsuka Moeko , Hughes Ryan T. , Glenn Chase , Brown Doris R.
Published: November 2019

57

Background: Palliative radiation therapy (PRT) offers effective symptomatic relief to cancer patients. Increased focus on quality of care and healthcare efficiency necessitate a better understanding of the temporal relationships between consultation for/initiation of PRT and length of hospital stay (LOS). This study aims to assess whether durations from admission to PRT consult/PRT initiation affect LOS. Methods: In an institutional review of patients who received PRT as inpatients between January 2017 and December 2018, 67 met inclusion criteria. Duration of time from admission to consultation or start of PRT were categorized using various thresholds. LOS was compared across groups using the Wilcoxon rank sum test and factors were evaluated as predictors of LOS using bivariate linear regression. Results: PRT was given for pain (37%), neurologic deficits/brain metastases (31%), and respiratory symptoms (19%). Multiple sites were treated in 31%; treatment sites included spine (45%), non-spine bone (27%), chest (22%), abdomen/pelvis (12%), brain (10%) and soft tissue (6%). At admission, patients had known metastases (66%), no prior cancer diagnosis (19%), or known primary cancer (15%). Median LOS was 12 days (IQR 7-18) for all patients. There was a significant difference in LOS for patients referred for PRT within 3 days of admission versus greater than 3 days (11 v. 21 days, p < 0.01). This difference was slightly greater using a threshold of 4 days (11 v. 25 days, p < 0.01) and 5 days (11 v. 26 days, p < 0.01), both of which remained significant when analyzing only patients with prior cancer diagnosis (n = 54). There was no difference in LOS using a threshold of 1 or 2 days. As a continuous variable, duration from admission to PRT was associated with LOS (OR 2.40, p < 0.01). Similar patterns were noted when analyzing by time from admission to PRT start. Conclusions: Earlier radiation oncology consultation for PRT is associated with shorter LOS in patients treated with PRT for symptomatic malignancy. Further research is needed to better define this relationship and improve systematic processes to facilitate early consultation and treatment. A palliative radiation oncology clinic was recently developed to address these issues at our institution.
Palliative care referral patterns of adolescent and young adult patients at a comprehensive cancer center.
Authors: Lockwood Bethany , Ntukidem Olanipekun Lanny , Ehrman Sarah , Lustberg Maryam B. , Bhatnagar Bhavana , Klemanski Dori
Published: November 2019

63

Background: Adolescent and young adults (AYA) diagnosed with cancer have distinct physical, developmental and psychosocial needs that are often unmet during oncology treatment. Such needs are further intensified for AYA patients with an advanced cancer diagnosis. Palliative Care (PC), specialized care for patients and families with serious illness, can address these needs throughout the disease trajectory including symptom management, supportive communication, and advance care planning. The incorporation of PC remains suboptimal despite evidence that palliative services can improve quality of life. In an effort to identify strategies to advance access to PC for the AYA population at our institution, the referral pattern to PC was studied. Methods: A retrospective chart review was performed to identify referral patterns to PC in the AYA population (ages 18-39) from July 2017 through June 2019 at a National Cancer Institute designated comprehensive cancer center. Descriptive statistics were utilized to summarize referral patterns and trends. Results: In the past 2 years, 1,894 AYA patients established oncology care at our institution. The most common AYA cancer diagnoses included hematologic 20.8% (n=944), thyroid 10.8% (n=490), brain 9.9% (n=451) and breast 9.1% (n=414). There were 311 (16%) referrals placed to PC, mostly in the inpatient setting (81.4%). Less than half (43%) of the inpatient referrals had a post-discharge follow-up appointment in the PC clinic. Multiple disease-specific service lines were represented including leukemia (40%), colorectal (14.5%), sarcoma (9%) and breast (9%). Quarterly volumetric trends remained static over the 2 years (average number of referrals: 54/quarter). The average age at cancer diagnosis in the AYA population was 30 years and 32.7 years (range 19-39) at time of PC referral. This was consistent with the average length of time from initial diagnosis to PC referral of 2.8 years. Conclusions: Comprehensive oncology care in the AYA population should include PC. Yet, involvement of PC in the AYA population during oncologic treatment was limited. Future research will investigate optimal models of integrative PC to address the unique needs of AYA cancer.
Embedded model palliative care (PC) at a community oncology practice in central Nebraska.
Authors: Kathman Cindy , Copur Mehmet Sitki , Price Penny , Edwards Carrie , Jonglertham Pornchai , Springer Carlene R. , Vacek Colleen , Reiners Debra , Hiller-Payne Brandy , Lounsbury Anita , Wagner Tabatha , Lauder Robin , Wilson Patricia , Mueller John , Molnar Sally , DeGodt Heidi , Arbogast Jessica , Muske Chandra , Robbins Leslie , Peterson Tonya
Published: November 2019

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Background: PC combined with cancer care has been shown to improve patient outcomes and caregiver satisfaction while lessening unnecessary health care utilization. 85% of cancer patients receive their oncology care in the communities they live. Establishing a viable and sustainable outpatient PC service in the community oncology setting is challenging and rare nationwide. We present our 18-month PC services since its implementation at Morrison Cancer Center, a community oncology practice. Methods: Cancer patients were referred to PC by oncologists for symptom management, psychosocial support, and Advanced Care Planning (APC). PC visits were provided at the oncology clinic, home, nursing home, or hospital by our PC team (APRN, Social Workers, Chaplain and RN's). Palliative Care Prognostic Index (PPI), time to PC consultation, proportion of patients --on chemotherapy, switching to hospice care, receiving chemotherapy within the last 30 days of life, visiting ER and/or being admitted to hospital within the last 30 days of life-- were studied. Results: Over an 18-month period 72 patients were referred for a total of 470 visits. Lung, pancreas, gastroesophageal, and head and neck cancers were topmost sites. PC referrals per quarter increased from an initial 4 to an 18 at 18 months. Mean time from diagnosis to PC referral was 5.6 months (range: 1-36). Referral reasons included symptom management/support (58%), goals of care (50%), and/or predetermined triggers (15%). Mean PPI score was 50% (range 30-70). All patients had ACP. While 83% of patients were able to continue on active cancer treatment, only 5% received chemotherapy within the last 30 days of life, and 4 % had two or more ER visits with or without a hospital admission. Eventually, 17% of PC patients transitioned to hospice care. Conclusions: A PC program fostering expert symptom management, seamless communication, and trusting relationships between oncologists, palliative care team, and patients, without prematurely stopping active cancer treatments, is feasible and can be incorporated into a community oncology practice as demonstrated by the growth and success of our program. Our model may set an example for similar practices in the community oncology setting.
Another hospital admission through the emergency room? Looking for a fragility pattern in advanced cancer patients.
Authors: Velutti Laura , Marinello Arianna , Cammarota Antonella , Grimaudo Maria Susanna , Saetta Annalisa , Giuffrè Santina , Lopane Diego , Digiacomo Nunzio , Provasoli Chiara , Gonçalves Pereira Frederico , Cullia Luca , Villa Elisabetta , Poggio Chiara , Ferrari Stefano , Pavesi Carlotta , Giordano Laura , Rimassa Lorenza , Santoro Armando
Published: November 2019

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Background: Cancer patients (pts) are often treated with anticancer therapy (CT) even in the last months of life and are often hospitalized through an access to the emergency room (ERa). This is frequently the time when a palliative care (PC) service starts, or when pts die. Methods: We performed a retrospective analysis of pts admitted to our Oncology Unit through an ERa. We evaluated: pts’ characteristics, histology, date of diagnosis, sites of metastases, comorbidities, previous CT and radiotherapy (RT), imaging procedures and other exams in the last 90 days (90d), previous ERa and admissions for supportive care (SC), including transfusions, parenteral/enteral nutrition, high-cost antibiotics, in the last 90d. Pts were divided into 2 fragility groups: less fragile (LF), candidate after discharge to further CT or follow-up, and more fragile (MF), pts candidate to PC or who died in the Oncology Unit. Results: From August 2017 to May 2018 441/756 pts (58.3%) were admitted through an ERa: women/men 219/222, median age 65.4 years (y), range (r) 18.9 - 89.7. 328 pts had visceral metastases, 287 pts had ≥1 comorbidity, 318 pts received ≥1 line of CT (r 1-8), 121 pts received ≥1 RT (r 1-5), 240 pts had ≥1 prior admission for SC (r 1-6), 224 pts had an ERa (r 1-6) and 141 pts had ≥1 hospitalization for SC (r 1-4) in the last 90d, 386 pts received ≥1 diagnostic exam in the last 90d (r 1-12). Pts were grouped as follows: LF/MF 236/205. Differences between the 2 groups were: pts ≥70 y 31% in LF, 40% in MF, p=0.047; visceral metastases 70.1% in LF, 85.1% in MF, p<0.001; ≥1 line of CT 64% in LF, 81% in MF, p<0.001; ≥1 RT 23% in LF, 32% in MF, p=0.036; admissions for SC 47% in LF, 62.9% in MF, p<0.001; ERa in the last 90d 39% in LF, 64% in MF, p<0.001; admissions for SC in the last 90d 24.4% in LF, 39.4% in MF, p=0.004. No other differences were observed between the 2 groups. Conclusions: We identified a MF profile: pts ≥70 y, with visceral metastases, ≥1 line of CT and ≥1 RT course for advanced disease, ≥1 prior hospitalization for SC, ≥1 ERa and ≥1 admission for SC in the last 90d. The identification of this fragility profile may help oncologists timely offer a PC program to advanced stage pts. This could prevent some ERa and hospital admissions close to the end of life.
Understanding of palliative care among members of the public.
Authors: Wong Joanne Liu , Blake Christopher , Swami Nadia , Pope Ashley , Hannon Breffni , Rodin Gary , Le Lisa W , Zimmermann Camilla
Published: November 2019

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Background: The World Health Organization (WHO) defines palliative care (PC) as an approach that improves the quality of life of patients and their families facing life-threatening illness. However, the public may be unaware of this definition. We assessed the Canadian public’s knowledge and attitudes toward PC before and after being provided the WHO definition. Methods: We engaged a health research firm to distribute a cross-sectional survey to members of the Canadian public. Eligible participants were >18 years of age, could comprehend English or French, and were currently residing in Canada. We assessed participants’ knowledge of and attitudes towards PC before and after reading the WHO definition of PC. Results were analyzed using the Wilcoxon Signed-Rank test. Results: Of 1518 participants (52% female), 45% (676/1518) stated they knew what PC was and could explain it, 32% (488/1518) knew about PC but could not explain it, 13% (198/1518) had heard of PC but did not know what it was, and 10% (156/1518) had never heard of PC. Of those who had heard of PC, 58% (784/1362) agreed PC is the last resort when other treatments have failed, 64% (877/1362) agreed PC means being close to death, and 67% (914/1362) believed PC meant being at “the stage that you can no longer take care of yourself”. Before reading the WHO definition, 56% (774/1362) agreed/strongly agreed that referral to PC would make them feel afraid; after reading the definition, this percentage was reduced to 41%, and degree of fearfulness was reduced in 46% (p<0.0001). Fifty-nine percent (898/1518) stated they did not know, prior to reading the WHO definition, that PC could be involved early in the course of illness, and 45% did not know PC could be provided together with other treatments aimed at prolonging life. Eighty-nine percent (1344/1518) felt the PC definition helped them to better understand what PC is, and 91% believed that Canadians should be made aware PC can be included early in the course of a patient’s illness. Conclusions: More than half of respondents had limited knowledge of PC and believed it was synonymous with end-of-life care. Provision of the WHO definition improved understanding and allayed fears of PC. Public educational initiatives may improve understanding and increase acceptance of PC.
Oncologists’ perspectives on medical marijuana for the elderly.
Authors: Azizoddin Desiree Rachel , Enzinger Andrea Catherine , Wright Alexi A. , Yusufov Miryam , Hong Fangxin , Tulsky James A. , Campbell Eric G , Pirl William F. , Nayak Manan , Braun Ilana
Published: November 2019

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Background: Cancer patients are increasingly using medical marijuana (MM) to manage symptoms and treatment side effects. Although cancer disproportionately affects the elderly, little is known about oncologists’ attitudes toward MM in this population. We surveyed US oncologists’ beliefs about the benefits of MM for older adults, and examined their associations with oncologists’ perceptions of MM efficacy and safety. Methods: 232 out of 400 randomly selected U.S. oncologists (63% response rate) completed a cross-sectional survey about their beliefs and recommendations regarding MM for cancer patients. Using Chi-square tests, we examined associations between oncologists’ demographics, their perceptions of geriatric MM use, as well as beliefs about comparative effectiveness of MM for cancer related symptoms, and comparative risks of MM to prescription opioids. Results: Among 232 oncologists included in this cohort, 109 (47.0%) reported that MM had at least some benefit for elderly cancer patients, 66 (28.4%) responded it was rarely or never beneficial, and 57 (24.6%) reported not knowing. There were no significant associations between oncologists’ beliefs about MM’s benefit for older adults and their sociodemographic characteristics. Those who believed MM was beneficial for the elderly were significantly more likely to report that MM was at least as effective as standard treatments for the following indications: coping (58.3% vs. 26.6%), appetite (83.3% vs 58.5%), depression (46.3% vs 25.0%), and nausea (66.7% vs 33.9%), respectively ( p < 0.001). In contrast, oncologists’ beliefs about MM for the elderly were not significantly associated with perceptions of the comparative risks of MM ( p > 0.05). Conclusions: In this nationally-representative sample of US oncologists, about half thought MM was beneficial for older adults with cancer. Oncologists’ support of MM for older adults was associated with perceptions of MM’s efficacy but was not associated with perceptions of MM’s risks. More research is needed regarding the safety and efficacy of MM to guide oncologists’ recommendations about its use in older adults.