bluuebunny/crossref_metadata_2025 huggingface dataset:
Advance care planning in Hispanic/Latino and non-Hispanic white patients with cancer.
Authors: Friedman X , Cardenas Veronica , Nelson Sandahl , Gabbai-Saldate Paulette , Ma Joseph , Cohen-Arazi Yael , Martinez Maria Elena , Ng Katrina , Roeland Eric
Published: November 2017

10

Background: Advance care planning (ACP) is a process whereby patients communicate their end-of-life treatment preferences. Despite a growing US Hispanic/Latino population, much remains unknown regarding ACP for Hispanic/Latinos. This study examined the association between ethnicity and ACP, including individual surrogate markers—code status documentation, advance directive (AD)/physician order for life-sustaining treatment (POLST) completion, and/or palliative care (PC) consultation—in deceased Hispanic/Latino vs white non-Hispanic (WNH) cancer patients. Methods: A retrospective analysis was performed in randomly-selected, matched pairs of deceased (2011-2016) Hispanic/Latino and WNH cancer patients at an NCI-designated cancer center. Pairs were matched based on sex, age (at diagnosis/death), and cancer type. Conditional logistic regression was used to assess ethnicity (Hispanic/Latino vs WNH) and the presence any ACP (yes/no). Secondary aims examined the association between ethnicity and the presence of individual ACP surrogate markers using separate logistic regression models. All analyses were completed using SAS 9.4. Results: 152 eligible matched pairs were analyzed with no significant differences in presence of any ACP, code status documentation, or PC consultation. Cancer patients with AD/POLST completion were 58% less likely to be Hispanic/Latino than WNH. Conclusions: Historically, ACP in cancer care is difficult to implement with 20-30% penetrance across all racial/ethnic groups. This study suggests even lower rates of AD/POLST completion in Hispanic/Latino patients consistent with prior studies. However, based on the small sample size, these results are not generalizable and requires further evaluation. This study affirms the need for continued efforts to improve AD/POLST completion in Hispanic/Latinos. [Table: see text]
Impact of socioeconomic status on pretreatment cachexia and survival in non-small cell lung cancer.
Authors: Lau Steven , Gannavarapu Bhavani S , Carter Kristen , Gao Ang , Ahn Chul , Meyer Jeffrey John , Sher David J , Jatoi Aminah , Iyengar Puneeth
Published: November 2017

101

Background: Socioeconomic status (SES) influences healthcare outcomes, but the influence of SES on cancer cachexia is unknown. We identify components of SES associated with pre-treatment cachexia in patients with non-small cell lung cancer (NSCLC) and assess their prognostic significance on survival. Methods: A prospectively maintained institutional tumor registry identified 1,365 patients with NSCLC consecutively treated at a tertiary care health system from 1/1/06 to 12/31/13. Insurance status was abstracted from the registry. Educational attainment and household income were estimated from census data using location of primary residence. Cancer cachexia was defined retrospectively using the international consensus definition. Multivariable regression analysis was used to identify prognostic factors of pre-treatment cancer cachexia and survival. Results: Cachexia was present at the time of NSCLC diagnosis in 30% of all patients including 17% of patients with stage I disease. Patients with Medicaid or no insurance were more likely to have pre-treatment cachexia compared to those with private insurance (Odds Ratio [OR] 1.9, 95% Confidence Interval [CI] 1.2-3.1; OR 2.1, 95% CI 1.2-3.4, respectively). Attainment of a high school diploma was inversely associated with pre-treatment cachexia (OR: 0.1, 95% CI 0.02-0.2). On multivariable analysis, comorbidity, histology, tumor grade, and disease stage were prognostic of survival among cachectic patients; however, insurance status, educational attainment, and household income were not. Conclusions: Lower SES is associated with pre-treatment cachexia in patients with NSCLC, but pre-treatment cachexia is detrimental to survival regardless of SES. Together, these findings suggest early intervention for patients with cancer cachexia may improve outcomes.
Palliative care in a community-based oncology private practice.
Authors: Friedman Loren L. , Cronin Paul , Siddiqui Muhammad M. , Garcia Marie A. , Anderson Linda C.
Published: November 2017

107

Background: Integration of palliative care in the outpatient oncology clinic improves the quality of care for patients with advanced cancer. While models of outpatient palliative care (PC) in the academic oncology clinic have been demonstrated, the feasibility of PC in a private practice oncology clinic has not been established. Methods: In 2014 our 8 office oncology practice composed of 30 physicians and 10 advanced practice providers hired a full-time PC physician. Our questions included: 1) Would the PC physician be valued by the oncologists in the practice; 2) Would internal referrals and follow-up encounters provide sufficient activity for PC physician employment; 3) Would the revenue received for patient encounters offset the cost to the practice of the PC physicians? We emailed a survey to providers; we tallied data on patient encounters; and we reviewed the actual dollar amount of reimbursements received from payers for PC evaluation and management codes for a 1 year period. Results: In our second full year, a single palliative care physician saw 487 initial consultations and 1273 follow-up encounters for a total of 1760 encounters. The collected revenue for these encounters covered 102% of the palliative care physician’s combined salary and overhead. This data enabled the additional hiring of a second PC physician in 2016. Of 36 providers surveyed, 24 (67%) completed our 10 question survey. On a 1-5 point scale, when asked to rank the positive influence of the palliative care program on the culture of patient care in the practice, the aggregate score was 4.96. When asked questions on how helpful the palliative care program was to the providers in managing a variety of patient concerns, all items scored between 4.5 and 5. A question on how helpful the PC physicians were as a curbside resource received an aggregate score of 5.0. Conclusions: Based on referral numbers and surveyed attitudes, PC physicians were readily accepted into the fabric of a community based oncology practice. Analysis of financial data demonstrates that the PC physician can cover a substantial part of their salary requirement through billing for patient encounters.
Palliative care utilization in oncology patients with 30-day hospital readmission.
Authors: Pandya Chintan , Nielsen Gradon , Hu John , Ram Jodi , Rozario Cheryl , Wallace Danielle , Hamel Lauren M. , Dougherty David W.
Published: November 2017

110

Background: Reducing the rate of hospital readmissions is an important aspect of improving quality of life and cost of care for patients with advanced cancer. Early Palliative Care (PC) has been shown to improve quality of life and downstream healthcare utilization in patients with advanced cancer. The aim of this study was to examine palliative care (PC) utilization and factors associated with 30-day readmission in cancer patients. Methods: All patients with 30 day readmissions to the inpatient oncology service at the Wilmot Cancer Institute from July 2015-June 2016 were identified. Chart reviews were conducted to determine primary cancer stage and type; reason for, length of stay and discharge disposition (e.g. discharged on hospice, deceased) for index and readmission; potential preventability of readmission; and if and when the patient had met with PC. Results: A total of thirty-nine patients experienced a 30-day readmission, with 95% of patients having stage IV disease and 77% having a primary lung or GI malignancy. Most patients (74%) had not met with PC at the time of the index admission and 49% of patients had not met with PC by the time of readmission. Forty one percent (N = 17) of patients either died during readmission or were discharged on hospice. Forty one percent (N = 7) of those that died during readmission or were discharged on hospice did not meet with palliative care. Forty four percent of readmissions were classified as potentially preventable. Conclusions: Nearly half of all advanced cancer patients had not met with PC by the time of their readmission. Upon readmission, many patients were either discharged to hospice or died, suggesting that patients with advanced cancer could benefit from earlier PC. Increased and improved patient-oncologist PC communication, including referrals to PC specialists, may reduce readmission rates for patients with advanced cancer.
Utilization of support services, emergency department, and hospital in advanced cancer patients with severe disease in a community cancer institute.
Authors: McNaughton Caitlyn , Gehron Emily , Sivendran Shanthi , Holliday Rachel , Horst Michael , Newport Kristina Braine
Published: November 2017

112

Background: Patients with advanced cancer are at high risk for emergency department (ED) and hospital utilization, which is distressing and costly. Palliative care consultation and symptom management clinics have been shown to decrease ED and hospital utilization, but the frequency and composition of these interventions is still being delineated. More evaluation is needed to determine practical approaches to implementing interdisciplinary management of distress for patients with advanced cancer in the community setting. This retrospective review evaluates healthcare utilization with respect to support services provided in our community based cancer institute. Methods: 157 patients with advanced cancer of lung, gastrointestinal, genitourinary or gynecologic origin diagnosed January 2015-December 2015 were reviewed retrospectively. Descriptive data including demographics, disease characteristics, palliative care consultation, support services utilized and ED visits/hospitalizations were collected for 12 months, or to date of death. Support services included physician assistant–led symptom management, nurse navigator, social worker, nutrition, financial counselor, chaplain, and oncology clinical counselor. Support service referrals were made based on identified needs. Severe disease was defined as death within 6 months of diagnosis. Results: Patients with severe disease had a mean of 6 ED visits per year, significantly greater than patients with non-severe disease (p < 0.001). Patients with severe disease also had more contacts with support services per year (30.3 vs 9.1, p < 0.001). A palliative care consult was placed in 50% of patients with severe disease, and 23% in patients with non-severe disease (p < 0.001). Conclusions: Patients with advanced cancer have evidence of significant needs as reflected by high healthcare utilization in the last 6 months of life. As needed involvement of support services correlated with severity of disease but did not result in decreased ED utilization or hospitalization. This suggests that availability of support services alone is not a feasible strategy to impact unplanned hospitalizations and ED visits.
A retrospective review of patients with hematological malignancy referred to an inpatient palliative care service in a tertiary hospital.
Authors: Meng Yee Choon , Koh Mervyn Yong Hwang , Chiam Zi Yan , Zhang Jun Jun , Hum Yin Mei, Allyn
Published: November 2017

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Background: Patients with hematological malignancies are referred to palliative care service later and less often than patients with solid organ tumor. However, there are no data in Singapore, on the referral pattern among patients with hematological malignancy. The objective of the study is to identify the characteristics and outcomes of patients with hematological malignancy referred to an In-patient Palliative Care Service (PCS). Methods: We performed a retrospective review of all patients with hematological malignancies referred to the in-patient PCS from December 2015 to December 2016. Basic demographics and outcomes of patients’ admission were collected as per protocol. Results: 53 patients were included in the study. 27 (50.9%) patients were male, 49 (92.5%) were ≥60 years old, 20 (37.7%) were receiving cancer treatment at the point of referral, and 24 (45.3%) had Palliative Performance Scale (PPS) ≤ 40%. The most common hematological diagnosis was lymphoma (N = 26, 49.1%). The top 3 reasons for referral were symptom management (N = 44; 83%), advance disease (N = 24; 45.3% and end-of-life discussion (N = 15, 28.3%). Among 44 patients referred for symptom control, 18 (40.9%) had pain, 12 (27.3%) had dyspnoea, 8 (18.2%) had confusion and 6 (13.6%) had fatigue or drowsiness. 30 patients (56.6%) died during the admission. Among 30 patients who died, the mean time from referral to death was 9.8 days; 16 (53.3%) died within 1 week from referral, 9 (30%) died between 1-4 weeks from referral and 5 (16.7%) died beyond 4 weeks after referral.5 patients (9.4%) had Advance Care Planning completed. Conclusions: Our review showed that patients with hematological malignancies are referred late in their disease trajectory and have high Palliative Care needs. Hence, collaborative effort to facilitate timely referral of patients with hematological malignancy to PCS will optimize end-of-life care.
Urgent versus elective inpatient anticancer therapy in patients with metastatic solid tumors: Analysis of admission characteristics and posthospitalization clinical outcomes.
Authors: McPherson Jordan P. , Namanny Halee R. , Brant Jamie L. , Patterson Paige A. , Howell Julie A. , Loveday Brighton A. , Montague Rachel M. , Piper-Williams Jaclyn J. , Shaw Jennifer S. , Sindt Jill E. , Thielking Paul D. , Biskupiak Joseph E. , Beck Anna Catherine , Stenehjem David D. ,   HCI Palliative Care Working Group
Published: November 2017

12

Background: Palliative chemotherapy is used urgently in the hospital due to rapid disease progression, risk of toxicity, or other cancer-related acute medical diagnoses. Our primary objective was to characterize the utilization of urgent anticancer therapy (antiCT) in metastatic solid tumor patients. Secondary objectives were to compare time to next treatment (TTNT) and overall survival (OS) between those who received antiCT during urgent and elective admissions, and to further characterize if goals of care (GOC) or prognosis discussions were included in the decision process. Methods: This was a single-center observational cohort study of patients with advanced solid tumors treated with antiCT during urgent versus elective inpatient admissions at Huntsman Cancer Institute from June 1, 2014 to June 30, 2016. Line of therapy, ICU utilization, readmission rate, palliative care (PC) consultation, and documentation of GOC and prognosis discussions were evaluated for patients who received urgent antiCT. Results: 265 patients were included. The majority were treated during urgent admissions (63.7%). Patients receiving urgent antiCT were older (57.6 ± 14.2 vs 54.9 ± 14.9 years, p < 0.001) with more advanced cancer at diagnosis (56.8% vs 37.5%, p = 0.009). Urgent antiCT was associated with both decreased median TTNT (3.5 vs 15.7 months; p < 0.001) and median OS (4.7 vs 31.4 months; p < 0.001) as compared to elective antiCT. Of those who received urgent antiCT, 47.9% were started on a new antiCT during admission. First-line therapy accounted for 58% of urgent antiCT, and 27.2% was third-line or higher. ICU care was utilized for 20.7% of these patients, and 23.1% were readmitted ≤30 days after discharge. PC was consulted for 37.9% during admission. Less than half (41.4%) had a documented GOC discussion; only 32.5% had a documented prognosis discussion. Conclusions: Urgent inpatient antiCT is associated with suboptimal advance care planning despite high risk of mortality in the 5 months following admission. Efforts to identify predictors of early mortality after urgent antiCT and incorporate earlier GOC and prognosis discussions are warranted.
Phase III safety evaluation of intravenous NEPA, a novel fixed antiemetic combination of fosnetupitant and palonosetron, over multiple cycles.
Authors: Schwartzberg Lee Steven , Andric Zoran Gojko , Kowalski Dariusz , Voisin Daniel , Rizzi Giada , Karthaus Meinolf
Published: November 2017

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Background: NEPA is an oral fixed combination of the selective NK1 receptor antagonist (RA), netupitant (300 mg), and pharmacologically distinct 5-HT3RA, palonosetron (PALO 0.50 mg), combining two guideline-recommended antiemetic classes in a convenient single capsule. Oral NEPA has shown superior prevention of chemotherapy-induced nausea and vomiting (CINV) over oral PALO, sustained efficacy over multiple cycles, and well-established safety in >1500 patients (pts). To offer additional convenience for health care practitioners and pts, an intravenous (IV) formulation of the NEPA fixed combination (fosnetupitant 235 mg/PALO 0.25 mg) was developed. Methods: This randomized, multinational, double-blind, stratified (by gender/country) phase 3 study in chemotherapy-naïve pts with solid tumors was designed to assess the safety of a single 30-minute infusion of IV NEPA prior to initial/up to 4 repeated cycles of highly emetogenic chemotherapy (HEC). Patients received either IV NEPA or oral NEPA, both with oral dexamethasone on days 1-4. Safety was assessed by treatment-emergent adverse events (TEAEs), laboratory tests, vital signs and ECGs. Results: 404 pts were evaluated for a total of 1312 exposures. Overall, 53% of pts were male with a mean age of 60 years; 99% of pts were white and cisplatin-containing regimen was the HEC for 96% of pts; lung cancer was the most common tumor (55% pts). The AE profiles were similar for both groups in cycle 1 and across all cycles (See Table), with no increased incidence of AEs in subsequent cycles. No infusion site reactions related to IV NEPA occurred. No clinically relevant changes in QTcor cardiac safety concerns were observed. Conclusions: IV NEPA is safe and well-tolerated over multiple cycles with a similar safety profile to oral NEPA in pts receiving HEC. Clinical trial information: NCT02517021. [Table: see text]
The utilization and impact of oncology supportive care clinics on patients with metastatic lung cancer.
Authors: Kim Yan S , Luo Esther J , Chin Matthew T , Leong Shelley , Rajan Sudhir S , Escobar Gabriel J
Published: November 2017

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Background: The American Society of Clinical Oncology has endorsed early integration of oncology with palliative care. In 2012, Kaiser Permanente Northern California (KPNC) introduced Oncology Supportive Care Clinics (OSCCs). OSCCs are outpatient palliative care clinics designed to incorporate palliative care into standard oncology practice at the time of a patient's cancer diagnosis. This study examines the utilization and impact of OSCCs on patients with metastatic lung cancer. Methods: We identified adult patients with incidental stage IV lung cancer using the KPNC cancer registry from 2012-2015 and followed them for 12 months. We ascertained OSCC utilization using KPNC’s electronic health record. We examined the patterns of OSCC referral/utilization and compared survival, in-hospital death, and treatment received in patients who used and did not use OSCC services. Results: A total of 607 patients were included and 245 (40.4%) were referred to OSCC. The median time from diagnosis to referral was 48 days and ¼ were referred within 15 days. The majority (86%) of the patients referred were seen by OSCC. Only 22 patients (9.0%) refused to be seen. We found no large patient- or facility-level differences between patients referred and not referred to OSCC. At the end of follow up, 398 (65.6%) of the patients died. Patients seen by OSCC were less likely to die (59.2% vs. 68.9%, p < 0.02) at 1 year. Fewer patients who used OSCC died in the hospital compared to those who did not (26 or 12.3% vs. 67 or 16.9%); however, it did not achieve statistical significance (p = 0.13). Among patients who used OSCC, 166 (78.7%) received anti-cancer treatment, compared to 221 (55.8%) among those who did not (p < 0.001). Conclusions: Despite having a robust infrastructure and integrated system in place, over half of the patients diagnosed with metastatic lung cancer did not receive a referral. Future work is needed to understand the reasons why so many patients were not referred. Furthermore, our data showed that receiving OSCC services did not adversely impact survival and the receipt of anti-cancer treatment. These findings serve to reassure patients and providers that the addition of palliative care does not harm patients or limit their treatment.
Integration and expansion of palliative care work force.
Authors: Bowlby Lynn , Turner Robin , Casarett David , Johnson Fred , Boulware Ebony , Webb Jason , Bain Morgan
Published: November 2017

126

Background: The specialty of Hospice and Palliative Medicine has grown out of the need for care of patients who are living longer with cancer and other serious illness and struggle with symptoms, decisions and care. Cancer patients and others often do not have access to Palliative Care services due to availability or accessibility of PC services. Since 2012, fellowship training is required for board eligibility but available programs do not meet the workforce need. As described by Weissman and Meier, viewing Palliative care services in the context of a primary, secondary or tertiary focus , allows for the expansion of these services outside of the traditional fellowship training. With additional intensive training, it is possible that experienced physicians can fill workforce gaps by providing primary palliative care in the providers practice area such as a clinic. Methods: The faculty member who will participate in a yearlong training program based in the Palliative Care Clinic is the Director of the Outpatient Clinic. This clinic is the center of the Duke resident ambulatory experience for the duration of their training. The complexity of these patients is high and often the DOC is the only place that these patients receive care. The Palliative Care training program will provide the faculty member the opportunity to see patients in the cancer center with board certified palliative care physicians. There will be 3 areas of focus for the trainee: clinical experience, didactic information and mentorship from a board certified palliative care provider around faculty identified cases from her own practice. Results: We have developed a yearlong intensive training program for experienced faculty to gain skills in Palliative Care. Conclusions: 1. It is hoped that this will allow for integration of primary palliative care into patient care areas where there is no formal palliative care program. 2. Integration of Palliative Care principles in the clinic to address symptoms of chronic severe illness as well as difficult conversations with more confidence and skill. 3. Earlier palliative care management–develop a systematic approach to assessing needs in high risk populations ie. Hospital Discharge reviews, now commonly done at the clinic.
Impact of palliative care (PC) consultation on quality of end-of-life (EOL) care in advanced cancer patients receiving care at a tertiary cancer center (TCC).
Authors: Watanabe Sharon , Faily Viane , Tarumi Yoko , Fainsinger Robin , Sinnarajah Aynharan , Potapov Alexei , Baracos Vickie
Published: November 2017

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Background: Early integration of PC with oncological care has been shown to improve outcomes in patients with advanced cancer, including quality of life and mood. It has also been suggested to have a positive impact on quality of EOL care. The purpose of our study was to examine how occurrence and timing of PC consultation are associated with quality of EOL care in advanced cancer patients receiving care at a Canadian TCC. Methods: In this retrospective study, patients who died between April 1, 2013 and March 31, 2014, had advanced cancer while receiving care at our TCC, and lived in the catchment area of our urban comprehensive integrated PC program were eligible. Date of death, demographics, and cancer type were obtained from the cancer registry. Date of diagnosis of advanced cancer was determined from electronic medical records. Occurrence and date of PC consultation were identified from the PC database. Data on quality of EOL care indicators were retrieved from the cancer registry, including, in the last 30 days of life: emergency room visits, hospital admission, hospitalization > 14 days, ICU admission, death in hospital, and chemotherapy use. Results: Of 1414 eligible patients, 1101 (77.9%) received PC consultation in hospital, outpatient clinic, or community. Patients who received PC consultation were younger than those who did not receive PC consultation (age 68.8 vs. 71.0, p = 0.01), and differed in the frequency of cancer types (p < 0.001), but not sex, marital status, or income. 679 patients (48.0%) had at least 1 indicator of quality of EOL care. Patients who did and did not receive PC consultation did not differ in the frequency of any indicators of quality of EOL care. There were also no differences in frequency of quality of EOL care indicators between patients who received their first PC consultation > 3 months vs. ≤3 months or > 6 months vs. ≤6 months before death. Conclusions: Among advanced cancer patients receiving care at our TCC, occurrence and timing of PC consultation did not affect quality of EOL care. Methodological and healthcare system differences may explain the discrepancy between our results and those of other investigators. Further research is needed.
The outcome of outpatient palliative care service at Yonsei Cancer Center, a tertiary cancer center in Korea.
Authors: Lee Si Won , Choi Hye Jin
Published: November 2017

131

Background: The importance of palliative care in cancer patients continues to be emphasized and studies are proving its importance. Several studies proved the improvement of quality of life in advanced cancer patients. The efficacy of symptom control based on outpatient palliative care service has not yet been reported in Korea. The objective of this study is to review the outcome of outpatient palliative care service at Yonsei Cancer Center, a tertiary cancer center in Korea. Methods: We retrospectively reviewed 155 cancer patients who used outpatient clinic at Yonsei Cancer Center in Korea between April 2014 and December 2014. Symptom severity was measured by modified Korean version of Edmonton Symptom Assessment System. Twelve symptoms were assessed: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, anorexia, constipation, wellbeing, financial distress. Higher score means worse symptom. ESAS scores at baseline and follow-up assessments were analyzed. Results: The 155 patients had following characteristics: female 52.3%, median age 65 years (range 58-75), Hepatobiliary-pancreatic cancer and lung cancer patients accounted for the largest portion (n = 37, 23.9%; n = 36, 23.2% respectively). Most patients were Eastern Cooperative Oncology Group performance status 1 (n = 28, 18.1%) or 2 (n = 24, 15.5%). Ninety-two (59.4%) patients were referred to the palliative care team after anti-cancer treatments were all finished. Overall the symptoms did not change significantly from baseline to 2 consecutive follow up assessment except anorexia ( p value = 0.0195). Patients who were on active anticancer treatment had tendency of higher ESAS score than those finished with the anticancer treatment. However, all symptoms except nausea were not statistically significant. Conclusions: Most patients in this study did not have severe symptom scores that would show the differences of the symptom changes. Nevertheless, although not statistically significant, we found that patients on active anticancer treatment had higher symptom burden than those who were finished with the anticancer treatment. More meticulous symptom management is necessary to improve the symptom control.
Objective smartphone measurements of physical activity and fitness in patients with cancer.
Authors: Douma Joeri A.J. , Verheul Henk M.W. , Buffart Laurien
Published: November 2017

132

Background: Optimal (study) treatment for patients with advanced cancer is influenced by their performance status (PS) before initiation of systemic therapy. An objective assessment of a patient’s physical function is difficult to make and is currently heavily depending on the estimation of their PS by the treating physician. Objectively measured physical activity (PA) and physical fitness (FIT) may be more predictive for survival and treatment tolerability than their PS. We hypothesize that an objective measurement may provide more accurate estimates of a patient’s physical function and thereby a better outcome of (study) treatment. Unfortunately, routine objective measurements are time consuming and costly. Therefore, we aimed to investigate the validity and reliability of smartphone measurements of PA and FIT in patients with cancer. Methods: At present, 56 ambulant patients with various types of cancer participated. Patients wore an accelerometer for 7, and an IPhone for 14 consecutive days to measure the mean number of steps per day. Patients performed a 6MWT twice with the use of an smartphone application in their home environment and once in a test environment in the hospital. To assess the validity, we calculated the intraclass correlation coefficient (ICC) between the accelerometer and the first week of the IPhone for PA, and between the 6MWT in the hospital and the home environment for FIT. To assess reliability, we calculated the ICC between the IPhone week 1 and 2 for PA, and between the first and second 6MWT in the home environment for FIT. Results: Validity was excellent for PA (ICC = 0.96,p < 0.05) and low for FIT (ICC = 0.33,p < 0.05). We found excellent reliability for PA (ICC 0.94,p < 0.05) and FIT (ICC = 0.93,p < 0.05). Conclusions: In this study we found that objective smartphone measurements of PA are valid and reliable. FIT assessments were reliable, but in its present form its validity was low. A prospective study has been initiated to investigate whether objectively measured PA and/or FIT, better predicts early trial discontinuation and survival than PS or patient-reported physical function.
Early integration of supportive oncology consultation for hospitalized cancer patients.
Authors: Woodfield Kellie , Adelson Kerin B. , Horton Jay , Smith Cardinale B.
Published: November 2017

136

Background: Integration of Palliative Care (PC) for patients with cancer is associated with improved symptom control, clearer understanding of prognosis, lower utilization of health care resources, and increased hospice use. Yet few studies identify which elements of a PC consultation are most associated with improved outcomes, particularly in the inpatient setting. This study describes the processes of a specialized, interdisciplinary, inpatient PC consultation service that utilized standardized referral criteria and demonstrated improved 30-day readmission, oncology service mortality, and hospice utilization. Methods: We implemented a 3-month intervention on the solid tumor oncology service requiring an automatic PC consultation for patients with one or more of the following criteria: stage IV disease, Stage III lung or pancreatic cancer, hospitalization within 30 days, > 7 day hospitalization, or uncontrolled symptoms. Descriptive statistics were used to identify specific processes associated with the consultation. Results: A total of 52 patients were evaluated. The median time of initial consult was on hospital day 2 and patients were followed for an average of 9 days (±11). The majority of patient encounters were by a physician (47%) or advanced practice nurse (42%), with 48% of encounters lasting 35-60 minutes. Integrative services (massage, yoga etc.) were offered in 72% of consults. The most common issues addressed throughout the consultation were pain (85%), non-pain symptoms (85%), transition planning (85%), and plan of care (82%). Overall, consulting teams addressed more PC needs than were initially identified by chart review. Conclusions: Implementing standardized PC consultations in patients with solid malignancies requires the full support of an interdisciplinary team. PC consultations are time-consuming undertakings, often addressing needs broader in scope than initially identified and requiring the use of specialty level PC in the majority of cases. Future efforts to implement similar interventions can use these data to identify specific staffing needs and to ensure cancer patients receive quality care.
Palliative care in hematologic oncology: A needs assessment.
Authors: Decastro Gene , Earle Bridget
Published: November 2017

137

Background: As patients with hematologic malignancies further enter the scope of practice for palliative medicine physicians, it is important to have an accurate view of their needs. Historically, there is a paucity of research examining symptom burden in this cohort. Even fewer studies explore the experience and perceptions of frontline hematology providers. As our Geriatrics and Palliative Medicine team at North Shore University Hospital (NSUH) embarked upon a collaborative Supportive Care model on our hospital’s dedicated Leukemia and Bone Marrow units, it was important to gain insight from providers about this population. Methods: We conducted a supportive care needs assessment survey of the staff (faculty, fellows, nurse practitioners, nurses, social workers, and case management) from the Leukemia and Bone Marrow units. The survey encompassed eighteen domains and attempted to assess their prevalence in patients according to the Hematology team. It included symptom burden, social and functional complexities, advance care planning, and goals of care. Free text responses were used to capture staff input about challenges in caring for this population Results: We received a response rate of 30% (30/101) with respondents primarily being nurses. It revealed the domains most commonly seen in this patient population by the team. Domains selected as “frequently” or “almost always” were fatigue (97%), nutritional issues (96%), gastrointestinal issues (93%), anxiety (80%), goals of care (69%), and advance directives (69%). We learned that symptom management was a challenge for the staff. They expressed that patients’ expectations about the impact of chemotherapy is a key area of importance. Lastly, communication with patients throughout treatment and caregiver support were consistent concerns from the team. Conclusions: Determining the four most prominent issues encountered by hematology staff were fatigue, nutritional, gastrointestinal, and anxiety can help to refine the symptom assessment. Moreover, communication and decision making concerns were important. These results underscore the necessity of assessing provider perspectives while treating those with hematologic malignancies to guide future initiatives.
Advance care planning in community: Evaluation of a two-session workshop.
Authors: Rabow Michael , McGowan Marilyn , Small Rebecca , Keyssar Redwing , Rugo Hope S.
Published: November 2017

14

Background: Engaging patients in advance care planning (ACP) is challenging. Group visits and multiple patient-clinician interactions appear to promote advance directive (AD) completion. We evaluated the effectiveness of a two-session ACP workshop. Methods: We conducted a nurse-led ACP workshop for patients and their family caregivers in a comprehensive cancer center. Patients were invited by their outpatient palliative care physician and an assistant helped coordinate attendance. Monthly sessions were 2 hours long and 2 weeks apart. The first session detailed the ACP process, featured the “Go Wish” card game, and introduced the “Five Wishes” AD. In the time between sessions, patients were encouraged to play Go Wish with family and to begin filling out their AD. The second session included questions and discussion, and helped patients complete, notarize, and scan their AD into the EMR. Workshop evaluation included the validated 4-question Sudore ACP Readiness Survey as well as semi-structured participant interviews. Results: Ten of 11 participants from 4 workshop offerings completed surveys. Median age was 48 years (range 41-72). Most patients (10/11, 90.9%) had breast cancer. Mean pre-workshop ACP readiness was 4.0 out of 5; post-workshop readiness increased nearly significantly to 4.325 (p = .057). Eight of the workshop participants (72.7%) had a new notarized AD scanned into the EMR. Participants most appreciated the chance to talk with other patients (“The most important thing was having a group there. I don’t think I ever would have read that packet if it had just been handed to me.”) and the chance to include their family caregivers (“My family and I had a rich and bonding talk, which was helpful for their own thinking about the AD for themselves as well.”). Two family caregivers completed their own AD. Patients who declined a workshop invitation most commonly reported they “did not have time” because of medical appointments. Conclusions: The ACP workshop was well received by participants and increased ACP readiness, discussion, and completion. The opportunities for group discussion and inclusion of family caregivers were important to participants. Barriers to attending workshops must be explored.
Successful integration of palliative care services into the multidisciplinary multiple myeloma clinics: An observational study based on a single institution experience.
Authors: Nagovski Neil , Brahim Amanda , Reynolds Patrick Taylor , Ruiz Marco
Published: November 2017

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Background: The pain syndromes, both acute and chronic are prevalent and often the only complaints affecting the patients’ quality of life and functional capacity. Here we describe our experience of successful integration of palliative care service into multiple myeloma (MM) management in a form of the disease specific multidisciplinary clinic. Methods: We have established a dedicated monthly multidisciplinary clinic for all patients diagnosed with symptomatic MM as a pilot project to incorporate different specialties involved in MM care with the goal to improve on disease management, increase compliance with office visits, reduce emergency department visits and benefit a healthcare system. Patients were able to have the same day visits with medical oncologist, radiation oncologists, palliative care physician, integrative medicine and medical psychologist. Over the course of two years (April 2015 through March 2017), we provided care to 39 unique MM patient. Results: After medical/transplant oncology encounters (N = 601), the most encountered specialists were palliative care (N = 208), followed by radiation oncology (N = 34) and integrative medicine/medical psychology (N = 33). The rate of missed office visits for multidisciplinary clinic was 5%, compared to average 7% for all cancer patients at our center. The rates of emergency department visits were rising in proportion to non-compliance with multidisciplinary clinic visits (correlation coefficient 0.43) Conclusions: Patients with MM cared for at the multidisciplinary clinic had better compliance with office visits and fewer unplanned emergency department visits in comparison patients with other oncologic disorders. The rates of emergency departmentvisits were proportional to non-compliance with multidisciplinary clinic visits. The degree of utilization of integrative medicine and psychology was comparable to radiation oncology encounters suggesting that psychological, behavioral, dietary interventions, complementary, physical therapies and rehabilitation have an important and growing role in MM management.
Implementation of a multidisciplinary palliative and supportive care education lecture series.
Authors: Chan Shawna , Liao Solomon , Randall Leslie M. , Kheriaty Aaron , Dayal Rakhi , Kuo Jeffrey V. , Nguyen Joseph , Vega Charles , Bota Robert , Barrios Cris , Dabral Mudit , Wei Randy
Published: November 2017

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Background: Nationwide surveys of residents including those in oncologic specialties reveal that trainees perceive their palliative and supportive care (PSC) educational curriculum as inadequate. For residents, PSC education varies from none at all to an organized department lecture series given by Palliative Medicine physicians. There have been no published experiences of institutional wide PSC lecture series open to all residents, fellows, and medical students. Methods: We piloted a monthly palliative care lecture series from August 2016 to June 2017 at UC Irvine. 12 physicians from 9 clinical departments provided monthly lectures on management of physical symptoms, psychosocial issues, cultural considerations, spiritual needs, care coordination, ethical/legal issues, communication/goals of care, and advance care planning. Lectures were advertised in advance to program directors and emails were sent the week prior to all trainees. At the end of each lecture, attendees were given a voluntary survey that consisted of 10 questions on self-perceived competency in PSC skills and 4 questions on attitudes toward PSC. Results: 143 (45 medical students, 98 residents) responses were received. Most residents (90.8%) and medical students (84.4%) viewed palliative care as an important competency. Only 16 responses from heme/onc, radiation, and gynecology oncology residents and fellows were received, comprising 11.2% of total responses. Residents characterized themselves as “not at all/minimally/somewhat confident” in their ability to care for patients with PSC issues in the following areas: management of opioids (44.2%), fatigue (82.7%), anorexia (79.6%), depression (65.3%), and prognostication (75.5%) Medical students characterized themselves as “not at all/minimally/somewhat confident” in the following areas: management of opioids (79.3%), fatigue (86.7%), anorexia (91.1%), depression (71.1%), and prognostication (91.1%). Conclusions: These findings suggest a need to further improve domains of palliative care training in residency programs and identify innovative ways to increase participation of residents and fellows from all oncologic specialties.
Areas for quality improvement in pediatric supportive oncology services.
Authors: Reichek Jennifer , Weldon Christine B. , Suh Eugene , Trosman Julia Rachel , Sanford Stacy D. , Dighe Dipti , Berardi Rosa , Downing Kim , Choi Daniel K. , Roggenkamp Betty , Pillay Smiley Natasha , Brown Melanie , Owen Erika D , Ganesan Rani
Published: November 2017

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Background: In 2013, the Institute of Medicine report recommended that supportive oncology services be initiated at time of diagnosis. Providers of pediatric cancer care in the Chicagoland community, supported by The Coleman Foundation, sought to define areas for quality improvement of supportive oncology delivery to children. Methods: Focus groups and surveys with clinicians providing pediatric cancer care and supportive services at 14 sites were used to prioritize areas needing improvement. Results: 100% (14/14) of sites participated. Of the eligible sites, 6 were pediatric cancer treatment sites and 8 cancer care community organizations. Sites demonstrated consistent agreement for 8 of the 12 areas of focus for improvement. Over 50% of sites reported areas of focus (table) as important or very important. Conclusions: Sites identified the need for quality improvement in delivery of psychosocial, survivorship and palliative care for pediatric cancer patients. Survey results demonstrate a need for collaboration and efforts to guide care delivery improvement across sites. [Table: see text]
Standardization of inpatient CPR status discussions and documentation within the Division of Hematology and Oncology at UPMC Shadyside Hospital.
Authors: Garcia Christine Ann , Bhatnagar Mamta , Rodenbach Rachel , Winfield Melissa , Graham-Pardus Abigail , Minnier Christopher , Hanchett Sharon , Kriner Jamie , Baird Emily , Leahy Janet , Chu Edward , Marks Stanley M. , Levenson Josh
Published: November 2017

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Background: Medical professionals are trained to provide life-sustaining and cardiac resuscitation measures for admitted hospital patients. However, not all patients desire such aggressive measures. Lack of discussion and/or documentation about resuscitation preferences has led to care incongruous with patient’s wishes as previously documented or reported to providers or family members. In December 2016, 49% of adult patients admitted to the inpatient oncology service at UPMC Shadyside had a code status discussion documented prior to discharge. The aim of this project is to improve the quality and rates of CPR status conversations. Methods: A workgroup was formed in January 2017 among key stakeholders representing oncology physicians and fellows, palliative care faculty, oncology nursing, advance practice providers (APPs), and internal medicine house staff. A quality improvement (QI) proposal was developed and approved by the UPMC Quality Improvement Committee in February 2017. All oncology faculty, fellows, housestaff, and APPs were reminded weekly to complete CPR status conversations and documentation. APPs were formally trained by palliative care specialists to discuss and document CPR/code status with all admitted patients. Hospital leadership received a monthly update of CPR status documentation rates. Results: Since project implementation, CPR status assessment rates have improved from 49% to 80% as of June 2017, and an additional 714 patients had a CPR status discussed and documented compared to June 2016. Formal system-wide expectations are being developed by the CPR assessment workgroup that all admitted patients should have CPR/Code status discussions and documentation upon admission. Conclusions: Standardization of CPR status assessment with formal training of clinicians and APPs has resulted in a significant increase in the number of CPR status assessments on the inpatient setting. A formal CPR status assessment expectations document is in the process of being developed among the workgroup. Formal trainings by palliative care specialists for APPs are ongoing. Future trainings are planned for physicians, housestaff and fellows.
Raising all boats in supportive oncology: Initial impact of the Coleman Supportive Oncology Collaborative (CSOC).
Authors: Gerhart James , Weldon Christine B. , Dale William , Patel Urjeet , Khosla Paramjeet , Lo Shelly S. , Newsom Carol , Robinson Patricia A. , Martin Joanna , Azizoddin Desiree , Knightly Eileen , Berardi Rosa , Diaz Aidnag , Lillis Teresa , Trosman Julia Rachel , Penedo Frank J.
Published: November 2017

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Background: The Institute of Medicine (IOM) and Commission on Cancer (CoC) recommend systematic delivery of supportive oncology and survivorship care to all cancer patients. CSOC aims to improve the quality of supportive care across Chicago-area providers. Methods: 35 CSOC participating institutions (cancer centers, support centers, hospice) formed care delivery design teams - Distress, Survivorship and Palliative. Teams collaboratively developed solutions to supportive oncology gaps: patient screening tools, care delivery processes, provider training, and quality metrics to assess supportive oncology quality and the CSOC impact. Six implementation centers (2 safety-net, 3 academic & 1 public) reviewed charts at baseline (2014 diagnoses) and after the initial implementation period (2015 diagnoses), compared by frequencies and Fisher’s exact test. Results: Eight metrics contained patient data at 2 time points; improvements were seen in 7/8 metrics. (See Table). Conclusions: CSOC developed supportive oncology screening, and care processes aligned with IOM and CoC standards. Significant improvements were shown after implementation across diverse settings. Ongoing work will further evaluate the impact of CSOC efforts on patient care. [Table: see text]