bluuebunny/crossref_metadata_2025 huggingface dataset:
Comics: Educating and introducing children to radiation therapy.
Authors: Sueyoshi Mark , Olch Arthur , Johns Natalie , Afaga Jordan , Wong Kenneth
Published: November 2018

155

Background: Comics can address topics in medicine and other facets of life in a format that is widely accessible. Literature suggests that Human-Centered Design strategies can reduce child/caregiver anxiety prior to radiation therapy. Thus, appropriately designed comics can bridge the gap between the practical realities of radiotherapy, like understanding the importance of remaining still in immobilization molds and the pediatric patient's desire for imagination and play. Similar patient-care interventions have been implemented in the form of toys, games, and books. The aim of this project was to draw out best practices in the development of a comic to prepare patients for radiotherapy. Methods: Comic production underwent an iterative process whereby a multidisciplinary team of a radiation oncology department defined a set of principles and goals. An artist then developed several drafts with the input of staff, patients, and family. Readability for the intended audience was assessed by established readability tests. Results: A 25-panel comic draft was produced by the multidisciplinary team that explained in simple terms how radiotherapy is used in a relatable and entertaining way. The dialogue was developed to accommodate the education level of both pediatric patients and caregiver(s) with the intention to be read as a shared experience. The Automated Reliability Index, Flesch Kincaid Grade Level, and Gunning-Fox Index measured readability as fourth, less than sixth, and sixth grade, respectively. The messages included an explanation of radiation, its necessity and likely side effects, the important alliance with the radiation oncology staff, and the central role of the patient. Conclusions: The development of a clear, succinct, and entertaining comic that is relatable to children undergoing radiotherapy is a challenging process, especially in a world awash with competing media. However, a graphic medium can provide an opportunity to convey information and reassurance for both the patient and family. Comics have the potential for greater patient satisfaction over traditional methods of information dissemination. Next steps will involve clinic-wide validation using standardized anxiety and family impact assessment tools.
Analysis of psychosocial and spiritual concerns in patients consulted for palliative radiation therapy.
Authors: Apkon Dana Jordan , Krishnan Monica Shalini , Abdia Younathan , Hertan Lauren Michelle , Fareed Muhammad Mohsin , Huynh Mai Anh , Parker Gregory McCarthy , Balboni Tracy A.
Published: November 2018

157

Background: Little is known about the prevalence of psychosocial and spiritual issues in patients being treated with palliative radiation therapy (PRT). This study assessed patients’ psychosocial and spiritual needs as interpreted by radiation oncologists at PRT consultation. Methods: This prospective, survey-based study assessed consecutive consults for PRT from May 19, 2014 to September 26, 2014 at 3 Boston-area community and academic hospitals. Consulting clinicians completed a survey to identify the presence of psychosocial and spiritual issues. 162 consecutive consults were surveyed with 139 psychosocial and spiritual assessments received (86% response rate). Psychosocial and spiritual domains include anxiety, depression, family conflict, family coping issues, personal worries, and spiritual need. Providers ranked the relevance (5-point Likert scale, not at all to extremely) of several palliative care issues, including psychosocial and spiritual issues. Results: Providers reported psychosocial or spiritual problems in 71.4% (n = 100) of consults. Psychosocial concerns were relevant in 68% of consults and spiritual concerns were relevant in 28%. The most frequent problems were anxiety (33.6%, n = 47) and personal issues (33.6%, n = 47), including financial worries. Univariate analysis showed association between psychosocial and spiritual concerns (p = 0.005). Providers treating patients less than 30 days from metastatic diagnosis more commonly reported spiritual concern (p = 0.020). Advanced care planning needs were also predictive of spiritual concerns (p = 0.026). At initial consult, 53% (n = 73) of providers ranked psychosocial problems as “Extremely” or “Very Important” to patient care. 10% of providers ranked spiritual problems as “Extremely” or “Very Important.” Conclusions: Providers noted relevance of psychosocial and spiritual issues to patient care. Given the prevalence of psychosocial and spiritual concerns in this population, it will be important for palliative providers to assess their patients routinely. The variability of predictors demonstrates the appropriateness of assessing all patients consulted for PRT for psychosocial and spiritual concerns.
Relationship processes and symptom burden in couples coping with metastatic lung cancer.
Authors: Milbury Kathrin , Yang Chanyi , Liao Zhongxing X. , Tsao Anne S. , Bruera Eduardo
Published: November 2018

169

Background: Attachment style is a complex behavioral control system rooted in neurophysiological processes which guides a person’s ability to elicit and respond to emotional closeness in an intimate relationship. Patients with high attachment anxiety and/or avoidance may engage in interpersonal behaviors that exacerbate their stress response and perhaps symptom burden. We hypothesized that, while patients’ insecure attachment is associated with increased symptom burden, partners’ positive relationship behaviors may protect against this association. Methods: Patients with metastatic NSCLC and their partners completed cross-sectional surveys assessing attachment (ECR) and emotional closeness during cancer-related discusssions (PAIR). Patients completed the MDASI to measure cancer-related symptoms. We used multi-level modeling for the dyadic analyses. Results: 54 patients (51% female; 80% White; µ age = 65 yrs) and their partners (51% female; 68% White; µ age = 64 years; µ relationship length = 27 years) participated. Patients with high attachment avoidance reported significantly higher cancer symptoms compared to those with secure attachment (MDASI µ’s: 2.14 vs .21, respectively; P<.05). Cancer symptoms were also significantly higher for patients whose partners reported low compared to high closeness during cancer-related discussions (MDASI µ’s: 1.08 vs .42, respectively; P<.05). In fact, there was a significant interaction between partners’ perceptions of closeness and patients’ attachment avoidance (P<.01) so that only patients with high avoidance reported significantly greater symptom burden if their partners reported low closeness (high avoidance and low closeness: MDASI µ = 2.73; high avoidance and high closeness: MDASI µ = 1.32). Conclusions: Patients’ attachment avoidance is significantly associated with their symptom burden. Partners who are able to maintain closeness during cancer-related discussions may protect patients with high attachment avoidance from experiencing increased symptom burden. Teaching partners of patients with insecure attachment to stay emotionally connected during cancer-related discussions may be an important target for psychosocial interventions.
Memorial Sloan Kettering-Frailty Index (MSK-FI): Validation and its relationship with postoperative outcomes of older survivors of cancer.
Authors: Shahrokni Armin , Tin Amy , Alexander Koshy , Sarraf Saman , Afonso Anoushka , Filipova Olga , Harris Jennifer , Downey Robert J. , Vickers Andrew , Korc-Grodzicki Beatriz
Published: November 2018

172

Background: Older cancer patients are at higher risk for poor postoperative outcomes. We tested the validity and utility of Memorial Sloan Kettering-Frailty Index (MSK-FI) in this setting. Methods: In a single institution, prospective cohort study, patients age 75+ received comprehensive geriatric assessment (CGA) by the Geriatrics service during preoperative evaluation. The MSK-FI was developed based on the modified Frailty Index, incorporating 10 comorbid conditions and one item related to basic and instrumental activities of daily living. With the total score ranging from 0 to 11, a score of ≥ 3 was considered frail. We validated the MSK-FI against the CGA, and assessed the relationship between MSK-FI frailty with short term (hospital length of stay (LOS), intensive care unit (ICU) admission) and long-term (overall survival) postoperative outcomes utilizing multivariable linear, logistic, and cox regression models, adjusting for age, duration of surgery, American Society of Anesthesiologists physical status classification, and preoperative albumin level. Results: In total, 1,137 cancer patients (median age 80) were included in the study. The prevalence of frailty based on MSK-FI was 41%. Frail patients were more likely to have poor Karnofsky Performance Status (56% vs. 29%), be dependent in basic and instrumental activities of daily living (72% vs. 40% and 64% vs. 34%), experienced a fall in the past year (30% vs. 18%), have slower gait speed (49% vs. 22%),be depressed (66% vs. 49%), have limited social activity (62% vs. 43%), take ≥ 5 medications (63% vs. 25%), experienced significant weight loss (24% vs. 16%), and suffer from polycomorbid conditions (87% vs. 26%). Frailty was associated with longer LOS in the hospital (1.9 days, p <0.0001) and higher odds of ICU admission (OR = 2.34, p = 0.005). With the median follow up of 12.1 months for survivors, frail patients were at higher risk for overall mortality (HR = 1.67, p < 0.001). Conclusions: MSK-FI is a valid instrument in predicting short and long-term postoperative outcomes of older adults with cancer. Future studies should assess the impact of administering MSK-FI on surgical decision-making, postoperative health care process, and outcomes.
Comparison of health care-related social media and Internet usage between patients treated with curative and palliative intent.
Authors: Magony Alexander , Hueniken Katrina , Kassirian Shayan , Geist Ilana , Paulo Chelsea , Eng Lawson , Smith Elliot Charles , Geist Arielle , Rao Pryangka , Brown M. Catherine , Liang Mindy , Yang Dongyang , Xu Wei , Bender Jackie , Gupta Abha A. , Liu Geoffrey
Published: November 2018

173

Background: Cancer patients (pts) are increasingly searching online for information and support. Online resource usage and preferences may differ between patients treated with curative versus palliative intent. Methods: Cancer pts completed a cross-sectional survey at Princess Margaret Cancer Centre, assessing their usage and perceptions of social media and the internet with regards to their cancer. Associations between patients’ responses and treatment intent were evaluated univariably (t-tests, chi-squared tests) and multivariably (linear/logistic regression). Results: In a univariable analysis comparing 65 palliative pts (PALL) and 222 curative pts, PALL were more likely to be older (p < 0.001) and less likely to be currently employed or a student (p < 0.001); they were less likely to use the internet (91% vs. 97%, p = 0.03), social media (68% vs. 87%, p < 0.001), and used social media less frequently than curative patients (66% vs. 83%, p = 0.01). PALL were less likely to be interested in an online personal health record (62% vs 76%, p = 0.04) and more likely to indicate that they would not use online information (17% vs. 7%, p = 0.02), compared to curative pts. PALL were more likely to be unfamiliar with social media (20% vs. 7%, p = 0.01), to not know how to use social media (21% vs. 7%, p < 0.001), and to have difficulty finding information (14% vs. 5%, p = 0.03). However, no significant differences by intent were identified after adjustment in a multivariable analysis controlling for age. Conclusions: After the age differences between both groups were adjusted for, there were no significant differences in patients’ online activity nor their perceptions of the trustworthiness, utility, and role of social media, and the Internet. These similarities suggest that online resources for PALL can be developed simultaneously with curative pts.
The lived experience of AYA mothers with advanced breast cancer.
Authors: Lundquist Debra , Berry Donna Lynn , Boltz Marie , Desanto-Madeya Susan , Grace Pamela
Published: November 2018

176

Background: Little is known about daily life experiences of young mothers with advanced breast cancer. Limited research suggests they face unique challenges differing from those of women at other life stages and with earlier stages of breast cancer. The larger study aimed to describe and interpret the lived experiences of young women with advanced breast cancer to contribute to our understanding of the needs of this population. Their role as mothers emerged as a significant theme. The goal of the overall study was to inform the development of person-centered interventions. Methods: Van Manen’s hermeneutic phenomenological method was employed in this longitudinal qualitative study. AYA women (25-39 years) with advanced breast cancer were purposively recruited via private Facebook groups specifically for women with breast cancer. Enrollment continued until thematic saturation was achieved. Data were collected through one or more semi-structured interviews over 6 months depending upon participant willingness, desire, or ability. Journals were provided to write additional thoughts. Data were drawn from interviews about daily life experiences. A major theme related to their identities as mothers emerged. Results: Twelve AYA women (mean age: 35.9) were included. All were married, had at least one child (10 months -14 years, median: 6.0 years), and most (n=7, 72.7%) worked full-time. Twelve participated in the first interview, 9 in a second interview, and 6 in a third interview. Three returned journals. The meaning of their experiences as mothers is captured by the theme: “ I’m Still Mom” and 7 subthemes: “ it’s so hard”, ” being a mom still”, “ what I can still do”, “there’s not enough time”, “being remembered”, “searching for resources”, and “ it’s not easy for my kids”. Conclusions: Being a mother is the first priority for these AYA women with advanced breast cancer, but they are hindered in their parenting activities by physical effects of their cancer and its treatment, uncertainty about their future, and worry for their children’s future. This study provides a base for further research on daily priorities for this population to inform future interventions to optimize quality of life consistent with their parenting priorities.
The association between physical functioning, symptom burden, and coping strategies with quality of life (QOL) in patients with chronic graft-versus-host disease (cGVHD).
Authors: Sommer Robert , Jacobs Jamie M. , Waldman Lauren , Traeger Lara , Greer Joseph , Vanderklish Julie , Chen Yi-Bin Albert , Spitzer Thomas R. , Temel Jennifer S. , El-Jawahri Areej
Published: November 2018

178

Background: Allogeneic stem cell transplant survivors with cGVHD experience substantial psychological distress and impairments in QOL. However, the relationship between patients’ physical functioning, symptom burden, coping strategies, and QOL over time is unknown. Methods: We conducted a longitudinal study of patients with moderate-severe cGVHD. We assessed patient-reported psychological distress (Hospital Anxiety and Depression Scale), QOL (Functional Assessment of Cancer Therapy-General), physical functioning (Human Activity Profile), cGVHD symptom burden (Lee Symptom Scale), and coping (Coping Inventory for Stressful Situations) at baseline, 3 months, and 6 months. Using mixed linear effects models, we examined the longitudinal relationship between QOL and physical functioning, cGVHD symptoms, and coping strategies. Results: We enrolled 53 patients with moderate (71.7%, 38/53) or severe (28.3%, 15/53) cGVHD. The rate of clinically significant depression and anxiety symptoms at baseline was 32.1% (17/53) and 30.2% (16/33), respectively, and did not change over time. Patients reported low QOL at baseline [M = 70.33, SD = 18.96], which did not change significantly over time [β = -0.66, SE = 1.11, P = 0.550]. Over time, higher physical functioning was associated with better QOL [β = 0.17, SE = 0.05, P = 0.001], while greater symptom burden was associated with worse QOL [β = -0.38, SE = 0.06, P < 0.001]. While the use of emotion-oriented coping was associated with lower QOL over time [β = -0.70, SE = 0.14, P < 0.001], the use of avoidance-oriented coping was associated with higher QOL over time [β = 0.38, SE = 0.10, P < 0.001]. Task-oriented coping was not associated with psychological distress or QOL. Conclusions: Patients with moderate-severe cGVHD report substantial psychological distress and persistently impaired QOL over time. Higher physical function and lower symptom burden are associated with improved QOL. The use of certain coping strategies was associated with changes in QOL. These data underscore the need for supportive care interventions to promote effective coping and enhance physical functioning in patients with cGVHD.
Supportive care in cancer: Impact of marital status on outcome of end-stage head and neck cancer.
Authors: Simpson Matthew C , Bukatko Aleksandr R , Knewitz Allison P , Donovan Connor L , Adjei Boakye Eric , Osazuwa-Peters Nosayaba
Published: November 2018

18

Background: The impact of marital status on cancer survival, including head and neck cancer (HNC), has been previously described. However, no previous study has shown whether being married impacts head and neck cancer patients with end-stage disease. The objective of this study was to determine the impact of marital status on survival of patients with stage IVc HNC. Methods: Patients ≥18 years from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed with end-stage (AJCC stage IVc) head and neck squamous cell carcinoma from 2007-2015 ( n=2,886) were included. Kaplan-Meier survival estimated crude survival differences stratified by marital status (married/partnered, never married, divorced/separated, widowed) using log-rank test, and in-between differences were determined using Bonferroni adjustments. Competing risks proportional hazards model determined the effect of marital status on death from HNC while controlling for covariates (age, year of diagnosis, county-level poverty percentage, sex, race/ethnicity, insurance, anatomic subsite, and treatment modality). Results: Patients were predominantly male (81%) and white (65%), with mean age of 62 years. Median overall survival for the cohort was 11 months. The Kaplan-Meier curves indicated at the end of follow-up that divorced/separated (HNSCC-specific survival percentage=13%), never married (8%), and widowed patients (12%) had significantly lower survival than married/partnered patients (20%) (Bonferroni p<0.01). After adjusting for covariates, the proportional hazards model indicated that divorced/separated (aHR=1.16, 95% CI 1.01, 1.33), never married (aHR=1.20, 95% CI 1.07, 1.36), and widowed patients (aHR=1.23, 95% CI 1.02, 1.48) were significantly more likely to die from HNSCC than married/partnered patients. Conclusions: Married patients with HNC enjoy better survival outcomes than those unmarried, and those widowed and divorced have worse outcomes. This study illustrates that supportive care, in the form of being married, impacts patients, including those with end-stage disease.
The association of marital status with suicide among male cancer patients in the United States.
Authors: Osazuwa-Peters Nosayaba , Simpson Matthew C , Bukatko Aleksandr R , Adjei Boakye Eric
Published: November 2018

181

Background: Suicide rate is among cancer survivors double that of the general United States population, and risk is significantly greater among males than females. Meanwhile, being married confers survival advantage across the cancer continuum, with males benefitting more than females. This study was aimed at determining whether marital status mitigated the risk of suicide among male cancer patients with advanced stage disease. Methods: Male patients with stage IV cancer of nine common cancer sites (prostate, lung/bronchus, colon/rectum, urinary bladder, melanoma of the skin, kidney/renal pelvis, non-Hodgkin lymphoma, head and neck cancer, liver/intrahepatic bile duct) diagnosed from 2007-2015 from the Surveillance, Epidemiology, and End Results 18 database were included. A multivariate competing risks proportional hazards model determined the impact of marital status on suicide while controlling for covariates (age, county-level poverty percentage, insurance status, race/ethnicity, cancer site). This model yielded adjusted hazard ratios (aHR) and 95% confidence intervals (CI). Results: There were 228,627 male patients included, with 330 patients committing suicide. The cohort was predominantly non-Hispanic white (71%), married/partnered (57%), and had an average age of 65 years. In the model including all nine cancer sites, divorced/separated (aHR = 1.92, 95% CI 1.40, 2.62), never married (aHR = 1.98, 95% CI 1.48, 2.66), and widowed patients (aHR = 1.50, 95% CI 1.01, 2.24) were more likely than married/partnered patients to commit suicide. Conclusions: Married cancer survivors with advance stage disease are less likely to die by suicide, highlighting the value of supportive care in cancer survivorship. Unmarried patients with advanced stage disease are candidates for surveillance to mitigate suicide risk.
Relationships between distress and sleep in advanced cancer patients and spouse caregivers.
Authors: Reblin Maija , Gonzalez Brian , Heyman Richard E , Ellington Lee , Vadaparampil Susan Thomas
Published: November 2018

195

Background: Sleep disturbance is a common problem among individuals with advanced cancer. Distress and sleep disturbance are highly interdependent in spouses. Little research has examined dyadic effects of psychological distress on sleep in patient-caregiver spouses, most of whom sleep together. The goal of this study was to determine how anxiety and depression impact one’s own sleep and partner’s sleep in advanced cancer patients and their spouse caregivers. Methods: As part of a larger study, 86 advanced cancer patients and their spouse caregivers completed surveys on demographics and self-reported health, including sleep duration, and the HADS measure of anxiety and depression. A path analysis was conducted to determine the impact of patient and caregiver anxiety and depression on their own and their partner’s sleep. Results: The majority of dyads were white (n = 79) and all were heterosexual. The patient was female in 25 couples. The average age for patients was 67 and 65 for caregivers; couples had been together an average of 35 years. Patients reported sleeping 7.2 hours/night (SD = 1.7) and caregivers reported sleeping 6.72 hours/night (SD = 1.3). Patient and caregiver sleep was significantly correlated (r = .42, p < .01). Controlling for age, sex, and general health, one’s own anxiety was negatively associated with one’s own sleep duration (patient B = -.12, p = .04; caregiver B = -.13, p < .01), but patients’ anxiety was not associated with caregivers’ sleep duration or vice versa. Individuals’ depression was not associated with their own sleep duration, but patient depression was positively associated with caregiver sleep duration (B = .10, p = .05). Conclusions: This is one of the first dyadic explorations of psychological distress and sleep duration in advanced cancer patients and spouse caregivers. The increase in the caregivers’ reported sleep duration associated with patient depression may be an early indicator of caregiver depression. These findings strongly support further research of the dyadic effects of distress on sleep to identify longitudinal effects on holistic sleep outcomes for spouses coping with cancer.
National trends in opioid-related hospitalizations among patients with cancer.
Authors: Chua Isaac S. , Leiter Richard , Brizzi Kate T. , Coey Charles A. , Mazzola Emanuele , Tulsky James A. , Lindvall Charlotta
Published: November 2018

199

Background: Cancer patients are routinely prescribed opioids for cancer-related pain. With recent attention to the opioid epidemic, we sought to identify risk factors and to describe the incidence of opioid-related hospitalizations among cancer patients. Methods: Serial cross-sectional study of adult cancer patients with opioid-related hospitalizations using the National Inpatient Sample (NIS) database from January 2006 to December 2014. We identified cancer patients using the International Classification of Diseases, Ninth Revision (ICD-9) codes. We defined opioid-related hospitalizations as ICD-9 codes for heroin poisoning, opioid poisoning, or opioid dependence or abuse in the primary diagnosis field. A logistic regression model identified predictors for opioid-related hospitalizations. We adjusted temporal trends for opioid-related hospitalizations for all-cause hospitalizations among cancer patients. Results: Among 25,443,362 hospitalizations for cancer patients, there were 14,336 opioid-related hospitalizations. Non-heroin opioid poisoning made up 88% of opioid-related hospitalizations. Predictors for opioid-related hospitalizations for cancer patients included drug abuse (OR 9.40, 95% CI 8.28 - 10.66), younger age [age 18 - 29 (OR 4.00, 95% CI 3.10 - 5.17); age 30 - 49 (OR 3.99, 95% CI 3.43 - 4.65)], depression (OR 2.17, 95% CI 1.97 - 2.39), alcohol abuse (OR 1.21, 95% CI 1.03 - 1.41), and year of hospitalization [2009-2011 (OR 1.19; 95% CI 1.07 - 1.32); 2012 - 2014 (OR 1.19; 95% CI, 1.06 - 1.32)]. On average, opioid-related hospitalizations increased by 0.003% per year (p = 0.002). Conclusions: Opioid-related hospitalizations among cancer patients are rare, appear to be increasing over time, and are largely due to non-heroin opioid poisoning. Standardized opioid risk screening based on validated predictors may identify cancer patients with the greatest risk of an opioid-related hospitalization.
Chemical coping and efficacy of buprenorphine for cancer pain.
Authors: Case Amy Allen , Hansen Eric , Nadagoundla Chitra , Wang Chong
Published: November 2018

200

Background: The management of cancer-related pain is challenging in the age of the opioid epidemic. Patients who struggle with substance misuse or chemical coping use these substances to dull emotional and or existential suffering. Buprenorphine is often used for cancer pain due to less reported euphoria when compared to other opioids. Methods: We conducted a retrospective review of patients in an outpatient palliative care clinic at a tertiary comprehensive cancer center who were prescribed buprenorphine for cancer pain. Total oral morphine equivalent (OME), as well as use of adjuvant non-opioid neuropathic pain medication, were assessed prior to transition to buprenorphine. Chemical coping behavior was defined as patients taking opioids for emotional pain in excess of the maximum prescribed amount. Pain scores were reported before and after buprenorphine administration using a Likert pain scale (0-10). Patients were also assessed for the presence of withdrawal symptoms after transition to buprenorphine. Results: Patients were predominantly female (75%), slightly more than half had a psychiatric diagnosis (56%), a majority were on non-opioid neuropathic pain medication (93%), and the majority were identified as chemical copers (75%). For all patients, the mean pain score prior to buprenorphine (pain pre) was 8.3 and the mean pain score on follow up post buprenorphine (pain post) was 6.1, with a reduction in mean pain score (pain change) of -2.0 (p = 0.059). Patients without chemical coping behaviors reported a significantly greater reduction in pain scores compared to patients with chemical coping (pain change -5.0 vs -1.3, p = 0.02). Illicit drug use and psychiatric co-morbidity were not associated with differences in reported pain scores. Only a small number of patients reported withdrawal symptoms (6%) during buprenorphine transition. Conclusions: Rotation to buprenorphine led to a trend of reduction in pain score, though not statistically significant. Patients without chemical coping experienced greater reductions in pain score than those with chemical coping behavior. Illicit drug use and psychiatric co-morbidity were not associated with differences in reported pain.
The rate and treatment outcome of thiamine deficiency in cancer patients diagnosed with delirium: A preliminary study.
Authors: Onishi Hideki , Ishida Mayumi , Uchida Nozomu , Sato Izumi , Takahashi Takao
Published: November 2018

205

Background: Vitamin B1 is essential for life, but cannot be synthesized in vivo and must be ingested from outside the body. Retention in the body is as short as 18 days, so that long-term appetite loss can easily lead to vitamin B1 deficiency, resulting in a condition known as Wernicke's encephalopathy (WE), which is characterized by disturbed consciousness, ataxia, and ocular movement disorders. Early detection and treatment with intravenous vitamin B1 usually results in recovery without sequelae, while a delay in detection can lead to severe brain damage (Korsakoff syndrome). The mortality rate is approximately 20%. Recent studies have shown that cancer patients may also experience thiamine deficiency and WE. WE is often overlooked as the typical symptoms are nonspecific, and some cases do not exhibit the disturbed consciousness characteristic of WE. Clinical awareness can be improved by confirming the actual rate and clarifying the associated symptoms, leading to more accurate WE diagnosis. Methods: We retrospectively examined the medical records for patients admitted to Saitama Medical University International Medical Center between 1 October 2014 and 31 May 2018 with cancer as the main disease who consulted the Psycho-oncology Department and were diagnosed with delirium by a psychiatrist. Patient background, medical treatment, neurological symptoms, blood biochemical findings, and disease course after vitamin B1 administration were examined. This study was approved by the IRB of this institution (Approval No. 18-080). Results: Eligibility criteria were met by 76 of 126 patients who received consultations during the study period, with 32 (43%) having a vitamin B1 deficiency. Vitamin B1 treatment led to a full recovery in 19 (59%) of these 32 patients. Conclusions: Our results show that the rate vitamin B1 deficiency in patients in this study was high, although >50% of the affected patients recovered with treatment. This indicated that it is necessary to pay close attention to vitamin B1 deficiency in cancer patients with psychiatric symptoms, and future study is planned to clarify the factors involved in the onset of vitamin B1 deficiency.
Pre- and post-comprehensive geriatric assessment in older patients with hematological malignancy before allogeneic stem cell transplantation.
Authors: Haggstrom Daniel Ernest , Figueroa-Sierra Marielys , Knight Thomas Gregory , Induru Raghava , DeRhodes Kim , Edeker Joanna , Cooper Markecia , Caprio Anthony
Published: November 2018

212

Background: Comprehensive geriatric assessment (CGA) is a multi-dimensional evaluation which influences medical decisions and predicts toxicity in older cancer patients. CGA pre-allogeneic stem cell transplant patients (ASCT) and repeated post-transplant provides information about treatment and helps to determine which parameters may predict ASCT outcomes. Methods: This was a prospective observational study evaluating 17 older patients with hematologic malignancy with CGA between December 9, 2016 and April 3, 2018 within the Levine Cancer Institute Senior Oncology Clinic. Included were validated measures across domains of cognition, disability, frailty, function and psychologic status. Repeat CGA was performed on surviving patients at least 99 days after ASCT (avg 122 days). Results: Median age was 66 (range 60-75) and the most common diagnosis was AML. There was no notable difference in pre and post-CGA physical and neurocognitive parameters for ASCT survivors (n=8). Within the deceased group (n=9) there was a longer TUG, lower patient-reported KPS, poorer psychological status, grip strength, and social support. Conclusions: There was no notable difference in the physical and neurocognitive CGA parameters before and after ASCT. Although the sample is small, there were notable trends toward lower patient-rated KPS compared to physician-rated KPS, poorer ADL function, slower TUG, and weaker grip strength in those patients who did not survive. CGA may identify older patients with hematologic malignancy who are at risk for worse outcomes post-ASCT.[Table: see text]
Discontinuation of adjuvant sunitinib due to adverse events in patients with high-risk renal cell carcinoma after nephrectomy: A combined analysis of phase III trials.
Authors: Ball Somedeb , Thein Kyaw Zin , Quirch Miguel , Adhikari Nimesh , D'Cunha Nicholas C. , Jones Catherine , Hardwicke Fred L. , Awasthi Sanjay , Tijani Lukman
Published: November 2018

215

Background: Dysregulation in the vascular endothelial growth factor (VEGF) pathway has been implicated in the pathogenesis of renal cell carcinoma (RCC). Sunitinib is an oral VEGF receptor tyrosine kinase inhibitor and has been approved in the adjuvant treatment of high-risk RCC. However, there are significant adverse events, impacting patients’ quality of life, and leading to treatment discontinuation. We performed a systematic review and meta-analysis of randomized controlled trials (RCT) to determine the risk of high-grade toxicities and the rate of treatment discontinuation due to adverse events. Methods: We conducted a comprehensive literature search using MEDLINE, EMBASE databases and meeting abstracts from inception through June 2018. Phase III RCTs which utilized adjuvant sunitinib in high risk RCC after nephrectomy and mentioned treatment interruption or discontinuation or dose reduction due to adverse events were included. Mantel-Haenszel (MH) method was used to calculate the estimated pooled risk ratio (RR) with 95% confidence interval (CI). Fixed effects model was applied. Results: Two phase III RCTs with a total of 1866 patients were eligible. Studies utilized sunitinib versus placebo. The randomization ratio was 1:1 in both ASSURE and S-TRAC studies. The incidence of high-grade adverse events was 568 (60.5%) in sunitinib group versus 183 (19.6%) in placebo arm, with the relative risk of 3.10 (95% CI: 2.69 – 15.93, P < 0.001). The reduction in dose was reported in 541 (57.9%) in study arm versus 86 (9.2%) in placebo group. The pooled RR for dose reduction was statistically significant at 6.28 (95% CI: 5.10 – 7.74, P < 0.001). The treatment discontinuation rate was 27.9% higher with sunitinib than with placebo (RR - 4.14; 95% CI: 3.31 – 5.16, P < 0.001). Conclusions: Our meta-analysis demonstrated that the rate of dose reduction, treatment discontinuation and the risk of grade 3 and 4 adverse events were notably high in sunitinib group. Timely recognition and proper supportive care are entailed in minimizing those adverse events which may ultimately improve patients’ quality of life and overall compliance.
The stability and variations in the reporting of the CAGE-AID screening questionnaire in cancer patients.
Authors: Edwards Tonya , Arthur Joseph Anthony , Joshi Neeraj , Kuriakose Leela , Joy Manju P , Dibaj Seyedeh , Zhukovsky Donna S.
Published: November 2018

224

Background: The CAGE-AID questionnaire (CA) is a 4-item patient reported validated screening tool has been used to assess risk of aberrant drug related behaviors in cancer patients receiving opioids. Consistency of responses to the CA between settings is lacking. We evaluated the frequency of CA positivity in each setting and change in score (+ or -) between the first inpatient supportive care consultation and the first outpatient follow up visit within 3 months. Methods: A retrospective chart review was conducted to ascertain CA scores and clinical and demographic characteristics of consecutive adult patients who were initially seen during inpatient consultation (T1) and had an outpatient follow up within 3 months (T2). CA positivity was defined as a score of ≥2 in males or ≥1 in females, with score at T2 considered the gold standard. Results: ±SD) was 122 mg (150) at T2. CA was completed for 87% of T1 patients and 94% at T2. Scores are noted below. Hispanics (23%) were more likely to be CA positive as compared with Caucasians (15%) and African Americans (11%), p= 0.02. Between T1 and T2, CA score changed from negative to positive in 4% and positive to negative in 1% of patients. The Kappa coefficient for agreement of CA between T1 and T2 was 0.74 (0.62, 0.86), p= 0.02. Conclusions: The rate of completion and consistency of patient responses to the CA was high irrespective of clinical setting. Between 10-13% of patients with advanced cancer are at increased risk for aberrant opioid use. Further studies are needed to evaluate the reasons for a change in CA scores between T1 to T2 in some patients so as not to miss those at higher risk for aberrant behaviors in need of additional monitoring and support. [Table: see text]
Spiritual pain and care needs of elderly cancer patients facing palliative chemotherapy decision-making: Qualitative study.
Authors: Tsuboi Rie , Sugishita Mihoko , Hirakawa Hirohisa , Ando Yuichi
Published: November 2018

25

Background: Although the number of elderly cancer patients who require chemotherapy has increased, few studies have investigated the process of palliative chemotherapy decision-making and care needs of elderly patients with advanced cancer. Methods: The study was conducted at Nagoya University Hospital in Japan from April to October 2017. Face-to-face interviews were conducted with patients over 70 with advanced cancer (n = 15, median age = 77 years, range 70 - 82) who made decisions of palliative chemotherapy initiation within 6 months. Patients’ families and physicians were also interviewed individually. Interview transcripts were qualitatively analyzed using a deductive-inductive approach. Results: Four main themes emerged: physician’s awareness of paternalism, training of communication about serious news, spiritual-care needs assessment, and support with the team. Both the patients and the physicians felt the necessity for physicians’ paternalism in patients’ decision-making. The physicians found treatment decision-making for elderly patients difficult because of the patients’ diversities. Patients had spiritual pains from the time of diagnosis and they continued throughout treatment periods. They fought the illness with the support of surroundings as a team. Conclusions: Paternalism was emphasized from both elderly patients and physicians in palliative chemotherapy decision-making. Improvement of the communication skills of physicians was needed. Patients had spiritual-care needs beginning with the early phase of the treatments and fought as a team with their supporters, including physicians against the cancer. Physicians should be aware of that and be actively involved in whole-patient care.
Stakeholders' perceptions and information needs regarding research medical donation (RMD).
Authors: Epstein Andrew S. , Shuk Elyse , Romano Danielle R. , Lynch Kathleen , Genoff Margaux , Khan Erva , Iacobuzio-Donahue Christine A , Hamilton Jada G.
Published: November 2018

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Background: Issues pertinent to serious illness are more prevalent in the current medical landscape of increasing technologic sophistication. RMD, the process of human tissue extraction within hours after death benefits cancer research but data are limited regarding barriers institutions face in accruing to RMD programs. Such data are needed due to the complex RMD process, such as communicating with patients (pts) and their proxies, and procuring tissue in a timely manner that also respects end-of-life care sensitivities. Methods: We explored perceived core needs and challenges of RMD by engaging stakeholders (cancer clinicians, pts, and their caregivers) in 8 teleconference focus groups from 2017-2018. Clinicians caring for pts with breast, pancreas, and lung cancers comprised 2 groups. Each cancer separately had 2 groups for pts and their caregivers. Each group lasted 90 minutes, was audio-recorded and transcribed. Research team members (2-3) recorded their observations about key themes from each transcript in an analysis template, with illustrative quotes supporting each theme. Following independent analysis, the coding team met to reach consensus on primary themes for that transcript. A consensus template describing the team’s views about themes from the transcript was generated. The team then met to establish agreement on the consensus templates and identify primary common and divergent themes across transcripts. Results: 45 people (13 clinicians, 24 pts, and 8 caregivers) participated in the groups. The themes identified were: 1) clinicians and pts generally had limited to no previous knowledge about RMD; 2) RMD was seen to mainly benefit research, not pts or families; 3) logistical and privacy questions and concerns arose; 4) introducing RMD was deemed sensitive and the timing patient-specific; 5) cancer type did not generally seem to impact RMD acceptability or participation. Conclusions: Patients, families, and cancer clinicians have generally low knowledge of RMD but upon learning about it, see it as a valuable program for scientific advancement, necessary to be carried out with individualized sensitivity to end-of-life issues, and through training programs with involved clinical staff.
The perspective of a breast cancer patient: A survey study assessing needs and expectations.
Authors: Sardar Muhammad , Shaikh Nasreen , Danish Mary , Sharon David Julius , Goldberg Dr. Shira
Published: November 2018

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Background: Patient satisfaction is one of the key indicators of health care quality. We aim to identify patients’ needs and expectations in a breast cancer clinic to provide a patient-centered care and better overall satisfaction. Methods: A 17-item survey was administered to 49 patients at a breast cancer clinic. The survey was designed after a thorough literature review and approved by an oncologist and a palliative care physician. Results: Self-reported knowledge about disease was reported adequate by 95.9% of our patients yet only 46.9% of our patients could identify the stage of their cancer. More education was desired by 39% of patients including various treatment options (35%), common complications (29%), prognosis (22%) and risk factors (14%). Cancer-related emotional stress and physical symptoms were reported by 53% of our patients. Social/professional life was affected by cancer in 49% of the patients. Majority of our patients (57%) wanted their oncologist to address social/emotional issues and 28% felt the need of more focus on physical symptoms in their subsequent visits. End-of-life care (EoLC) discussions were considered an integral component of overall care by 22% of our patients. Components of EoLC discussions that patients stated they could benefit from included prognosis (24.5%), life expectancy (24.5%), treatment effect on quality of life (20.4%), palliative care (10.2%), hospice (10.2%), advance directives (14.3%), and family involvement in medical decision-making (12.2%). More patients wanted to initiate EoLC discussions when they requested it (30.6%) or their oncologist thought it was appropriate (30.6%) as compared to when it may change treatment course (12.2%) or at diagnosis (8.2%). More patients wanted to have EoLC discussions only once (40.8%) as compared to at regular intervals (32.7%). Conclusions: A discrepancy between self-reported and actual knowledge in breast cancer patients emphasizes the need of patient education. Most patients rely on their oncologist for their diagnosis related emotional and social issues. Surprisingly, a quarter of our patients consider EoLC discussions important even though majority of our patients were healthy and having stage I disease.
Incorporating geriatric patient reported outcomes into novel screening tool of distress and supportive care concerns.
Authors: Gerhart James I , Gordon Ana , Roggenkamp Betty , Khosla Paramjeet , Trosman Julia Rachel , Martin Joanna , Scheu Amy , Wiebe Lauren Allison , Berardi Rosa , Chow Selina Lai-ming , Pasquinelli Mary , Feldman Lawrence Eric , Dale William , O'Mahony Sean , Mumby Patricia B. , Deamant Catherine , Weldon Christine B.
Published: November 2018

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Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. The Supportive Oncology Collaborative, collaborative of 100+ clinicians funded by The Coleman Foundation, developed a patient-centric screening tool (CSOC-ST) adapted from ASCO Distress, NCCN Distress Problem List, IOM report and CoC standards, and other validated sub-tools (Weldon, ASCO-Q 2017). The Collaborative then revised the CSOC-ST tool to align with geriatric guidelines. Methods: Literature and guidelines review of geriatric screening, added items to CSOC-ST, and piloted at 4 sites. Descriptive statistics and Fisher’s exact test used. Results: 473 patients screened with added geriatric relevant items to CSOC-ST: self-care concerns (PROMIS Instrumental Support), living alone (ASCO Distress 2014), and memory / cognition (PROMIS item bank). Treatment/care concern items were revised to identify health care power of attorney and advance directive interest. Geriatric related items endorsed by patients, see Table. PHQ4, Anxiety and Depression, average score 2.4 (mild > 3). Higher scores on the PHQ-4 were significantly associated with each of the following: self-care concerns, memory/cognition concerns and specific treatment/care concerns (p < .0001). Conclusions: Pilot results and comparison to geriatric guidelines identified important items to support geriatric patient reported outcomes screening. After pilot, added 3 items for falls/frailty. Eight sites implementing this CSOC-ST.[Table: see text]