bluuebunny/crossref_metadata_2025 huggingface dataset:
The efficacy of psycho-oncological intervention on anxiety and depression in gastrointestinal tumor patients.
Authors: Mangelsen Sophie , Kadur Nancy , Stuebs Patrick
Published: November 2018

160

Background: We aimed to investigate the degree of anxiety and depression associated with the physical consequences of gastrointestinal tumors in relation to the treatment situation. Methods: 104 patients undergoing chemotherapeutic treatment were included in the study. The efficacy of the interventions and the changes in the stress level were evaluated by using the Hospital Anxiety and Depression Scale. Additionally, three intervention groups in individual setting: Conversational, relaxation and psycho-educational. Results: We demonstrate that overall the gastrointestinal patients were psychologically strained by anxiety and depression before the start of psycho-oncological intervention (at the beginning of chemotherapy). MA_t1 = 6,61 ( mA_t1_curative = 6,55 ; mA_t1_palliative = 6,64); η 2 A_t1 = 0,667; MD_t1 = 6,68 ( mD_t1_curative = 6,28 ; mD_t1_palliative = 6,88). Palliative patients seemed to be more strained in descriptive terms than patients in curative treatment situation. We determined an increase in a clinically relevant cutoff of about 32 % (anxiety) to about 54 % (depressiveness) in both pre-post survey groups. Anxiety and depressiveness showed a declining trend towards the end of the intervention or chemotherapy, independent of the curative or palliative treatment situation. Differential effects in effectiveness on anxiety and depression levels were observed between the various interventions ( p > .05). A significant decrease in anxiety towards the end of chemotherapy was empirically evident only in patients in adjuvant treatment ( MA_t1 = 6.95; Mt2 = 4.97; p > .016), we did not observe any correlation with the interventions. In addition, a reduction in both anxiety and depressiveness was found in the relaxation group in patients in adjuvant treatment. Conclusions: Our data demonstrates the importance of relaxation and discussion intervention over a purely psycho-educative intervention. A particular strength of our study lies in its longitudinal design and in its focus on a group of patients with exclusively gastrointestinal tumors. Further studies are needed to optimize the therapeutic potential of relaxation and discussion intervention in gastrointestinal cancer.
Electronic distress screening for early symptom identification and management.
Authors: Meadors Patrick , Meadors Pamela , York Beth , Walsh Declan
Published: November 2018

170

Background: Sustainable comprehensive screenings for cancer-related symptoms and distress is a challenge for large multisite cancer centers. Technological solutions are necessary to compile patient-reported outcomes at institutions with high volumes across broad geographic regions. Interdisciplinary collaboration and leadership engagement is required to effectively screen for and manage symptoms. Once integrated, electronic distress screening (EDS) produces large symptom databases for management of cancer related symptoms, strategic programmatic growth, and research. Methods: System-wide (n=44 clinic locations) implementation of EDS at consultation visits and simulations occurred in phases between November 2016-Dec 2016. EDS content, clinical sensitivity thresholds, and referral processes were developed with input from Supportive Oncology Department. Automatic alerts via email based on clinical thresholds developed and various symptoms profiles used to aid referrals to supportive oncology resources. Information and Analytic services ensured clinical integration into the EMR, delineation by clinic site, and troubleshooting. Ongoing completion rate tracked and sent to all practice managers. Results: The network-wide EDS completion rate for January 2017-June 2018 is 69% (26,564 completed out of 38,435 eligible patient encounters). Mean completion time per patient was 8 minutes. 84% of clinic sites (n=37) screened >50% of eligible patients and 46% of clinics (n=20) screened >75%. Triggered referral rates were established for all supportive oncology sections (e.g. 60% of patients reported clinically significant distress and 18% indicated being at risk for malnutrition). All screening data available for ongoing analysis. Conclusions: EDS can be integrated as a solution for distress and cancer related symptoms in multisite cancer centers. Interdisciplinary collaboration is needed to ensure clinical relevance. Phased rollouts, structured education, and completion rate dashboards help establish leader buy-in and consistent symptom screening. Such symptom databases allow large cancer hospital networks to strategically allocate limited resources based on highest volume/acuity/symptom profiles.
Predictors of quality of life, symptoms of anxiety, and depression in Latino patients with cervical cancer.
Authors: Galindo Vazquez Oscar , Menes Mayra CU , Ortiz David , Meneses-Garcia Abelardo , Aguilar Jose Luis , Montalvo-Esquivel Gonzalo , Gómez Ángel Herrera , Caballero-Tinoco Rosario
Published: November 2018

171

Background: Cervical cancer is considered one of the most frequent cancers among women and with the greatest causes of death in the world. In Mexico it is considered the second cause of death. Objective: The identify predictors of quality-of-life, symptomatology of anxiety and depression in patients with cervical cancer. Methods: 192 patients with cervical cancer aged between 44 and 60 years were included, through interview and consultation of the clinical file, information on sociodemographic and clinical variables were obtained. Instrument: European Organization Scale for Cancer Research and Treatment and Quality of Life (EORTC QLC-C30) and Hospital Anxiety and Depression Scale (HADS). Statistical analysis: Chi square or Fisher´s exact test. The association of the variables was evaluated by logistic regression analysis. Results: 48% had poor quality of life, 24% with depression, and 29% with anxiety.The predictors of a low quality of life are: presenting one or more comorbidities, family history with cancer, presenting anxious, and depressive symptoms Conclusions: Psychological assumptions are predictors of variables such as quality of life, in a population with cervical cancer, in Mexico this group of patients have low educational and economic levels. Psychosocial care programs are required in this group of Latina women.
Addressing health disparities in survivors of breast cancer through lifestyle modifications and group support.
Authors: McDunn Susan H. , Olorunfemi Olatokunbo , Rogowski Wendy , Tahsin Bettina , James Venita , Giese Karen , Miranda- Ocasio Harry , Fogelfeld Leon
Published: November 2018

177

Background: Obesity and inactivity have been shown to adversely affect outcomes in survivors of breast cancer. These factors may contribute to poorer outcomes in women of black and Hispanic populations, and those from lower socioeconomic backgrounds. We sought to improve overall well-being and limit weight gain in patients from these underserved populations through a group lifestyle intervention in a public hospital setting. Methods: 46 women were recruited and gave informed consent after completion of adjuvant chemotherapy for stage I-III breast cancer to participate in this feasibility pilot program. Blood work, body measurements, diet, two-minute walk tests, and PHQ9 depression scores were collected at the first and last of six monthly sessions. The group classes were led by a registered dietician and included diet and light exercise instruction at each visit. Results: Patient demographics and results are in the table below. Trends for non-completers included younger age, ethnicity, no hormonal therapy, lower baseline weight, lower HOMA IR, and dropout after two sessions. Among the 40% who completed all six sessions, there was a trend toward greater well-being (lower PHQ) with slight weight gain and increased insulin resistance. Completers tended to start in the same cohort and were more likely to complete if they attended more than two visits. Conclusions: Greater well-being may be an important outcome for group lifestyle improvement programs in populations with disparities. Motivations for better attendance may include group bonding. Participants will continue to be followed to obtain information on long-term weight change and cancer recurrence.[Table: see text]
A systematic review of symptom experiences in survivors of colorectal cancer.
Authors: Han Claire J , Yang Gee-Su , Reding Kerryn , Syrjala Karen L
Published: November 2018

186

Background: Colorectal cancer (CRC) is the third most common cancer diagnosis in the US. With expanding survival rates, increasing numbers of CRC survivors live with long-term disease and treatment-side effects. There is limited research about symptom experiences from which to provide evidence-based symptom management guidelines for CRC survivors. This study systematically reviews published studies on symptoms in CRC survivors, with an aim to understand symptom experiences and with a broad goal of developing effective symptom interventions and improving CRC survivorship. Methods: A systematic search for relevant studies between the years 2005-2018 was conducted with Scopus, CINAHL, Medline via PubMed, Web of Science, EMBASE, Cochrane Library (CENTRAL), and PsycINFO. A systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Results: Of an initial 588 unique studies, 33 were identified for inclusion in the systematic review. The majority of studies were conducted in the UK or had a cross-sectional design. The European Organization for Research and Treatment of Cancer Quality of Life-C30 was the most frequently used instrument to assess symptoms. When we converted symptom severity scores and symptom occurrences among CRC survivors on a 0-100 scale, the most severe and frequently reported symptom across the 33 studies was fecal incontinence (mean severity: 50 points; mean occurrence: 52%), followed by fatigue (mean severity: 49 points; mean occurrence: 44%). Patients who reported lack of symptom management information, poor family and social supports, and presence of a stoma also reported more frequent and more severe symptoms. Symptom experiences were correlated with poor quality of life, low physical activity, daily life interferences, problems with sexual relationships, financial concerns, and negative body image. Conclusions: CRC survivors experienced a unique set of symptoms. Research is needed on symptom trajectories across the cancer continuum, strategies to incorporate family and other social supports for managing symptoms, and to enhance communication between oncologists, patients and caregivers that will support improved symptom control.
Incidence of skeletal-related events in men with castration-resistant prostate cancer.
Authors: Kawai Alison Tse , Martinez David , Saltus Catherine W. , Vassilev Zdravko , Soriano-Gabarro Montse , Kaye James A.
Published: November 2018

188

Background: Skeletal-related events (SREs) are common in men with bone metastases and have negative consequences for patients with castration-resistant prostate cancer (CRPC), including pain, reduced quality of life, and increased risk of death. Published data on background rates of SREs in men with CPRC in real-world practice are sparse. Methods: We included men aged ≥ 65 years in the SEER-Medicare database with a prostate cancer diagnosis in 2000-2011 if they had no prior malignancy, had surgical or medical castration, and met protocol-defined criteria for castration resistance. Castration resistance was inferred from subsequent treatment with any of these systemic therapies: abiraterone, cabazitaxel, docetaxel, enzalutamide, mitoxantrone, or sipuleucel-T. The first occurrence of an SRE was identified in Medicare claims using diagnosis or procedure codes for fracture, bone surgery, radiation therapy, or spinal cord compression. We estimated incidence rates (IRs) of SREs in all eligible person-time and stratified by person-time before and after any use of the following bone-targeted agents (BTAs): alendronate, denosumab, ibandronate, pamidronate, risedronate, or zoledronic acid. Results: Of 2,234 men with CRPC (84% white, mean age 76.6 years), 896 (40%) had an SRE during follow-up, with 74% occurring within a year after cohort entry. Overall, the IR of SREs was 3.78 (95% CI, 3.53-4.03) per 100 person-months. The IR of SREs before any BTA use was 4.16 (95% CI, 3.71-4.65) per 100 person-months, and after any use was 3.60 (95% CI, 3.32-3.91) per 100 person-months. Conclusions: In this large cohort of elderly men with CRPC in a real-world setting in the U.S., SREs were common, with most occurring within a year after cohort entry. Although a direct causal interpretation of the difference in rates before and after BTA use is not possible (since confounding by indication and other factors cannot be excluded), further analysis may address at least some potential confounders.
Symptom burden in hospitalized patients with curable and incurable cancers.
Authors: Waldman Lauren , Newcomb Richard , Nipp Ryan David , Hochberg Ephraim P. , Jackson Vicki , Greer Joseph , Ryan David P. , Temel Jennifer S. , El-Jawahri Areej
Published: November 2018

190

Background: Inpatient supportive care interventions are targeted to patients with advanced solid tumors due to perceived higher symptom burden. Yet, few studies have characterized symptom prevalence in hospitalized patients with curable cancers. We aimed to describe and compare symptom burden and palliative care utilization in hospitalized patients with curable and incurable cancers to determine the allocation of such supportive care resources. Methods: We conducted a single center study of 1549 patients (238 curable hematologic, 239 curable solid, 123 incurable hematologic, 949 incurable solid cancers) who experienced an unplanned hospitalization between 9/14 - 4/17. On admission, we assessed patients’ physical symptoms (Edmonton Symptom Assessment System) and psychological distress (Patient Health Questionnaire - 4 and Primary Care PTSD Screen). Results: The median number of moderate to severe symptoms reported by patients with curable hematologic, curable solid, incurable hematologic, and incurable solid cancers were 5 [3-6], 5 [3-7], 5 [4-6], and 6 [4-7], respectively. Most patients reported moderate to severe fatigue (83.6%, 82.9%, 81.3%, 86.9%). Table 1 depicts rates of psychological distress. In adjusted analyses patients with incurable solid cancers reported higher symptom burden (β = 7.6, p < 0.01), depression (β = 0.4, p = 0.01), and anxiety (β = 0.3, p = 0.03) symptoms, but no difference in PTSD symptoms. Among patients in top quartile of symptom burden, palliative care was consulted in 16.2%, 7.9%, 23.8%, and 49.6% (p < 0.01) of patients with curable hematologic, curable solid, incurable hematologic, and incurable solid cancers, respectively. Conclusions: Hospitalized patients with solid and hematologic cancers experience substantial physical and psychological symptoms regardless of the curability of their illness. Palliative care is rarely consulted for highly symptomatic patients with curable cancers. Inpatient supportive care interventions should target the needs of all highly symptomatic patients with cancer. [Table: see text]
Efficacy of intravenous (IV) NEPA, a fixed NK1/5-HT3 receptor antagonist combination, for prevention of emesis following highly emetogenic chemotherapy (HEC).
Authors: Roeland Eric , Gralla Richard J. , Zhang Li , Hesketh Paul Joseph , Schwartzberg Lee Steven
Published: November 2018

194

Background: An IV formulation of NEPA (fixed combination of fosnetupitant 235 mg and palonosetron 0.25 mg) was recently approved offering clinicians an additional antiemetic treatment option. Approval of IV NEPA was based on showing pharmacokinetic bioequivalence and comparable safety to oral NEPA. This post-hoc analysis presents the efficacy of IV NEPA relative to that of oral NEPA and other NK1 RAs in the HEC setting. Methods: Data is compiled from 3 pivotal NEPA registration studies in a total of 951 adult chemotherapy-naïve patients with solid tumors undergoing predominantly cisplatin-based HEC. All studies had similar inclusion/exclusion criteria. IV NEPA was administered as a single 30-min infusion and a single capsule of oral NEPA was given prior to HEC. All patients received dexamethasone (DEX) on Days 1-4. Data is also compiled from registration HEC trials on other NK1 RA (aprepitant, fosaprepitant, rolapitant) regimens. No emesis rates are summarized for the overall phase (0-120h) of the initial cycle of HEC for each study and also pooled for oral NEPA. No formal statistical comparisons were performed. Results: The overall no emesis rate was 84.2% for IV NEPA and 81.6% for oral NEPA for the pooled studies. The no emesis rates for aprepitant, fosaprepitant and rolapitant regimens ranged from 66.0% to 77.7%. Clinical trial information: NCT02517021. Conclusions: Both IV and oral formulations of NEPA represent effective and convenient single-dose prophylactic antiemetics targeting two distinct CINV pathways, offering comparable options for clinicians/patients in different settings.[Table: see text]
Fractional CO2 laser therapy for genitourinary syndrome of menopause (GSM) in survivors of breast cancer (BC).
Authors: Quick Allison M , Zvinovski Filadelfiya , Hudson Catherine , Hundley Andrew , Evans Cynthia , Suresh Anupama , Stephens Julie , Carpenter Kristen , Ramaswamy Bhuvaneswari , Reinbolt Raquel E. , Noonan Anne M. , VanDeusen Jeffrey Bryan , Wesolowski Robert , Stover Daniel G. , Williams Nicole Olivia , Sardesai Sagar D. , Smith Karen L. , Faubion Stephanie S. , Loprinzi Charles L. , Lustberg Maryam B.
Published: November 2018

202

Background: Fractional CO2 laser therapy is an emerging treatment for GSM. The objective of this study was to determine the feasibility, tolerability and preliminary efficacy of fractional CO2 laser therapy in BC survivors. Methods: This was a single arm feasibility study of BC survivors with dyspareunia and/or vaginal dryness. Participants received three treatments with office-based fractional CO2 laser on at least 30 day intervals and returned for a one-month follow-up. Feasibility was defined as treatment completion without serious adverse events (SAE) in a minimum of 80% of patients. Primary efficacy was evaluated using the mean change (∆) in the score on the Vaginal Assessment Scale (VAS). Secondary efficacy endpoints included mean ∆ in scores on the Female Sexual Function Index (FSFI) and Urogenital Distress Inventory (UDI). Descriptive statistics (means and 95% confidence intervals (CI) for continuous variables and proportions for categorical variables) were used. Results: The study is ongoing with 65 patients enrolled. To date, 37 patients have completed all study treatments and follow-up. Median age for those who have completed treatment was 57 years (range 34-72). Most were ER/PR positive (78%) and Her 2 negative (81%) with stage I (43%) or II (41%) BC. Ninety-five percent were receiving endocrine therapy, most commonly aromatase inhibitors (73%). No SAEs were reported in the 37 patients who have completed study treatments and their outcomes are as follows. Based on the VAS, 78% reported moderate-severe dyspareunia and 89% reported moderate-severe vaginal dryness at baseline. At follow up, 28% reported moderate-severe dyspareunia and 28% reported moderate-severe vaginal dryness. The VAS score improved from baseline to follow up (mean ∆ 4.1; 95% CI [3.1, 5.1]). Similarly, the FSFI score improved (mean ∆ -10.0; 95% CI [-13.2, -6.9]) and the UDI score improved (mean ∆ -5.7; 95% CI [-10.1, -1.3]). Final efficacy analysis will be reported once all patients have completed all time points. Conclusions: Fractional CO2 laser treatment is feasible and tolerable in BC survivors and may reduce symptom burden from GSM. A randomized controlled trial with sham laser is currently in development. Clinical trial information: NCT03307044.
Association of impairments in activities of daily living (ADLs) with symptom burden, health care utilization, and survival among hospitalized patients with advanced cancer.
Authors: Lage Daniel E , El-Jawahri Areej , Fuh Charn-Xin , Newcomb Richard , Jackson Vicki , Greer Joseph , Temel Jennifer S. , Nipp Ryan David
Published: November 2018

203

Background: Hospitalized patients with cancer often have impaired ADLs related to age, comorbidities, and both cancer and treatment-related morbidity. However, the relationship between ADL impairment and patients’ symptom burden and clinical outcomes has not been well described. Methods: We prospectively enrolled patients with advanced cancer with unplanned hospitalizations at an academic medical center. Upon admission, nurses assessed patients’ ADLs (mobility, feeding, bathing, dressing, and grooming). We used the Edmonton Symptom Assessment Scale (ESAS) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, comparing symptom burden between patients with and without ADL impairment. We used regression models adjusted for age, sex, education, Charlson comorbidity index, months since advanced cancer diagnosis, and cancer type to assess the relationship between any ADL impairment and hospital length of stay, the composite outcome of death or readmission within 90 days of discharge, and survival. Results: Among 932 patients, 40.2% had at least one ADL impairment. Patients with ADL impairment were older (67.2 vs. 60.8 years, p<0.001), had higher Charlson comorbidity index (1.1 vs. 0.7, p<0.001), and higher physical symptom burden (ESAS Physical 35.2 vs. 30.9, p<0.001). Those with ADL impairment were more likely to have moderate to severe constipation (46.7% vs. 36.0%, p<0.01), pain (74.9% vs. 63.1%, p<0.01), drowsiness (76.6% vs. 68.3%, p<0.01), as well as symptoms of depression (38.3% vs. 23.6%, p<0.01) and anxiety (35.9% vs. 22.4%, p<0.01). In adjusted models, ADL impairment was associated with longer hospital length of stay (B=1.30, p<0.01), higher odds of death or readmission within 90 days (odds ratio=2.26, p<0.01), and worse survival (hazard ratio=1.73, p<0.01). Conclusions: Hospitalized patients with advanced cancer who have ADL impairment experience a significantly higher symptom burden and worse health outcomes compared to those without ADL impairment. These findings highlight the need to assess and address ADL impairment among this population to enhance their quality of life and care.
Prediction of hospitalizations in patients with cancer age 70 and older receiving chemotherapy.
Authors: Voutsadakis Ioannis , Reed Melissa , Patrick Caitlyn , Quevillon Travis , Walde Natalie
Published: November 2018

216

Background: Chemotherapy is one of the main treatments for cancer and is associated in many cancers with significant benefits in overall and disease-free survival. Nevertheless, it is also associated with adverse effects that may lead to hospitalizations in older patients with comorbidities or decreased general status. We aimed to identify factors associated with hospital admissions in this population. Methods: Records of cancer patients 70 years-old or older who received adjuvant chemotherapy or first line chemotherapy for a cancer in a single center were retrospectively reviewed. Demographic, disease and treatment data were extracted. Factors associated with hospitalizations during chemotherapy treatment were evaluated in a univariate analysis with the x2 or the Fisher’s exact test. Factors identified were fitted in a multivariate regression model. Results: Among the 276 patients included in the study, 117 (42.4%) were male and 159 (57.6%) were female. Most patients (53.6%) were 70 to 75 years-old, but there were also significant proportions of patients that were 76 to 80 years-old and above age 80 (29.0% and 17.4% respectively). Chemotherapy was given in the adjuvant setting in 51.1% of patients and in the first line metastatic setting in 48.9% of patients. Treatment was with single chemotherapy drug in 22.8% of patients and poly-chemotherapy was given in 77.2% of patients. One hundred and six patients (38.4%) had a hospital admission during or up to a month after their chemotherapy treatment. Factors associated with admission in the multivariate analysis included ECOG PS > 1 (p = 0.04, odds ratio 1.4, 95% CI: 1.0-1.9) and hypoalbuminemia (p = 0.03, odds ratio 0.94, 95% CI: 0.88-0.99). Among the 174 patients that had a good PS (ECOG PS = 0 or 1) and normal albumin, only 28.7% had been hospitalized during treatment, while 62.3% of the 77 patients with PS of 2 or 3, hypoalbuminemia or both were hospitalized during or within the month after completion of treatment. Conclusions: Good ECOG PS in combination with a normal albumin is predictive of lower hospitalization rate in cancer patients 70 years-old and older receiving chemotherapy.
Symptom science research conducted in NCI community programs over the past decade.
Authors: St. Germain Diane C. , O'Mara Ann M.
Published: November 2018

220

Background: With the rising number of survivors across many cancer sites, increasing attention is being paid to assessing, preventing, and managing cancer and treatment related symptoms. This presentation will discuss the breadth of the symptom management portfolio within the community research programs funded by the NCI: The Community Clinical Oncology Program (CCOP) and the NCI Community Oncology Research Program (NCORP) from 2008 to 2018. Trends in types of symptoms and study designs will be described to identify research gaps. Methods: Symptom management research was operationally defined as any clinical study focusing on cancer and treatment related symptoms and/or related psychological, social and spiritual problems. The primary endpoint is measured by a patient reported outcome (PRO). Using this definition, a search was conducted of the NCI database to capture clinical studies implemented in the CCOP and NCORP networks from 2008 to 2018. Results: Between 2008 and 2018, 68 clinical studies were conducted in the NCI community research programs that met this definition. During this period of time, the most frequently studied symptom was neurotoxicities (n = 13), comprised of chemotherapy induced peripheral neuropathy (n = 3), neurocognition (n = 9) and ototoxicity (n = 1). Gastrointestinal symptoms (n = 10), pain (n = 9) and fatigue (6) were the following most frequent. The least studied symptoms included genitourinary symptoms (n = 1), vaginal health (n = 1), sexual desire (n = 1), psychosocial (n = 2) and lymphedema (n = 2). The predominant trial design was phase II or III randomized clinical trial with the remaining longitudinal, cohort design. Further delineation of these data will be presented. Conclusions: The prevalence of the symptoms studied within the NCI community programs mirrors the symptom literature in terms of frequency. Cancer survivors have reported a number of symptoms not adequately addressed by their clinicians such as sexual health and psychosocial issues. This gap also mirrors the frequency of research conducted in the community networks. Future research in the network focusing on these understudied areas should be considered by investigators.
Exercise counseling in integrative cancer care: Effects on patient self-reported symptoms and quality of life.
Authors: Lopez Gabriel , Eddy Carol A , Liu Wenli , Li Yisheng , Chen Minxing , Cohen Lorenzo
Published: November 2018

227

Background: Exercise has shown benefits for cancer prevention and contributes to improved treatment-related outcomes. We reviewed characteristics of cancer patients referred for physical therapist-led exercise counseling at a comprehensive cancer center and its effects on self-reported symptoms and quality of life. Methods: Patients presenting for outpatient exercise counseling from February 2016 to May 2017 completed the Edmonton Symptom Assessment Scale (ESAS; 0-10 scale, 10 most severe) pre/post-encounter and PROMIS10 global health assessment pre-encounter. ESAS individual items and subscales of Physical Distress (PHS), Psychological Distress (PSS), and Global Distress (GDS) were analyzed. We used paired t-tests to compare: (1) ESAS symptoms before and after each encounter and (2) ESAS and PROMIS10 scores at baseline and first follow-up. Results: Of 350 participants, most were female (77.7%), white (66.3%), and had breast (43%) cancer; 31% had at least one follow-up visit with the physical therapist. Symptom scores at baseline (frequency; mean) included poor sleep (68.2%; 3.5), poor well-being (67.4%; 3.2), and fatigue (64.7%; 3.1). Examination of pre- to post-exercise counseling outcomes revealed statistically, and clinically significant improvement in GDS (-3.32, SD 6.52, p<0.001). On follow-up, statistically and clinically significant improvements were observed for ESAS measures of fatigue (-1.22, p=0.01), GDS (-4.81, p=0.01), and PHS (-3.1, p=0.03) and PROMIS10 global health, mental health, and physical health scores (all p’s<0.05). Conclusions: Patients presenting for exercise counseling had a low to moderate symptom burden and experienced significant improvement in global distress after one encounter. Longitudinal evaluation revealed improvement in global health and fatigue. Additional research is needed to learn more about patient selection and timing of exercise counseling interventions.
Voice of cancer patients (VoCP): Patient perceptions regarding use of marijuana and its derivatives in cancer.
Authors: Aggarwal Sangeeta , Bhowmick Jyoti , Sharma Rishi , Singh Manish , Gond Rahul Kumar , Dash Isa , Aggarwal Alok
Published: November 2018

228

Background: Despite legal controversies, medical Marijuana use is increasingly accepted for mitigating side effects from chemotherapy in cancer patients. In this study we analyzed cancer patient perception and experience on the use of Marijuana and its derivatives. Methods: We collected 15.7 million freely shared messages from cancer patients from 52 unrestricted web forums. Using our VoCP platform based on techniques artificial intelligence, we processed unstructured text and analyzed these messages to extract relevant information and experiences on the use of Marijuana and its derivatives. Results: Of 15.7 million messages, 27,510 messages from 11,244 distinct users discussed Marijuana and cancer. 2,770 users had firsthand experience and shared 5,251 messages. Overall, 876 users (1,150 messages) were satisfied, 319 users (332 messages) were dissatisfied, and the remaining 1,575 did not say. Common reasons for use of Marijuana included nausea (526), insomnia (526), appetite (165), pain (122), weight loss (102), fatigue (57), anxiety (60), gastroparesis (27), and neuropathy (11). Questions asked by patients were related to people’s experience with marijuana, availability, preparations, efficacy, legality views, and side effects. Common cancer types where marijuana use was discussed were breast (3745), lung (1,476), colorectal (675), head and neck (405), pancreatic (239), stomach/esophagus (485), lymphoma (512), CNS tumors (499), and unspecified type (1,869). Methods of use discussed by ,1338 users and included smoking (875), oils (368), tincture (31), capsules (11), and other edibles (41). Source of obtaining marijuana mentioned as legal organization / licensed practitioner (254), online (34), friends and family (33), and growing ( 34). 1,111 messages discussed availability of marijuana. 2,912 messages discussed legal issues concerning Marijuana. 1,737 said that it is legal in their states and 1,179 said that it is illegal. Conclusions: Marijuana and its derivatives are increasingly being used by cancer patient to mitigate cancer and treatment-related side effects, and the use is increasing as recreational use of marijuana is being legalized in more states.
Prognostic awareness and illness understanding in patients with malignant glioma and their caregivers.
Authors: Landay Sophia , Anand Maya V. , Quain Katharine M. , El-Jawahri Areej , Greer Joseph , Temel Jennifer S. , Forst Deborah Anne
Published: November 2018

33

Background: Malignant gliomas (MG) are rapidly progressive, incurable tumors. Patients with glioblastoma, the most common MG, have a median survival of approximately 14 months when treated aggressively. Despite this poor prognosis, data is lacking on patients’ and caregivers’ (CGs’) understanding of patients’ prognosis and treatment goals and their communication preferences. We assessed prognostic awareness (PA) in patients with MG and their CGs three months following diagnosis. Methods: We conducted a prospective study in patients with newly diagnosed MG and their CGs. At three months post-diagnosis, we administered to patients and CGs the Prognosis and Treatment Perceptions Questionnaire, which assesses illness understanding, goals of treatment, and likelihood of cure. Results: At three months after diagnosis, 82.9% (68/82) of patients and 81.3% (52/64) of CGs reported that knowing prognosis is “extremely” or “very” important, yet only 42.6% (35/82) of patients and 60.9% (39/64) of CGs reported accurate PA, defined as responses of “unlikely,” “very unlikely,” or “no” chance of cure. 46.3% (38/82) of patients and 46.9% (30/64) of CGs reported that their oncologist’s primary goal was to “extend life as long as possible,” while 25.6% (21/82) of patients and 10.9% (7/64) of CGs stated that their oncologist’s goal was to cure their cancer. Patients’ primary goal was most frequently “to cure my cancer” [40.2% (33/82)], while CGs most often presumed that their loved ones’ treatment goal was to “extend life as long as possible” [43.8% (28/64)]. Conclusions: Patients with MG and their CGs report that PA is important, but most patients, and to a lesser degree their CGs, have inaccurate PA. Additionally, patients’ treatment goals differ from CGs’ perceptions of patients’ goals and oncologists’ presumed goals. Patients’ primary goal is often curative, while CGs frequently presume that their loved one’s goal is to prolong life without aiming for cure. Patients and CGs most often presume that their oncologists are primarily aiming to extend survival rather than cure their disease. Further investigation of interventions to improve conversations about prognosis among patients with MG, their CGs and their oncologists is warranted.
Physician attire and palliative care patients’ perception of physician compassion and professionalism: A randomized controlled trial (RCT).
Authors: Azhar Ahsan , Tanco Kimberson Cochien , Haider Ali , Cantu Hilda P. , Hernandez Carolina Diaz , Rantanen Petra A , Park Minjeong , Liu Diane D. , Williams Janet L. , Bruera Eduardo
Published: November 2018

39

Background: Environment is important component of communication skills. Physicians’ communication style including attire may influence patient perceptions. Previous studies mostly based on pictures of providers in different attires provide conflicting evidence. This RCT aimed to explore the effects of physician attire on patients’ perceptions of compassion, professionalism and physician preference. Hypothesis was that patients will perceive the doctor in formal attire as more compassionate than the doctor wearing casual attire. Methods: 105 English speaking adult follow-ups at outpatient supportive care center, were randomized to watch 2 standardized, 3-minute video vignettes, with similar script, depicting a routine clinic encounter. In one video, physician was wearing formal attire with tie and buttoned up white coat, while in the other, physician was in casual attire without a tie or white coat. Actors and patients were all blinded to purpose of the study. Investigators were blinded to the videos watched by patients. After viewing each video, patients completed validated questionnaires rating their perception of physician compassion (0 = best, 50 = worst) and professionalism (5 = poor, 25 = very good). Patients were also asked to rate their preference for the physician. Results: There were no significant differences between formal and casual attire for compassion [median (IQR), 25 (10, 31) vs 20 (8, 27); P = 0.31] and professionalism, [17 (13, 21) vs 18 (14, 22); P = 0.42]. 32 (30%) patients preferred formal, 33 (31%) preferred casual attire and 40 (38 %) patients had no preference. Subgroup analysis did not show significant differences among age, sex, marital status and education level for compassion, professionalism and physician preference. Conclusions: Doctor’s attire did not have an effect on patients’ perception of physicians’ level of compassion and professionalism. Dress code also did not influence the patients’ preference for their doctor or their trust and confidence in the doctor’s ability to provide care. There is need for more RCTs in area of communication skills specifically to better understand the impact of different attires on patient perceptions. Clinical trial information: NCT03168763.
Mindfulness training to support advance care planning: Qualitative findings from a randomized pilot.
Authors: Johns Shelley A. , Cottingham Ann H. , Gowan Tayler , Talib Tasneem L. , Stutz Patrick V. , Faidley Micah T. , Maiko Saneta M.
Published: November 2018

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Background: Emotional discomfort talking about end of life (EOL) often inhibits advance care planning (ACP). Mindfulness meditation facilitates emotional regulation through present-centered awareness and non-reactive coping and may help adults with cancer and their family caregivers (CGs) approach ACP with greater ease. As part of a randomized pilot study of a mindfulness intervention, we conducted qualitative interviews with cancer patients and their CGs to explore participants’ perceptions of the effects of mindfulness on EOL discussions and ACP. Methods: Adults with advanced solid malignancies and an estimated prognosis of < 12 months were randomized with their CG (N = 55 dyads) to receive standard care alone or standard care plus a 6-session mindfulness intervention that included guided mindfulness meditation, mindful communication practices, and ACP information. A subset of mindfulness patients (n = 20) and CGs (n = 15) completed semi-structured qualitative interviews post-intervention that were recorded, transcribed, and coded using a deductive approach. Results: Researchers identified three primary themes. For patients and CGs, the mindfulness intervention: (1) enhanced awareness and discussion of ACP; (2) increased acceptance of poor prognosis; and (3) fostered supportive communication. Consistent with these themes, patients noted that the intervention enabled them to begin to accept that cure may not be possible, helped them “get over the hurdle” of talking about EOL, and provided an opportunity to reflect on their life priorities, including goals of care. CGs reported that the intervention fostered ACP conversations that had been previously avoided, enhanced understanding of patient preferences that often differed from their own, and increased ability to accept realities of the patient’s illness. Patients and CGs both reported improved understanding of the need to plan for EOL, greater openness to discussing sensitive issues, and an enhanced ability to listen more deeply and communicate with greater kindness. Conclusions: Findings support the use of mindfulness training to equip patients and CGs for timely EOL discussions and ACP. Clinical trial information: NCT03257007.
Cellular phone-based application as a tool in pediatric palliative care.
Authors: Ah Chu SÃ¡nchez MarÃa Sabina
Published: November 2018

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Background: Free cross-platform instant messaging is a popular way of communicating in Panama. Is it possible to apply this in Palliative Care (PC)? Methods: This is a descriptive transversal study of some problems we could solve internally with the help of this cell phone-based application. The universe is the total of consultations of the PC Pediatric Support Team in Panamá Children’s Hospital to the National Program of PC from May 2016 to July 2018. First, we developed a chat group, so all 55 members of the national palliative program can share specific information related to PC topics. We describe the most common problems that we can solve with the help of instant messaging technology such as: 1. Presentation of cases at the time of their going-back home from the hospital-team to the community-team. 2. Presentation of urgent cases to the National Aero-Naval Force to be transported by boat or plane. 3. Education of mothers on specific problems they have at home. Results: We had 113 consultations in pediatric palliative care group. Of those, 78% had to be presented to the community-health-care-center (88 cases). The time-of-response was in the range of 5-120 minutes. We had to arrange sanitary transportation by boat or plane in 14% of the cases. Of those cases we obtained a response by the Aero-Naval force in less than 24 hours. We solved specific palliative symptom problems such as: fever, administration of the rescue dose, mucositis, and coping problems in some patients that lived more than two hours from the nearest health-center. For this we used educational videos made for this purpose. Conclusions: Instant messaging technology is used for the provision of palliative care communication, safety transportation and clinical problem solving. It had to be used in conditions that protect the privacy of patients and families. This current study suggest that this is a new opportunity that must be considered for its efficiency in solving specific problems.
Subcutaneous administration at home for symptom management in palliative care.
Authors: Rodriguez Luisa Fernanda , Consuegra Pareja Cesar Antonio , Bastidas Alirio , Leon Marta Ximena , Umbacia Alejandra , Garcia Andrea , Moreno Juan Pablo , Bruera Eduardo
Published: November 2018

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Background: Patients who require home-based palliative care have advanced complex illnesses with functional limitations and decline. Subcutaneous administration of drugs and hydration is a possible alternative when oral intake is hampered. This observational study characterized the use of subcutaneous catheters at a home based palliative care program in Bogotá, Colombia. Methods: Consecutive medical records from September 1, 2017 to February 28, 2018 were reviewed for 272 patients at a home based palliative care program who received subcutaneous administration of drugs and/ or hydration. Statistical analysis was performed to describe the characteristics of the population and its relation to the use of subcutaneous catheters using SPSS tool. Results: The mean age was 72 years (SD: 18), 163 (60%) were females, with a mean in Barthel Index 20 (SD:22), Karnofsky Performance Status Scale 36 (SD: 9.6), PPS of 36 (SD: 11), and PPI 6 (SD: 3.4). The mean time for subcutaneous use was of 34 days (SD: 52). The main indication for the subcutaneous route was poor symptom control in 162 (60%), and because of reduced oral intake in 107 (39%). The administration of drugs was done by a family member in 207 (76%), all trained by a nurse (spouse 14%, offspring 52%, others 34%). The mean number of drugs used per catheter was 3,7 (SD: 1,7). The most common opioid was hydromorphone (57%) followed by morphine (35%). Other medications used were haloperidol (59%) and midazolam (23%). The most common site of application was the upper right extremity. The change of the catheter due to dysfunction was made in 98 (36%) subjects, due to infection in 9 (3.3%) of the 272 patients and 1.5% of 594 catheter insertions. An association with catheter dysfunction was found after multivariate analysis of the time of catheter use and the number of medications. 240 patients (88.2%) died with the catheter in place. Conclusions: Subcutaneous administration of hydration and drugs when used with proper education, training, and followed up by home care programs is a useful strategy for delivering care at home for optimal symptom control for patients receiving palliative care.
The impact of emergency general surgery on end-of-life care among older patients with metastatic cancer.
Authors: Lee Katherine C , Lilley Elizabeth J. , Sturgeon Daniel , Lipsitz Stuart R. , Havens Joaquim M , Roeland Eric , Cooper Zara
Published: November 2018

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Background: Despite high post-discharge mortality among older patients with metastatic cancer who undergo emergency general surgery (EGS), little is known about the impact of EGS on the type of end-of-life care received. We sought to examine the association between EGS and established markers of high intensity or poor quality end-of-life care for cancer patients. Methods: This retrospective cohort study used 2001-2013 Surveillance, Epidemiology, and End Results-Medicare to identify beneficiaries 65 years or older, diagnosed initially with stage IV cancer (lung, colorectal, breast, ovarian, pancreatic, or melanoma), who received one of the seven highest-burden EGS operations, and died within 180 days of surgery. Non-EGS controls were exact-matched by age, sex, race, cancer type, and cancer diagnosis date then assigned a pseudo-exposure date corresponding to the EGS date. Conditional logistic regression adjusting for region and Charlson score was performed among pairs discharged alive to compare location of death (facility or home/hospice), healthcare utilization (hospitalization, intensive care unit (ICU) stay, emergency department (ED) visit) in the last 30 days of life, and hospice use (death in hospice, hospice enrollment less than three days from death). Results: Among 1,129 matched pairs, EGS patients had higher odds of death in facility (OR [95% CI]: 1.29 [1.05 - 1.58]) as well as hospitalization (1.83 [1.54 - 2.18]), ICU stay (2.05 [1.66 - 2.53]) or ED visit (1.76 [1.47 - 2.10]) in the last 30 days of life compared to non-EGS patients. EGS patients had higher odds of dying in hospice (1.22 [1.02 - 1.45]), but also experienced higher odds of hospice enrollment less than three days from death (1.72 [1.20 - 2.46]). Conclusions: Older patients with metastatic cancer who survive EGS experienced higher intensity end-of-life care than similar non-EGS patients. Such EGS patients may benefit from targeted interventions during the emergent hospitalization to improve the end-of-life care received.
When is the best time to transfer terminally ill cancer patients from hospitals to palliative hospice home care? Analysis of a questionnaire survey of 1,055 surviving families.
Authors: Nakajima Maria Michiko , Nakajima Shuhei James , Horikoshi Noboru , Isogawa Akihiro , Kondo Yurin , Nakajima Go , Takeshita Nobuhiro , Kawakami Kazuyuki , Suga Shigehiro , Nakajima Michiko , Hayashi Kazuhiko
Published: November 2018

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Background: It is difficult to know when the best timing is to transfer terminally ill cancer patients from hospitals to palliative hospice home care for their quality of life to death. This study aimed to articulate the best time for medical teams working in hospitals to refer their terminally ill cancer patients to palliative home care. Methods: A statistical analysis of a survey was conducted with 1,055 surviving families whose members had died with palliative home care from 1995 to 2014. The questionnaire included the following 8 contents: 1. transfer timing from hospitalization to the home care; A. appropriate, B. too late, C. too early; and the contextual items ware, 2. peacefulness of patient at dying, 3. peacefulness of patient all through the care, 4. physical pain, 5. mental pain, 6. spiritual pain, 7. alleviation of family sufferings, 8. satisfaction of family as care-givers. The response rate is 31% (311 persons). However, we excluded responses without names on the questionnaire, of non-cancer patients, with death location out of home, and without answer to question 1, resulting in 166 responses for analysis. Results: Focusing on the question 1, number of responders are A; 113 (68%), B; 52 (31%), C; 1 (0.6%). The medians of home care days to death are A; 66, B; 23, C; analysis impossible. Comparison of respondents’ satisfaction according to number of days of palliative home care revealed that 89.4% people with two months or more before their patients’ death were satisfied (A), while 10.6% of those who had less than two month were unsatisfied (B+C). Conclusions: Most surviving families were satisfied if they had two months or more for palliative home care. This survey suggests the relevancy to start preparation for discharge that enables the patients to stay home with their family members for two months or more. [Table: see text]