bluuebunny/crossref_metadata_2025 huggingface dataset:
Integration of supportive care in immuno-oncology trials: Investigating the incidence and severity of immune-related toxicities among older adults versus mid-age patients on immunotherapy-based phase I clinical trials.
Authors: Subbiah Ishwaria Mohan , Hess Kenneth R. , Fujii Takeo , Lui Anna , Subbiah Vivek , Naing Aung , Hong David S.
Published: November 2017

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Background: Older adults (65y+) with cancer are underrepresented in trials of novel drugs notably in phase I clinical trials with immunotherapies. The trepidation over immune-related toxicities in the context of older age and associated comorbidities may function as a barrier to participation. To that end, we investigated the enrollment and incidence of immune related adverse events of older adults enrolled in phase 1 immunotherapy trials. Methods: We identified 422 consecutive pts w advanced cancer treated on immunotherapy-based phase I trials bw 04/2009-09/2015, and collected pt/disease characteristics and immune-related adverse events (irAE) such as endocrinopathies, diarrhea/colitis, pneumonitis, constitutional (fatigue, fever, anorexia), myalgia, and dermatitis. Results: Older adults comprised 27% of trial participants (116 of 422 pts, median age 70y) while 256 pts were mid age (61%, median 56y). Most common cancers were GI (n = 108, 26%), thoracic/head/neck (n = 84, 20%), GU (n = 54, 13%), and GYN (n = 47, 11%). Median PFS was comparable among older pts (2.4m) and mid age (2.1m). Older adults had a higher incidence of irAE than mid age (low grade [G1/2] 49% vs 34%, p 0.02; high grade [G3/4] 19% vs 11%. p 0.14). The odds ratio of high grade events among older adults vs mid age pts was 1.81 (95% CI 1.01, 3.24; p 0.05) and low grade events was 1.85 (95% CI 1.20, 2.85; p 0.0055). Most common G1/2 irAE among all patients was fatigue (n = 76, 18%), dermatitis (n = 59, 14%), fever (n = 29, 7%) and anorexia (n = 28, 7%) with older adults having a greater incidence of low grade fatigue (25% vs 15%, OR 1.84, 95% CI 1.09, 3.10, p 0.025). Conclusions: Older adult participation remained under 30% for immunotherapy-based phase I trials. This early analysis suggests a higher incidence of toxicities among older adults, which calls for the urgent integration of comprehensive supportive care strategy to guide seniors through therapy. This work lays the foundation for future studies investigating the early involvement of supportive care through treatment on early phase clinical trials with immunotherapeutic agents.
Defining the elements of early palliative care (PC) that are associated with patient-reported outcomes (PROs) and the delivery of end-of-life (EOL) care.
Authors: Hoerger Michael , Temel Jennifer S. , Jackson Vicki , Park Elyse , Pirl William F. , El-Jawahri Areej , Gallagher Emily R. , Hagan Teresa , Jacobsen Juliet , Perry Laura , Greer Joseph
Published: November 2017

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Background: Early PC integrated with oncology care improves quality of life, mood and the delivery of EOL care among patients with advanced cancer, but little is known about which elements of PC practice are associated with such outcomes. The goals of this study were to describe the key elements of early PC across the illness trajectory and examine whether variation in visit content was associated with changes in PROs and the delivery of EOL care. Methods: The study cohort included patients with incurable lung or non-colorectal gastrointestinal cancer who were randomized to early PC integrated with oncology care (n = 171). Patients completed measures of quality of life (Functional Assessment of Cancer Therapy-General, FACT-G) and mood (Hospital Anxiety and Depression Scale, HADS; Patient Health Questionnaire–9, PHQ-9) at baseline and 24 weeks. PC clinicians completed electronic post-visit surveys documenting PC visit content. Data on EOL care were abstracted from electronic health records. We examined variation in visit content over time and used linear and logistic regression to identify whether the percentage of visits emphasizing a given content area was associated with PROs and EOL care. Results: We analyzed 2,921 PC visits, most of which focused on coping (64.2%) and symptom management (74.5%). By 24 weeks, patients who had a higher percentage of visits focused on coping experienced improved quality of life (p = .02) and depression (HADS: p = .002; PHQ-9: p = .005). Having a higher percentage of visits focused on treatment decisions was associated with a reduced odds of new chemotherapy (p = .02), hospitalization (p = .001), and ED admission (p = .04) in the 60 days prior to death. Focusing on advance care planning was associated with an increased odds of receiving hospice care (p = .01) and dying at home (p = .03). Conclusions: PC clinicians’ attention to coping is associated with improvements in PROs, and the focus on treatment decisions and advanced care planning is associated with higher quality EOL care. This study defines the key elements of early PC for patients with advanced cancer and furthers the development and dissemination of this integrated model of care. Clinical trial information: NCT01401907.
Evaluation of family perceptions of palliative medicine department family meetings: Before, during, and after.
Authors: Cartin Andrea , Ocampo Sonia , Méndez Adriana , Murillo Yandali , Zeledón Daniela , Campos Rodbin , Rebolledo María Luisa , Hincapie Tatiana , Houed Julia , Vasquéz Alberth , Williams Marco Vinicio ,   Administración del Hospital México
Published: November 2017

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Background: A Palliative Medicine Department (PMD) began in March of 2011 at a national hospital in Costa Rica. Treatment has focused on patient care, and attending the needs of the patients’ family; therefore, an integral approach to the family unit has been performed by a program of Family Meetings(FM). The program has allowed the families of Hematooncological disease patients to be involved in advanced care planning, and defining primary goals of treatment, while receiving information and psychological support. This study reports the families´ perception of the PMD FM before and after the meeting; and the evaluation of the family by the Palliative Care team, during the meeting. Methods: Information was gathered between of April and July of 2015 using a set of three questionnaires - one before, one during and one after - the meetings in the PMD. The information included population characteristics, the family’s feelings and concerns, and their level of satisfaction of their doubts being addressed and answered. Also, information was obtained concerning the agreed upon care plan and the diagnosis of the family established by the team. Results: A total of 47 family members ware included the study. Before, the interviewees most commonly referred feeling anxious (67.4%), sad (19%) and powerless (14%); the information they wanted to obtain was associated with the evolution and prognosis of the disease, and the best moment to initiate hospice care. Afterwards, families referred feeling anxious (35%), sad (34%) and powerless (31%). The most common family diagnosis was anticipatory grief (59%), and an adequate support network was identified in 38.5% of families. The agreed upon care plan mainly included education of coping and communication methods with the patient, patient homecare education, and immediate referral to hospice care. Conclusions: This study concluded that despite an increase in feelings of sadness and powerlessness, families reported a decrease in anxiousness; this was associated with families’ reporting that their doubts were addressed and answered in 97.9% of cases. Also, the set of questionnaires used during the Family meetings are a useful tool for patients’ family evaluation and diagnosis.
Propensity score matched analysis of a palliative radiation oncology consult service’s impact on length of stay and total costs during hospitalization.
Authors: Chang Sanders , May Peter , Goldstein Nathan , Ricks Doran , Rosenzweig Kenneth , Dharmarajan Kavita Vyas
Published: November 2017

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Background: The Palliative Radiation Oncology Consult Service (PROC) was a clinical service model developed in 2013 at Mount Sinai Hospital to provide individualized, goal-directed treatment to advanced cancer patients requiring palliative radiation therapy (PRT). We assessed its impact on length of stay (LOS) and total costs incurred during a hospitalization among patients who underwent PRT for symptomatic bone metastases while in the hospital. Methods: In our observational cohort study, we identified patients who underwent their first PRT course for bone metastases during a hospitalization between 2/2010 and 12/2016. Total costs (direct and indirect costs) during the hospitalization were extracted from the institution’s cost accounting system. Propensity score matching (PSM) was performed against age, Charlson comorbidity index (CCI), gender, race, primary cancer, and health insurance status. Balance across groups was verified by standardized differences before and after PSM. Average treatment effects (ATE) of hospital costs and LOS were calculated from generalized linear models with a γ distribution and log link adjusted by propensity score weights. PRT patients treated before 2013 (before PROC was established) were compared to those treated after 2013 (after PROC was established). Results: In total, 181 patients were included, with 76 treated before and 105 treated after PROC. Before propensity score matching, patients treated prior to PROC’s establishment had a median total hospital cost of $72,787 (range, $5,981-$324,652) and a median LOS of 28 days (range, 2-105); whereas patients treated after PROC had a median total hospital cost of $49,950 ($7,585-$620,943) and a median LOS of 19 days (2-139). After matching, patients had an ATE of -$16,877 total hospital cost (95% CI [-33,250,-504], p = 0.043) and -8.5 days in LOS (95% CI [-13.9,-3.2], p = 0.002). Conclusions: PROC, a clinical service model that integrated principles of palliative care practice within radiation delivery, led to substantial cost-savings and shorter lengths of stay for advanced cancer patients requiring PRT for bone metastases during a hospitalization.
Treatment, logistical, and cost burden of prior authorization in community practice.
Authors: Bulbul Ajaz , Huber Matney , Rashad Sadaf , Mino Emilio Araujo , Bautista Adrianna , Salcido Paula , Marquez Jowana , Khorsand-Sahbaie Masoud
Published: November 2017

164

Background: Prior authorization (PA) process is complicated and labor intensive and with limited resources available to community practices, significant opportunity to reduce the costs of therapy exists by transforming this decision support process while being compliant with guidelines Methods: We retrospectively evaluated 123 patients between November 2016 and June 2016 across our three rural oncology practices with no dedicated in-house pharmacy. An established PA workflow involved two physicians, 1 nursing staff and 2 clerical staff involved in the process to manage PA for high cost imaging (PET/CT/MRI) or after a high-risk/cost prescription was initiated by a medical provider to a local pharmacy, specialty or mail-order pharmacy. Two Physicians determined strength of concordance with National Comprehensive Cancer Network (NCCN) guidelines. We examined approval rates, method of communications, time to approval and whether these variables were associated treatment delay and insurance provider Results: Eight decision steps were necessary to obtain a PA. Forty-nine Medicare (39%), 21 managed Medicaid (17%), 29 commercial insurance (23.5%) and 14 commercial insurances (11%) required PA mostly for targeted therapy (29%), oral chemotherapy (28%), PET/CT (24%). Approval rate was 94.3% on first attempt with only 1.6% being denied after an appeal process. 89% concordance with NCCN guidelines was seen. Median time to start treatment was 4 working days (Mean 4.7; Range 0-18 days). PA requests were associated with greatest delay in approval time with managed Medicaid (7 v 1.51 days; p < 0.0001) compared to Medicare, when specialty pharmacy was used (5.2 v 2.3 days p < 0.03) and when fax was used versus online (4.1 v 2.3 days p < 0.02). Conclusions: The impact of the PA process on care delivery and cost reduction are not clear. Current process is particularly burdensome on small practices especially given the high approval rates. Significant opportunity exists to reduce the inefficiency of this system using a computer algorithm-based PA using real-time online decision support system using NCCN guideline concordance
Could payer mix affect length of stay or readmissions among an outpatient palliative care cohort?
Authors: Zarrabi Ali John , Armstrong Karen , Curseen Kimberly A. , Quest Tammie E.
Published: November 2017

165

Background: Outpatient palliative care clinics (PCC) are a developing frontier of palliative medicine. Characterizing and promoting financially viable models for payment of services are imperative to the sustainability of PCC. There is a paucity of research addressing payer mix – meaning the breakdown of individuals and organizations that pay for a provider's services – in PCC or its impact on metrics important to quality in PC such as hospital length of stay (LOS) and hospital readmissions. We seek to describe the payer mix for our academic outpatient PC practice. Furthermore, we sought to identify if payer mix (commercial, government—Medicare, Medicaid – or self-pay) influenced hospital LOS, discharge to hospice, or readmissions. Methods: After obtaining IRB approval, we conducted a retrospective chart review of supportive oncology patients from 2014-2017 (n = 3137) using data restricted to ICD10 codes for solid tumors. We performed bivariate tests and multivariable logistic regressions to examine the main effects of length of stay (LOS), readmissions, insurance status, and discharge disposition using SAS version 9.4 (Cary, NC). Results: Payer mix included 711 (24%) commercial insurance enrollees, 2357 (75%) Medicare or Medicaid recipients, and 38 (1%) self-pay. Mean LOS was 12.7 days (SD 16.38). The majority (94%) of patients had more than 5 readmissions. Commercial insurance was associated with prolonged LOS ( > = 30 days), discharge disposition to hospice, and hospital readmissions ( > 5) compared to government insurance (p < 0.05). Of the 3137 patients, 325 (10%) expired, 1328 (42%) were discharged to hospice, while 1463 (47%) were discharged to rehab, skilled nursing facilities or home care. Conclusions: The majority of patients in our academic PCC had governmental insurance and were less likely than those with commercial insurance to have prolonged LOS, discharge to hospice, or hospital readmission. These findings provide evidence that further investigation is needed to examine the effect of payer mix on PCC and patient outcomes.
Implementation of an interdisciplinary care team to create individualized care plans for high risk oncology patients: A model to decrease aggressiveness of care at the end of life and improve cost effectiveness of care.
Authors: Kunapareddy Girish Chandra , Hooley Joseph , Varella Leticia , Poole Christa , Tackitt Helen , Booker Stacey , Best Carolyn , Fetto Julie , Lagman Ruth , Montero Alberto J. , Parala Armida
Published: November 2017

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Background: Due to complexity of disease and treatments, oncology patients have among the highest hospitalization rate, especially towards End of Life (EOL). In our cancer institute, just 6% of all discharged patients accounted for >40% of unplanned readmissions, and continue to be highest risk of future admissions, ICU stay, ED visits, overuse of chemotherapy and under use of hospice care. We hypothesized that developing individualized care plans (ICP) for this high-utilization group will provide guidance in the complex care they require to reduce unnecessary and aggressive medical services. Methods: An Interdisciplinary Care Team (ICT) was created consisting of palliative medicine and oncology physicians, social workers, care coordinators, and nurses. On a bimonthly basis, patients with at least two unplanned hospital readmissions over the last 60 days were identified. ICPs were created using a team-based approach with parallel input from patient’s primary outpatient providers. Results: A total of 36 patients, 226 hospitalizations, and 163 ED visits were evaluated over a 6-month period, with an average number of hospitalizations of 1.08 per patient month (ppm). After implementation of ICP, hospitalizations decreased to 0.23 ppm, with an average length of stay decrease from 7.17 to 4.06 days per admission. Average ED visits decreased from 0.58 to 0.34 ppm, and the average number of unplanned readmissions decreased from 0.43 to 0.13 ppm. Of the 10 patients expired since creation of ICP, 8 utilized hospice care, while 2 patients died in an ICU. Average time to death from creation of ICP was 72 days among this cohort, while time to death from last exposure to chemotherapy was 58 days. Conclusions: Creation of individualized care plans for high-utilizing cancer patients decreased number of hospitalizations, ED visits, unplanned readmissions, and length of stay. A dedicated focus from a team of experts, beyond disease biology, on a unique patient situation may result in improved patient experience with decreased aggressiveness of care at EOL and overall resource utilization.
Early specialist palliative care for all hospitalized advanced cancer patients (ACP)? Effect of “up-front” versus “on demand” palliative care on outcomes.
Authors: Malec Monica , Hlubocky Fay J. , Levine Stacie K. , Wroblewski Kristen , Thomas Ashley , Lane Bradford , Dale William , Daugherty Christopher
Published: November 2017

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Background: Palliative care improves outcomes for cancer patients, especially those with advanced disease. Optimal timing for initiation of specialist palliative care remains undetermined. We created a Supportive Oncology inpatient service that integrates immediate “up-front” palliative care (IPC) consultation for selected ACP to supplement our usual oncologic care (UOC) service, which continued to utilize “on-demand” palliative care consultation. Here, we compare ACP populations and selected outcomes between these two versions of in-patient cancer care. Methods: A retrospective cohort analysis of ACP receiving either IPC or UOC between Jan 2015-Dec 2015 (N=809). ACP were compared for age, gender, race, and ethnicity. Disease severity was determined by APR DRG weight, Risk of Mortality (ROM), and Severity score. Outcomes included examining differences between groups for: Length of stay (LOS), Cost, and 30 day readmission rate. Univariate and multivariate analysis were employed. Results: 468 ACP were admitted to IPC and 341 to UOC. Compared with UOC, ACP assigned to IPC were significantly younger (61.1±13.2 vs 63.3±13.0, p=0.02); more likely female (50% vs 40%, P=0.005); and more likely to be AA (47% vs 35%, P=0.005). After adjusting for gender, age, race, and encounter type, ACP receiving IPC had higher ROM (52% v 47%, p=0.03). There were no differences in APR DRG weight (p=0.30) or Severity scores (p=0.34). IPC had significantly lower costs ($12,050 vs $15,990, p=0.003), less 30-day readmissions (16% vs 23%, p=0.03), and a trend toward shorter LOS (5.6 ± 4.9 vs 6.2 ± 6.5, p=0.10). Hospice referral and survival data will be presented. Conclusions: Our data provides additional evidence for the benefits of earlier specialist palliative care consultation services, including patients traditionally identified as underserved.
Randomized trial of a cognitive-behavioral therapy mobile app for anxiety in patients with incurable cancer.
Authors: Greer Joseph , Jacobs Jamie M. , Pensak Nicole , MacDonald James J , Fuh Charn-Xin , Perez Giselle Katiria , Ward Alina , Holt Anne , Tallen Colleen , Muzikansky Alona , Traeger Lara , Penedo Frank J. , Safren Steven A. , Pirl William F. , Temel Jennifer S.
Published: November 2017

175

Background: Patients with incurable cancer often experience marked anxiety that is associated with poor quality of life (QOL), high symptom burden, and complications with medical treatment. The aim of this study was to test the efficacy of a mobile app-based cognitive-behavioral therapy (CBT) intervention to treat anxiety symptoms in patients with incurable cancer. Methods: From 2/15 to 8/16, 145 patients with incurable cancers (e.g., advanced lung, breast, GI/GU, sarcoma, melanoma) who screened positive for at least mild anxiety symptoms (Hospital Anxiety & Depression Scale-Anxiety subscale, HADS-A > 7) were randomized 1:1 at two cancer centers to receive either the CBT mobile app for anxiety or a mobile health education program (control), delivered via tablet computers. The CBT app consisted of 7 modules teaching skills to relax the body, reduce worry, stay present-focused, improve communication, and plan/pace activities, which patients completed over 12 weeks. To assess anxiety, mood, and QOL, we administered the Hamilton Anxiety Rating Scale (HAM-A), Clinical Global Impression Scale (CGI), HADS, and Functional Assessment of Cancer Therapy-General at baseline and 12 weeks. General linear models were used to assess the effect of the intervention on patient outcomes over time. Results: The sample was predominantly female (73.8%) and white (91.7%), with a mean age of 56.45 ( SD= 11.30) years. Both study groups reported significant improvements in anxiety, depression, and QOL from baseline to post-assessment (all p-values < .002), with no differences in the improved outcomes between groups. Secondary analyses revealed interaction effects on anxiety between the intervention and baseline HAM-A scores. Among patients with higher baseline anxiety, those randomized to the CBT app had greater improvements on the HAM-A ( p= .043), CGI ( p= .048), and HADS-A ( p= .001) compared to the health education control group. Conclusions: Patients with incurable cancer who received either a CBT mobile app intervention or mobile health education program reported improvements in anxiety, depression, and QOL. However, the CBT mobile app had better outcomes than health education for patients with higher baseline anxiety. Clinical trial information: NCT02286466.
Selecting a prepared medical decision maker.
Authors: Zhukovsky Donna S. , Soliman Pamela T. , Mathew Boby , Mills Sarah , Bodurka Diane C. , Meyer Larissa , Westin Shannon Neville , Nowitz Marisa , Archie LaShan , Fenton Shauna , Lang Kai E. , Williams Janet L. , Boving Valentine
Published: November 2017

18

Background: Selection and preparation of a medical decision maker (MDM) is key to person-centered advance care planning (ACP). ASCO’s Quality Practice Oncology Initiative recommends that all new patients (pts) discuss advance directives or ACP by the third office visit (OV). Methods: We collected baseline data from 9/8/16-12/31/16 for all new pts presenting with invasive malignancy to 4 gynecologic oncologists. A patient needs survey (PNS) was conducted at the 1st OV to evaluate if pts had completed a medical power of attorney (MPOA) & pt desire for additional assistance with advance directives (AD) or ACP. Electronic health records (EHR) were reviewed for the 1st 3 OV to determine disease status, presence of scanned MPOA and nature and type of ACP notes, including documentation of MD/advance practice provider (MD/APP) discussion of MPOA, social work (SW) MPOA counseling & elements suggesting selection of a prepared MDM. Pearson Chi-Square or Mann-Whitney U test were used for comparisons, as appropriate. Results: Of 150 women, disease status was available for 133 (91%). Data presented are for pts with known status. Median (range) number of visits was 2 (1-3). 29% reported having an AD, but only 11% had a MPOA in the EHR. (See Table). Conclusions: Our data suggest that current processes do not successfully capture the majority of already completed MPOA, most pts do not perceive the relevance of selecting a prepared MDM and that most named MDMs have not been well prepared. Other than for visit #, there were no significant differences by disease status. Future QI cycles will focus on more active pt engagement. [Table: see text]
Association of anxiety and depression concerns with overall levels of patient reported distress during radiotherapy.
Authors: Landy Robin , Whitaker Dale Alan , Jagadesh Niveditha , Strong Gerald , Chimato Nicolette , Heckman Michael , Kaleem Tasneem , Buskirk Steven J. , Vallow Laura , Tzou Katherine S. , Ko Stephen , Peterson Jennifer Layton , Day Atiya , Nelson Kimberly , Habboush Jacob , May Byron C. , Miller Robert Clell
Published: November 2017

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Background: The purpose of this study was to examine the associations of three different measures of anxiety and depression with patient reported distress (PRD) level and survival after radiotherapy (RT). Methods: 518 patients who underwent RT between 2012 and 2016 were included in this retrospective study. PRD was assessed at the time of RT using the NCCN thermometer and a 30 question survey of distress related items. PRD and clinical and demographic data was retrospectively collected and analyzed. The three measures this study focused on that assessed patient anxiety and depression involved asking patients about their level of concern regarding feeling down, regarding loss of interest, and regarding feeling nervous. Associations between baseline patient characteristics and survival after start of RT were evaluated using single variable Cox proportional hazards regression models. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated. Associations of level of concern regarding patient anxiety/depression with survival after RT were evaluated using single variable and multivariable Cox proportional hazards regression models. Results: Overall, PRD level and concern regarding anxiety/depression were positively correlated (p < 0.001). Additionally, there was a significant association between level of concern regarding feeling down and palliative patients (p = 0.03). There was also a significant association between level of concern regarding loss of interest and palliative patients (p = 0.03), with level of concern highest for thorax, breast, and head and neck. There was also a significant different between level of concern regarding feeling nervous and gender (p = 0.05). There was not a significant difference between any of the three measures and survival after RT (all p ≥ 0.21). Conclusions: Anxiety and depression in patients receiving palliative and curative RT was associated with overall distress. Baseline screening of PRD may identify patients who would benefit from intervention to address the causes of their underlying anxiety and depression.
Perceptions of stress in adolescent and young adult (AYA) cancer patients and survivors in Kansas City, KS, and Copenhagen, Denmark: A pilot study.
Authors: Elsbernd Abbey , Crenner Christopher , Boisen Kirsten , Bækgaard Larsen Hanne , Hjerming Maiken , Loew Thomas W. , Rosell Tarris , Panicker Jyoti
Published: November 2017

186

Background: Adolescent and Young Adult (AYA) Oncology is a developing field of medicine with unique challenges in the clinical setting. People at this stage of life face many difficulties, which may be compounded by lack of insurance coverage and barriers in accessing health care resources. The goal of this pilot study is to examine how stress levels and psychosocial well-being are affected by healthcare system, insurance status, and other AYA-specific factors. Methods: 38 AYA patients ages 15-30 who have received, or are currently receiving treatment for an oncology diagnosis completed an online survey and 10-item interview, with 29 patients at University of Kansas Medical Center, Kansas City, United States, and 9 patients at Rigshospitalet, Copenhagen, Denmark. Survey measures included the Perceived Stress Scale (PSS) standardized tool, and questions relating to patient concerns, resources utilized, and general thoughts on healthcare. Results: Differences in quantitative stress levels were not significant between the two study sites. In Kansas City, female gender was identified as a significant variable for increased PSS values. In addition, Kansas City patients expressed increased reported practical concerns, such as the role of social workers, transportation, insurance, and disruptions in work and school life due to treatment. Danish patients expressed more positive practical concern statements, citing Danish government resources such as physical therapy and psychiatry services. Qualitative data for both sites placed highest emphasis on the connection that AYA patients have with their healthcare team. Both U.S. and Danish patients reported diverse concerns and positive experiences. Conclusions: AYA oncology patients are a diverse group who have not yet been sufficiently studied, and face many struggles that are unique to this age group. More research on a broad scale is needed, as the data collected in this study suggest results that may prove significant with more time available and larger patient sample sizes. The first author of this abstract has been selected as a semifinalist by the Fulbright commission to expand this pilot project in 2017-2018.
Geriatric syndromes and association with distress in older cancer patients.
Authors: Sanders Barton J. , Huang Chao-Hui , Rocque Gabrielle Betty , Williams Grant R , Pisu Maria J , Kenzik Kelly , Kvale Elizabeth Ann
Published: November 2017

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Background: Geriatric syndromes are multifactorial conditions affecting the elderly that are associated with decreased quality of life and poor outcomes. We sought to quantify the prevalence of geriatric syndromes in a group of navigated cancer patients and identify conditions associated with distress. Methods: Distress assessments were conducted between January 2012 and December 2015 on enrollment into the PCCP, a lay-navigation program that serves Medicare recipients in the UAB Health System Cancer Community Network. Assessments were made using a modified Distress Tool, which captures sources of distress in multiple domains. We identified questionnaire items related to common geriatric syndromes including functional decline, sensory impairment, cognitive and mood changes, sleep problems, incontinence, pressure ulcers, and malnutrition. Prevalence of geriatric syndromes was indicated by reported distress for an item that mapped to one of the above syndromes. Results: 8,014 patients were surveyed; 53 % of patients were 65- 74 yoa with 47% > 74 yoa while 52% were female. The most common cancer types were breast (18%), lung (17%), and gastrointestinal (16%). Of all surveyed patients, 1,779 (22%) reported distress related to at least one geriatric syndrome. The most common complaint was decline in functional ability relating to ADLs (11%) and IADLs (7%). Conclusions: Geriatric syndromes, such as functional disability, contribute to distress in older patients with cancer patients. Early screening and identification may lead to timely intervention to help improve quality of life. Further research is needed to describe the relationship between these syndromes and health outcomes, such as their association with health care utilization in older adults with cancer.
Predictors of quality of life in non-muscle-invasive bladder cancer survivors.
Authors: Jung Ahrang , Crandell Jamie , Nielsen Matthew Edward , Smith Sophia Kustas , Palmer Mary H. , Bryant Ashley Leak , Mayer Deborah
Published: November 2017

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Background: Non-muscle-invasive bladder cancer (NMIBC) survivors face frequent invasive surveillance cystoscopies, repeated treatment, and the highest recurrence rates and medical cost among all cancer survivors for the remainder of their lifespan. Despite the burdens of survivorship for this group, very little is known about the quality of life (QOL) impact of NMIBC diagnosis. We identified factors associated with QOL in NMIBC survivors. Methods: 2000 patients were randomly selected from the 5979 NMIBC population diagnosed between 2010-2014 in North Carolina. These patients received a mailed survey including cancer-specific (EORTC QLQ-C30) and NMIBC-specific (QLQ-NMIBC24) measures of QOL. QOL in this population was described, and hierarchical multiple linear regression was used to determine which patient and disease characteristics are associated with QOL. Results: 376 survivors were included in the analyses (response rate 22%). The mean QOL scores for the following domains include (range 0- 100, higher score is better in all domains but symptoms): global health 73.6±21.7, function 84.8±18.5, symptoms 15.5±17.2, NMIBC-specific sexual function 31.5±27.1 and NMIBC-specific sexual enjoyment 48.1±38.1. Survivors reporting significantly lower global health status were more likely to be male (p < .01), lower income (p = .02), stage Tis at diagnosis (p < .01), and have lower cognitive abilities (p < .01). Lower function (p < .01) and higher symptoms (p = .01) were seen in survivors who were not cured or unsure whether were cured (vs. cured). Lower global health status (p < .01) and higher symptoms (p < .01) were found in survivors who had not received intravesical immunotherapy. Lower social support was associated with lower global health status (p < .01) and lower function (p < .01). A higher number of comorbidities and more cognitive general concerns were associated with poorer QOL in all domains (all p < .01). Conclusions: We identified correlates of QOL in NMIBC survivors. Special attention should be given to those with high risk of lower QOL, including patients with more comorbidities, more cognitive general concerns, or lower social support.
Suicide risk in persons with colorectal cancer: A population-based study.
Authors: Deng Aileen , Basu Mallick Atrayee
Published: November 2017

196

Background: Patients with cancer have nearly twice the incidence of suicide compared to the general population. To date, identifying patients at risk for suicide remains challenging. Colorectal cancer (CRC) is the third most common cancer in the US. The purpose of this study was to identify risk factors associated with higher suicide rates (SR) among patients with CRC. Methods: A retrospective analysis was completed using Surveillance, Epidemiology, and End Results data from 1973 to 2014. Comparisons with the general US population were based on US mortality data collected by the National Center for Health Statistics. Suicide incidence, rates and standardized mortality ratio (SMR) were obtained by SEER*Stat 8.3.4. Results: Among 414788 patients with CRC observed for 2785811 person-years, 747 suicides were identified, for an adjusted SR of 26.7/100,000 person-years (SMR 1.40 [95% CI 1.30-1.50]). Higher SRs were associated with male sex, non-white or non-black race, being unmarried and having advanced disease at diagnosis (Table 1). SR was highest in the first year after diagnosis (SMR 2.00 [95% CI 1.68-2.37]) and with increasing age at diagnosis among unmarried patients. In patients 60 to 64 years at diagnosis, SR was highest in unmarried men (SMR 3.72 [95% CI 2.61-5.15]) and lowest in married women (SMR 0.61 [95% CI 0.17-1.57]). Conclusions: CRC is one of the most common cancers in the US. Patients with CRC have a 1.5-fold increase in SR compared to the general population. Suicide screening should especially target those in their first year after diagnosis, particularly older, unmarried patients. [Table: see text]
Perceptions on the effect of physical activity on quality of life, overall survival, and fatigue in palliative cancer patients.
Authors: Balaratnam Karmugi , McFarlane Graham , Selby Peter , Alibbhai Shabbir , Brown M. Catherine , Jones Jennifer M. , Howell Doris , Pringle Dan , Xu Wei , Liu Geoffrey , Eng Lawson
Published: November 2017

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Background: Physical activity is an important lifestyle recommendation for all patients’ wellbeing. With better cancer treatments and palliative patients living longer, maintaining physical activity is becoming an important survivorship goal, even in the palliative setting. We assessed cancer patient’s perception of the effect of physical activity on their quality of life, overall survival, and fatigue. Methods: In a cross-sectional survey across all cancer sites, patient perception of the effect of physical activity on three outcomes: quality of life, overall survival, and fatigue. Palliative status was determined by chart review and primary oncologist assessments. Regression-based estimates of the odds ratios and confidence intervals (CI) described any differences in perception between palliative and non-palliative patients. Results: Of 1283 patients recruited, 1080 completed the entire survey; median (range) age was 58 (18-98) years; 54% were female; 15% were palliative. Palliative patients were less likely than non-palliative patients to believe that physical activity improved overall survival, with an odds ratio of 0.53 (95%CI 0.34-0.83; P = 0.006). Palliative patients were less likely to perceive that physical activity improved fatigue, with odds ratio 0.68 (95%CI: 0.47-0.97; P = 0.04). Although not statistically significant, palliative patients also perceived less of a positive effect of physical activity on quality of life with an odds ratio of 0.65 (95% CI 0.47-0.97; P = 0.12). Results were similar regardless of whether patients were asked to perceive the effect of physical activity on themselves or in the general cancer patient. Conclusions: Palliative patients were more likely to believe that physical activity did not improve their overall survival and fatigue compared to the curative counterparts. Also, there was no significant difference in the perception of the effect of physical activity on the quality of life among the two groups of cancer survivors. Since palliative patients are living longer, future research can focus on implementing exercise recommendations and following up so the actual benefits can be seen.
Who, what, where, when, and how? Advance care planning documentation practices and accessibility in the electronic health record.
Authors: Walker Evan Justin , Mcmahan Ryan , Barnes Deborah , Katen Mary , Lamas Daniela , Sudore Rebecca
Published: November 2017

2

Background: Documenting patients’ advance care planning (ACP) wishes is essential to providing value aligned care, as is having this documentation readily accessible. Early ACP is increasingly being recognized as integral to oncologic care, however, little is known about current documentation practices. In this cross-sectional study, we describe ACP documentation practices and accessibility of documented ACP discussions in the electronic health record (EHR). Methods: Participants were recruited from outpatient clinics at the San Francisco VA, were ≥60 years old, with ≥2 chronic/serious conditions and ≥2 primary care visits in the past year. ACP documentation was abstracted from the EHR in 2013-2015 and included any prior legal forms/orders and ACP discussions documented within the prior five years. Frequency and type of ACP documentation was calculated using percentages and means. For discussions, author discipline and location of documentation was determined. Discussions were deemed “accessible” if documented in a designated ACP posting location or “not easily accessible” if recorded as free text in progress notes. Results: The mean age of 414 participants was 71 years (SD ± 8), 9% were women, 43% were non-white, and 51% had documented ACP including 149 (36%) with ACP forms and 138 (33%) with ACP discussions. Seventy-five (54%) discussions were documented by social workers and 49 (36%) by primary care providers. However, 76 (55%) discussions were not easily accessible. For 27 (18%) participants with advance directives, subsequent discussions documented a change in treatment preferences. Nineteen (70%) discussions reporting a change in wishes were not easily accessible. Conclusions: Half of chronically ill, older patients had documented ACP wishes, including a third with documented ACP discussions. Most discussions were documented by social workers and were not easily accessible, although discussions often represented changes from prior advance directives. Clinician education and EHR changes to ensure documented discussions are accessible are important patient-safety and quality improvement targets to ensure patients’ wishes are honored.
Effectiveness of an advance care planning patient navigator on advance directive completion by electronic versus staff-based referrals at a major cancer hospital.
Authors: Ito-Hamerling Gayle , Emanuel Lindsay , Zachariah Finly
Published: November 2017

20

Background: Advance Care Planning (ACP) is a central component of patient-centered care, helping ensure patient values and preferences guide clinical decisions. Patient navigators have been utilized effectively in healthcare for numerous roles, and more recently for ACP. At City of Hope National Medical Center (COH), an ACP-focused navigator was hired to support patients, families, and staff with Advance Directive (AD) notarization and primary ACP conversations. Methods: The Department of Supportive Care Medicine at COH with significant institutional collaboration and administrative support created a patient-centered ACP program and marketing campaign, called “Plan Today for Tomorrow.” In 2016, an ACP navigator joined the team to facilitate AD completion. Referral to the ACP navigator occurred either through staff endorsement and/or the institution’s technological screening platform deployed in a majority of COH outpatient clinics. Staff referrals came from physicians, clinical social workers, nurses, or from the Sheri & Les Biller Patient and Family Resource Center. Prior to the ACP navigator, all referrals were addressed by Clinical Social Workers (CSWs). Results: In a review of 14 months of data, the ACP navigator followed up on 1,125 referrals, 574 were from staff, while 551 were from the institutional tablet-based screening platform. Follow-up on staff referrals resulted in an 86% AD completion rate. Follow-up on tablet-based screening resulted in a 23% AD completion rate. Conclusions: The presence of an available onsite ACP-focused navigator was more effective in facilitating AD completion of staff generated AD referrals as compared to AD completion of tablet-based patient screening AD referrals. The presence of the ACP navigator to facilitate AD completion decreased workload for CSWs, creating increased opportunity for CSWs to work at the top of their professional license. Further work is needed to increase the effectiveness of AD completion from tablet-based screening referrals.
Incidence of palmar-plantar erythrodysesthesia and hypothyroidism in patients with metastatic cancer treated with cabozantinib: A systematic review and meta-analysis of randomized controlled trials.
Authors: Thein Kyaw Zin , Zaw Myo , Han Myat M. , Teerakanok Jirapat , Jones Catherine , Tijani Lukman , Hardwicke Fred L.
Published: November 2017

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Background: Cabozantinib is an oral inhibitor of multiple tyrosine kinases, including VEGFR, KIT, RET and MET, and is proven to be beneficial in different types of tumors. Nevertheless, there are noteworthy safety concerns. We performed a systematic review and meta-analysis of randomized controlled trials (RCT) to determine the risk of palmar-plantar erythrodysesthesia (PPE) and hypothyroidism among patients with metastatic cancer treated with cabozantinib. Methods: We systematically conducted a comprehensive literature search using MEDLINE, EMBASE databases and meeting abstracts through January 31, 2017. The randomized controlled phase 3 trials that mention PPE and hypothyroidism as adverse effects were incorporated in the analysis. Mantel-Haenszel method was used to calculate the estimated pooled risk ratio (RR), and risk difference (RD) with 95% confidence interval (CI). Random effects model was applied. Results: Three phase 3 RCTs with a total of 1999 patients were eligible for analysis. Studies compared cabozantinib (C) vs everolimus, C vs placebo, C vs prednisone, were included in the analysis. All grade-PPE incidence was 499 (36.6%) in cabozantinib arm vs 26 (3.36%) in control arm with a RR of 13.998 (95% CI: 5.409 – 36.224, P < 0.0001). The absolute RD was 0.374 (95% CI: 0.258 – 0.489, P < 0.0001). High-grade PPE was reported in 93 (7.58%) in cabozantinib group vs 3 (0.39%) in control group with a RR of 12.486 (95% CI: 4.529 – 34.426, P < 0.0001). The RD was 0.080 (95% CI: 0.045 – 0.115, P < 0.0001). The overall incidence of hypothyroidism was noted in 292 (23.82%) in cabozantinib arm vs 24 (3.1%) in control arm. The pooled RR of hypothyroidism was 15.825 (95% CI: 1.229 – 203.820, P = 0.034) and RD was 0.237 (95% CI: 0.113 – 0.361, P < 0.0001). Conclusions: Our meta-analysis demonstrated that cabozantinib contributed to significant toxicity of all-grade and high-grade PPE as well as hypothyroidism. Identifying these toxicities may aide physicians in providing good supportive care and patients’ quality of life.
Risk of hematological toxicities and febrile neutropenia in patients with hormone receptor-positive HER2-negative metastatic breast cancer treated with CDK 4/6 inhibitors: A systematic review and meta-analysis of randomized controlled trials.
Authors: Zaw Myo , Thein Kyaw Zin , Tun Aung , Han Myat M. , Radhi Saba , Hardwicke Fred L. , Jones Catherine
Published: November 2017

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Background: Majority of breast cancers express the estrogen receptor or progesterone receptor. CDK4/6 signaling plays a role in endocrine therapy resistance and the benefit of inhibition of these pathways has been proven in studies. Yet the impact of these agents on hematological toxicities and febrile neutropenia is a considerable safety concern. Hence, we performed a systematic review and meta-analysis of randomized controlled trials (RCT). Methods: MEDLINE, EMBASE databases and meeting abstracts from inception through June 2017 were queried. RCTs that mention anemia, thrombocytopenia, leukopenia, neutropenia and neutropenic fever as adverse effects were incorporated in the analysis. Mantel-Haenszel method was used to calculate the estimated pooled risk ratio with 95% confidence interval (CI). Random effects model was applied. Results: Five RCTs (four phase 3 and one phase 2 studies) with a total of 2671 patients were eligible for analysis. The study arm used palbociclib-letrozole, palbociclib-fulvestrant, ribociclib-letrozole and abemaciclib-fulvestrant while the control arm utilized placebo in combination with letrozole or fulvestrant. The relative risks (RR) of all-grade side effects were as follows: anemia, 3.77 (95% CI: 2.47 – 5.75, p < 0.0001); thrombocytopenia, 9.69 (95% CI: 4.26 – 22.04, p < 0.0001); leukopenia, 11.68 (95% CI: 8.19–16.65; p < 0.0001); and neutropenia, 14.09 (95% CI: 10.73–18.49; p < 0.0001). The RR of high-grade adverse effects were as follows: anemia, 2.66 (95% CI: 1.29 – 5.45, p = 0.008); thrombocytopenia, 7.08 (95% CI: 1.95 – 25.74, p = 0.003); leukopenia, 33.58 (95% CI: 14.49–77.77; p < 0.0001); and neutropenia, 40.33 (95% CI: 19.34–84.10; p < 0.001). The pooled risk of neutropenic fever was statistically significant at 4.26 (95% CI: 1.11–16.26; p = 0.034). Conclusions: CDK 4/6 inhibitors based regimen significantly contributed to all hematological toxicities as well as febrile neutropenia. These toxicities affect patients’ quality of life, add financial burden and may lead to drug dosing inconsistencies.