bluuebunny/crossref_metadata_2025 huggingface dataset:
Validity and reliability of Korean version of simplified nutritional appetite questionnaire in patients with advanced cancer: A multicenter, longitudinal study.
Authors: Koh Su-Jin , Oh So Yeon , Baek Ji Yeon , Kwon Kyung A. , Jeung Hei-Cheul , Lee Kyung Hee , Won Young-Woong , Lee Hyun Jung
Published: November 2017

211

Background: Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. Nutrition risk screening aims to increase awareness and allow early recognition and treatment of cancer cachexia. Therefore, screenings should be brief, inexpensive, highly sensitive, and have good specificity. SNAQ is a simple screening tool including 4 questions, and validated to predict weight loss within 6 months in community-dwelling adults and nursing home residents. Our study aimed to translate the SNAQ into Korean, and to assess the validity and reliability of the translated screening tool in advanced cancer patients. Methods: The SNAQ was translated into Korean according to linguistic validation. The internal consistency of the SNAQ was evaluated by Cronbach’s alpha coefficient. Test–retest reliability was evaluated using the intraclass correlation coefficient. Concurrent validity was evaluated by measuring the Pearson’s correlation coefficient between the SNAQ and Mini-Nutritional Assessment (MNA) and Patient-Generated Subjective Global Assessment (PG-SGA). Results: In the 194 patients included in full analysis set, cancer stage was predominantly (98.5%) metastatic, the mean age was 60 years, and the mean BMI was 24 kg/m2. According to MNA score ≤11, 57 patients (29.3%) were malnourished. The mean score of the Korean version of the SNAQ was 13.8 (SD = 2.5) with a range of 6–19. Cronbach’s alpha coefficient was 0.74, and intraclass correlation coefficient was 0.87. The SNAQ was moderately correlated with MNA(r = 0.4043, p < 0.0001) and PG-SGA(r = -0.5297, p < 0.0001). A significant weight loss of 5% of the original body weight within 6 months occurred in 46 (24.7%) of the 186 patients. SNAQ score ≤14 predicted 5% weight loss with a sensitivity of 56.5% and a specificity of 44.3%. Conclusions: The Korean version of the SNAQ had high validity and reliability. SNAQ is useful for the screening tool for advanced cancer patients. The SNAQ had a limitation to predict impending weight loss in advanced cancer patients.
Modeling of quality of life in older adults with advanced cancer: Data from a URCC NCORP multisite trial.
Authors: Flannery Marie Anne , Culakova Eva , Xu Huiwen , Loh Kah Poh , Kamen Charles Stewart , Wells Megan , Geer Jodi , O'Rourke Mark Allen , Vogelzang Nicholas , Dale William , Duberstein Paul , Mohile Supriya Gupta
Published: November 2017

218

Background: While the importance of symptom assessment is well recognized in Palliative Care (PC), limited evidence is available on the growing population of older adults with advanced cancer. Increasingly geriatric assessment (GA), which incorporates validated tools to assess health status, is advocated as a component of the care for older patients with cancer, but is not routinely incorporated into PC evaluations. We tested the hypothesis that variability in QoL for older adults with advanced cancer would be predicted by both symptoms and GA. Methods: Data from an ongoing cluster RCT conducted at 68 oncology practices were analyzed. Inclusion criteria were: > 70 years old, advanced solid tumor diagnosis, impairment in at least 1 GA domain (e.g., function). Multiple reliable and valid objective assessments and self-report measures for each GA domain were completed. Symptoms were assessed by MD Anderson Symptom Inventory (MDASI). Hierarchical regression modeling was conducted. The dependent variable was FACT score at Time 2 (4-6 weeks). The independent (Time 1) variables were entered in 3 steps: 1) gender, race, educational level( < or > high school), cancer type ( GI / Lung or other), receiving chemotherapy; 2) MDASI, 3) GA measures: Polypharmacy, Blessed Orientation and Memory Concentration Test, % weight loss, Short Physical Performance Battery, Instrumental Activities of Daily Living (IADL), Older Adult Resource Survey (OARS) Comorbidity, OARS Medical Social Support, and Generalized Anxiety Disorder-7. Results: N = 342 at time 1 (Mean age 77 years, 43% female, 90% white, 51% high school graduates, 49% GI or Lung cancer, 68% on chemotherapy). N = 303 at time 2(11% attrition due to death or withdrawal). Overall, 46% of variance in QoL was explained (demographic and disease characteristics: 4% [p = .05], symptoms: 32% [p < .0001], GA measures: 10% [p < .0001]). Significant individual GA predictors of worse QoL were lower social support, higher anxiety, impairment in IADLs, and poorer physical performance. Conclusions: Findings suggest that GA explains variance in quality of life scores for older adults with advanced cancer and reinforce the importance of symptom assessment and management in this population. Clinical trial information: NCT02107443.
Nasal vestibulitis as an under-recognized and undertreated side effect of cancer treatment.
Authors: Cathcart-Rake Elizabeth Jane , Smith DeAnne R. , Loprinzi Charles L.
Published: November 2017

219

Background: Dryness, crusting, and bleeding of the nares due to inflammation, termed nasal vestibulitis (NV), is infrequently reported as a side effect of cancer treatments. However, one study described 115 patients who developed NV while undergoing targeted therapies; many were treated with bacitracin ointment (Ruiz et al Sup Care Cancer 2015). Methods: This study surveyed 94 patients regarding the presence of nasal symptoms during cancer treatments. Participants were consented for the study if they had undergone at least 6 weeks of cancer-directed therapy in the Mayo Clinic Chemotherapy Unit. They were asked about types of nasal symptoms, severity, and symptom treatments. A chart review was then conducted to determine documentation of symptoms, the presence of concurrent illnesses, and cancer treatment regimens. Results: Ninety-four patients completed questionnaires, with 41% reporting unpleasant nasal symptoms that they attributed to cancer treatments. Of the symptomatic patients, 46% had dryness, 33% had discomfort, 54% had bleeding, and 46% had scabbing. Average severity was 1.9 on a scale from 1 to 3 (1 = mild, 3 = severe). Symptoms were noted in patients undergoing a variety of cancer treatment regimens, with the highest frequency in patients undergoing a taxane-containing regimen (46%). 62% of patients with symptoms said they reported them to their provider, but only 41% of chart notes (for 16 patients) contained documentation of such, most frequently described as “allergies” or “epistaxis.” Only 10% of symptomatic patients had nasal swabs; all of which were obtained during respiratory illness or pre-op. 49% of patients with nasal symptoms reported treating their symptoms. Antihistamines (7 patients), nasal saline (6 patients), or nasal lubricants (i.e. Vaseline; 7 patients) were used; 2 patients applied bacitracin. 18% of symptomatic patients had providers who recommended treatments, including 2 patients who were thought to have concurrent infection and were treated with antibiotics. Conclusions: NV symptoms are prevalent among oncology patients, but infrequently recorded or treated by providers.
Caregiver stress: Clinical evaluation and intervention strategies for caregiver burden prevention.
Authors: Velutti Laura , Pavesi Carlotta , Poggio Chiara , Carettoni Beatrice , Saetta Annalisa , Arcanà Concetta , De Maio Ana Paula , Lopane Diego , Speciale Tatiana , Mazzieri Stefania , Rimassa Lorenza , Santoro Armando
Published: November 2017

22

Background: Caregivers (CGs) of advanced cancer patients (pts/ACPs) experience a higher incidence of medical and psychological conditions compared to general population. Methods: We conducted a prospective assessment of the caregiver burden (CGB) - a term describing the physical, psychological, emotional, social, and financial problems often experienced by CGs - to identify potential risk management strategies. We used the Caregiver Burden Inventory (CBI), a multi-dimensional questionnaire with 5 subscales: Time Dependent, Developmental, Physical, Social, Emotional CGB, as a quantitative tool to investigate the level of stress of our pts CGs. Also, we used a semi-structured interview with 5 questions as a qualitative tool. Results: From Dec 2016 to Feb 2017 we administered the CBI and the interview to 37 CGs (F/M 31/6) of ACPs in 3 different settings: inpatient (9 CGs), outpatient (15 CGs), home-based (13 CGs). The quantitative data analysis showed that CGs had a variable emotional load, mostly of moderate level. In particular, the level of stress of our pts CGs of outpatients and inpatients was higher in the physical dimension, while was higher in the time dimension for CGs of home-based pts. Semi-structured interviews showed that CGs of home-based pts did not feel adequate to provide assistance to their relatives, and had partial or poor knowledge of basic care, especially of in-bed mobilization and hygiene techniques. In the other 2 settings, CGs showed a higher level of stress due to the lack of a professional contact person throughout the care pathway, and experienced the need of psychological support. Overall, the qualitative assessment showed that CGs lives were strongly affected by caregiving. Conclusions: Our results confirm published data showing that assisting ACPs is a particularly difficult task for the CGs. Therefore, we implemented potential improvement strategies: in the home setting, specific attention to the educational aspects of basic care; in the inpatient setting, a weekly meeting for physicians, nurses, and psychologists, to discuss the most difficult cases; in the outpatient setting, a 25% increase in the number of visits for pain and supportive therapy to offer a better continuity of care.
Level of burden of supportive care-relevant pharmacogenetic markers in general population.
Authors: McLeod Howard L. , Patel Jai Narendra , Wei Min , Rosenberg Zeil
Published: November 2017

221

Background: Precision medicine has become part of oncology, with implications for therapy selection, treatment avoidance, dosing, and risk prediction. The presence of clinically predictive germline variants has also opened the hope that objective predictors of patient toxicity will be in the future. This is an opportunity for oncology, where selection from amongst apparently equal supportive care treatment options can be subjective. Methods: The incidence of genetic risk for untoward drug effect was characterized in 1193 consecutive patients submitted for clinical pharmacogenetics testing using a 50 gene panel. Not all were cancer patients, so this reflects a potential patient population. For each patient, the need to stop/avoid, adjust dose, and select an alternate medication was determined for the treatment of pain (CYP2D6, CYP1A2, OPRM1), nausea/vomiting (CYP2D6), antifungal prophylaxis (CYP2C19) or depression (CYP2D6, CYP2C`9). It is recognized that there are many sources of variation in the response and toxicity to these classes of medications. Results: Of the 1193 patients, 173 (14.5%) would have a recommendation to avoid oxycodone, codeine, or tramadol therapy and a non-standard dosage for 893 patients (75%). A change in antiemetic would be suggested for 35 patients (3%). If voriconazole antifungal prophylaxis was clinical required, 289 (24%) would need a dose increase, while 45 (3.8%) should be switched to a different regimen. The majority (759 patients; 64%) should avoid some of the commonly used agents for depression because of lack of efficacy or heightened risk of toxicity, while 195 patients would need a dose adjustment. Conclusions: Pharmacogenetics markers that put patients at risk for lack of efficacy or toxicity to supportive care medications was commonly observed. Thankfully there are many options for most supportive care areas, allowing genetic information to help focus treatment selection. In addition, for number of supportive care medications we do not know the sources of variable response, genetic or otherwise. There are opportunities to apply precision oncology principles to patient management now, while research helps toward the goal of objective medication selection.
Off-label drug use in home palliative care: A non-evidence-based established practice.
Authors: Velutti Laura , Pavesi Carlotta , Lopane Diego , Arcanà Concetta , Saetta Annalisa , De Maio Ana Paula , Speciale Tatiana , Rimassa Lorenza , Santoro Armando
Published: November 2017

225

Background: Advanced cancer patients (pts) often present with multiple concomitant symptoms and off-label use of drugs (indications doses formulations administration route) is a common practice. Drugs mixture (DM) solutions by continuous administration are frequently used. However, evidence-based data in this setting is scarce. Methods: We performed a retrospective analysis of 576 consecutive care pathways provided by our Home Palliative Care (HC) Service from Jul 2010 to Jun 2017. Infusions were administered subcutaneously (sc) or by a venous (iv) access, by elastomeric pumps (EP) (5 days - 2 mL/h) with drugs diluted in 0.9% NaCl with no light protection. We analyzed: treated symptoms, drugs, doses/concentrations, solution transparency, administration route, infusion duration, clinical response, adverse events (AEs), compliance/treatment acceptability, device proper functioning, and treatment interruptions. Results: We analyzed 266 pts out of 576 care pathways treated with DM infusions, M/F 143/123, median age 70 yrs (21-92); treated symptoms: pain (50%), nausea/vomiting (20%), dyspnea/agitation (20%), dysphagia/mucositis (18%); infused drugs: morphine, midazolam, dexamethasone, ranitidine, metoclopramide, scopolamine, alizapride, haloperidol, furosemide, and ketorolac. Median number of drugs in the DM was 3 (1-6). Administration route was sc in 214 pts/80%, iv in 52 pts/20%. Median infusion duration was 5 days (0-64). Symptoms control was achieved within 72 h in 69% of pts. No AEs related to the infusion devices were observed. Compliance was good in 92% of pts, poor/inadequate in 8%. 5 EP malfunctions were observed: 1 human error, 1 device obstruction due to furosemide flocculation, 3 unexplained. Also, 3 pts required sc infusion interruption due to fluid accumulation near the injection site. Conclusions: This retrospective analysis on a large number of pts shows efficacy and tolerability of DM administration by EP in the HC setting. Treatment compliance was high, no AEs were observed, EP malfunction and therapy discontinuation were rare. However, there are still many open questions about the off-label use of drugs in this setting, and prospective trials are strongly suggested.
Opioid switch and change of route of administration in palliative care cancer patients treated by morphine: Update of French guidelines.
Authors: Poulain Philippe , Michenot Nathalie , Rostaing Sylvie , Baron Laurent , Krakowski Ivan
Published: November 2017

226

Background: In 2002 guidelines for the treatment of cancer pain (National Federation of French Cancer Centers) were adapted to the availability of drugs in France. In 2015, a group of experts nominated by the 3 French Societies involved in cancer pain (AFSOS, SFAP, SFETD: Supportive Care, Palliative Care and Pain Societies), reviewed these guidelines and established new ratios for morphine switching and/or changing the route of administration in patients whose pain was not adequately controlled. Methods: A review of the literature via Pubmed (key words: morphine, oxycodone, fentanyl, hydromorphone, methadone, tapentadol, pain, cancer, palliative care, opioid rotation, opioid switching, equianalgesic ratios) plus a manual search, led us to retain 43 original works containing good scientific evidence (methodology French Health Authority).Final approval for publishing was obtained from each of the aforementioned three scientific committees of the societies. Results: Experts explained why the theory of opioid rotation using fixed ratios was no longer appropriate for a secure practice. In the light of recent publications enhancing our knowledge on the efficacy of new drug switching ratios and for changing the route of administration of morphine, the group of experts recommended to use reconsidered switching ratios favoring security over efficacy, to minimize overdosing and adverse effects. Consequently, after the new conversion ratio (using slow release opioids) was applied, a second titration should be done by using normal release rescue formulations for breakthrough pain episodes. Conclusions: This work can be apply to an international situation (despite different drug availability amongst countries). A smartphone app is available for rapid and secure dose conversions and will be translated into English. The adequate opioid dose is obtained from a theoretical dose calculation adapted to patient’s personal situation and needs (second titration). Continuous updating of good practice guidelines may provide security and adequacy of prescription for adequate and safe pain relief for our patients, limiting overconsumption and risk of misuse.
Efficacy and side effect profile of olanzapine versus haloperidol for symptoms of delirium in hospitalized patients with advanced cancer: A multicenter, investigator-blinded, randomized, controlled trial (RCT).
Authors: Van Der Vorst Maurice , Neefjes Elisabeth C.W. , Boddaert Manon S.A. , Verdegaal Bertha A.T.T. , Beeker Aart , Teunissen Saskia C.C. , Beekman Aartjan TF , Wilschut Janneke A. , Berkhof Johannes , Verheul Henk M.W.
Published: November 2017

231

Background: Delirium is highly prevalent in patients with advanced cancer. Patients experiencing delirium may require pharmacological treatment to reduce distressing symptoms. Atypical antipsychotics, like olanzapine, are potentially safer and more effective than haloperidol, but no phase III RCTs are reported in patients with advanced cancer. Methods: Hospitalized patients with advanced cancer diagnosed with delirium ( DSM-IV-TR criteria) were randomly assigned centrally (1:1) to olanzapine or haloperidol. Dosages were up-titrated. Primary endpoint was delirium resolution rate (DRR), defined as Delirium Rating Scale-Revised-98 (DRS-R-98) total severity score < 15.25 points and ≥ 4.5 points reduction. Secondary endpoints: time to recovery, grade ≥ 3 side effects (Common Terminology Criteria for Adverse Events version 3.0), and distress (Delirium Experience Questionnaire). The study was powered to increase DRR with 25% for olanzapine compared to haloperidol. Results: Between January 2010 and June 2016, 100 of the anticipated 200 patients were enrolled in the study from 6 sites in the Netherlands and randomly assigned to olanzapine (n = 50) or haloperidol (n = 50). Baseline characteristics were well balanced. Interim analysis showed a difference in DRR of -12.2% (95% confidence interval (CI) = -32.0%- 7.4%); 45% for olanzapine (95% CI 31.0-58.8) vs 57% for haloperidol (95% CI 43.3-71.0), P = 0.22).Time to recovery was 4.5 days in the olanzapine arm vs 2.8 days in the haloperidol arm (P = 0.20). There was no difference in grade ≥ 3 side effects between both arms (OR 0.44, 95% CI 0.14-1.40; P = 0.16). Mean level of distress in patients was 2.1 (SD 1.4) for olanzapine vs 2.3 (SD 1.4) for haloperidol (P = 0.80). Formal interim futility analysis indicated a conditional power of 0.086, implying a very low likelihood (8.6%) of reaching the expected DRR superiority rate of 25% for olanzapine. Therefore, the study was prematurely terminated. Conclusions: No difference in efficacy and side effect profile was observed between haloperidol or olanzapine treatment for delirium in patients with advanced cancer. Clinical trial information: NCT01539733.
Development of a digital tool to assess the risk of thromboembolic disease and prescription of prophylactic anti-thrombotic therapy in oncologic patients.
Authors: Garcia Montes Lizbett Vanessa
Published: November 2017

232

Background: Thromboprophylaxis for oncologic patients represents a huge challenge. The existence of more specific guidelines for anti-thrombotic therapy in hospitalized and ambulatory oncologic patients is an unmet need. Methods: We present an observational, descriptive, retrospective and transversal study, from January 2012 to December 2016, all the oncologic patients hospitalized for any cause in the Hospital Español de México were included. We reviewed clinical files and obtained demographic and disease characteristics necessary to stratify the risk of thromboembolism using the Khorana score. A bivariate analysis was done between the risk of thromboembolism and the use of thromboprophylaxis and a multivariate analysis to identify the reproducibility of Khorana score in Mexican patients. Results: Of the 1048 patients included in the study, 65.6% (688 patients) were categorized by the Khorana score with intermediate risk of thromboembolism, 26% (273 patients) with low risk and 8.4% (87 patients) with high risk. In the low risk group 80.6% used some kind of prophylaxis, in the intermediate risk group 83.2% and in the high risk group 87%, nevertheless only 19.7% met the recommendations published by international guidelines (ASCO, ESMO) and the Khorana score and also this data confirmed the reproducibility of Khorana score in Mexican patients. Conclusions: The 80.3% of all the patients didn’t obey the recommendations stablished by the American and European guidelines. We propose a digital tool to monitor and manage the risk of thrombosis as a health condition associated with cancer. This could be use in an easy way of each member of the multidisciplinary team, to stratify cancer patients by risk to receive the correct prophylactic anti-thrombotic therapy. This is nowadays an unmet need for oncologic patients, and in our country this type of tool, will help to save resources and re-direct them to patients who will actually benefit from the prophylactic treatment.
Cancer-related fatigue in cancer survivors (CS) with no active treatment.
Authors: Soriano Maria , Alvarez-Bustos Alejandro , Ramos Javier , Piquin Carmen , Osorio Pablo , Ros Javier , Ramírez Miguel , Gutierrez Sanz Lourdes , Nuñez García Beatriz , Gomez-Bravo Raquel , Brea Lidia , Fiuza-Luces Carmen , Lucia Alejandro , Pagola Itziar , Cebolla Hector , Ruiz-Casado Ana
Published: November 2017

238

Background: Fatigue is a subjective experience that should be systematically assessed at the initial visit, at regular intervals and as clinically indicated. Quality of fatigue management should be included in institutional continuous quality improvement projects. The PERFORM questionnaire (PQ) was developed among Spanish speaking patients for the assessment of fatigue. Methods: Outpatients recruited for projects in which physical condition and physical activity (PA) were evaluated, rated their fatigue severity on the PQ (12-60, being 60 no fatigue). PHUEM-01 evaluated early colon CS after finishing adjuvant treatment (AT). PHUEM-02 early breast CS at the end of AT. PH-UEM-03 evaluated colorectal CS (localized and metastatic) at the time of diagnosis. MS-04 evaluated fatigue at the time of diagnosis of different tumors (localized and metastatic). Physical condition was evaluated through the one-mile walk test (VO2MAX) and handgrip dynamometer. Heart rate was measured as a sign of autonomic dysfunction. PA was objectively evaluated through accelerometers generating weekly MVPA information. Results: 262 CS (63% women) were recruited, (110 breast, 119 colorectal, 14 other), mean age 60. 30% of survivors reported no fatigue. Mean PERFORM score 48,34; VO2max 25.5 ml/kg/min; handgrip 29,14 kg; HR 75 bpm. Women, younger CS, CS with worse physical condition, higher BMI, higher HR and less active CS reported more fatigue (only sex, handgrip strength and weekly PA were statistically significant for the overall population). Breast CS reported higher scores of fatigue than colorectal CS (p < 0.000). For breast CS there was an association between fatigue and HR which was not seen in the overall population. Metastatic colorectal did not report worse scores of fatigue than CS with localized tumors. Conclusions: As a subjective symptom, fatigue is unpredictable and its severity and interference with daily activities can be bothersome in an unexpected population (young CS, early stages) with no active treatment. More physically active and fitter CS are less fatigued. Mechanisms underlying cancer-related fatigue could be different for different tumors. More research in prevalence, evaluation, mechanisms and management of fatigue is needed.
Clinical assessment of emotions in patients with cancer: Diagnostic accuracy compared to two reference standards.
Authors: Verheul Henk M.W. , Braamse Annemarie , Aerts W , Hoogendoorn A W , Snoek F J , Van Linde Myra Ellen , Dekker Joost
Published: November 2017

24

Background: Previous research has suggested that clinical assessment of emotions in patients with cancer is suboptimal. Since well-trained and experienced doctors and nurses may differentiate between emotions that do or do not necessitate professional mental health care, we hypothesized that clinical assessment may be more accurate than previously concluded. This study aimed to evaluate the diagnostic accuracy of clinical assessment of emotions. Methods: The study was designed as a retrospective cohort study at a department of medical oncology. The clinical assessment of emotions by medical oncologists and nurses was derived from the patient file. Emotional distress and need for emotional care was assessed using the Distress Thermometer and Problem List. The sensitivity, specificity and diagnostic odds ratio of clinical assessment was calculated, with either (i) emotional distress or (ii) need for professional mental health care as a reference standard. Results: Clinical assessment resulted in notes on emotions in 42.2% of the patient files (n =185), with 36.2% of patients experiencing emotional distress and 10.8% expressing a need for professional mental health care. As expected, the sensitivity of clinical assessment of emotions was higher with ‘need for professional mental health care’ as reference standard, compared to ‘emotional distress’ as reference standard (0.85 versus 0.54, p < 0.001). The diagnostic odds ratio showed a similar pattern (9.66 versus 2.10, p = 0.02). For specificity, equivalent results were obtained with the two reference standards (0.63 versus 0.64, p =0.63). Conclusions: Medical oncologists and nurses seem to differentiate between emotions that do or do not necessitate professional mental health care, resulting in a high sensitivity of clinical assessment of emotions in patients with cancer.
Utilization of gabapentin for cough in cancer: A case series.
Authors: Feliciano Josephine Louella , Razzak A. Rab , Waldfogel Julie , Doberman Danielle J , Smith Thomas J.
Published: November 2017

241

Background: Refractory cough is a significant problem for cancer patients. Therapeutic options are suboptimal and based on low quality of evidence. Gabapentin is a gamma aminobutyric acid analog that may regulate neurotransmitter release via activity at the alpha-2-delta subunit of voltage dependent calcium channels. It is hypothesized to ameliorate cough through a central mechanism and is effective in relieving chronic refractory idiopathic cough. However, gabapentin has not been studied in cancer patients with cough. We report the use of gabapentin for chronic, refractory cough in adult cancer patients. Methods: We identified 3 male patients with metastatic cancer evaluated by palliative care for refractory cough. Data regarding diagnosis previous treatments for cough, dosage of gabapentin, and symptomatic outcomes are reported. Results: Case 1 is a 68 y.o. male with NSCLC and malignant pleural effusion had chronic cough despite thoracentesis that was associated with fatigue, sleep disturbance, and worsened with movement, pain, and sitting upright. Previous treatment for cough included benzonatate, codeine, dextromethorphan, albuterol inhaler, and ranitidine, without relief. He received gabapentin 300 mg three times a day. Case 2 was a 68 y.o. with NSCLC and a left mainstem bronchus obstructive mass not amenable to stent. Cough was associated with eating and sleep disturbance, and he could not lie flat for radiation planning. He received gabapentin 300 mg at night. Case 3 was a 48 y.o. with salivary duct carcinoma and a cavitary S. Pyogenes pneumonia treated with antibiotics and chest tube drainage and had persistent cough. He received gabapentin 300 at night. All patients had cough relief within 24 hours and were controlled until death. Conclusions: Gabapentin at doses up to 1800 mg per day has been studied in refractory chronic idiopathic cough and found effective relative to placebo with significantly more improvement in cough frequency, severity, and quality of life. Chronic cough in cancer patients can be a debilitating symptom and interventions are inadequately effective, with little quality evidence to support their use. Our case series suggests that further studies of gabapentin in cancer-related chronic cough are warranted.
Patient engagement with a smartphone mobile app for adherence to oral chemotherapy.
Authors: Ream Molly , Jacobs Jamie M. , Fishbein Joel N , Pensak Nicole , Nisotel Lauren Ellen , MacDonald James J , Buzaglo Joanne S. , Lennes Inga Tolin , Safren Steven A. , Pirl William F. , Temel Jennifer S. , Greer Joseph
Published: November 2017

243

Background: Patients prescribed oral chemotherapy receive minimal supervision and support for adherence. We developed a smartphone mobile app consisting of medication reminders, symptom reporting, clinician communication, and educational resources for improving adherence and symptom management. In this study, we sought to identify potential correlates of app usage. Methods: From 12/2014 to 08/2016, 181 patients with diverse malignancies prescribed oral chemotherapy enrolled in a randomized trial to test the efficacy of a smartphone mobile app to improve adherence and symptoms. Medication adherence was monitored using electronic pill caps (MEMScaps). At baseline and 12 weeks, participants completed a measure of treatment satisfaction (FACIT-TS). We gathered clinical and treatment data from the electronic health record. Through the app we collected data on engagement: total number of minutes, days of usage, and number of completed symptom reports. We calculated Pearson correlations to identify associations between app engagement, using a latent variable for overall engagement, with adherence, treatment satisfaction and healthcare utilization. Results: 91 patients were randomly assigned to receive the mobile app. Over the 12-week study period, participants used the mobile app for a mean of 59 minutes (SD = 68) and 21.75 discrete days (SD = 21.24 days), completing 15.92 symptom reports (SD = 14.15) on average. Higher app engagement was associated with having a lower proportion of missed doses (r = -.248, p = .035) over the study period. Patients who became less satisfied with their communication with physicians (r = -.278, p = .019) and nurses (r = -.238, p = .047) used the app more. Higher app engagement was associated with fewer emergency department visits resulting in hospitalizations (r = -.252, p = .029). Conclusions: Among patients prescribed oral chemotherapy, higher usage of a mobile app targeting adherence was related to fewer missed doses and ED visits leading to hospitalization. Fostering patient engagement with the app may also serve to buffer difficulties in patient-clinician communication about care. Clinical trial information: NCT02157519.
Biomarkers to evaluate distress in cancer patients.
Authors: Labbe-Coldsmith Elise , Butler Thomas Wayne , Naylor Paige , Aragon Ileana
Published: November 2017

251

Background: Self-report assessments of stress are a popular, but limiting practice, particularly for underserved populations that may struggle with poor psychological insight and illiteracy. Assessment of stress via biomarkers may be a more inclusive approach to stress assessment for patients with cancer. However, as the rise in popularity regarding biomarker function as outcome data has risen, so to have questions regarding the validity of this endeavor. The current study aimed to explore the convergent validity of inflammatory biomarkers (C-Reactive Protein; CRP, Interleukin 6; IL-6, and Cortisol) while also exploring predictors of stress (e.g., sex, race, marital status) in an underserved, diverse cancer population. Methods: Upon IRB approval, patients ( N = 37) were consented and contributed plasma and serum for the examination of biomarkers (CRP, IL-6, and Cortisol). Next, patients completed the Calgary Symptoms of Stress Inventory (CSOSI; Carlson & Thomas, 2007) to assess for biopsychosocial stress levels. The C-SOSI produces one total score and eight subscales measuring physiological, psychological, and social domains of stress. Results: The mean age of patients was 59.6 ( SD= 13.3) and 56.8% were women. The majority of participants identified as White (56.8%), and a wide variety of cancer types was represented. Biomarkers were analyzed via Quantikine ELISA kits. Correlational analyses revealed that certain subscales showed a positive relationship via medium sized significant correlations. Aside from the Anger subscale, only the physiological subscales were correlated with the biomarkers. The Anger subscale was significantly correlated with Cortisol ( r = .348, p = .035), as was Muscle Tension ( r = .341, p = .039), and Upper Respiratory ( r = .382, p = .02). While Cardiopulmonary Arousal was correlated with CRP ( r = .437, p = .007) and IL-6 ( r = .340, p = .04). Interestingly, IL-6 and CRP were correlated, however, Cortisol was not correlated with IL-6 or CRP. Additional analyses demonstrated significant differences for stress between men and women, which will be discussed. Conclusions: It appears that the biomarkers capture physiological aspects of stress, which may serve in screening patients for psychological intervention.
Factors affecting adherence to standard cisplatin (CDDP)-based chemotherapy regimen for locally advanced squamous cell head and neck (H&N) cancer in an inner city safety net hospital.
Authors: Singh Sunny R K , Malapati Sindhu Janarthanam , Lu Pei , Rosen Fred R.
Published: November 2017

252

Background: The non-operative standard of care for advanced, non-metastatic H&N cancer is high dose CDDP (100 mg/m2) given every 21 days for 3 cycles concurrent with radiation. Many patients are either started on or switched to an alternative regimen due to pre-treatment co-morbidities or development of CDDP related toxicity. In clinical practice, the percentage of patients not receiving current standard of care and reasons thereof are not well defined. This and the consequence of such deviation from treatment is what we propose to study. Methods: This is a retrospective study including 45 patients from 2014-2016 with advanced, non-metastatic H&N cancer treated with definitive concurrent chemoradiation. All patients were evaluated by ENT, Medical and Radiation Oncology and were presented to the multidisciplinary H&N Tumor board. Results: In the studied population, 73.3% were African Americans , 82.2 % males, 91.1% smokers and 97.7 % ECOG 0-1 at presentation. In all, 11.1% patients were unable to receive CDDP and received an alternate drug because of frailty, ECOG 2 status, pre-existing CKD, hearing problems or neuropathy. Of the 40 patients (88.8%) receiving CDDP, only 8 (17.7%) completed 3 cycles on schedule without changes. Of the remaining 32 (71.1%) receiving CDDP, 13 (40.6 %) were switched to alternate drug and 19 (59.3%) required only a dose decrease/delay. The reasons included CDDP related toxicity (54.05%), frailty or comorbidities (27%), worsening ECOG and fluid overload due to CDDP associated hydration. Toxicities leading to change in regimen included mostly AKI (63.15%) and also neutropenia, ototoxicity, nausea, vomiting and diarrhea. Mean duration of radiation therapy in patients receiving standard regimen was 52.2 days and in patients deviating from standard regimen was 55.1 days. Data supporting trend of poorer outcomes in those who deviate from standard regimen will be reported later. Conclusions: Majority of patients (82.2%) with advanced, non-metastatic H&N cancer being treated with definitive concurrent chemoradiation deviate from standard of care CDDP regimen with at least half due to cisplatin related toxicity.
Ultrasound application in point of care by palliative medicine physicians: Initial experience of oncology palliative medicine consultation in two rural area hospitals in Costa Rica.
Authors: Villalobos Karol
Published: November 2017

254

Background: Point of care Ultrasonography (POCUS)—that is ultrasonography performed and interpreted by the clinician at the bedside—is a method of clinical focused evaluation assisted by ultrasound equipment which gives the health provider in limited resources conditions, a prompt and accurate diagnosis for a limited number of pathologies. Development of portable ultrasound equipment with accessible technologies in terms of health investment, allows developing such practice in non-conventional resource-limited settings as patient homes. Our proposal is to show point of care ultrasonography (POCUS) experiences by two Palliative Care specialist doctors with in government-managed Social Security service (CCSS) in rural areas in Costa Rica. Methods: Limited diagnosis examinations were performed both at the hospital as well as at out of hospital sites in rural areas of Turrialba, and San Carlos, Costa Rica. Percutaneous procedures took place at the hospital following monitoring and aseptic standards, using two different units (Contec CMS600P2B, Phillips Clearvue 550). Results: Each brief case presented in this article shows effective Point of Care Ultrasound uses for patients with life-limiting conditions in resource-limited settings. Use of this technology by palliative medicine specialists in these cases helped patients and their families by accelerating right diagnosis, limiting unnecessary hospital transportation or by helping making safer procedures. Conclusions: Point of care ultrasound usage by palliative medicine specialists is an innovation breaking paradigms that has shown in our case to be a successful help as an evaluation strategy in a limited-resources rural environment, with a frail population.
Effects of examination room computer on cancer patients perception of physician's compassion, communication skills, and professionalism: A randomized clinical trial.
Authors: Haider Ali , Tanco Kimberson Cochien , Epner Margeaux , Azhar Ahsan , Williams Janet L. , Frisbee-Hume Susan , Allo Julio A. , Liu Diane D , Bruera Eduardo
Published: November 2017

26

Background: The use of electronic health records (EHR) continues to rise in various clinical settings. The full effects of EHR use on physician-patient interactions remain unclear. This study aims to compare patient perception of physician’s compassion, communication skills, and professionalism between a traditional face to face clinic visit with a visit where an examination room computer is used by the physician to access and document patient information. Methods: RCT was conducted at an outpatient supportive care center. 120 English speaking adults with advanced cancer were recruited. Patients were randomized to watch 2 standardized, 3-minute video vignettes depicting a routine physician-patient clinical encounter. Both videos had identical script. In one video, physician communicated face to face while in the other video physician used the examination room computer during conversation. Both actors and patients were blinded to the purpose of the study. Investigators were blinded to the sequence of videos watched by the patients. After viewing each video, patients completed validated questionnaires rating their perception of physician’s compassion (0 = best, 50 = worst), communication skills (0 = poor, 70 = excellent) and professionalism (0 = poor, 20 = very good). Patients were also asked to rate their overall physician preference. Results: After watching the first video, the face to face clinical encounter resulted in better compassion scores (median [interquartile range], 9[0-18] vs 20[6-28]; P = .0003), communication skills 65[54-70] vs 54[41-63]; P = .0001) and professionalism 19[5-20] vs 14[11-17]; P = .013). After crossover analysis, we found a significant period ( P = .004) and sequence ( P = .005) effect favoring the second video on compassion scores. After watching the second video, 86 (72%) of the patients preferred face to face communication. Conclusions: Patientsperceived physicians who communicated face to face without the use of computer as more compassionate, professional and with better communication skills. Moreover they preferred face to face physician to be their provider. Clinical trial information: NCT02957565.
Understanding the goals of chemotherapy for metastatic cancer: A survey of patients receiving palliative treatment in the Philippines.
Authors: Cauton Pauline Anne Peronilla , Francia Marie Belle Dela Cruz
Published: November 2017

28

Background: Chemotherapy for metastatic cancer is, for most cases, primarily given with palliative intent. An unrealistic expectation of cure with chemotherapy can influence a patient’s decision to receive treatment with significant physical, financial and psychological effects. This study describes how patients receiving palliative chemotherapy view their illness and treatment. Methods: Patients receiving chemotherapy for metastatic cancer were asked about their understanding of treatment goals using a questionnaire based on portions of the Cancer Care Outcomes Research & Surveillance (CanCORS) survey. The prevalence of responses reflecting a belief of cure with chemotherapy was determined. Additional information gathered included other expectations and attitudes towards illness and treatment. Results: A total of 90 patients receiving treatment at St. Luke’s Cancer Institute participated. Ninety-five percent (n = 85) said they believed chemotherapy could, however likely, cure their cancer. The likelihood of having an unrealistic expectation about chemotherapy was high regardless of sex, age, civil status, social class, educational attainment, cancer type, illness duration, and number of lines of treatment received. As for other expectations of chemotherapy, majority agreed that chemotherapy was somewhat likely to prolong life (51.1%), achieve symptom control (51.1%), and have side effects (50%), yielding a pattern of responses almost identical to the ones about cancer cure. Patients said they worried most about treatment cost and side effects. Despite this, an overwhelming percentage said they would choose to pursue life-prolonging treatment no matter what the cost (physically and financially). Less than half (43.7%) expressed an openness to discuss advance directives with their doctor. This could be seen as an extension of their inaccurate understanding of prognosis, or conversely as a manifestation of avoidance or denial. Conclusions: Many factors influence a patient’s perception of his/her illness and treatment. Further study on specific patient and physician factors may identify key areas of improvement for effective communication.
Systematic review on shared decision making for patients with lung cancer: Effects on distress and health care utilization.
Authors: Geerse Olaf , Stegmann Mariken , Kerstjens Huib A.M. , Hiltermann Thijo Jeroen Nicolaas , Bakitas Marie , Zimmermann Camilla , Deal Allison Mary , Berger Marjolein , Berendsen Annette J.
Published: November 2017

31

Background: Lung cancer is associated with significant distress, poor quality of life, and a median prognosis of less than one year. Shared decision making (SDM) has been recommended as a strategy to help guide patients facing difficult treatment trade-offs. Potential benefits of SDM include enhanced knowledge and better congruence between treatment decisions and patients’ personal values and have been described in multiple diseases. We investigated the impact of SDM on distress and healthcare utilization among patients with lung cancer. Methods: We performed a systematic literature search in the CINAHL, Cochrane, EMBASE, MEDLINE, and PsychINFO databases. Studies were eligible when conducted among patients with lung cancer, evaluated SDM, and measured distress and/or health care utilization as outcomes. Risk of bias was assessed using the Cochrane risk of bias tool. Results: A total of 11 articles were identified: two retrospective cohort studies and nine articles reporting on eight randomized controlled trials. Overall, the risk of bias of included studies was low, except for a high risk of bias concerning blinding of participants or personnel. All studies reported on a broad supportive care intervention with SDM as a component of the intervention. No beneficial effect was found in five studies measuring generic distress, while one study reported beneficial effects on depression. There was conflicting evidence regarding the effects of SDM on healthcare utilization; of the seven studies analyzing this, five studies found evidence for a reduction in healthcare utilization. Conclusions: Although relevant, only scarce evidence is currently available on the effects of SDM on distress and healthcare utilization among patients with lung cancer. Thus, additional research is needed before SDM can be recommended in the lung cancer context.
Anxiety in breast cancer patients treated with neoadjuvant therapy: Effects on surgical plan and role of supportive care.
Authors: Li Huaqi , Cheung Winson Y. , Myers Paula , McKevitt Elaine , Willemsma Kaylie , Deruchie Tan Adam , Chia Stephen K. L. , Simmons Christine E.
Published: November 2017

35

Background: The impact of high anxiety on surgical decision making has been demonstrated in various cancer settings. For patients undergoing neoadjuvant therapy (NAT) for breast cancer, supportive services can be offered prior to surgery and may help them choose between the options of bilateral mastectomy, unilateral mastectomy, or breast conserving surgery (BCS) where clinically appropriate. However, the effect of anxiety at initial diagnosis and psychological support on these decisions has not yet been studied. Methods: A prospective database of breast cancer patients treated with NAT at the British Columbia Cancer Agency was utilized to extract demographic information, surgical plan with regards to BCS and unilateral or bilateral mastectomy, and information about supportive services utilized. This was correlated with anxiety scores at initial consultation recorded by the Edmonton Symptom Assessment System and the Psychosocial Screen for Cancer. Patients were excluded if they had bilateral breast cancer, BRCA mutation, or missing data. Fisher’s exact tests were applied for statistical analysis. Results: From 2012-2016, 361 potential patients were identified. In total, 203 patients met eligibility criteria: 93 patients (46%) had low anxiety and 110 patients (54%) had high anxiety. Patients with high self-reported anxiety at initial consultation were 19% more likely to undergo aggressive surgery (bilateral mastectomy for unilateral disease or mastectomy for BCS eligible disease) than those with low self-reported anxiety at initial consultation (37% VS 18%; p = 0.003). Of the 110 patients with high anxiety, only 46 patients (42%) utilized counselling before surgery. No significant difference in rate of aggressive surgery was observed in patients with high anxiety who had counselling compared to those who did not (33% VS 41%; p = 0.43). Conclusions: High anxiety at initial consultation is associated with a 19% increase in aggressive surgery compared to patients with low anxiety. Counselling resources are currently underutilized by eligible patients, but this did not have an impact on surgical decision making in this study. This may be an area of opportunity for further research.