bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient-centered conversations: Advance care planning values in the adult oncology population.
Authors: Mikan Sabrina Q. , Hoverman J. Russell
Published: February 2017

147

Background: Over the past 2 years a structured advance care planning program (ACP) has been created, piloted and is evaluated monthly at 10 Texas Oncology practices. This program is a systematic process for assessing patient values, is physician supported and is delivered by advanced practice providers at each site. Patient values and quality of life are at the center of the conversations, enhancing patient-centered care and communication with their oncology providers. Targeted patient populations include metastatic lung, pancreatic and colon cancers. Methods: Over the past 14 months, 332 patients engaged in ACP in ten sites. Descriptive statistics for each site were calculated and examined to explore 1) ACP counseling sessions, 2) number of Patient Values questionnaires completed, 3) frequency of code status documentation in the health record, and 4) hospice enrollment for both the targeted and all metastatic populations. Results: A three month review revealed the ACP work within all metastatic populations at the ten sites. Targeted population totals showed continued increase in the percentages of patient ACP engagement at each site. For the practice as a whole, and the targeted population, 9-23% of patients have received an ACP counseling visit. There have been 149 completed Patient Values questionnaires. In the electronic health record, there are 2,233 (24%) patients who have a documented code status. A range of hospice enrollment from 8-28% in the targeted populations has continued to improve hospice length of stay. Conclusions: The patient is invited to explore their treatment options, their personal values and the completion of the advance directive documents. Truthful conversations are critical between patient and provider in order to create a meaningful treatment plan, and to allow the patient to gain understanding about their options. Early palliative care referrals are integrated into each session for symptom management through local partnerships with palliative care physicians. Education regarding life-sustaining interventions help the patient determine their choices for medical care. Having ACP counseling is important at any stage of health and particularly within life-limiting disease.
Implementation of NCCN palliative care guidelines by member institutions.
Authors: Portman Diane G. , Albizu-Rivera Alexandra , Thirlwell Sarah , Codada Shirley N. , Donovan Kristine A.
Published: February 2017

15

Background: To promote access to quality, evidence-based palliative care (PC) and help cancer patients experience the best quality of life possible throughout the illness trajectory, the National Comprehensive Cancer Network (NCCN) has developed PC guidelines to guide symptom screening, assessment, PC interventions, and reassessment by the oncology team. We sought to evaluate use of the guidelines among NCCN member institutions. Methods: In April and May 2014 an invitation and reminders to participate in an online survey were sent electronically to NCCN PC guidelines panel members. If a panel member did not reply, individuals involved in the provision of PC at the same institution were approached. Results: Responses were received from 21 (84%) of the 25 member institutions. All of the institutions report having an interdisciplinary team with PC expertise. Among respondents, 38% have an accredited/certified PC program and 52% have an institutional PC quality improvement program in place. Fifty-two percent submit data to the National Palliative Care Registry. Forty-three percent have guidelines or triggers in place for the use of PC services. Only 10% actively employ the NCCN guidelines to screen for PC needs or make PC referrals; the guidelines are more often used to guide patient assessment (38%) and clinical practice (43%). When asked to endorse other PC referral criteria, 76% indicated the discretion of the oncology provider(s) and 29% the National Consensus Project for Quality Palliative Care. Sixty-two percent agree providers concur on the elements of PC and 29% agree as to who should receive PC. Only 19% agree early integration of PC should occur for all oncology patients and 43% agree PC referrals occur in a timely and efficient manner. The most frequently cited barriers to the provision of quality PC are: attitudes toward PC (71%), insufficient staffing (61%) and limited financial resources (57%). Conclusions: Implementation of the guidelines at NCCN member institutions is incomplete. There appears to be a lack of consensus about when and for whom PC should be provided. Future research should be designed to enhance understanding of the barriers to care and improve implementation of the guidelines.
A randomized, double-blind trial evaluating the palliative benefit of either continuing pamidronate or switching to zoledronate in patients with high-risk bone metastases from breast cancer (The Odyssey Study).
Authors: Jacobs Carmel Maree , Kuchuk Iryna , Smith Stephanie , Mazzarello Sasha , Vandermeer Lisa , Bouganim Nathan , Dent Susan , Gertler Stan Z. , Verma Shailendra , Young Vince , Song Xinni , Simos Demetrios , Dranitsaris George , Cella David , Clemons Mark
Published: February 2017

155

Background: Questions remain around the optimal use of bone-targeted agents (BTA) in patients with bone metastases (BM) from breast cancer (BC). In Canada pamidronate (PAM) is the most commonly used BTA in BC.We explored whether a switch to a more potent BTA, like zoledronic acid (ZA), in patients who remain at high risk of skeletal related events (SREs) despite PAM use is associated with significant palliative benefit. Methods: BC patients with high risk BM (prior SRE, bone progression, bone pain or levels of bone turnover marker serum C-telopeptide (sCTX) >400ng/L) despite >3 months of PAM use were eligible. Patients were randomized in a double–blind manner to either switch to ZA or continue on PAM every 4 weeks for 12 weeks. Primary outcome was the proportion of patients achieving a fall in sCTX at 12 weeks. Secondary outcomes were pain control (BPI and FACT-BP) and toxicity. Results 73 patients completed the study. Median age 61 years (range 37 – 87), prior duration of PAM use 10 months (range 3 – 118). sCTX levels for all patients at baseline, 372+/- 471, week 12, 209 +/-290. Proportion of patients achieving a fall in sCTX from week 0 to week 12, 26/31 (84%) in ZA arm, 17/30 (57%) in PA arm, p=0.0262. Two patients were unable to complete the study due to deterioration in renal function (both receiving PAM), four due to progressive disease (two receiving ZA, two PAM), two patients chose to discontinue the study before completion (both receiving ZA). Four patients (5%) had SRE’s during the study, two receiving ZA, two receiving PAM. Quality of life and pain analysis shows no difference between week 0 and week 12 scores in either arm. Toxicity was predominantly grade 1 and 2, numerically there were more adverse effects in the ZA arm than PAM. Conclusion Switching patients with high risk BM from PAM to ZA leads to a reduction in sCTX levels but may be associated with more toxicity. Quality of life and pain scores were similar between the two treatments. While the literature suggests that a reduction in sCTX may correlate with reduced rate of SREs, given the lack of symptom improvement a switching strategy cannot be recommended. NCT01907880 Clinical trial information: NCT01907880.
Coping with cancer treatment-related financial burden.
Authors: Nipp Ryan David , Zullig Leah L. , Samsa Gregory , Peppercorn Jeffrey M. , Schrag Deborah , Taylor Donald H. , Abernethy Amy Pickar , Zafar Yousuf
Published: February 2017

161

Background: Growing evidence suggests that financial distress is a side effect of cancer care needing attention. Little is known about how patients cope with treatment-related financial distress. This study describes how patients with cancer cope with treatment-related costs and identifies those at greatest risk for using potentially harmful cost-coping strategies. Methods: Eligible patients for this cross-sectional, survey study were adults being treated for solid malignancies enrolled June 2010 to May 2011 in a national copay assistance program. Coping strategies were grouped as lifestyle-altering or care-altering. Descriptive statistics and analysis of variance assessed coping strategies and relationships between covariates. Results: Among 174 participants, 89% used at least one lifestyle-altering strategy to cope with costs, while 39% used a care-altering strategy. Most common care-altering coping strategies included: not filling a prescription (28%); and taking less medication than prescribed (23%). Lifestyle-altering strategies included: spending less on leisure activities (77%); spending less on basics (57%); borrowing money (54%); and spending savings (50%). The mean number of coping strategies was higher for patients < 65 than for those ≥ 65 (Table). Lower-income patients used more care-altering strategies than higher-income patients. Patients with more education and shorter duration of chemotherapy adopted more lifestyle-altering strategies than their counterparts. Conclusions: Patients were generally more likely to use lifestyle-altering approaches to cope with treatment-related financial burden, but more than one-third adopted care-altering strategies. Younger patients and those with lower incomes were more likely to alter their care. Screening for and anticipating potentially harmful cost-coping behavior in the oncology clinic is important to reduce patient distress and promote optimal care. [Table: see text]
The conversion ratio for opioid rotation from hydrocodone to other strong opioids in cancer patients.
Authors: Reddy Akhila Sunkepally , Yennu Sriram , Wu Jimin , Liu Diane , Reddy Suresh K. , De la Cruz Maxine , Bruera Eduardo
Published: February 2017

164

Background: Cancer pain is initially treated with intermediate strength analgesics such as hydrocodone and subsequently escalated to stronger opioids. There are no studies on the process of opioid rotation (OR) from hydrocodone to strong opioids in cancer patients. Our aim was to determine the conversion ratio (CR) for OR from hydrocodone to morphine equivalent daily dose (MEDD) in cancer outpatients. Methods: We reviewed records of 3,144 consecutive patient visits at our Supportive Care Center in 2011-12 for OR from hydrocodone to stronger opioids. Data regarding demographics, Edmonton Symptom Assessment Scale (ESAS), and MEDD were collected in patients who returned for follow up within 6 weeks. Linear regression analysis was used to estimate the CR between hydrocodone and MEDD. Successful OR was defined as 2-point or 30% reduction in the pain score and continuation of the new opioid at follow up. Results: 170/3,144 patients underwent OR from hydrocodone to stronger opioid. 72% were white, 56% male, and 81% had advanced cancer. The median time between OR and follow up was 21 days. 53% had a successful OR with significant improvement in the ESAS pain and symptom distress scores. In 100 patients with complete OR and no worsening of pain at follow up, the median CR (Q1-Q3) from hydrocodone to MEDD was 1.5 (0.9-2) and hydrocodone dose to MEDD correlation was.52 (P<0.0001). The correlation of CR with hydrocodone dose was -0.52 (P<0.0001). The median CR of hydrocodone to MEDD was 2 in patients receiving < 40mg of hydrocodone/day and 1 in patients receiving ≥ 40mg of hydrocodone/day (P<0.0001). The median conversion ratio of hydrocodone to morphine was 1.5 (n=44) and hydrocodone to oxycodone was 0.9 (n=24). Conclusions: Hydrocodone is 1.5-fold stronger than Morphine. The median conversion ratio from hydrocodone to MEDD varied according to hydrocodone dose/day. [Table: see text]
A nomogram for predicting serious complications in patients with solid tumors and apparently stable febrile neutropenia: Prospective data on 781 consecutive episodes from the FINITE study.
Authors: Ghanem Ismael , Antonio Rebollo Maite , Garrido Marcelo , Martinez Jeronimo , Font Carme , Ramchandani Avinash , Biosca Merce , Beato Carmen , Martinez de Castro Eva , Castanon Eduardo , Echaburu Juan Virizuela , Espinosa Javier , Sevillano Elena , Aragon Manrique Isabel , Cardona Merce , Mondejar Rebeca , Baron Francisco , Acevedo Francisco , Jiménez-Fonseca Paula , Carmona Bayonas Alberto
Published: February 2017

165

Background: An accurate estimate of the likelihood of serious complications in patients with otherwise apparently stable febrile neutropenia (FN) may assist in decision-making regarding individualized therapy. Our group has developed a prognostic score for predicting complications in patients with solid tumors and apparently stable episodes called CISNE (Clinical Index for Stable Febrile Neutropenia). The purpose of this study is to present a nomogram based on the previously mentioned index in a broader dataset of patients. Methods: FINITE is a prospective and multicenter study which aims to investigate prognostic factors and outcomes of FN episodes with clinical stability at first assessment, defined as events without acute organ dysfunction, vital signs abnormalities or major infections. We performed a nomogram based on the CISNE score which includes the following prognostic variables: ECOG PS≥2, chronic obstructive pulmonary disease, cardiovascular disease, mucositis NCI grade ≥2, monocytes <200/mm3 and stress-induced hyperglycemia. A calibration plot was used to analyze the accuracy of this multivariate nomogram. Results: From October 2012 to December 2013, 781 patients with apparently stable FN were recruited in 21 Spanish hospitals. The rate of infection-related complications and death was 15.6% (95% confidence interval [CI], 12.9-18.6%) and 1.7% (95% CI, 0.98%-3.01%). A nomogram was designed according to the CISNE score. The area under the ROC curve was 0.836 (95% CI, 0.808-0.861). The observed and predicted probabilities also matched closely. Conclusions: Our group has developed a user-friendly nomogram for predicting complications in patients with apparently stable FN. This nomogram may be particularly useful to prevent premature discharges of cancer patients starting inpatient management.
How to create a successful cancer self-management intervention: Development, evaluation, and lessons learned.
Authors: Goldberg Jessica , Hinchey Jenna , Feder Shelli , Schulman-Green Dena
Published: February 2017

168

Background: Cancer self-management (SM) is individuals’ engagement in tasks related to the medical, physical, spiritual, and emotional management of cancer. Reports of SM interventions often focus on efficacy and do not detail processes of development and evaluation. We delineate our creation of a patient-oriented and informed cancer SM intervention, Managing Cancer Care: A Personal Guide (MCC), and share lessons learned to improve intervention efficacy and fidelity. Methods: We developed and evaluated MCC in 5 stages: needs assessment interviews (n=25); development of MCC; focus group (n=6); pilot testing with metastatic breast cancer patients (n=23); and population testing with non-metastatic breast cancer patients (n=110). We performed content analysis on qualitative data and used descriptive statistics to analyze module ratings and frequency of use in the pilot and population tests. Results: We identified cancer SM practices, preferences, facilitators, and barriers, and designed MCC based on interview data, related literature, and SM theory. The MCC prototypeconsisted of 7 magazine-style modules designed to be user-friendly, concise, and personalized. Although well-received, we made substantial changes based on focus group data, with additional revisions after the pilot test. Module ratings and frequency of use differed between pilot and population samples. Among metastatic patients, median ratings (1-10, low/high) for MCC as a whole on both content and format were 8 (range 2-10). The most popular module was Care Options, which tied with Managing Transitions as most frequently used. Among non-metastatic patients, median ratings were 8 (range 1-10) and 9 (range 2-10) on content and format, with the Managing Your Symptoms module being most popular and most frequently used. Conclusions: Data from our metastatic and non-metastatic samples suggest differing SM priorities. Lessons learned in creating patient-oriented cancer SM interventions include acknowledging that there are no “one size fits all” solutions, resisting assumptions about reception of potentially emotional content, maintaining flexibility, and negotiating the tension between research and real world settings.
Multidisciplinary risk assessment to reveal cancer treatments in complex cancer patients.
Authors: Huillard Olivier , Boudou-Rouquette Pascaline , Chahwakilian Anne , Montheil Vincent , Thomas-Schoemann Audrey , Orvoen Galdric , Cabanes Laure , Durand Jean-Philippe , Cessot Anatole , Giroux Julie , Tesniere Antoine , Stephanazzi Jean , Mosnier-Pudar Helen , Alexandre Jerome , Goldwasser Francois
Published: February 2017

170

Background: Older age is a cause of disparity in cancer treatment decision and treatment guidelines for patients with comorbidities, polypharmacy, denutrition or psycho-social frailty are needed. A pre-therapeutic multidimensional assessment might improve the complex patient management. We developed an experimental program of integrated medicine called ARIANE. We report 18 months activity of this outpatient setting evaluation, its feasibility and impact on treatment decision-making. Methods: Complex patients with predefined cancer treatment strategy entered into the program. A one-day evaluation combined consultations of cardiologist, geriatrician, diabetologist, anesthetist, pharmacist, pain specialist, dietician, psychologist and social worker. Evaluation of performance status, EKG, ejection fraction, ASA score, diabetes, social vulnerability and malnutrition was performed including a geriatric assessment, which focused on items like comorbidity (CIRS-G), dependance (ADL, IADL), fails (Up and Go Test), cognitive impairment (MMSE, Clock Drawing Test) and depression (GDS scale). A pharmacist assessed the risk of drug-drug interactions. Results: Eighty-seven pts, median age 81 years (range 25-94), 76% male, 51% PS 0-1, 77% grade 3 or 4 comorbidity were included. Genito-urinary, lung cancers and sarcoma represented 77% of pts. Eighty-two percent of pts were assessed by at least ≥ 7 participants. Identified factors of vulnerability were polypharmacy (n=65; 75%; >3 drugs), social distress or severe malnutrition (both n=21; 24%), depression (n=17; 19.5%) and cognitive impairment (n=13; 15%). We identified drug interaction in 18 pts (27%). The risk assessment resulted in anticancer treatment changes in 47/87 patients (54%): protocol adaptation (n=19/87; 22%), less aggressive treatment (n=15/87; 17.2%), or more intensive therapy (n=13/87; 15%). Conclusions: A one-day multidisciplinary risk assessment is an answer to the complexity of unfit cancer patients and improves the safety of anticancer treatments.
Meta-analysis of trials comparing standard antiemetic treatment (SAT) with aprepitant containing antiemetic regimens (ACAR) for prevention of chemotherapy-induced nausea and vomiting (CINV).
Authors: Gupta Neha , Hatoum Hassan , Al Ustwani Omar , Danchaivijitr Pongwut , Wang Katy , Pili Roberto
Published: February 2017

171

Background: Various randomized controlled trials (RCTs) have shown improved outcomes with addition of aprepitant to standard antiemetic treatment (SAT) in preventing CINV. We conducted a meta-analysis to study the overall impact of ACAR in CINV prevention in adults. Methods: We searched Pubmed and Ovid databases, and American Society of Clinical Oncology meetings abstracts for RCTs using ACAR with SAT for CINV prevention in adult cancer patients (pts). Major study end points were complete response to treatment (CR; defined as no emesis and no use of rescue medications) in overall phase (OP; 0-120 hours of chemotherapy), acute phase (AP; 0-24 hours) and delayed phase (DP; 24-120 hours). Additionally, we assessed the control of nausea and toxicity profile (TP). Stouffer's Z-score method was used to calculate the overall effect. Results: 16 RCTs (5,547 pts) were included. 11 trials (3,314 pts) involved highly emetogenic chemotherapy (HEC) and 5 trials (2,233 pts) involved moderately emetogenic chemotherapy (MEC). ACAR increased CR in OP from 47% to 63% (OR=0.52, CI=0.46 to 0.58; p<0.001), in AP from 73% to 81% (p<0.01), and in DP from 51% to 66% (p<0.001). Significant increase in nausea control was seen in DP (p=0.03) but not in OP or AP. Incidence of various toxicities was statistically similar in both groups except slightly higher rate of fatigue (p=0.02) and hiccups (p<0.001), and lower rate of neutropenia (p=0.02) in ACAR. Conclusions: ACAR is effective in CINV due to both HEC and MEC in adult cancer pts. ACAR improves the control of emesis in all phases, and nausea in delayed phase only. With the exception of causing more fatigue & hiccups, and lesser neutropenia, overall TP of ACAR is similar to SAT.
Outpatient implementation of a patient self-reported symptom system in an integrated health system.
Authors: Adonizio Christian S. , Wojtowicz Mark , Wade James , Keifer Lisa , Graves Thomas , Darer Jonathan
Published: February 2017

172

Background: To date, process-related outcomes dominate the landscape of the measurement of quality of oncologic care. Use of patient-reported outcomes has the potential to enhance value-based performance measurement. We performed a pilot study of integrating patient-reported data (PRD), into the daily work-flow of outpatient oncology clinics in an integrated health system, Geisinger Health System (GHS). Methods: All patients in the pilot were asked their pain scores by nurses according to existing procedures. In addition, the MD Anderson Symptom Inventory (MDASI) questionnaire was given to patients via touch screens in exam rooms. Four oncologists participated in the study at two sites. The study was reviewed by the GHS IRB and was granted exemption status. Results: 63 patients successfully used the touch screen monitors to complete the MDASI with minimal impact to clinic flow. Compared to the existing EHR-prompted nursing-collected pain score method, the PRD/MDASI method identified an additional 31% of patients with severe pain who were previously identified as having “no pain” (Table). 75% of patients identified as having “moderate pain” by the current method report “severe pain” by the PRD method. Conclusions: This pilot study demonstrates that the collection of PRD can be integrated into routine oncological clinic workflows with minimal interference with clinical flow. The study also shows that the collection of PRD may be superior to clinician screening at the time of the encounter alone. GHS will integrate PRD fully into its EHR in August 2014. GHS is developing evidence-based, standardized symptom management protocols and expanding the use of PRD in clinical care. [Table: see text]
Prevalence and correlates of patient symptom burden at initiation of curative chemotherapy.
Authors: McCarty Caitlin , Traeger Lara , Greer Joseph A. , Temel Jennifer S. , McDonnell Theresa Margaret
Published: February 2017

176

Background: Side effects of curative chemotherapy regimens are highly prevalent and can lead to unplanned oncology clinic visits or hospital-level care. The current study aim was to examine physical symptoms among patients at their first chemotherapy visit, even prior to receiving their first infusion, in order to characterize symptom burden and unmet needs at this early stage of care. Methods: The current study utilized baseline data from a larger health services research trial for consecutive patients initiating chemotherapy for non-metastatic breast (48.0%), colorectal (28.0%), or lung (24.0%) cancer (n=75). Patients were invited to complete a self-report survey at their first chemotherapy visit, including demographics and measures of physical symptoms (Memorial Symptom Assessment Scale) and psychological distress (Patient Health Questionnaire-4; score ≥ 3 indicates positive anxiety or depression screen). Results: Among participants (M age=55.3 [SD=13.3]; female=70.7%), more than half (54.7%) endorsed at least one physical symptom -- primarily fatigue (34.7%) and constipation (29.3%). Additionally, one-fourth (25.3%) screened positive for anxiety (22.7%) and/or depression (9.3%). There were no differences in physical symptom bother or likelihood of fatigue or constipation, by factors including patient age, gender, marital status, work status, disease type, recent surgery, or concurrent radiotherapy. However, patients with positive anxiety and/or depression screens reported greater symptom bother and were more likely to endorse fatigue relative to those with negative screens (Mbother=4.5 vs. 1.3; fatigue=78.9% vs. 19.6%, p’s<.01). There was no difference in constipation between these groups. Conclusions: Symptom frequency was markedly high among patients initiating curative chemotherapy, with at least half reporting physical symptoms prior to their first infusion, and psychological distress clustered with general symptom bother and fatigue. Future work should explore 1) the extent to which physical and psychological symptoms at chemotherapy initiation may be associated with longitudinal symptom profiles, and 2) strategies for addressing symptom burden early on in outpatient care.
Association of high symptom burden with oral oncolytic agents.
Authors: Severson Jane Alcyne , Mackler Emily , Marini Bernard , Blayney Douglas W.
Published: February 2017

177

Background: Increasing numbers of cancer patients are being treated with oral oncolytics. This change represents a shift from frequent direct observation during intravenous therapy to periodic observation and increased necessity for improved monitoring and self-care management. Despite this shift, patients are at risk to develop many of the same chemotherapy-associated symptoms and toxicities. We sought to understand the symptom burden associated with use of oral oncolytics. Methods: Michigan Oncology Quality Consortium (MOQC) sponsored a quality improvement initiative focused on improving oral oncolytic care. Eight oncology practices participated. Patients were assessed with a modified Edmonton Symptom Assessment System (ESAS) prior to each outpatient visit. A total of 537 surveys were analyzed. 13 measures were categorized into mild (0 to 3), moderate (4 to 6), and severe (7 to 10) symptom burden. Results: Overall, the average ESAS symptom score was mild in 81% of patients, moderate in 13% of patients, and severe in 6% of patients. These average scores, however, obscure the significant burden in select ESAS domains. For example, 39% of patients categorized their overall well-being as being moderate/severely affected; 38% of patients felt they were moderate/severely fatigued, and 21% indicated moderate/severe neuropathy symptoms. Notably, 118/537 (24%) of the assessments had 4 or more symptoms rated moderate to severe. Conclusions: Patients taking oral oncolytics experience significant symptom burden that impacts quality of life. Intolerance of oral oncolytics may lead to adherence issues, potentially affecting expected outcomes. Given the prevalence of symptoms and potential for toxicity, self-care strategies to improve early recognition and treatment of symptoms by patients taking oral oncolytics are necessary. [Table: see text]
The routine use of the Edmonton classification system for cancer pain in an outpatient supportive care center.
Authors: Arthur Joseph , Yennu Sriram , Nguyen Linh , Tanco Kimberson , Chisholm Gary B. , Hui David , Bruera Eduardo
Published: February 2017

180

Background: There is no standardized and universally accepted pain classification system for the assessment and management of cancer pain in both clinical practice and in research studies. The Edmonton Classification System for Cancer Pain (ECS-CP) is an assessment tool that has demonstrated value in assessing pain characteristics and response. The purpose of the study was to determine the relationship between the negative ECS-CP features and some pain related variables like pain intensity and opioid use. Also, we explored whether the number of negative ECS-CP features was associated with higher pain intensity. Methods: Electronic charts of 100 patients at the outpatient supportive care clinic in a comprehensive cancer center were reviewed for patient characteristics, initial ECS-CP assessment, the morphine equivalent daily dose (MEDD), opioid rotation, the Edmonton Symptom Assessment Score (ESAS), Memorial Delirium Assessment Scale (MDAS), performance status, and the use of adjuvant analgesics. Results: Ninety one out of the 100 charts were therefore eligible for analysis. The median age was 58.4 years. The most common primary cancer site was gastrointestinal cancer (22.1%). The median pain intensity was 6 and the median MEDD was 45mg. Incident pain was the most common ECS-CP feature (60%) and cognitive dysfunction was the least frequent feature (2%). Neuropathic pain was associated with higher median pain intensity (7 vs. 5, p=0.007) and median MEDD requirement (83 vs. 30, p=0.013). Psychological distress was associated with higher median pain intensity (7 vs. 5, p=0.042). Incident pain was also associated with a trend for higher pain intensity (6 vs 5, p= 0.06). A higher number of negative ECS-CP features was associated with higher pain intensity (p=0.01). Conclusions: The ECS-CP was successfully completed in the majority of patients, demonstrating its utility in routine clinical practice. Neuropathic pain and psychological distress were associated with higher pain intensity. Also, neuropathic pain was associated with higher MEDD. A higher sum of negative ECS-CP features was associated with higher pain intensity. Further studies will be needed to explore this observation.
Effect of duloxetine on chemotherapy-induced painful peripheral neuropathy.
Authors: Hirayama Yasuo , Terui Takeshi , Koike Kazuhiko , Kusakabe Toshiro , Horiguthi Hiroto , Ishitani Kunihiko
Published: February 2017

181

Background: Approximately 20% to 40% of patients with cancer who receive neurotoxic chemotherapy will develop painful chemotherapy-induced peripheral neuropathy. Smith et. al firstly reported that duloxetine was effective on above neuropathy after taxanes and platinums (JAMA 2013), so we planed to evaluate the duloxetine effect in Japanese patients after above drugs and more expanding drugs include vinca alkaloids and bortezomib. Methods: Patients were randomized to receive either duloxetine followed by vitamin(V)B12 or VB12 by duloxetine. The initial treatment consisted of 20 mg of duloxetine or 1.5g VB12 for the first week and 40mg of duloxetine or VB12 daily for 3 additional weeks (an open label, randomized, crossover). Dose reduction by the adverse effects was permitted. The primary hypothesis was that duloxetine would be more effective than VB12 in decreasing chemotherapy-induced peripheral neuropathic pain. Numbness and Pain severity were assessed weekly using visual analogue scale (VAS). This research was approved by the Research Ethics Committee of Higashi Sapporo Hospital and University Hospital Medical Information Network (UMIN) Center in Japan.Thirty-four cases (Breast cancer: taxanes 2, gastric cancer: taxane 5, colon cancer: oxaliplatin 6, Malignant lymphoma: vincristine 13, multiple myeloma: bortezomib 8) were made an entry in our institution. Five cases dropped out because of the adverse effect with sleepy and general malaise. Results: Obvious improvements of VAS scores of numbness and pain were observed in duloxetine group. Significant differences of delta VAS (pre VAS scale – 4 weeks VAS after drug administration) were observed between duloxetine group and VB12 group in the aspect of numbness (p=0.02) and pain (p=0.03). Conclusions: Among patients with painful chemotherapy-induced peripheral neuropathy, the use of duloxetine compared with VB12 for 4 weeks resulted in a reduction in numbness and pain, but there are many cases with drop out by the adverse effects. Clinical trial information: 000011554.
Palliative care needs: Symptom reporting during geriatric oncology evaluation.
Authors: Flannery Marie Anne , Pandya Chintan , Tejani Mohamedtaki Abdulaziz , Kamen Charles Stewart , Magnuson Allison , Dale William , Morrow Gary R. , Mohile Supriya Gupta
Published: February 2017

184

Background: Although extensive descriptive work has been conducted on the symptom experience in cancer, relatively little is known about the specific palliative care needs for geriatric oncology populations. When all age groups are studied older individuals report less symptoms and the symptom experience of older cancer patients is minimized. Utilizing data collected from two geriatric oncology referral clinics the primary aim of this study was to identify geriatric oncology patients’ symptom reports, the number of symptoms experienced, and interference reported from symptoms. Methods: Patients referred to a geriatric oncology consult clinic were asked to complete the MD Anderson Symptom Inventory (MDASI) total of 13 items. In addition all patients underwent comprehensive geriatric assessment with a battery of tests. Results: 192 patients completed the symptom inventory with a median age of 81 years (range 65-95). 94% of patients reported at least one symptom, >45% reported experiencing 10 of the 13 symptoms (mean number of symptoms =5.7, SD= 3.7). Most frequently reported symptoms were in order: drowsiness, trouble remembering, dry mouth, disturbed sleep, pain, distress, decreased appetitive, dyspnea, and sadness. Severity ratings for individual symptoms M’s= 0.3-2.5, although the complete range of 0-10 was reported. 67% of patients reported that symptoms were interfering with their quality of life, general activity level and walking ability. Conclusions: In contrast to the myth that older cancer patients have minimal symptoms, at time of referral to a geriatric oncology consultation patients report on average experiencing six symptoms which interfere with their quality of life. There is an intersection between geriatric oncology and palliative care and these descriptive findings highlight the importance of systematic symptom assessment for older individuals with cancer to identify needed symptom relief strategies.
Thromboembolic events in French patients with breast and prostate cancer hospitalized in 2011 and 2012: Incidence and costs.
Authors: Scotte Florian , Borget Isabelle , Vainchtock Alexandre , Martelli Nicolas
Published: February 2017

192

Background: Venous thromboembolic event (VTE) is a common complication for cancer patients, leading to hospitalizations that increase the burden of cancer management. We evaluated the incidence and costs of VTE-related hospitalizations for patients with breast or prostate cancer, two of the most frequent cancers in France. Methods: We used the French national hospital database (PMSI) to select new patients with BC or PC in 2010, who had at least one VTE-related hospitalization during the following two years. VTE-related stays and patients were identified using the disease-specific ICD-10 codes. Hospital costs were estimated from the healthcare system perspective and included care, treatments, accommodation/investment costs and medical/technical procedures, using the French official tariffs. Results: Among 107,916 new patients with BC or PC, 2,268 were hospitalized for a VTE, representing an overall of 2,814 admissions. VTE was classified as primary or related diagnosis (PD/RD) in 1,004 (36%) admissions. Among those PD/RD admissions, pulmonary embolism was the most frequent diagnosis as it led to 626 (62%) stays. Deep venous thrombosis was the second cause of hospitalization (248 admissions; 25% of PD/RD admissions). Re-hospitalisation for recurrence was frequent, as it occurred 546 cases (19.4%) of all VTE-related hospitalizations. For a patient who did not experience recurrence, the mean cost per patient was €3,302 and €3,611 for BC and PC patients respectively. But this amount was highly increased for patients with recurrent VTE, to €5,545 per BC patient and €5,692 per PC patient. Finally, VTE-related hospitalizations were responsible for an overall expenditure of €3.40 million over two years, including €335,000 due to recurrent events. Conclusions: In cancer patients, VTE-related hospitalizations remain frequent and induce an elevated cost. Adequate prophylaxis and management could be an efficient way to reduce the incidence of this common complication and its economic burden. [Table: see text]
Daily patient-reported assessment of pain, anxiety, or distress, problems or concerns, and need to see physician during 100 courses of radiation therapy.
Authors: Howell David D. , Wilson Colette M. , Moore William Andrew
Published: February 2017

193

Background: Patients (pts) undergoing radiation therapy (RT) treatment (Rx) may have pain, anxiety or distress (AoD), or other problems at the time of initiation of RT. Pts may also develop or have an exacerbation of one or more problems during RT. While undergoing RT, pts are seen weekly by the treating physician (MD), and seen daily by the treating radiation therapy technologists (RTT). Pts can develop problems between weekly MD visits which may benefit from expedited interventions. A protocol was developed where pts would be asked four questions each treatment day by the RTT: 1) Are you having pain, and if so, how would you rate it on a scale of zero to 10? (PainQ) 2) Are you having anxiety or distress today? (ADQ) 3) Are you having new problems or concerns? (ProConQ) 4) Do you want to see the physician today? (CMDQ) This information was charted, and used in pt management. Methods: 100 consecutive pt charts were reviewed for demographics including gender, age, primary malignancy, region treated, number of Rx and radiation dose. Daily answers from the four question instrument were also reviewed for each pt course of RT. Results: Of the 100 pt, 56 were male. Disease distribution: Breast-22; Prostate-20; Head and Neck-20; Lung-13; Brain-7; Other-18. For the ADQ, 83 did not report anxiety or distress; 17 reported AoD on 1-2 occasions. For the ProConQ, 35 reported none, 34 reported yes on 1-2 occasions, 22 reported yes on 3-5 occasions, and 9 reported yes on >5 occasions. 29 reported yes on 2 days in a row, and 15 reported yes on 3 days in a row. For the PainQ, 31 reported no pain throughout their course of RT, with 22, 23, and 25 reporting pain of any magnitude for 1 to 5, 6 to10, and >10 days, respectively. 22 reported pain level > 6 on at least one occasion. For CMDQ, 26 pts did not request to see the MD greater than the usual weekly visit, 71 and 3 requested to see the MD an additional 1 to 5, and 6 to 10 times. Conclusions: A simple four question daily query of pts undergoing a course of RT is feasible, and may prompt the need for evaluation and interventions between scheduled MD visits. This may facilitate more expeditious interventions for Rx related toxicity and treatment-dependent or independent symptoms or needs.
Outcome of cancer patients admitted through the emergency department (ED) of a comprehensive cancer center: A call for ED-based palliative care.
Authors: Elsayem Ahmed F. , Silvestre Julio , Merriman Kelly W. , Chaftari Patrick S. , Gonzalez Carmen E. , Yeung Sai-ching J.
Published: February 2017

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Background: The National Cancer Policy Forum advocated for improving quality of end life care, and reducing cost for cancer patients. Identifying those at high risk for Intensive Care Unit (ICU) admission, and hospital death may allow earlier palliative care and avoid futile interventions. The purpose of this study is to examine risk factors for ICU admission, and hospital death among cancer patients admitted through the emergency department (ED). Methods: We queried MD Anderson Cancer Center databases for all patients who visited our ED in 2010. ICU admission and hospital deaths of these patients were reviewed, and individual patients’ data were analyzed. Results: In 2010, 16,038 ED visits were made by 9,246 unique cancer patients. Of these patients, 5,362 (58%) were admitted to the hospital at least once (range 1-13 admits). Of all patients admitted through the ED, 697 (13%) were admitted at least once to ICU. Of all patients admitted, 11% died during hospitalization; of those, 29% died in ICU. Among patients who died in ICU, 73/233 (31.3%) had hematologic malignancies and 96/354 (27.1%) had solid tumors (P<0.001). Patients admitted to ICU had median lengths of hospital stay (MLOS) of 13 days for hematologic and 8 days for solid tumors (P<0.001; using means); patients without ICU admission had MLOS of 6 and 5 days, respectively (P<0.001). In a multivariate logistic regression model for predicting in-hospital mortality, we found that ED presenting symptoms of respiratory distress or altered mental status; primary tumor of lung cancer, leukemia, unknown primary, or lymphoma; and nonwhite ethnicities were independent predictors of death. Insignificant factors included age, gender, residence, fever and pain. Conclusions: Cancer patients admitted through the ED experience high ICU admission rate, and hospital mortality. Lung and certain other cancers; race; and symptoms of respiratory distress and altered mental status were associated with increased risk of in-hospital death. Patients with these risk factors may benefit from efforts to improve palliative care and prevent futile interventions.
Pain in cancer patients: Pain assessment both by patients and family caregivers and problems experienced by caregivers.
Authors: Ovayolu Ozlem , Ovayolu Nimet , Aytac Sema , Serce Sibel , Sevinc Alper
Published: February 2017

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Background: Pain is among the most important symptoms in terms of prevalence and a major cause of distress for cancer patients and their family caregivers. Thus, we conducted this study with the aim to compare assessment of pain among cancer patients and their caregivers and to determine the problems experienced by caregivers. Methods: A cross-sectional and descriptive design was used. This study was conducted in a chemotherapy unit and an adult oncology clinic with 220 patients diagnosed with cancer who admitted to an oncology hospital and 220 caregivers. The study data was collected using a questionnaire and Visual Analogue Scale (VAS where “0: no pain”, 10: severe pain”). Statistically significant levels were set at p < 0.05. Results: Patients were found to experience abdominal pain most of the time (29.1%) and their pain was intermittent (67.7%), stinging (16.4%) and lasted for 0 to 2 hours. Pain was diminished after use of analgesic in 50.5% of patients, worsened with physical activity in 17.7%, was associated with nausea in 7.7% and potent opioids were used for the relief of pain in 33.2% of patients. Pain severity as assessed by patients and their caregivers was 7.1±2.8 and 7.3±2.4 respectively and the most common pain-related problems in cancer patients were fatigue (p<0.05), loss of appetite and insomnia (p>0.05) as reported by both patients and caregivers. Compared to their caregivers, patients more frequently reported pain-associated financial constraints and negative effects of cancer pain on their work life and domestic life and family relationships, all of which were statistically significant (p<0.05). The caregivers most commonly reported fatigue (56.8%) in their role as a caregiver. The caregivers were also found to experienc sleep problems (40.9%), loss of appetite (27.7%), distress (19.1%), hopelessness (17%), economic difficulty (16.8%), problems in their own life (14.1%) and fatique (12.7%). Conclusions: Pain assessments of both patients and caregivers and seeking their input on how to manage potential pain-related problems are crucial to achieve adequate pain control and distress.
Outcomes of supportive/palliative care (SPC) for advanced cancer patients (AdCa) in a general public hospital and a comprehensive cancer center.
Authors: Delgado-Guay Marvin Omar , Ferrer Jeanette , Ochoa Jewel , Cantu Hilda , Williams Janet L. , Park Minjeong , Asirot Rechelle L. , Enwemnwa Nneamaka , Flores Renee , Guanlao Rodrigo C. , Haq Faheem M , Kamineni Suchrita R. , Bruera Eduardo
Published: February 2017

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Background: AdCa experience severe physical, psychosocial and existential distress. Their needs might not be met only by standard care. We compared outcomes of AdCa receiving SPC at a General Public Hospital (GPH) and at a Comprehensive Cancer Center (CCC). Methods: We reviewed 364 consecutive AdCa(182 at GPH and 182 at CCC). AdCa were managed by SPC-specialists with common clinical-pathways. We assessed symptoms(Edmonton Symptom Assessment System:ESAS) and outcomes at consult and first follow-up. Results: Race was White, African-American, and Hispanic in 42(23%), 70(39%), 63(35%) at GPH vs. 112(64%, p<0.0001), 30(17%, p<0.0001), 20(11%, p<0.0001) at CCC, respectively. Age, gender and cancer diagnoses were similar at both sites. 98(54%) at GPH vs. 181(99%) at CCC reported to have some health-insurance(p<0.0001). Symptoms at consult-time at GPH and CCC: Pain 133(85%) vs. 151(91%,p=0.0586); Fatigue 127(80%) vs. 153(94%,p<0.0001); Nausea 69(44%) vs. 89(55%,p=0.0438); Depression 79(51%) vs. 109(68%,p=0.0015); Anxiety 72(46%) vs. 121(75%,p<0.0001); Drowsiness 78(50%) vs. 119(76%, p<0.0001); Appetite 89(56%) vs. 146(91%, p<0.0001); Dyspnea 72(46%) vs. 107(65%,p=0.0004); Sleep 90(59%) vs. 142(88%,p<0.0001); and Well-Being 95(63%) vs. 132(93%,p<0.0001). Both SPC provided multiple not different interventions: opioid-management, medication review for polypharmacy, bowel-regimen, antiemetics, and interdisciplinary counseling. At follow-up ESAS-improvement(decrease ≥2 points) was: pain 21/80(26%) at GPH vs. 43/107(40%) at CCC(p=0.0469), anxiety 18/75(24%) vs. 40/98(41%,p=0.0202); appetite 15/74(20%) vs. 37/90(41%,p=0.0043); sleep 20/74(27%) vs. 42/95(44%,p=0.0215); nausea 23/77(30%) vs. 35/97(36%,p=0.3879); depression 18/74(24%) vs. 30/94(32%,p=0.2796). Median Time(range) from consult-to-follow-up at GPH 21 days(0-427) vs. 14 days(1-275,p=0.032), and from consult-to-death at GPH 53 days(1-699) vs. 51 days(1-898,p=0.8473). Conclusions: AdCa at GPH and CCC had frequent and severe-symptoms. Response-rate was lower and follow-up less-frequent at GPH. SPC needs to be more frequent and more resources are needed at GPH.