bluuebunny/crossref_metadata_2025 huggingface dataset:
Communicating the introduction of psychology services in the palliative care (PC) cancer setting: A randomized double blind trial.
Authors: Ann-Yi Sujin , Tanco Kimberson Cochien , Carmack Cindy L. , Liu Diane D. , Bansal Swati , Williams Janet L. , Lim Kyu-Hyoung , Bruera Eduardo
Published: November 2018

129

Background: Despite high distress and empirical support for psychosocial services for cancer patients, the utilization of these services continue to be low. Our aims are to ascertain if the manner of introducing psychology services impact patients’ acceptance of services and identify factors associated with acceptance and barriers of psychology utilization. Methods: 100 PC cancer patients who have not received prior psychology services were randomized to observe two video vignettes: one showed a physician introducing a counselor and psychology services to the patient (PI); another showed a counselor entering and introducing psychology services alone (CI). Randomization was stratified using baseline Hospital Anxiety and Depression Scale scores. After viewing both videos, patients completed a survey regarding preference, attitudes, and barriers for psychology services. Patients were blinded regarding the purpose of the study and investigators were blinded to content and order of videos presented. Results: 64 patients reported a preference with 34 preferring PI (p=0.37) and 36 reporting no difference. Younger patients preferred PI (85.7%) versus CI (14.3%, p=0.03). Most reported being aware of available psychology services (N=63), and half (N=50) had been offered psychology services by their physician. Only 40 (40%) patients felt psychology services would be helpful for them, and 43 (43%) reported it would be beneficial for their family/caregivers. Those who found it helpful for themselves or family had higher anxiety than those who did not find it helpful (p=0.03 and p=.02 respectively). The most commonly endorsed barriers for psychology services were travel (N=25) and finances (N=21). Conclusions: We found no significant difference in preference of introduction of psychology services except in patients less than 40 years old who preferred PI. Patients with higher anxiety felt psychology services were helpful for self and family. Only 40% perceived psychology services as useful for self and family. More research is needed to investigate the most effective approach for introducing psychology services to increase perception of usefulness and utilization in cancer patients. Clinical trial information: NCT03035448.
The pyramid of treatment levels: A tool to convey goal-based treatment options.
Authors: Leeper Heather , Kamell Andrew
Published: November 2018

147

Background: 60% of Americans die in acute care hospitals and under 40% of advanced cancer patients have end-of-life care discussions with their health care providers. Didactic methods and tools to teach about symptom management, navigation of treatment decisions, code status, and end-of-life care decisions within an inpatient setting are a necessity to meet this high demand. Methods: A model of medical care systematically dividing clinical management decisions into escalating levels of medical care relative to illness severity, treatment goals, and code status was created. The model is illustrated as a pyramid with a base of symptom management as the initial level of medical care. The second level represents disease-focused medical care including antibiotics, disease-modifying drugs, and chemotherapy administration. Hospitalization with increasingly complex and invasive interventions represents the third level followed by critical illness care including ICU admission and vasopressors as the fourth level. Intubation comprises the fifth level and CPR forms the top of the pyramid. Results: This model has been used extensively at our institution in educating medical students, residents, fellows, and faculty. All groups reported it was helpful in understanding POLST forms, code status, and collaboratively developing appropriate goal-based care plans with their patients. Symptom management remaining as a non-negotiable foundation of care emphasizes its importance. This depiction of medical care may facilitate goals of care and code status discussions and is particularly helpful for determining appropriate care goals or options when considering de-escalation of medical therapies. Used implicitly or explicitly in patient and family discussions, it has facilitated decision-making and discerning the appropriateness of the overall treatment plan relative to patient goals of care. Conclusions: This model of care with its companion pyramid accommodate a wide range of clinical scenarios, is an effective, high yield didactic device for patients, families, and healthcare providers alike, and has applications as supportive tool to optimize goal-based clinical decision making in the context of serious illness.
Needs for patients with cancer who have young children.
Authors: Kojima Rebekah , Takada Hiromi , Yoshida Tetsuhiko , Shimizu Masaki , Kiuchi Daisuke , Ishiki Hiroto , Satomi Eriko
Published: November 2018

150

Background: The number of cancer patients has been increasing in Japan. It is estimated that 56,143 parents with 87,017 young children (under 18 years old) are diagnosed with cancer per year in Japan (Inoue, 2015). The aim of this study is to investigate the needs of cancer patients who have young children. Methods: The survey was conducted from February to April 2018 to the cancer patients who have young children treated at the National Cancer Center Hospital with the questionnaires. It was on items about parenting concerns evaluated with the 4-point Likert scale: 1. strongly disagree, 2. slightly disagree, 3. slightly agree, and 4. strongly agree. The items included “cancer notification to their children”, “parental anxieties”, and others. The items were analyzed separately. Results: The respondents were 152 (143 cancer patients (94%) and nine spouses (6%)). Most respondents (92%) agreed the importance of psychosocial support for the children and parents in hospital. The average age of their young children (n = 237) was 9.5 (ages 0 – 17). The result showed that 148 (62%) children were told true parents’ illness. This study also revealed that parents were struggling with the conflict telling their children truth. Most parents wanted to protect children from emotional distresses and were afraid of it or don’t know how to cope with some changes during treatments. Conclusions: The study describes how cancer impacts on parents for child rearing. Almost all of the patients with minor children had been found psychologically distressed. It is necessary to improve an effective psychosocial support system in hospitals for cancer patients with young children based on their needs.
Associations between the patient-physician relationship and health-related quality of life among patients with cancer.
Authors: Mbah Olive , Schaal Jennifer , Cykert Samuel , Eng Eugenia , Robertson Linda , Baker Stephanie , Black Kristin Z. , Dixon Crystal , Ellis Katrina , Elkins Wendi , Guerrab Fatima , Jordan Lauren C , Lightfoot Alexandra , Padilla Neda R. , Samuel Cleo A.
Published: November 2018

162

Background: Health-related quality of life (HRQOL) is an important cancer care outcome. Patient-physician communication is linked to HRQOL, yet less is known about the role of other aspects of the patient-physician relationship in explaining HRQOL outcomes in cancer patients. Using secondary data from the Accountability for Cancer Care through Undoing Racism and Equity study, we examined associations between multiple patient-physician relationship factors and HRQOL in breast and lung cancer patients. Methods: The analysis included 283 patients receiving care at two cancer centers from 2013-2017. Survey data on socio-demographics, HRQOL, and patient-physician relationship (i.e., doctors’ respectfulness, time spent with doctors, doctors’ involvement of patient in decision-making, satisfaction with quality of care) were collected at baseline and during treatment. The primary outcome was a binary measure of poor-fair (vs. good-excellent) HRQOL 90 days post-diagnosis. We employed multivariate logistic regression to assess associations between patient-physician relationship factors and HRQOL. Results: In adjusted analyses, patients reporting high levels of physician respect had 78% lower odds of reporting poor-fair HRQOL than patients reporting low levels of respect (Adjusted Odds Ratio[AOR] = 0.22; 95%CI = 0.08-0.59). Patients who were optimally involved in their care had lower odds of poor-fair HRQOL than those less involved (AOR = 0.30; 95%CI = 0.12-0.77). Finally, patients who very satisfied with the quality of their care had a 40% lower odds of poor-fair HRQOL than those less satisfied with care (AOR = 0.40; 95% CI = 0.13-0.99). There was no association between amount of time spent with doctor and HRQOL. Conclusions: Multiple aspects of the patient-physician relationship, including doctor’s respectfulness, doctors’ involvement of patient in decision-making, and patient satisfaction with quality of care are associated with HRQOL among breast and lung cancer patients. Given the important role that HRQOL plays in treatment adherence and outcomes, these findings highlight the need for systems of care that optimize the physician-patient relationship in cancer care.
Health after cancer: Early patient experience in a pilot survivorship clinic embedded in primary care.
Authors: Schapira Lidia , Winget Marcy , WU Siqi , Kim Jennifer , Brown-Johnson Cati
Published: November 2018

180

Background: Prior research has identified barriers to provision of quality survivorship care in primary care settings such as lack of expert knowledge and training, primary care burden and insufficient communication with oncologists. We implemented a survivorship clinic at an academic medical center in the primary care division with the goal of defining the elements required for a seamless transition and co-management. Methods: The primary care physician received training in cancer survivorship based on the ASCO Curriculum, shadowing of 3 breast medical oncologists and 1 gynecologic oncologist, attendance at the 2018 Cancer Survivorship Symposium and NCCN’s Cancer Survivorship Advocacy Meeting. Patients with breast and gynecologic cancers were referred by their oncologists or APP (PA or NP) at various points in their cancer trajectory. Clinical characteristics of patients were abstracted from the electronic medical record and in-depth interviews were conducted with 2 patients. Results: 41 patients attended the survivorship clinic. The majority (88%) were breast (63%) or gynecologic (24%) cancer survivors. Patient age was evenly distributed with 8 age < 46, 11 age 46-59, and 7 age > = 60. 23 (56%) patients had stage < 3 at diagnosis. 21 (51%) had been cancer-free for five years + and 4 were referred by their oncologist to help with patient co-management during cancer treatment. Of the 8 breast cancer patients < 46 years old, 6 had a genetic mutation and 7 were interested in fertility. 15/26 breast cancer patients are currently on endocrine therapy. Interviewed patients expressed appreciation for receiving whole-person care and knowing there is bidirectional communication between clinicians. Conclusions: Cancer survivors are open to and interested in a survivorship visit based in a primary care clinic; this includes both patients who have been cancer-free > 5 years as well as those recently treated with curative intent. Greater efforts are needed to train primary care physicians to deliver survivorship visits that are customized to meet the needs of cancer survivors.
Multimodal therapy for the treatment of sleep disturbance in patients with advanced cancer.
Authors: Yennu Sriram J. , Carmack Cindy L. , Balachandran Dave , Williams Janet L. , Lu Zhanni , Park Minjeong , Hess Kenneth R. , Ochoa Jewel , Bruera Eduardo
Published: November 2018

185

Background: Poor sleep quality is frequent in patients with advanced cancer (62%), and is associated with a severe symptom distress and mortality. There are limited evidence based treatment options in advanced cancer patients.To obtain feasibility, preliminary estimates of the effects of various treatments [light therapy, melatonin, Methylphenidate] and combinations of treatments in multimodal therapy (MMT) to improve sleep quality, as measured by change in Pittsburg Sleep Quality Index (PSQI) scores from baseline to Day 15. We also examined MMT effects on FACT-G, insomnia - Insomnia severity index (ISI), actigraphy. Methods: Cancer patients with moderate sleep disturbance were eligible. Using a double-blind (patient, investigators) randomized factorial study design, eligible Pts were randomized into 1 of the 8 arms of the study which included all possible combinations of the interventions (light therapy, melatonin, and methylphenidate) and/or their corresponding placebo treatments for a duration of 2 weeks. All patients received 3 sessions of standardized CBT. Linear regression analysis was used to assess treatment effects. Results: 84% (54/ 64) randomized Pts were evaluable. At baseline, median (IQR) total PSQI was 13 (12, 15); and ISI was 18 (14, 21). There were no differences in the demographics and baseline sleep quality between groups. The adherence rates for light therapy, melatonin, and methylphenidate were 93%, 100%, and 100% respectively. Light therapy had moderate effects on sleep quality (effect size .43, P=0.017). No significant differences in ISI, FACT-G scores, and objective sleep variables between groups. There were no significant difference in adverse events by groups (P=.97). Conclusions: MMT interventions to treat sleep disturbance were feasible. Light therapy provided the best signal for improvement in sleep quality, and should proceed to large randomized control trials. Clinical trial information: NCT0168029. [Table: see text]
Total relaxation: A Buddhist mindfulness-based intervention pilot studies in laypersons and cancer patients.
Authors: Suwanvecho Suthida , Suwanvecho Buntharika , Pongpirul Krit
Published: November 2018

187

Background: Total relaxation (TR), a mindfulness-based intervention based on the Buddha’s teaching of Sutra on Full Awareness of Breathing (Anapanasati Sutta) and Sutra on the Four Establishments of Mindfulness (Satipatthana Sutta). This study was aimed (1) to explore benefits of TR perceived by laypersons and (2) to share experience in piloting the intervention in cancer patients. Methods: Laypersons who attended the 5 - day retreat program with daily TR sessions at Khao Yai, Nakhon Ratchasima, Thailand during October 22-26, 2014 responded to the Edmonton Symptom Assessment Scale (ESAS) before and after the TR session on the first day (TR1 Before, TR1 After) and after the fourth TR session (TR4 After). ESAS was responded by cancer patients who visited Horizon Cancer Center, Bumrungrad International Hospital before and after their participation in a 45 minute TR group session. Paired t-test was used to evaluate the before-after difference in score of each matched variables. Results: Of 162 laypersons, 90.74% responded. They reported a significant improvement of all ESAS items (p < 0.001). Ten cancer patients (6 breast, 2 colon, and 1 stomach cancers and 1 lymphoma) who participated in the TR group session also saw the improvement of all ESAS items, with the mean differences ranging from 0.36 (feeling depressed) to 3.09 points (fatigue/tiredness). No adverse events were observed. Conclusions: Total relaxation is a Buddhist mindfulness-based technique that can improve undesirable symptoms of layperson and cancer patients.
A comparison of the attitudes about the legalization of marijuana use for medical purposes by cancer patients in two cancer centers located in a legalized and a non-legalized state.
Authors: Tanco Kimberson Cochien , Dumlao Donato , Kreis Rebecca Rae , Nguyen Kristy , Dibaj Seyedeh , Liu Diane D. , Marupakula Vidyasagargoud , Shaikh Ayesha , Williams Janet L. , Cantu Hilda P. , Jones Marie , Beers Wendy , McMahon Michael , Allo Julio A. , Noggy Brenda , Baile Walter F. , Bruera Eduardo
Published: November 2018

191

Background: There is limited evidence on the perception of medical marijuana (MM) among cancer patients in a legalized vs. a non-legalized state. In this study, we compared the attitudes of cancer patients in a legalized (Arizona) vs. a non-legalized state (Texas) on legalizing marijuana for medical use and their perception of its medical usefulness. We also examined their preference of MM for pain, anxiety and depression against current treatments and examined any demographic, physical or psychosocial association with its perception. Methods: Two hundred adult cancer patients were enrolled from the outpatient palliative care centers at Banner MD Anderson Cancer Center in Gilbert, AZ and The University of Texas MD Anderson Cancer Center in Houston, TX. All patients were residents of the state where they were enrolled. Various physical and psychosocial instruments were collected including a survey designed to determine attitudes and beliefs of patient towards MM. Due to the sensitivity of information, no identifiers were associated with data recorded. Results: No significant difference was found between both locations in attitude towards legalizing MM [Arizona 92% (85 - 97%) vs. Texas 90% (82 - 95%); p = 0.81] and belief of its usefulness [Arizona 97% (92 - 99%) vs. Texas 93% (86 - 97%); p = 0.33]. Patients preferred MM over current treatments for anxiety [60% (51 – 68%); p = 0.003] but not for pain and depression. Patients who favored legalizing MM were younger (median age 59 vs. 67 y; p = 0.027) and had worse Edmonton Symptom Assessment System fatigue (median 5 vs 3; p = 0.015) and appetite (median 3 vs 0.5; p = 0.004) scores. There was a significant difference among those who have used MM (95%) and have not used MM (88%) in support of legalization of MM (p = 0.024). Conclusions: Cancer patients from both legalized and non-legalized states showed strong support for legalization of marijuana for medical purposes and strong belief in its medical use. Patient who are younger, and had worse fatigue and appetite showed higher support for medical marijuana.
Patient-reported outcomes with metastatic castrate-resistant prostate cancer.
Authors: Mullally Jimmy , Davella Christopher , Parikh Rahul Atul , Van Londen G J. , Appleman Leonard Joseph
Published: November 2018

207

Background: Prostate cancer accounts for approximately 10% of cancer deaths in men worldwide. Clinical trials for metastatic castrate resistant prostate cancer (mCRPC) have established survival benefit with use of abiraterone (ABI) with prednisone or enzalutamide (ENZ). Despite their wide utilization, little is known about patient quality-of-life (QOL) outcomes for these agents. Our study evaluates patient reported QOL while taking ENZ or ABI/prednisone. Methods: 22 mCRPC patients were enrolled in an open label, nonrandomized manner to receive oral ENZ (n=12) or ABI/prednisone (n=6) per oncologist’s discretion. Patients completed multiple QOL validated questionnaires, including EPIC-26, FACT-P, and FACT-COG at baseline, 1,2,3,6,9 and 12 months or until progression/change of therapy. Surveys were scored by treatment group using mean, median, range, and standard deviations. QOL parameters were compared between the two groups with two-sided, two-sample T test and linear mixed models. Results: Surveys discontinued prior to 1 year secondary to disease progression/change of therapy were 58% and 33% for ENZ and ABI, respectively. By month 3, 50% of surveys were returned for ENZ and 33% for ABI. Month-to-month comparisons of QOL parameters including urinary irritation, incontinence, bowel, sexual, hormonal function, and overall well-being showed no significant differences between treatment groups or different rates of change. Perceived Cognitive Impairment was significantly lower for patients on ABI in month 3, yet Perceived Cognitive Ability favored ENZ in months 2 and 3. All other data points for cognition showed no significant differences. Conclusions: Data from FACT-COG shows discordance in perceived Cognitive Impairment and Abilities between ENZ and ABI in months 2-3. Other QOL domains indicated no difference between the two groups. The study was limited by a significant portion of patients with disease progression/change of therapy. For those on therapy, survey compliance remained high. Thus, the use of questionnaires is a feasible means of assessing patient outcomes and can be adapted to larger studies.
CACHEXIO: Evaluation of body composition changes and immunotherapy in patients with metastatic cancer.
Authors: Roeland Eric , El-Jawahri Areej , Horick Nora , Nelson Sandahl H , Gallivan Andrea , Nipp Ryan David , Cohen-Arazi Yael , Friedman Sarah , Sera Chris , Ma Joseph , Baracos Vickie E , Patel Sandip Pravin , Phull Hardeep
Published: November 2018

209

Background: Given body composition predicts toxicity for patients receiving cytotoxic chemotherapy, we explored changes in body composition and biomarkers as predictors of immune-related adverse events (irAEs) and health care utilization. Methods: We conducted a longitudinal study of patients with metastatic solid tumor receiving immunotherapy (07/2014-10/2017). Eligible patients had a computed tomography (CT) scan prior to first-line immunotherapy with at least two additional CT scans at three, six or nine months after immunotherapy initiation. We analyzed body composition using cross-sectional CT scans at the third lumbar vertebra. We utilized mixed effect linear regression models to assess longitudinal changes in body composition (weight, skeletal muscle, total adipose). We examined associations of baseline body composition and biomarkers (albumin, neutrophil-lymphocyte ratio (NLR)) with the incidence of irAEs and healthcare utilization (hospitalizations/ED visits) using logistic regression. Results: Of 140 patients treated with immunotherapy, 61 met inclusion criteria. The majority (80%) received prior chemotherapy and the most common malignancies included lung (26%), head and neck (20%), and melanoma (20%). We found that one-third (n=19) experienced an irAE and colitis (53%) was the most common irAE. Patients experienced substantial weight loss over time (B= -1.88, p<0.001) with a decrease both in skeletal muscle (B= -3.08, p=0.001) and total adipose tissue (B =-50.44, p<0.001). We found greater skeletal muscle at baseline was associated with lower risk of health care utilization (OR 0.98, 95% CI: 0.965-0.998, p=0.03). We observed no association with biomarkers and/or body composition variables with irAEs or health care utilization. Conclusions: Patients with metastatic cancer receiving immunotherapy lose weight including skeletal muscle and adipose tissue. Aside from higher baseline skeletal muscle predicting less health care utilization, we did not observe any other associations between body composition changes and irAEs or health care utilization.
Preliminary validation of the Edmonton Symptom Assessment Scale – Acute Leukemia (ESAS-AL) in patients with acute leukemia (AL).
Authors: Tricou Columbe , Mah Kenneth , Malfitano Carmine , Rydall Anne , Schimmer Aaron David , Rodin Gary , Zimmermann Camilla
Published: November 2018

210

Background: Patients with AL have numerous symptoms resulting from their disease and its treatment. Here we report on a preliminary evaluation of an ESAS version including AL-specific symptoms (ESAS-AL). Methods: Forty-two inpatients with newly-diagnosed AL (31 AML, 11 ALL), receiving induction chemotherapy, completed baseline assessments with the ESAS-AL and the Memorial Symptom Assessment Scale (MSAS) as part of a clinical trial. The ESAS-AL includes the nine usual ESAS symptoms (rated from 0-10), as well as five symptoms reported by patients with AL in a previous longitudinal study: trouble sleeping, mouth sores, diarrhea, constipation, and itching. Correlations between each ESAS symptom and the corresponding MSAS symptom (rated 1-4) were calculated using Spearman’s correlation. Results: The mean age was 52.86 (SD 15.84). Most correlations were moderate to large and were highly significant (Table). Correlations ranged from 0.86 (ESAS-AL/MSAS Itching) to 0.20 (ESAS-AL Anxiety/MSAS Worried). Correlations for 4 physical symptoms specific to ESAS-AL (itching, diarrhea, mouth sores, and constipation) were among the highest (rs>.70). Correlations between ESAS-AL trouble sleeping and MSAS difficulty sleeping and between ESAS-AL anxiety and MSAS worried were lowest (rs<.30). ESAS-anxiety correlated better with MSAS nervous (rs=.61). Conclusions: Well-defined ESAS-AL physical symptoms are highly correlated with equivalent MSAS symptoms, whereas less well-defined symptoms have weaker correlations. These findings provide preliminary support for the validity of the ESAS-AL. Further data collection for larger-scale validation is ongoing. [Table: see text]
A systematic review and combined analysis of phase III trials to evaluate the safety of adjuvant sunitinib in patients with high risk renal cell carcinoma after nephrectomy.
Authors: Quirch Miguel , Thein Kyaw Zin , Ball Somedeb , Adhikari Nimesh , Jones Catherine , D'Cunha Nicholas C. , Awasthi Sanjay , Tijani Lukman Aderoju , Hardwicke Fred L.
Published: November 2018

214

Background: Sunitinib, an oral vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor, has been approved in adjuvant treatment of high risk renal cell carcinoma (RCC) after nephrectomy despite distinct results among studies, along with notable safety concerns. We undertook a systematic review and meta-analysis of randomized controlled trials (RCT) to determine the risk of grade 3 and 4 adverse events in patients treated with adjuvant sunitinib. Methods: MEDLINE, EMBASE databases and meeting abstracts from inception through June 2018 were queried. Phase 3 RCTs which utilized adjuvant sunitinib in high risk RCC after nephrectomy were included. Mantel-Haenszel (MH) method was used to calculate the estimated pooled risk ratio (RR) with 95% confidence interval (CI). Random effects model was applied. Results: Two phase III RCTs with a total of 1866 patients were eligible. Studies utilized sunitinib versus placebo. The randomization ratio was 1:1 in both ASSURE and S-TRAC studies. The RR of high-grade adverse effects were as follows: hypertension, 4.26 (95% CI: 2.89 – 6.26, p < 0.001); fatigue, 5.40 (95% CI: 3.49 – 8.34; p < 0.001); rash/desquamation, 5.00 (95% CI: 1.59 – 15.68; p = 0.006); hand foot syndrome, 18.68 (95% CI: 5.98 – 58.28, p < 0.001); asthenia, 6.57 (95% CI: 1.005 – 43.04; p = 0.049); diarrhea, 18.08 (95% CI: 6.63 – 49.32; p < 0.001); dyspepsia, 12.68 (95% CI: 2.40 – 66.80, p = 0.003); stomatitis, 29.15 (95% CI: 5.73 – 148.18; p < 0.001); nausea, 19.63 (95% CI: 3.81 – 100.97; p < 0.001); and vomiting, 8.21 (95% CI: 2.21 – 30.51; p = 0.002). Conclusions: The rate of high-grade hypertension, fatigue, asthenia, dermatological toxicities, including hand foot syndrome, and gastrointestinal toxicities were extremely high in patients treated with adjuvant sunitinib, compared to placebo arm. Fatigue, hand foot syndrome and gastrointestinal toxicities significantly contribute to patients’ quality of life and providing good supportive care is warranted.
Hits and misses: A longitudinal examination of congruence between patient-reported quality-of-life concerns in advanced cancer and discussions with oncologists.
Authors: De Sola-Smith Karen Marie , Bell Janice , Tancredi Daniel J , Kravitz Richard L , Duberstein Paul , Epstein Ronald M. , Fenton Joshua J
Published: November 2018

22

Background: Quality of life (QOL) support is critical to high quality advanced cancer care and is associated with improved patient outcomes, but most patients report unmet supportive care needs. To understand supportive care provision in routine oncology, we examined the agreement, or congruence, between patients’ self-reported symptoms and topics discussed with oncologists over an extended interval of care. Prior research suggests that patient-provider rapport and overall QOL influence discussion of patient concerns, therefore we estimated effects of two predictors of interest: therapeutic alliance between patient and oncologist, and global QOL. Methods: We conducted a secondary analysis of data collected in the VOICE study. Patients with advanced cancer (n=196) completed measures of symptoms (e.g., pain, nausea, emotional concerns) and QOL, as well as an inventory of topics discussed with oncologists over the prior 3 months. Data were collected at quarterly intervals for up to 48 months, resulting in 901 paired reports of patients’ symptoms and discussions with oncologists. We constructed congruence as a multinomial outcome with four discrete categories: congruence (symptom reported/discussed), unaddressed concern (symptom reported/not discussed), surveillance (symptom not reported/discussed), and no supportive care concern (symptom not reported/not discussed). We then estimated effects of global QOL and therapeutic alliance using multi-level logistic regression. Results: Congruence was most common for pain (49.9%), while emotional concerns were most likely to be unaddressed (50.5%). Higher therapeutic alliance with oncologists was associated with lower odds of unaddressed pain (OR 0.94, CI 0.89-1.00) and emotional concerns (OR 0.95, CI 0.91-0.98). Higher global QOL was associated with higher odds of unaddressed emotional concerns (OR 1.11, CI 1.02-1.20). Congruence outcomes were stable over time. Conclusions: Oncologists may improve congruence by strengthening therapeutic alliance, by more consistently discussing emotional concerns, and by prioritizing topics for discussion according to patients’ needs.
Sexual health in young women with metastatic breast cancer: The state of the science.
Authors: Silverman Marissa Rose , Rabow Michael W.
Published: November 2018

223

Background: The incidence of metastatic breast cancer (MBC) in women under 40 is increasing. Sexual health is a key element of quality of life (QOL) and is impacted by MBC. While those searching the Internet receive primarily anecdotal information, the state of the science around MBC and sexual health for young women appears to be limited. Methods: Four databases were searched for English language articles: PubMed, PsycINFO, Embase, and Sociological Abstracts.Search topics included sexual health, sexual activity, intimacy, gender identity, sexual orientation, body image, and/or intimate partner relationships among young women with MBC. Results: 598 studies were reviewed; 9 met selection criteria. Four studies were included on body image and sexual activity: 2 reported a correlation between young age and poor body image; in a third, no relationship was found for women 30-49; in the fourth, among patients with metastatic or localized disease, women < 45 placed greater importance on body image or changes in sex life than women > 65. Three studies examined sexual health and treatment: a review of hormonal therapies in young patients recommended that sexual side effects be considered; a qualitative study reported on the impact of mastectomy on feelings of femininity and body image; an observational study of patients with locally recurrent or MBC found younger age was associated with greater vaginal dryness and decreased sexual interest/activity. One qualitative study did not find patterns of difference in sexual health needs related to age-patients of all ages and relationship status desired more information. In a study of QOL and MBC, younger age was associated with less sex life satisfaction. Subjects across all studies were primarily white, and sexual activity studied was primarily heterosexual, vaginal sex. Conclusions: The scientific literature on sexual health among young women with MBC is exceedingly limited. Studies that do examine sexual health often exclude those with MBC, do not examine the impact of age, and are focused on heterosexual, white women. Understanding the impact of MBC on young women’s sexual health can inform future care practices for this growing population.
Novel first-in-class small molecule targeting APE1/Ref-1 to prevent and treat chemotherapy-induced peripheral neuropathy (CIPN).
Authors: Kelley Mark R. , Messmann Richard Adam , Fehrenbacher Jill
Published: November 2018

229

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is an acute and chronic debilitating side effect of a number of chemotherapeutic agents lacking FDA-approved interventions or strategies resulting in dose-limiting neurotoxicity. CIPN can persist following discontinuation of the drug with up to 40% of patients having continued CIPN five years after treatment ends. Thus, CIPN directly affects cancer survivorship, quality of life, and may limit future treatment options if cancer recurs. Although the cellular mechanisms mediating CIPN remain to be determined, several lines of evidence support the notion that DNA damage caused by anticancer therapies could contribute to the neuropathy. Methods: Using an experimental model of isolated sensory neurons in culture, we established a causal relationship between cancer-therapy-induced neurotoxicity and DNA damage and repair. Results: Genetically reducing the activity of APE1 increased the neurotoxicity produced by platin treatment, whereas augmenting the activity of APE1 lessened neurotoxicity. Furthermore, using a targeted small-molecule, APX3330, which increases DNA repair of APE1 in neurons, it lessened neurotoxicity using a variety of endpoints ex vivo; e.g. DNA damage, CGRP release. We will present data using animal models of CIPN demonstrating a protective effect of APX3330 using either cis- or oxaliplatin without diminishing the anti-tumor effect of the platins. A Phase 1 clinical trial for safety/RF2D for APX3330 has completed (NCT03375086). Conclusions: Effective prevention and management of CIPN hinges on understanding its pathophysiology. While multiple causal mechanisms may be at work, we believe that the induction of oxidative DNA damage in sensory neurons is a major cause of CIPN. Thus, enhancement of oxidative DNA damage repair by APX3330 results in reduction of CIPN.
Standardizing goals of care (GoC) documentation for new patients with metastatic disease.
Authors: Kidwai Wajih , Engelking Constance , Pyle Jennifer , Chiang Anne C.
Published: November 2018

26

Background: Executing GoC discussions is an established national standard, underpins high quality patient-centered cancer care and ensures that patients participate actively in treatment decision-making. Capturing key aspects of those discussions in electronic documentation can be challenging when provider time is limited. This project sought to standardize workflow components to enable provider capacity to meet a GoC standard that ≥75% of patients presenting with metastatic cancer have a GoC discussion by their third visit as evidenced by retrievable documentation (EMR format and location). Methods: Baseline data describing provider: patient GoC interactions with eligible patients was obtained and presented. Providers reached consensus on a consistent timing, location and content for electronic GoC documentation. Patient assessment parameters for identifying patients needing GoC discussions were generated, a procedure outlining documentation expectations and facilitative tools were developed. Clinicians were educated on their roles in the process. A variety of quality improvement tools were utilized in project execution (e.g. focus groups, process mapping, cause-effect diagraming, pareto and control charting). Results: See table. Conclusions: Despite time constraints in a busy practice, the ≥75% target set for retrievable GoC documentation was exceeded within the 9-month project timeframe. Providers improved their documentation with familiarity and experience over time. Compliance with documentation location and use of smart phrases were not fully realized, likely due to the short timeframe for adoption of all elements of project aims. Continued improvement is expected as providers become more comfortable with the process and additional facilitative strategies are further integrated including expanding nursing assessment of patients' GoC needs, dedicating time in scheduling templates, Epic alert builds and utilizing Palliative Care Team assist for patients deemed uncomfortable with GoC discussions.[Table: see text]
Prognostic understanding and barriers to palliative care in patients with metastatic lung cancer on immunotherapy.
Authors: Steffen Laurie , Lycan Thomas , Levine Beverly J , Gabbard Jennifer , Ruiz Jimmy , Grant Stefan C. , Blackstock A. William , Weaver Kathryn E. , Petty William J.
Published: November 2018

36

Background: Communicating prognosis and integrating palliative care (PC) are challenging yet vital aspects of quality care for patients with metastatic non-small cell lung cancer (NSCLC). These tasks may be more difficult in the setting of immunotherapy, as this modality may offer a durable response but only in 10-20% of patients. Our goal was to identify correlates of prognostic understanding and interest in PC among stage IV NSCLC patients receiving immunotherapy. Methods: We conducted a cross-sectional survey of 60 patients (M age = 62.5 years; SD = 9.3 years; 40% male; 45% ≤ high school degree; 68% ECOG ≤ 1) undergoing immuno- or chemo-immunotherapy for stage IV NSCLC (80% de novo) at an academic medical center. Results: Most patients (73%) reported that knowing their prognosis was very important. Nearly all said the goal of treatment was to help them live longer (98%), feel better (95%), and completely rid them of cancer (85%); 49% thought they were likely to be cured. Only 17% of patients were interested in meeting with PC; 12% had been referred. Those patients with worse performance status (PS; ECOG 2-3) (79% vs. 35%, p = .002) and who had not yet had an appointment to assess treatment response (67% vs. 37%, p = .03) were more likely to believe they would be cured. There were no differences in expectation based on treatment response, time since diagnosis, de novo versus recurrent metastatic disease, or health literacy level. Interest in meeting with PC did not significantly differ based on expectation for cure, though only 13% of those who thought a cure was unlikely were interested in PC compared to 21% who thought a cure was likely. Patients noted multiple barriers to PC, including preference for self-management (58%), lack of provider recommendation (47%), misconceptions (e.g., PC is for people about to die; 45%), and access barriers [e.g., time (36%) and cost (24%)]. Conclusions: Many patients receiving immunotherapy for stage IV NSCLC may expect curative treatment even when they are not actually responding or have poor performance status. Efforts to improve palliative care literacy and use in this population should address PC misconceptions and emphasize its role, including how it can support self-management.
A systematic process to enhance selection of a prepared medical decision maker.
Authors: Zhukovsky Donna S. , Haider Ali , Naqvi Syed Mussadiq Ali Akbar , Joshi Neeraj , Soliman Pamela T. , Mathew Boby , Bodurka Diane C. , Meyer Larissa , Westin Shannon Neville , Frumovitz Michael M. , Archie LaShan , Fenton Shauna L , Williams Janet L. , Boving Valentine G
Published: November 2018

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Background: Selecting a prepared medical decision maker (MDM) is an integral component of advance care planning (ACP), an interdisciplinary process supported by prognostic awareness. ASCO’s Quality Initiative recommends providers discuss ACP or advance directives (AD) with all new patients with invasive malignancy (NP) by the third office visit (OV). In this quality improvement project, our goal was to increase documented social work (SW), counseling, and education regarding selection of a prepared MDM to 70% and to increase scanned MPOA in EHR 2x by 3R OV. Methods: All SW received institutional training regarding important elements to include when providing counseling and education regarding selection of a prepared MDM. We collected data from EHR of all NP of five gynecologic oncologist champions, including responses to patient needs survey (PNS), AD questions at first OV and ACP physician/Advanced Practice Provider (MD/APP), and SW ACP notes derived from templates with structured elements. Data were collected during baseline and three intervention cycles (C). C1: coaching RN to ask PNS AD questions from a “culture of yes”, C2: NP viewing brief video about importance of MPOA; C3: providing cards with simple definitions of AD to use with NP. Results are presented for C1-3 versus baseline. Results: Total NP=351 (baseline 133, C1-3 218). Intervention group (IG) patients requested more assistance with AD (15 vs. 5%, p=.005) and wanted more information (16 vs. 8%, p=.02) than baseline. Documented social work ACP notes by the third OV were less frequent in the IG (30 vs. 48%, p=.001); there were fewer documented SW ACP notes in those without scanned MPOA (72 vs. 58% without note, p=.01), and no increase in scanned MPOA (13 vs. 11%, p=.516). Physician documentation of MPOA discussion increased (38 vs. 8%, P.000), but discussion of treatment goals did not (84 vs. 68%, p=.112). Conclusions: Interventions resulted in increased MD/APP discussions of importance of MPOA and NP requests for discussion, but fewer SW ACP discussions. There was no increase in scanned MPOA. Current processes reach only a minority of NP and do not effectively engage NP in selecting a prepared MDM. More proactive approaches systematically incorporating ACP discussions into care in an iterative manner are needed.
Process measures of palliative and end-of-life care among young adults who died from cancer.
Authors: Poort Hanneke , Zupanc Sophia , Wright Alexi A. , Lindvall Charlotta
Published: November 2018

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Background: Timely delivery of palliative and end-of-life care (EOL) are essential components of high-quality cancer care. To date, however, few studies have examined process measures for EOL care in young adult (YA; ages 18-35 years) cancer decedents. Methods: We conducted a retrospective study using medical records of YA decedents who received cancer treatment at an academic cancer center between Jan. 1, 2012 and June 13, 2018. We used natural language processing (NLP) with validated key words to identify documentation of four process measures – palliative care involvement, and discussions of goals of care, code status, and hospice – from documented clinical encounters in the medical record within 6 months of death. Results: During this period 146/2,878 (5.1%) YA patients had a recorded death date and a first note at least 31 days prior to death. In this decedent cohort, the mean age was 28.2 years (SD=4.4) and 58.9% were men. The most common diagnoses were brain cancer (33.6%), sarcoma (19.9%), and breast cancer (12.3%). The 146 patients accrued 26,441 clinical notes during the last 6 months of life (median=116.5 notes, IQR 37.0-222.0). Using NLP, we identified that 68.5% of the 146 YAs had at least one process measure documented in the last 6 months of life, including: 54.1% palliative care involvement; 56.8% discussions of goals of care; 47.3% discussions of code status; and 51.4% discussions of hospice. On average, palliative care was documented 7.5 times (range 0-75); goals of care 6.1 times (range 0-43), code status 1.9 times (range 0-12), and hospice 8.1 times (range 0-67). Late documentation of process measures (defined as first recorded within 30 days of death) included: hospice (45.3%), code status (30.3%), palliative care (20.8%), and goals of care (9.6%). Notably, in 31.5% of YAs, we did not detect documentation of any process measures prior to death. Conclusions: In this cohort of YA cancer decedents, nearly one-third of YAs did not have documentation of any process measures, highlighting the importance of efforts to improve EOL care communication with this young population.
Does ACP promote increased hospice utilization? A practice experience among three diverse OCM populations in Texas.
Authors: Mikan Sabrina Q. , Taniguchi Cynthia B. , Wilfong Lalan S. , Hoverman J. Russell
Published: November 2018

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Background: A community oncology practice participating in the Oncology Care Model (OCM) has interest in promoting hospice utilization through delivery of proactive advance care planning (ACP) services. This review of data seeks to understand geographic and ethnic variations in Medicare population utilization of ACP program services and timely transition to hospice care at the end of life. The study population included over 43% having stage IV disease at diagnosis; 19% had lung cancer. Methods: Three sites in Texas were selected for review. Site 1: central Texas urban community with primary non-Hispanic population. Site 2: south Texas urban community with primary Hispanic population. Site 3: central/east Texas rural community with primary non-Hispanic population. A 15-month retrospective review of ACP and hospice data was performed for deceased patients having OCM enrollment between January 1, 2017 and March 31, 2018. A total of 224 chart reviews were performed. Results: Little difference in hospice utilization is noted among the various populations, each demonstrating a hospice transition of care for more than 60% of OCM participants reviewed. All sites, however, showed median days in hospice care of five days or less. Formal ACP education was provided for 22% to 27% of urban study populations, while occurring for only 12% of patients seen in the rural setting. Written Advance Directives are captured in the electronic medical record more frequently for non-Hispanic patients when compared to those of Hispanic ethnicity. Formal values and goals for care were not routinely and formally assessed at these study sites, even though a validated tool for assisting with this important component of end-of-life preparedness is available. Conclusions: This study identified notable gaps in service provision to assist patients with end-of-life decision making. Increased efforts to provide ACP counseling services are needed to assist patients and families with ability to consider the additional level of care that is provided when electing hospice care. Overall, work is needed to improve hospice length of stay in all sites reviewed, but particularly among the Hispanic population of south Texas.