bluuebunny/crossref_metadata_2025 huggingface dataset:
Universal screening for depression in cancer patients and its impact on management patterns.
Authors: Shreders Amanda , Niazi Shehzad , Hodge David , Chimato Nicolette , Agarwal Ankit , Gustetic Elaine , Hammond William Adam , Dholaria Bhagirathbhai R. , Ailawadhi Sikander
Published: February 2017

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Background: Screening for distress in cancer patients (pts) is recommended by several national guidelines. High distress scores are associated with increased depression. We established universal depression screening and investigated its impact on cancer patient management. Methods: Patient Health Questionnaire (PHQ9) was administered to newly diagnosed cancer patients prior to receiving their first non-oral antineoplastic agent. Patient demographics, disease characteristics, chronic medication load, antidepressant use, treatment interruptions, weight change, referral and adherence to psychiatry were recorded. Pts with high (> 9) and low (< 4) PHQ9 scores were compared using Chi-square and Wilcoxon rank-sum tests. Results: Screening was performed in 1,190 consecutive pts over an 18 month period at Mayo Clinic. Responses were received from 1055 (89%) pts, of which 144 had high score (PHQ-H). These were compared with 99 randomly selected low score (PHQ-L) pts. The 243 pts (median age 65; range 18-92 years) in the final analysis included: 53.5% females, 90% Caucasians, 74% married and 77% living with others. Diagnosis was solid organ cancer in 81% and metastatic disease in 54% patients, and 13% were on antidepressants for preexisting depression. PHQ-H were more likely to be on antidepressants than PHQ-L (19% vs. 3%; p = 0.0002), be referred to psychiatry (69% vs. 12%; p < 0.0001), attend psychiatry appointment (45% vs. 12%; p < 0.0001) and require behavioral therapy (50% vs 8%; p = 0.0065). PHQ-H did not have a significantly increased antidepressant use, treatment interruptions (p = 0.5) or weight change (p = 0.4). Race, gender, chronic medication load, marital status, living situation, metastatic disease and type of cancer were not significantly different between PHQ-H and PHQ-L. Conclusions: We implemented a universal depression screening and management plan for cancer pts and noted that previously being on antidepressants was associated with higher patient distress. Higher score led to more frequent behavioral therapy, possibly preventing non-compliance or need for increased psychotropic medications. Our model identifies cancer pts with depression and implements an effective management plan for their care.
Results from a Train-the-Trainer Communication Program for Oncology Nurses.
Authors: Wittenberg Elaine , Ferrell Betty R. , Hanson Jo , Eggly Susan
Published: February 2017

26

Background: Oncology nurses working across the cancer continuum need communication tools in order to navigate between oncology and palliative care for the benefit of patients and their families. An evidence-based communication training course funded by the National Cancer Institute and identified by the acronym COMFORT was provided to 187 oncology nurses across the nation. Launched in 2015, it is the first train-the-trainer communication training course for nurses and addresses communication across the cancer continuum. Methods: The curriculum, emphasizing team communication, teaches nurses how to provide life-altering news, assess patient/family health literacy needs, practice mindful communication, acknowledge family caregivers, and address communication openings and goals. The curriculum covers the continuum of cancer care (diagnosis, treatment, survivorship, recurrence, end of life). Two courses were held and participants were contacted at six months for follow-up evaluation. Results: Course participants reported teaching an additional 2,460 healthcare providers, primarily nurses (1,961) and physicians (264). On average, each participant trained 21 nurses and two physicians. The training manual, which was provided during the course, was used by 81% of course participants and was rated as effective (7.71 out of 10). The most commonly taught curriculum modules were Communication (25.5%), Mindful Communication (22.3%), Team Communication (18.5%), and Family Caregivers (11.4%). Course participants reported that their institution were most effective with communication during treatment (7.21 out of 10) and least effective communication occurred during bereavement (5.02), at time of death (5.97), through survivorship (5.63), and with patients facing end of life (6.09). Conclusions: The train-the-trainer model for communication training appears to be a viable and promising strategy for broadly teaching communication across the cancer continuum. Train-the-trainer is less costly than traditional on-site training methods and allows instruction to be tailored to address the institution’s least effective communication practices across the cancer continuum.
Patient communication prior to initial consultation for palliative radiotherapy.
Authors: Paulsson Anna , Braunstein Steve E.
Published: February 2017

30

Background: For patients undergoing radiation treatment for advanced cancer, coordination between multiple care teams is required. The radiation therapy care pathway is complex, with numerous components, including consultation, planning, treatment delivery, and follow up care. Fragmented care can result from suboptimal communication among referring providers and patients. Prior to initial consult with a radiation oncologist, many patients are unaware of the complex logistics, resulting in additional distress. We conducted a survey to determine how to improve communication to better prepare patients for radiation therapy. Methods: In a pilot project to address communication barriers for patients receiving radiotherapy, a brief 10-question multiple choice survey was developed to gather patient-reported data at the time of initial consultation for palliative or primary CNS radiation treatment. The survey addressed patient understanding of the indication, logistics, and expected outcomes and toxicity of radiotherapy. Results: Our preliminary data is gathered from 16 patients who filled out a survey at the time of consult. Of this group, 10 patients received palliative radiotherapy for advanced malignant disease. Ninety percent of patients were able to correctly identify the role of the radiation oncologist in cancer care. Only 30% demonstrated understanding of the logistics of radiotherapy, including details of planning and multisession treatment delivery. Several patients noted concerns about the logistics and expected efficacy of treatment. No patients were previously informed of the indication of radiotherapy for pain palliation. Conclusions: Initial survey results suggest that advanced cancer patients are often mis- or under-informed about their disease status and the indication of radiotherapy in treatment and palliation of symptoms. Improved communication with patients referred for radiation therapy consultation may alleviate their concerns and enable them to set appropriate expectations for subsequent radiotherapy, minimizing distress. Ongoing survey results will be utilized to identify opportunities to educate providers towards better patient communication.
Poor prognostic indicators for patients treated with radiosurgery for brain metastases.
Authors: Garcia Michael A , Anderson Wendy , Fogh Shannon E. , Nakamura Jean L. , Theodosopoulos Philip , McDermott Michael , Sneed Patricia Penny , Braunstein Steve E.
Published: February 2017

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Background: Radiosurgery (SRS) is a standard palliative treatment for patients with limited number of brain metastases. Growing evidence supports the use of SRS for more extensive disease. As SRS is increasingly used in advanced cancer, we sought to identify predictors of survival after SRS to help better inform patients about prognosis. Methods: We reviewed patients treated with SRS for brain metastases at the University of California, San Francisco (UCSF) from Jan 2010-Dec 2013. Before SRS, all patients were screened for appropriateness of SRS at a multidisciplinary conference. Post-SRS overall survival (OS) was estimated by Kaplan-Meier method and compared by log-rank tests. Frequencies of death within 30 days of SRS were compared by chi-squared tests. Results: Demographic and imaging data was available for 326 SRS patients. At SRS consult, 90% patients were Karnofsky Performance Status (KPS) ≥ 70. Median number of brain metastases at consult was 2 (range 1-37). Median follow up was 13 months. Median OS after SRS was 11 months. Median OS was shorter for patients with KPS < 70 (4 months) compared to those with KPS ≥ 70 (12 months) (p < 0.001). Overall, frequency of death within 30 days of SRS was 5.4%. Within 30 days of SRS, 13% of patients with KPS < 70 died compared to 3.8% with KPS ≥ 70 (p = 0.03). Death within 30 days of SRS was more common among patients with uncontrolled (10%) versus controlled primary tumors (3%) (p = 0.02). Both uncontrolled primary tumor and KPS < 70% were associated with death within 30 days of SRS on multivariate analysis (p = 0.02 and p = 0.03, respectively). Patients with both KPS < 70 and uncontrolled primary tumors had frequency of death within 30 days of 29%. Factors not associated with death within 30 days were age, extracranial metastatic disease burden, histology, number of brain metastases, prior whole brain radiotherapy, SRS, or neurosurgery. Conclusions: Death within 30 days of SRS within the UCSF cohort is uncommon, likely due to multidisciplinary screening for patients expected to live long enough to benefit from SRS. Most patients who die within 30 days of SRS have both KPS < 70 and uncontrolled primary tumors. The potential for poor prognosis should be discussed with these patients during shared-decision making.
Who chooses palliative chemotherapy when a cure is possible? Results of a risk tolerance survey of laypersons.
Authors: LeBlanc Thomas William , Scherr Karen , Wang Annabel , Lemmon Monica , Ubel Peter A.
Published: February 2017

35

Background: Many patients with acute myeloid leukemia (AML) face a difficult choice about whether to receive palliative chemotherapy or high-dose, potentially-curative chemotherapy that poses a risk of early death. How people weigh these factors in decision-making is unknown. We hypothesized that the possibility of cure primarily drives decision-making, regardless of treatment risk. Methods: We designed an electronic survey describing two treatment paths: (1) high-dose chemotherapy with possibility of cure but a 10% risk of early death, and (2) palliative chemotherapy with no chance of cure but no risk of early death. We recruited respondents via Amazon MTurk and presented 7 scenarios in random order, varying only the likelihood of cure associated with high-dose chemotherapy. Subjects rated their preferred treatment on a 4-point Likert scale. We assessed numeracy and attitudes toward chemotherapy using validated scales, and employed attention checks for quality assurance. Results: 100 subjects completed the survey (median age 30.5; 52 female, 85 Caucasian). 46 (46%) had at least a bachelor’s degree, and numeracy was generally high (median 4.75 out of 6). Respondents’ preferences for intensive chemotherapy varied with likelihood of cure, however some displayed a fixed preference for either curative or palliative treatment throughout, regardless of benefit level. For example, given a 50% likelihood of cure 20 respondents (20%) still preferred palliative therapy; similarly, with only a 1% likelihood of cure 28 respondents (28%) still preferred high-dose chemotherapy. In a multivariable model, preference for palliative chemotherapy was significantly predicted by subjects’ scores on the attitudes toward chemotherapy scale (p < 0.001), controlling for age, education and numeracy. Conclusions: Contrary to our hypothesis, a significant proportion of subjects preferred palliative chemotherapy, even in scenarios where high-dose chemotherapy conferred a high likelihood of cure. Pre-existing attitudes toward chemotherapy appear to drive patients’ decision-making about even potentially curative treatments. This finding may have significant implications for risk communication in oncology.
Frequency and factors associated patients decisional control preferences (DCP) in patients with advanced cancer (ACP).
Authors: Yennu Sriram , Rodrigues Luis Fernando , Shamieh Omar M. , Tricou Columbe , Filbet Marilène , Naing Kyaw , Ramaswamy Akhileswaran , Bautista Mary Joycylyn S. , Perez-Cruz Pedro Emilio , Muckaden Mary Ann , Bunge Sofia , Fakrooden Sarah , Sewram Vikash , Noguera Tejedor Antonio , Park Minjeong , Liu Diane D , Reddy Suresh K. , Bruera Eduardo
Published: February 2017

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Background: To determine the frequency and socio-demographic and clinical factors associated passive DCP among ACP across the world. Methods: We conducted a survey of ACP referred to palliative care across 11 countries across the five continents across the world. Information was collected on socio-demographic variables, and using validated measures including Karnofsky Performance Scale, Decision Control Preference Scale, and Satisfaction with the Decisions and Care questionnaire. We analyzed using descriptive statistics and logistic regression analysis was performed. Results: Median age was 58 years, karnofsky 70, and 55% were female. Shared, Active and Passive DCP were 33.2%, 44.1% and 22.6% respectively (n = 1490). 91% were satisfied by the way the actual decisions were made. Concordance between the actual decision making and DCP was highest in cohort from USA [k = 0.74 (0.65-0.82) and lowest in Brazil 0.33 (0.22-0.44)]. “Satisfaction with the way the decisions about their care was made” was 91%. Better Karnosfsky performance status (OR 0.99, P = 0.017), higher education status (OR 0.64, P = 0.001) Country of origin (Brazil, France, Singapore, South Africa, Jordan were significantly associated with passive decision making preference (Table 1). Conclusions: DCP is based ACP’s performance status, education and is culture specific. Individualized understanding DCP may be important for quality care and patient satisfaction outcomes. [Table: see text]
Development of a decision support aid to support goals of care conversation for hospitalized patients with cancer.
Authors: George Marina Ciny , Stone Lisa E , Stepan Karen , Gallagher Colleen M. , Moore Jessica Anne , Gaeta Susan , Meyer Margaret W. , Volk Robert Joseph , Zhukovsky Donna S.
Published: February 2017

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Background: Goals of care (GOC) conversations between oncologists and patients are often ill-defined due to poor physician and patient preparation and unclear goals. Hospitalization may further increase patients’ fear and confusion about GOC. Creating a tool to facilitate shared decision making is critical to support patients and their health care team in this process. In this study, we have collected data as the initial step in the development of a decision aid (DA) for GOC conversations with hospitalized patients with advanced cancer. Methods: A group of 14 content experts including diverse health professionals, patients and caregivers responded to a needs assessment to determine key questions to elicit involved stakeholders’ perceptions on relevant content for the DA. Questions were used to conduct semi-structured interviews with patients, a clinician focus group and a patient and caregiver focus group. All responses were audio-recorded and transcribed. Results: There were 30 participants: 10 patient interviews and 10 participants in each focus group. Patients generally wanted as much information as possible about prognosis and choices, but acknowledged they were often overwhelmed and frustrated at not receiving information sooner. Most were clear about who they would include in their GOC discussions. Clinicians’ concerns included not destroying patients’ hope and uncertainty about how to achieve the delicate balance of delivering bad news while preserving hope. Clinicians also felt challenged by the time needed to conduct GOC conversations and how to initiate them. Patient and caregivers emphasized the value of a multimodal approach to GOC conversations. Individually, they varied in their readiness for and the ideal timing of GOC conversations, noting these could be early or late in their illness trajectory. Conclusions: We see a need for personalization in a decision support aid to have clear goals of care. Patients differ in readiness to activate different parts of the decisional tree at different times. This will be used to guide design of a decision support aid to support hospitalized patients with advanced cancer to have a meaningful goals of care conversation with their clinicians.
Can we improve the quality of documented end-of-life conversations using a structured, multicomponent intervention?
Authors: Paladino Joanna , Lakin Joshua , Miranda Stephen , Gass Jonathon , Bernacki Rachelle , Koritsanszsky Luca , Kavanagh Jane , Palmor Marissa , Hirschhorn Lisa , Lamas Daniela , Sanders Justin , Neville Bridget , Lipsitz Stu , Block Susan
Published: February 2017

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Background: Conversations about serious illness care goals are often inadequate and fail to address key elements of high-quality discussions. Methods: As part of a cluster-randomized trial of a multi-component communication intervention, we conducted a retrospective chart review of 147 deceased oncology patients to assess frequency and timing of documentation of end-of-life (EOL) conversations; charts of a subset of 20 intervention and 20 matched control patients underwent detailed review to assess quality. A systematically developed abstraction tool was used by two blinded researchers. The tool contained 25 elements reflecting four EOL conversation domains: goals/values, illness understanding/prognosis, EOL care planning, life-sustaining treatments. Results: Of 153 intervention patients, 44.4% died (n = 68); of 161 controls, 49.1% died (n = 79). Significantly more intervention patients than controls (92.7% vs 74.7%, p = 0.006) had at least 1 documented EOL discussion before death; intervention conversations occurred 3 months earlier (median 147 days vs 62 days, p = 0.003). 59.4% of intervention conversations were documented in a retrievable EHR location compared to 10.2% of controls (p = 0.001). In the detailed review, 85% (n = 17) of intervention and 40% (n = 8) of controls had at least 1 documented discussion about values/goals (p = 0.0001), with an average of 3.6 of 8 elements (0.7 of 8 for controls) (p = 0.0003). 85% percent (n = 17) of intervention and 30% (n = 6) of controls had at least 1 documented discussion about prognosis (p = 0.0014), with an average of 2.5 of 7 elements (0.5 of 7 for controls) (p = 0.001). 85% of intervention (n = 17) and 55% of controls (n = 11) had at least 1 documented discussion about EOL planning (p = 0.009). 55% of intervention and 30% of controls had at least 1 documented discussion about life-sustaining treatments (p = 0.20). Conclusions: The intervention resulted in more, earlier and better documentation of serious illness care goals. Across 3 of 4 domains of quality, intervention patients had more detailed information about their EOL care preferences, demonstrating that the intervention results in more patient-centered, comprehensive discussions. Clinical trial information: NCT01786811.
Effect of a communication skills intervention on resident comfort and knowledge of discussing goals of care and advance care planning.
Authors: Patel Rushil Virendra , Golding Elizabeth , Lampkin Aaron , Larach Mary Walker , Klima Lawrence
Published: February 2017

50

Background: Inpatient providers are sometimes challenged with advanced care planning for their patients. At a teaching hospital, resident physicians find themselves tasked with this responsibility for inpatients they may have only just met, as well as in their assigned outpatient panel. Education on communication skills though has been shown to improve resident comfort level and knowledge of discussing goals of care and advance care planning. Methods: Internal medicine categorical residents (n = 15) and preliminary (n = 3) residents at a university-affiliated, community hospital learned the fundamentals of discussing goals of care and advance care planning using selected modules from the Center for Advancing Palliative Care’s (CAPC) online curriculum in communication skills during their outpatient clinic rotation from February through June 2016. Residents then discussed a patient encounter from their experience with their colleagues along with a member from the inpatient palliative care team and a clinical psychologist in weekly 1-hour afternoon sessions. A pre- and post-intervention survey was administered and recoded by a numerical identifier to assess the change in each resident's comfort level and knowledge level with conducting these discussions with their patients. Sessions were also audiorecorded to identify recurrent themes and insights for future follow-up projects. Results: Preliminary analysis (n = 11) demonstrates a statistically significant improvement in the median difference between overall resident comfort level (p = 0.007) and knowledge (p = 0.027) of discussing goals of care and advance care planning. Several participants also expressed desires for additional opportunities to practice these skills under supervision by experienced providers. Conclusions: Residents value developing skills requisite to facilitate goals of care discussions and advance care planning. Further opportunities for practice and feedback should be identified.
Advance care planning preferences in Hispanic population with cancer in the Bronx.
Authors: Cardenas Mori Jhosselini
Published: February 2017

6

Background: We aim to explore medical information-sharing and decision-making preferences of Hispanic patients in the Bronx. Methods: We are recruiting cancer patients who self-identify as Hispanic and are waiting at the oncology clinic at Montefiore Medical Center Cancer Center before an appointment. Results: To date we have interviewed 110 patients. The majority (60, 52.6%) preferred shared decision-making with their doctors, families or both, while 45 (39.5%) had an active decision-making style. A minority (9, 7.9%) had a passive decision-making style, deferring to their families and only 1 (0.9%) had a passive decision-making style deferring to the physician. The only demographic characteristic that was associated with decision-making preference was language; those who are English-speaking were more likely to endorse an active decision-making style (Chi2 = 7.06, p = 0.029) and less likely to endorse shared decision-making (Chi2 = 6.33, p = 0.042). The majority of patients agreed or strongly agreed that they wanted to hear all of the information regarding their diagnosis, treatment options, treatment expectation and treatment risks and benefits. Conclusions: These results confirm our hypothesis that most Hispanic patients prefer either an active or shared decision-making process rather than a passive decision-making process. Most patients prefer disclosure of diagnosis, prognosis and plan.
Short-course radiation for palliation of squamous cell carcinoma of an unknown primary of the head and neck.
Authors: Rich Shayna Eliana , Mendenhall William M.
Published: February 2017

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Background: The purpose of this study was to examine the treatment patterns used for palliative radiotherapy for squamous cell carcinoma of an unknown primary of the head and neck and to compare the acute toxicity and tumor response for these patients for the most common dose-fractionation regimens. Methods: Patients with biopsy-proven squamous cell carcinoma of an unknown primary with cervical lymphadenopathy were included who were treated with radiation therapy with palliative intent at a single institution between 1966 and 2015 (N = 45). Chart abstraction was performed on the radiation therapy records and follow-up visit notes. Results: Most patients presented with N3 disease (32/45, 71%), with symptoms of pain (19/45, 42%), or with difficulty swallowing (12/45, 27%). Patients were most commonly treated with 20 Gy in 2 fractions (13/45, 29%) or 30 Gy in 10 fractions (13/45, 29%). Toxicity was mild regardless of dose-fractionation, with only 6 patients experiencing dysphagia and 1 having a pulmonary embolus. Most patients had a partial nodal response during the radiation course (25/45, 56%), and partial symptom response by the first followup (17/33, 52%). Results were similar for 20 Gy and 30 Gy courses. Median survival was approximately 5 months and did not differ by radiation course. Conclusions: Patients treated with dose-fractionations of 20 Gy in 2 weekly treatments or 30 Gy in 10 fractions had minimal toxicity. Most patients had an excellent response in nodal size during radiation and nearly all had symptomatic response within the first month of follow. Patients with advanced disease of the head and neck may have a surprising durability of response with even a short course of palliative radiation therapy.
Caregivers' accuracy in reporting patients' symptom: A preliminary report.
Authors: Langer Paola , Perez-Cruz Pedro Emilio , Carrasco Escarate Cecilia , Bonati Pilar , Batic Bogomila , Tupper Laura , Gonzalez Otaiza Marcela
Published: February 2017

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Background: Improving symptom control during end of life (EOL) is a core goal of palliative care. When patients are not able to report their symptoms, caregivers (CG) report symptom intensity as surrogates. Data show that there is good agreement between patients and CG in reporting symptom intensity. However, little is known about factores that influence CGs’ accuracy. The aim of the study was to determine CG accuracy of advanced cancer patients’ symptoms and to identify CG factors that could modify it. Methods: In this prospective study, patients with advanced cancer enrolled in the National Program of Palliative Care at a public Hospital in Santiago, Chile and their CGs independently scored ten patients’ symptoms using the Edmonton Symptom Assessment Scale (ESAS). Correlation between patient and CG scores were estimated for each symptom. Differences between patient and CG scores were calculated for each symptom and were transformed into positive values. A continuous variable was created with the sum of all the differences as an indicator of caregiver overall accuracy, with smaller scores meaning better accuracy. CG depression, anxiety (HADS) and burden (ZARIT) were also assessed. Results: 36 patients and their CG were included in this preliminary analysis. Mean patient age was 64, 20 (56%) females, 13 (36%) had GI cancer, 7 (19%) lung cancer and 16 (45%) other. Mean caregiver age was 53, 25 (69%) female. We found positive correlations between patients’ and caregivers’ assessment of pain, fatigue, nausea, anorexia, dyspnea, depression and insomnia (r > 0.3 and p < .05 for each symptom). CG accuracy ranged between 10 and 44 points (mean 25, standard deviation 9) and was not associated with CG age, gender, depression, anxiety or burden. CG accuracy was negatively associated with CG worrying thoughts as assessed by one of the HADS questions (Coef -3.99, p = .015), meaning that CG were more accurate when their worrying thoughts were higher. This association remained significant when adjusted by CG depression, anxiety and burden. Conclusions: CG are more accurate in reporting patient symptoms when their levels of worrying thoughts are higher. This information may have implications in interpreting CG report during EOL.
Edmonton Symptom Assessment Scale (ESAS): Time duration of self-completion versus assisted-completion in palliative care patients—A randomized controlled trial.
Authors: Wong Angelique , Rodriguez-Nunez Alfredo , Tayjasanant Supakarn , Park Minjeong , Liu Diane D , Allo Julio , Frisbee-Hume Susan , Bruera Eduardo
Published: February 2017

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Background: ESAS is a multidimensional assessment tool for self-reporting of symptom intensity. Unfortunately, ESAS is not used often in clinical care due to the perception that it may be time consuming. Our aim was to compare the time duration of self-completion (SC) of ESAS for the first time by patients with advanced cancer vs. assisted-completion (AC) with a health care professional (HCP). Methods: In this randomized controlled trial, patients with advanced cancer who have never completed the ESAS at MD Anderson were allocated (1:1) with a web-based system to either to self-completion of the ESAS form vs assisted completion by the research assistant. Time of completion was measured by the research assistant using a stop watch. Patients completed the Rapid Estimate of Adult Literacy in Medicine (REALM) test prior to administration of the ESAS. In the self-completion group, the nurse reviewed the responses to verify that the reported ESAS scores were correct (nurse review). Results: 127 patients were enrolled (69 patients to AC and 58 to SC). The median age was 60 years old, and median REALM score was 65. The median (IQR) time of SC alone was significantly less than AC (1.2 minutes (.7, 1.5) vs 1.82 minutes (1.3, 2.3), p = .000). With nurse review time included, the SC time increased to 1.92 minutes (p (vs. AC) = .28). Lower literacy (REALM) score was significantly associated with increased completion time (p = .007). Other demographical and clinical variables were not significantly associated with completion time. 73/127 (58%) patients reported they did not mind completing the ESAS alone or with the help of the nurse. Conclusions: The ESAS can be completed in less than 2 minutes with or without assistance by a HCP. When nurse review time was included, there was no difference in time of completion as compared to assisted completion. Our results support that regular clinical use of ESAS will have minimal impact on clinical time.
Experience of weight loss and its burden in patients with non-small cell lung cancer: Results of an online survey.
Authors: Rodriguez Ana Maria , Duus Elizabeth M , Friend John
Published: February 2017

71

Background: The main objectives of this study were to characterize and compare the burden of non-small cell lung cancer (NSCLC) patients who reported considerable weight loss ( ≥ 5% of their body weight in the past 6 months or ≥ 2% for a BMI less than 20 kg/m2) to those who did not. Methods: 95 advanced NSCLC patients were surveyed from the online patient-powered community PatientsLikeMe. Self-reported demographic and clinical characteristics were recorded. Appetite, distress and concerns, health-related quality of life (QLQ-C15-PAL) and anorexia-cachexia symptoms/concerns (FAACT A/CS) were summarized. The results obtained between patients who lost considerable weight and those who did not were compared, using a two-tailed t-test or a Kruskal-Wallis test. Patients with weight loss were additionally asked open-ended questions on burden and concerns. Results: 35 (37%) patients were classified as having considerable weight loss at the time of the survey and 60 (63%) where classified without. Most patients were female (81%), American (81%), and mean age was 59 years. 61% of patients indicated not receiving either chemotherapy or radiotherapy at the time of the survey. Patients with weight loss reported significantly (p < 0.05) lower overall quality of life (55.2 vs. 66.9), worsened anorexia-cachexia symptoms/concerns (30.7 vs. 36.0), and higher symptomology, specifically fatigue (64.8 vs. 49.1), nausea (19.5 vs. 9.2), and appetite loss (41.0 vs. 23.9) – than patients without weight loss. In addition, significantly more patients who lost weight reported moderate/high distress levels than patients who did not (71% vs. 38%). For patients with weight loss, change in food taste, fatigue, and decrease in appetite were the most frequently reported symptoms with the greatest impact on their lives. Conclusions: Our results support that weight loss negatively affects cancer patients’ quality of life and is associated with more distress and symptoms—particularly fatigue, and appetite loss. Weight loss-related symptoms also significantly impact their lives. Interventions targeted at maintaining/increasing body weight may help to improve well-being and reduce key symptoms in advanced NSCLC patients with considerable weight loss.
Usability and acceptance of novel personal health technology to support early palliative care for patients with cancer and caregivers.
Authors: Bell Janice , Reed Sarah C. , Kim Katherine , Ngo Victoria , Wait Wendy , Apesoa-Varano Ester , Morgan Joy , Whitney Robin L. , Blackmon Emma , Joseph Jill
Published: February 2017

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Background: Little research has assessed whether and how technology can support early palliative care. Our team developed a HIPAA-compliant, cloud-based Personal Health Network (PHN) with a secure, online network of family, caregivers, clinicians and service providers designated by the patient; symptom reporting/management resources; and support for communication among network members via audio/video conferencing, messaging, and document sharing. This study examines PHN usability and acceptance, and identifies additional functions for early palliative care. Methods: Patients undergoing chemotherapy in a Comprehensive Cancer Center (n = 19) and their caregivers (n = 17) watched video demonstrations of the technology, participated in semi-structured interviews, and completed surveys measuring computer self-efficacy, PHN usability and acceptance. Results: Most participants were male with college education; mean age was 58 years. Most had a tablet or desktop computer (75%), a mobile phone (94%) and believed that technology improves the security of medication information (66%). At the same time, only 44% used email to contact healthcare providers and 30% used the internet to connect with others for support and information. Most reported the PHN was easy to learn and use and was an efficient and useful tool for patient-driven social networking, team communication, care coordination and symptom management. Participants suggested adapting the PHN to support spiritual and emotional needs and advance care planning. Common concerns included skepticism about receipt of timely responses from providers to symptom reports and the need for ongoing support for older adults with limited technology experience. Conclusions: These preliminary findings support adaption of the PHN to support palliative care components identified as important to patients and caregivers and further PHN usability and acceptance testing in larger, more diverse samples. The results also underscore the need for systems to support technology users, to clarify expectations of response time with patients and caregivers, and to assure these expectations can be met by healthcare providers.
Assessment of the relationship between three cancer survivor well-being tools.
Authors: Marchionda Paula , Deprey Mary Jo , Chamovitz Stuart , Jacobson Marty , Hall Kathleen
Published: February 2017

74

Background: In 1999, the National Comprehensive Cancer Network issued guidelines for improving well-being of cancer survivors. Three tools, the Eastern Cooperative Oncology Group Performance Status (ECOGPS), the National Comprehensive Cancer Network Distress Thermometer (NCCNDT), and the Subjective Happiness Scale (SHS), are currently being used in a rural oncology survivorship clinic to assess patients’ well-being. The question arose whether all three tools are necessary for adequate patient assessment. Methods: Charts were reviewed on patients seen in a cancer survivorship clinic between January 1, 2015 and January 31, 2016. Well-being measures included the ECOGPS, the NCCNDT, and the SHS, all of which have been validated in prior studies. Patient demographics and well-being measures were captured in a database. Patient identifiers were removed to protect privacy. Data was stratified by age, gender, type and stage of cancer, and treatment type. ECOGPS, NCCNDT, and SHS scores were analyzed using Spearman rho to determine the relationships, if any, among the scores. A strong relationship was present if the correlation coefficient was > ± 0.7. A moderate relationship was present if the correlation coefficient was ± 0.4 to ± 0.7. Results: An analysis of all patient visits (n = 158) showed no strong or moderate correlations between performance and happiness (rs = -0.207), performance and distress (rs = 0.393), or distress and happiness (rs = -0.383). However, in subgroup analyses, a strong correlation was seen between happiness and performance for ages18-39 (rs = 0.830) and for those 6-12 months post-treatment (rs = -0.714). A strong correlation was also seen between distress and happiness for thoracic (rs = -0.801) and head and neck (rs = -0.847) cancer types, as well as those 1-3 years (rs = -0.718) and 3-5 years (rs = -.0754) post-treatment. A positive correlation was seen between performance and happiness for men (rs = 0.341), whereas females saw a negative correlation (rs = -0.349). Conclusions: Results indicate that these tools capture different aspects of patients’ well-being. Continued use of all three is recommended. Results obtained from stratified groups may be used for future studies.
Using patient-reported outcomes to assess the effectiveness of topical hormonal replacement therapy (THR) for vaginal complaints (VC) after anti-hormonal therapy (HT) treatment for breast cancer (BC).
Authors: Jamy Omer HASSAN , Vontela Namratha Reddy , Gatwood Justin , Walker Mark Stephen , Stepanski Edward J. , Vidal Gregory A.
Published: February 2017

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Background: THR is sometimes used for treatment of VC in BC patients previously treated with HT. The safety of this practice remains a question but the effectiveness of this strategy has not been reported. Methods: We conducted a retrospective analysis of patient reported symptoms at the West Cancer Center (WCC) between 2002 and 2014. Early stage BC patients previously treated with HT with reported VC ± THR were statistically matched 1:1 using propensity score matching with calipers of 0.01. Demographics and clinical characteristics were extracted from electronic records and a proprietary patient-reported outcomes database: the Patient Care Monitor (PCM). A baseline PCM score for vaginal dryness and sexual dysfunction was noted at the initiation of THR and was followed for 12 months. Univariate statistics compared the resulting cohorts and repeated measures ANOVA assessed the impact of topical therapy. Results: We compared 74 THR patients to 74 controls (Table). The mean reported symptom scores were 3 fold higher in the active group with no statistical improvement in symptom scores noted at 6 or 12 months (Table). At the WCC, of the 5,479 patients with VC analyzed, only 5% received THR. The study was underpowered for survival analysis. Conclusions: In our study, increased severity of VC was associated with increased use of THR. However, there is no evidence that THR was effective in alleviating symptoms of vaginal dryness or sexual dysfunction. [Table: see text]
Sleep quality among inpatients with acute myeloid leukemia.
Authors: LeBlanc Thomas William , Aibel Kelli , Meyerhoff Ryan , Harpole David , Abernethy Amy Pickar , Yang Chi-Fu Jeffrey
Published: February 2017

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Background: Anecdotally, sleep is thought to be a significant problem for inpatients receiving treatment for acute myeloid leukemia (AML), butsleep disturbances in this setting are not well-characterized. We aimed to assess the feasibility of measuring sleep in AML patients using a wearable actigraphy device. Methods: Using the Actigraph GT3X “watch,”we assessed the total sleep time, sleep onset latency, wake after sleep onset, number of awakenings after sleep onset, and sleep efficiency for inpatients with AML receiving induction chemotherapy during their hospitalization. We also assessed patient self-reported sleep quality using the Pittsburgh Sleep Questionnaire Index (PSQI). Results: Of the thirteen patients enrolled in the study, 11 completed actigraphy and PSQI assessments. Two patients who were transferred to the ICU were excluded from this analysis. Data collection was feasible; patients wore the Actigraph device for a mean (SD) of 120 (58) hours. Subjects’ mean age was 55.9 (15.7) years. Mean length of hospitalization was 34 (13) days. The mean PSQI global score was 8.10 (4.91) indicating generally poor sleep. Actigraphy measures also suggested poor sleep. Overall sleep quantity was insufficient, with a mean total sleep time in minutes of 366.5 (61.0). Patients’ sleep was often interrupted, with a mean number of awakenings after sleep onset of 4.9 (3.3), average awakening length in minutes of 7.8 (5.5), and mean wake after sleep onset in minutes of 37.2 (26.4). Mean sleep onset latency in minutes was 0.4 (0.5) and sleep efficiency was high (90.7% (0.1)), suggesting that patients did not have difficulty falling asleep but rather experienced poor sleep due to external factors. Conclusions: Actigraphy assessment of sleep in AML inpatients is feasible, and suggests significant impairments in both quantity and quality of sleep. While patients did not appear to have difficulty falling asleep, they experienced significant sleep disturbances, perhaps from external factors like interactions with staff and interruptions such as from administration of medications, lab draws and vital sign measurements. Supportive care interventions are needed to further improve sleep quantity and quality among inpatients with AML.
Use of the Edmonton Symptom Assessment Scale in patients with advanced cancer referred to an embedded palliative care clinician.
Authors: D'Ambruoso Sarah , Walling Anne M. , Hurvitz Sara A. , Drakaki Alexandra , Goldman Jonathan Wade , Pietras Christopher , Watts Frances , Coscarelli Anne , Wenger Neil
Published: February 2017

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Background: Physical and emotional symptoms are highly prevalent in patients with advanced cancers and contribute to overall distress level and decreased self-reported quality of life. Oncology organizations and accrediting bodies now routinely recommend universal distress screening among patients with advanced cancers. Palliative and supportive care clinicians play an important role in implementing symptom and distress screening in cancer centers. Methods: As part of an embedded palliative care nurse practitioner (PC-NP) intervention within a large ambulatory oncology clinic, patients with advanced breast, GU, GI and lung cancer were screened for physical and emotional symptoms using the Edmonton Symptom Assessment Scale (ESAS) and treated appropriately including referral to psychology-based supportive care clinic for moderate to severe anxiety and depression or clinician-identified need. We used pre-test post-test methods to see if symptoms improved after enrollment in an embedded palliative oncology program. Results: Sixty-eight patients were screened at initial visit and 41 had follow-up screening during the first 13 months of the program with a part-time PC-NP. Only the 41 patients who had both an initial and a follow-up visit were included in the analysis. Patients were assessed using the ESAS at initial visit and at a follow-up visit an average of 5.9 weeks later (RANGE 1.0-30.6), and significant reductions were found in self-reported pain (4.0 v. 3.0), shortness of breath (3.0 v. 2.1), lack of appetite (2.8 v. 2.1), and overall well-being (4.7 v 3.8) (p < 0.05). Emotional symptoms (anxiety and depression) also decreased but were not statistically significant. Aggregate scores (emotional symptoms plus physical symptoms plus well-being) demonstrated a 6 point reduction in severity (26.2 baseline to 20.3 at follow-up, p = 0.17). Conclusions: These findings are suggestive of improvement in cancer-related symptoms and distress after enrollment in an embedded palliative oncology program. More rigorous study designs are needed to better understand the impact of the intervention on symptom management.
Differences in the symptom distress between young adult and adult patients with advanced cancer admitted to acute palliative care unit.
Authors: Kang Beodeul , Kim Yu Jung , Park Ji Soo , Choi Hye Jin
Published: February 2017

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Background: Understanding about young adults with advanced cancer in palliative care was still insufficient. The purpose of this study was to identify the differences in symptom distress between young (20-39 years) and older (≥ 40 years) adults with advanced cancer who were admitted to acute palliative care unit. Methods: We retrospectively analyzed 502 consecutive patients admitted to acute palliative care unit between April 2015 and March 2016 in two tertiary cancer centers. Descriptive statistics, analysis of Edmonton Symptom Assessment Scale (ESAS), and Symptom Distress Scale (SDS) were performed. Results: Among 502 patients, 33 (7%) were aged 20-39 years, and 469 (93%) were aged ≥ 40 years. The most common malignancies among the young adult patients were stomach and colorectal cancers. SDS was similar between young adult (38.7 ± 15.1) and old adult (41.5 ± 13.7) patients. However, pain, nausea, poor feeling of well-being sense, sleep disturbance, and financial distress were numerically higher in young adult group than older adult group. Especially, sleep disturbance (5.72 vs. 4.56, p = 0.030) and financial distress (4.44 vs. 2.87, p = 0.008) showed statistically significant difference. Conclusions: Young adult advanced cancer patients appear to show different symptom profiles. Further research is needed to identify determinants and to provide timely integration of palliative care services for this unique patient cohort.
Contemporary treatment patterns and short-term outcomes in men with very high-risk prostate cancer.
Authors: Tosoian Jeffrey J. , Sundi Debasish , Chapin Brian Francis , Antonarakis Emmanuel S. , Chappidi Meera , Alam Ridwan , Glavaris Stephanie , Karnes R. Jeffrey , Pienta Kenneth J. , Tran Phuoc T. , Schaeffer Edward M. , Ross Ashley
Published: February 2017

103

Background: Beginning in 2014, the National Comprehensive Cancer Network (NCCN) recognized very high-risk (VHR) prostate cancer (cT3b-T4, or primary Gleason pattern 5, or more than 4 biopsy cores with Gleason score 8-10, or multiple HR features) as a classification distinct from high-risk (HR) disease. Using prospectively collected institutional data, we describe contemporary treatment patterns and short-term outcomes in the VHR population. Methods: Men who underwent radical prostatectomy (RP) between January 2010 and June 2015 were identified using the Johns Hopkins RP database, and trends in management were compared across the study period. Pathological and short-term clinical outcomes were assessed in men with VHR cancer. Non organ-confined disease (NOCD) was defined as ≥ pT3 disease or lymph node positivity, persistent postoperative PSA as ≥ 0.2 ng/mL, and biochemical recurrence (BCR) as a PSA ≥ 0.2 ng/mL following an initial undetectable postoperative PSA. Results: During the study period, 4,954 men underwent RP, of which 161 (3.2%) men had VHR cancer at diagnosis. The annual proportion of men who underwent RP with VHR cancer increased over the study period (chronologically 1.8%, 1.0%, 3.3%, 4.1%, 5.6%, and 5.2%; p<0.001). Sixteen percent of men with VHR disease were enrolled in pre-surgical clinical trials, with an increase from 0% of men in 2010 to 19.1% in 2015 (p=0.11). At RP, 39% of the VHR cohort had seminal vesicle invasion, 26% had lymph node involvement, and a total of 74% had NOCD. Following surgery, 33% of men had PSA persistence, and 40% experienced either PSA persistence or BCR during follow-up (median 13.4 months). Of 136 men with at least one follow-up assessment, 15 (11.0%) developed metastasis; 33% of the cohort was treated with radiation therapy, 42% with androgen deprivation, and 15% with docetaxel. Conclusions: The VHR population carries the greatest risk of clinical progression following local treatment. Over the past five years, we have observed increasing surgical treatment and clinical trial enrollment at our institution. Continued assessment of post-operative interventions and outcomes will help to facilitate counseling and establish point estimates from which to power clinical trials.