bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum-derived bovine immunoglobulin in the alleviation of irinotecan-induced mucositis.
Authors: Bateman Emma Hazel , Weaver Eric , Klein Gerald , Plews Erin , Wignall Anthony , Wozniak Belinda , White Imogen , Keefe Dorothy M. K.
Published: February 2017

166

Background: Gastrointestinal (GI) mucositis is associated with diarrhoea and intestinal barrier dysfunction caused by apoptosis, immune dysfunction, and microbiome alterations. Serum-derived bovine immunoglobulin (SBI) has been shown to ameliorate inflammation in colitis models, has been shown to improve HIV-induced enteropathy and nutritional status, and is being investigated in post-surgical recovery in oncology patients. We investigated in a rat model whether SBI was effective in alleviating symptoms of GI mucositis. Methods: Animals were gavaged with 250 or 500mg/kg of SBI twice daily, before intraperitoneal administration of 200mg/kg irinotecan on day 4, and for 6 days post-irinotecan. Animals were monitored for bodyweight and diarrhoea. Tissues were collected at necropsy 6, 48, 96 and 144 hours post-irinotecan. H&E-stained colon and jejunum were analysed for histological damage. Results: The overall incidence, severity and duration of diarrhoea, and clinical symptoms of mucositis, were decreased in irinotecan-treated animals that had received SBI. Animals receiving 500 mg SBI/kg also tended to lose less bodyweight than animals treated only with irinotecan (P>0.10). Animals receiving SBI had less pronounced irinotecan-induced changes in neutrophil levels (P≈0.02), and lower tissue damage scores than those receiving irinotecan alone (P<0.0001). Conclusions: Twice-daily oral gavage of SBI was well-tolerated, and reduced the incidence, severity and duration of irinotecan-induced mucositis. SBI was associated with less pronounced changes in inflammatory cell levels and intestinal tissue damage. Ongoing experiments aim to explore the mechanisms of SBI-associated gastrointestinal protection.
Frequency and burden of patient-reported chemotherapy toxicities in community-based oncology practices.
Authors: Friese Christopher Ryan , Stella Philip J. , Lavasseur Beth , Adams Paul T. , Swafford Lauren , Lewis JoAnn , Mendelsohn-Victor Kari Michigan
Published: February 2017

178

Background: Patient-reported outcomes measurement is recommended to improve care delivery. Toxicities are important to study given their impacts on treatment completion. We captured patient-reported toxicities in community-based oncology practices and identified toxicities associated with excess health care service use. Methods: We surveyed newly-diagnosed patients who completed their first chemotherapy cycle at 5 community practices. Exclusion criteria were prior cancer history, non-English speakers, psychiatric diagnosis, and clinical trial participation. At the second cycle return visit, patients completed a questionnaire that measured the severity of nausea, vomiting, diarrhea, constipation, mouth sores, intravenous catheter problem, pain, fever/chills, extremity edema, and dyspnea. These were rated on a 5-point scale (1= did not experience to 5 = very severe). Patients also reported unscheduled oncologist visits, emergency department visits, or inpatient hospitalization. Results: Of 117 eligible patients, 106 (91%) participated. Most patients (98%) were white, 25.5% were male, and the mean(SD) age was 60 (11) years. The most frequent diagnoses were breast (43%), lung (21%), colorectal cancer (13%), and non-Hodgkin lymphoma (13%). Between cycle 1 and 2, frequent severe or very severe toxicities were nausea (30%), pain (18%), diarrhea (9%), and mouth sores (9%). 15% of patients had an unscheduled oncologist visit, 18% had an emergency department visit, and 9% of patients were admitted. Nausea (11.3%) and diarrhea (6.6%) were frequent reasons for unscheduled oncology visits; nausea and pain (both 5%) for emergency department visits, and; pain and dyspnea (both 2%) for hospitalization. Conclusions: Patient-reported toxicity monitoring is feasible and informative in community-based oncology practices. Despite widespread antiemetic use, nausea is a pervasive problem for newly-treated patients and drives excess service use. Pain assessment and management strategies are needed to reduce emergency department visits and hospitalizations.
The benefits of early integration of palliative care as a part of standard outpatient oncology care.
Authors: Srivastava Piyush
Published: February 2017

18

Background: It is well known that palliative care (PC) services are skillful in aligning patients' goals of care with healthcare team’s plan of care and treating symptoms related to an advanced disease. The culture of PC is now focusing efforts upstream since earlier interaction fosters more thoughtful discussion of goals and more effective symptom management. Decreased or late access to PC services has traditionally been due to physician factors, including inaccuracies in prognostication, personal bias and lack of awareness of PC mission. With this understanding, we have consciously constructed a robust, standardized, formalized process in the oncology setting for patient identification and automatic referral to the outpatient PC clinic as a part of usual care to diminish the influence of oncologists. Methods: Due to the wide geographic area of our population, there are five ½ day outpatient PC clinics, two of which are embedded in outpatient oncology centers at two medical centers. These are staffed by an MD and RN, with option of chaplain and social work interventions. The Edmonton Symptom Assessment Scale serves as our tool to monitor patient’s clinical course. We have created a reproducible, patient selection and outreach process to make PC as part of ‘normal’ cancer care. Results: 330 oncology patients were seen over a 20 month period. Of these only 8 PC clinic patients received chemotherapy in the last 30 days prior to death vs 153 patients who were not seen in PC clinic. Within the last 14 days of life no patients who were seen in PC clinic received chemotherapy vs 54 patients who were not seen in clinic. This compares well to the national average of 10%. 55% were referred to hospice compared to the national average of only 11%. The average LOS for hospice was 50.8 days compared to the national average of 40.6 days. ER visits decreased by 15% and hospital admissions decreased by 63% for patients with PC clinic encounters. Subjectively, patient’s symptoms improved by 75%. Conclusions: These upstream encounters facilitate more thoughtful medical decision making for patients with terminal cancer diagnosis, improving quality of care and QOL and positively affecting hospital utilization.
Association of opioid requirement and cancer pain with survival in advanced non-small cell lung cancer.
Authors: Zylla Dylan Michael , Kuskowski Michael , Gupta Kalpna , Gupta Pankaj
Published: February 2017

183

Background: Pain is associated with shorter survival in non-small cell lung cancer (NSCLC). Lung cancer cells express opioid receptors. Opioids promote angiogenesis, tumor growth and metastases, and shorten survival in animal models. Methods: To examine if long-term opioid requirement, independently of chronic pain, is associated with survival, we studied 209 patients treated with chemotherapy for stage IIIB/IV NSCLC. Pain was stratified by proportion of time patients reported specific levels of pain. Opioids were converted to oral morphine equivalents (OME) for comparison. The effects of pain, opioid requirement, and known prognostic variables on survival were analyzed in univariable and multivariable models. Results: Both severity of pain and greater opioid requirement in first 90 days after starting chemotherapy were strongly predictive of shorter survival on univariable analysis. Patients with no/mild chronic pain and requiring <5 mg/day OME during first 90 days had nearly 12 months longer median survival compared to patients requiring ≥5 mg/day OME and/or experiencing more pain. Differences in survival remained remarkably similar when chronic pain and opioid requirement were assessed over the entire clinical course (until death or last follow-up). In multivariable models, both opioid requirement and chronic pain remained independent predictors of survival, after adjustment for age, stage and performance status. Conclusions: Severity of chronic cancer-related pain or greater opioid requirement are associated with shorter survival in advanced NSCLC, independently of known prognostic factors. While pain adversely influences prognosis, controlling it with opioids does not improve survival. Prospective studies should determine if achieving pain control using opioid-sparing approaches improves outcomes.
Hypertension, proteinuria, and overall survival in elderly cancer patients treated with bevacizumab.
Authors: Launay-Vacher Vincent , Janus Nicolas , Ray-Coquard Isabelle Laure , Gligorov Joseph , Selle Frédéric , Beuzeboc Philippe , Daniel Catherine , Spano Jean-Philippe , Thery Jean Christophe , Goldwasser Francois , Mir Olivier , Rey Jean-Baptiste , Jouannaud Christelle , Morere Jean F. , Oudard Stephane , Deray Gilbert , Scotte Florian
Published: February 2017

186

Background: MARS is a multicentric, non-interventional, prospective study which first reported the high prevalence of both baseline and de novo hypertension (HTN) and proteinuria (Pu) in several sub group of cancer patients [Gligorov J et al. SABCS 2013; Ray-Coquard I et al. ASCO GI 2014; Ray-Coquard I et al. ASCO GU 2014; Goldwasser F et al. ECC 2013; Launay-Vacher V et al. ASCO 2013]. In this sub-group analysis, we focused on elderly cancer (EC) patients treated by bevacizumab. Methods: MARS included 1,124 patients, all naïve of any previous anti-VEGF treatment. A First Renal Assessment was performed at baseline before the anti-VEGF was started with periodic follow-up for 1 year. Elderly was defined as age ≥65 years at inclusion. Univariate (UA) and multivariate analyses (MA) tested the associations of HTN and Pu, at baseline or de novo, with overall survival (OS) (pre-planned) in EC patients. Results: 845 patients treated with bevacizumab were included. Among them 226 were EC patients (colorectal 81, breast 78, ovarian 26, lung 22). At inclusion, HTA was statistically higher in EC patients (table), mean aMDRD was 79.6 ml/min/1.73m2 and 15.1% had aMDRD<60. De novo HTA; de novo Pu and Scr increase were not statistically more frequent in EC patients than in non-EC patients. In addition, renal function decreased by -4.1 ml/min/1.73m²/year and 16.2% had aMDRD<60 at the end of follow-up. Baseline and de novoHTN and Pu were not associated with reduced OS in EC patients in both UA and MA analyses. Conclusions: There were no differences in term of renovascular safety in EC patients treated by bevacizumab. Furthermore, HTN and Pu were not associated with OS in EC patients treated by bevacizumab. Therefore, renovascular events should not be contraindicated at the initiation of the treatment or when the patient is already on treatment. [Table: see text]
Assessing the value of progression-free survival (AVALPROFS).
Authors: Fallowfield Lesley , Matthews Lucy , Catt Susan L. , MacKenzie Mairead , Gath Jacqui , Jenkins Valerie A.
Published: February 2017

187

Background: Controversy exists about progression free survival (PFS) as an endpoint in novel cancer therapy trials. PFS is attractive for practical and methodological reasons but is not always a surrogate for overall survival. It is debatable whether or not PFS has discernable clinical benefit for patients (pts), the main treatment (tmt) goal. Also overlooked are pt perceptions. Few trials directly address if disease stabilisation is worth tmt side effects (SEs) or include relevant patient reported outcome (PRO) measures. AVALPROFS examines longitudinally pts’ understanding of therapeutic intent, PFS and the value placed on drugs that control cancer but have SEs. We report the pilot study here. Methods: The primary pilot aim was to obtain feedback from pts having drugs offering only PFS or modest OS gains, about the acceptability and comprehensibility of PROs for use in a longitudinal study. These included validated quality of life and anxiety measures and 4 study specific interview schedules. In close collaboration with Independent Cancer Patients’ Voices (ICPV) and using an iterative process, draft interviews (pre-tmt, on-tmt, at withdrawal due to toxicity or progression) were developed. Pilot study pts’ clinic consultations were taped prior to home interviews by researchers. Results: 11/19 eligible pts with metastatic breast, lung and head and neck cancers at different treatment phases participated. No pt recalled the phrase PFS being used in consultations. Few knew their latest scan results. Some were confused about the therapeutic aims of further tmt, 4/10 thought it would extend survival. All had experienced or anticipated considerable toxicity. None found the interview schedules too upsetting; all provided comprehensive feedback about these and the trade-off questions. Conclusions: PFS is confusing and questions remain about its true value. Involvement of ICPV in potentially distressing research about study design and PROs at the outset was invaluable. Inclusion of feedback from pilot study pts permitted further refinements to the AVALPROFS study which is currently open and recruiting. Clinical trial information: 16342. [Table: see text]
Symptom clustering among patients visiting a supportive oncology clinic.
Authors: Wrammert Kathryn C. , Harrell Gwendolynn , O'Neill Michael , Grandhige Anjali , Moulia Danielle , Aktas Aynur
Published: February 2017

188

Background: Multiple symptoms are common and often severe in patients with cancer. Identification of symptoms which cluster may serve to elucidate the pathophysiology of the disease and aid in symptom management. Our aim was to define symptom clusters occurring among cancer outpatients receiving chemotherapy. Methods: New and returning patients referred to a supportive oncology clinic (SOC) from our health system’s oncologists from November 2011 through May 2014 completed the Condensed Memorial Symptom Assessment Scale plus a sexual dysfunction structured assessment. Data were collected prospectively from 323 consecutive initial visits. Patients rated from 0-4 how bothersome 15 cancer symptoms were; symptoms were then graded as present (1+) or absent (0). Hierarchical cluster analysis with average linkage was used to identify symptom clusters. The absolute value of the correlation between symptoms was used as the measure of similarity between pairs of symptoms. A correlation of ≥0.6 was used to define the final clusters. A symptom cluster was defined as two or more symptoms that predictably occur together. Results: Three clusters were identified: 1. Psychological (worrying, feeling sad, feeling nervous); 2. Treatment-related (lack of energy, feeling drowsy, difficulty concentrating, dry mouth, constipation); 3. Gastrointestinal (weight loss, lack of appetite, nausea). Pain, difficulty sleeping, shortness of breath, and loss of interest did not cluster with any symptom. Gastrointestinal symptoms are important within the clusters. The prevalence of worrying, feeling sad, and feeling nervous did not cluster with lack of energy or difficulty in sleeping, nor pain with worrying or feeling sad. Conclusions: Three symptom clusters were identified as showing high absolute correlation: a psychological cluster, treatment-related cluster, and gastrointestinal cluster. Identifying symptom clusters may promote our understanding of the pathophysiology of cancer, help prioritize effective pharmacotherapies, and identify drugs likely to help more than one symptom.
Association between feeling of well-being and overall survival in advanced lung or non-colonic gastrointestinal patients receiving palliative care.
Authors: Yennu Sriram , Kim Yu Jung , Zhang Yi , Park Ji Chan , Hui David , Kang Duck- Hee , Arthur Joseph , Chisholm Gary B. , Williams Janet L. , Reddy Suresh K. , Bruera Eduardo
Published: February 2017

199

Background: The aim of this study was to determine the association between feeling of well-being (FWB, 0= best, 10= worst) and overall survival in advanced lung or non-colonic gastrointestinal patients who were referred to an outpatient palliative care clinic (OPC). We also determined the predictors of severity of moderate or severe - feeling of well-being in advanced lung or non-colonic gastrointestinal patients presenting to palliative care. Methods: We reviewed the records of consecutive patients with incurable advanced lung cancer and non-colonic gastrointestinal cancer presenting to OPC. Edmonton Symptom Assessment System (ESAS) scores were obtained at the initial visit between from Jan. 1, 2008-Dec. 31, 2013. Descriptive statistics were used to summarize patient characteristics. Clinically significant FWB was defined as ≥4/10. Overall Survival (OS) was calculated from the time of diagnosis of advanced cancer to death or last contact. Univariate analyses were performed and only significant variables were included in multivariate regression analysis to determine factors associated with severity OF FWB. Results: A total of 826 evaluable patients were analyzed (median age, 62 years; 57% male). Median ESAS FWB scores was 5 IQR (3-7). Worse FWB was significantly associated with OS (months) 6.33 (5.03, 8) vs 4.2 (3.37, 4.67) P=0.0003, from the time of diagnosis of advanced cancer. The final model of the Backwards Stepwise regression of factors associated with OS found that FWB (HR 1.09, p=0.3) was not an independent predictor of OS. ESAS FWB was significantly associated with ESAS fatigue (OR 2.31, p<0.001); anxiety (OR 1.98, p<0.001); anorexia (OR 2.31, p<0.001); CAGE positivity [alcoholism] (HR 1.80, p=0.008); and family distress (HR 1.93, p=0.002). Conclusions: Worse ESAS FWB showed univariate association with OS but it does not appear to be an independent predictor of OS when controlling for other known predictors. ESAS FWB was significantly associated with fatigue, anxiety, anorexia, CAGE positivity, and family distress, suggests that ESAS FWB may be a multidimensional screening measure for patient reported health related quality of life.
Infrastructure to improve together: Fostering palliative care (PC) and quality improvement (QI) learning in oncology through a virtual learning collaborative (VLC).
Authors: Kamal Arif , Prestrud Ann Alexis , Ast Katherine , Bruno Julie , Gavigan Molly , McNiff Kristen K. , Abernethy Amy Pickar , Von Roenn Jamie H.
Published: February 2017

20

Background: PC and oncology teams can most effectively improve patient experience during cancer when the specialties improve care processes together through collaborative QI activities. To support collaboration ASCO, the American Academy of Hospice and Palliative Medicine, and Duke University developed a partnership to pilot the ASCO VLC. This pilot will develop and test a scalable model for quality improvement and dissemination of best practices, focused on improving palliative care in oncology. Methods: The ASCO VLC integrates lessons learned through the Breakthrough Series, ASCO Quality Training Program, and others. An Advisory Committee representing expertise in medical oncology, palliative care, geriatrics, nursing, social work, survivorship, health services research, and quality improvement oversees the pilot project. Content in the VLC website was refined based on feedback gathered through a needs assessment survey of pilot participants. Results: The online collaborative and learning platform went live in June 2014. The site houses live and recorded educational sessions covering PC and QI topics, includes discussion boards to foster interactions between practices, supports sharing of tools and resources, and allows practices to submit their problems and aims statements, and results of their work for peer review and feedback. 24 practices were recruited to participate; 73% from community/private practice sites. In response to the needs assessment, 85% of participants responded with a high sense of comfort with PC; yet, only 33% had similar comfort with QI. When asked to rank their top preference, respondents were most interested in learning about pain and symptom management (44%), or advance care planning (22%). Ongoing mixed qualitative and quantitative assessments through Spring 2015 will assess feasibility and acceptability of the ASCO VLC model. Conclusions: We are creating an online virtual learning collaborative as a sustainable infrastructure to support and foster clinician education and dissemination of PC best practices in oncology.
Pain score, analgesic utilization, and patient satisfaction among cancer patients at a community cancer center.
Authors: Zylla Dylan Michael , Fulbright Jim , Pawloski Pamala A. , Illig Lisa , Peck Adina , Van Peursem Sarah , Richter Sara , Larson Amber
Published: February 2017

203

Background: Cancer-related pain is common, negatively impacts quality of life and survival, and often requires opioid analgesics. Patient level data describing the incidence and severity of pain, medication utilization, and patient satisfaction associated with care are lacking. An understanding of cancer pain prevalence and analgesic utilization is needed to initiate quality improvement (QI) interventions. Methods: We analyzed 2 months of outpatient oncology clinic encounters from the electronic medical record (EMR) and conducted a patient survey of 163 cancer patients to obtain baseline data on pain levels, opioid and non-opioid treatments, and patient satisfaction. Our survey incorporated questions from the Brief Pain Inventory to validate EMR reports and obtain patient satisfaction data. Results: Moderate to severe pain is reported in nearly 1 of every 9 cancer patient encounters (Table 1). On average, we achieved a personal pain goal (PPG) in 83.5 % of all patients (n=109). Among patients receiving opioids, a PPG was achieved in 16 of 29 patients (55.2%). Of the 13 opioid-consuming patients not achieving a PPG, 12 were not on a long-acting opioid, and 5 had never discussed a pain management plan with their physician. Oxycodone CR is the most commonly prescribed long-acting opioid (40.4% versus morphine SR (26.1%), methadone (23.0%), and fentanyl transdermal (10.6%)). Conclusions: Moderate to severe pain is commonly encountered among patients receiving cancer care in the clinic setting. Increasing the proportion of patients achieving a PPG is a critical quality and patient satisfaction goal, and may be improved by creating a pain plan incorporating a long-acting opioid. Our QI intervention aims to improve pain assessment documented in the EMR and educate both patients and staff regarding appropriate pain management. [Table: see text]
Reduced symptom burden after visiting an outpatient supportive oncology clinic.
Authors: Wrammert Kathryn C. , Harrell Gwendolynn , O'Neill Michael , Grandhige Anjali , Binney Zachary O. , Quest Tammie E.
Published: February 2017

204

Background: Outpatient palliative care in supportive oncology clinics (SOC) is growing and has shown promise in controlling symptoms. We sought toinvestigate the impact on symptom burden of a SOC in a National Cancer Institute-designated Comprehensive Cancer Center. Methods: New and returning SOC patients referred from our health system’s oncologists from November 2011 through May 2014 completed the Condensed Memorial Symptom Assessment Scale plus a sexual dysfunction structured assessment. Visits include a structured symptom assessment and personalized treatment plan from the clinic’s part-time physician and/or nurse practitioner. Patients rated from 0-4 how bothersome 15 cancer symptoms were. Descriptive statistics were calculated. We used the Wilcoxon signed rank test to compare symptom scores at patients’ first and second visits. Results: 135 patients had multiple SOC visits. Mean age was 54.7 (SD 12.5) years. 55.3% were female. The most common cancers were breast, lung, and head and neck (18.1% each). Median time between visits was 29 days (mean: 52.8, range: 2-446). The most bothersome symptoms at baseline were pain (mean 3.1, SD 1.3), lack of energy (2.4, SD 1.3), and difficulty sleeping (2.1, SD 1.6). Least bothersome were dyspnea (0.8, SD 1.1), sexual problems (0.9, SD 1.4), and nausea (1.0, SD 1.3). Energy, pain, drowsiness, constipation, sleep, worrying, sadness, and nervousness were significantly improved at follow-up with reductions between 0.2 (drowsiness) and 0.5 (pain) points (all p<0.05). Weight loss trended toward improved (p=0.053). Conclusions: 8 of 15 symptoms significantly improved after the first visit to a small-scale SOC. These reductions may underestimate the SOC’s effect if disease was progressing or overestimate differences if disease was shrinking, but such data were unavailable. Larger multi-site trials with well-defined interventions and control groups are needed.
A study of in-patient oncology satisfaction.
Authors: Moka Nagabhishek , Jubelirer Steven , Welch Christine A. , Taylor Martha B.
Published: February 2017

205

Background: The European Organization for Research and Treatment in Cancer (EORTC) developed the EORTC-IN-PATSAT32 survey for in-patient satisfaction (use permission granted). Methods: The EORTC-IN-PATSAT32 survey administered after consent, at discharge on an oncology floor at a large university affiliated community hospital. Comparisons were made to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), which were collected during the same time period. Results: The average age of those completing the 282 surveys was 60.2 ± 12.3. Males made up 50.2% of the population, 96% were Caucasian, 66% were married, and 49% had a high school education or less, 4% were enrolled in a clinical trial and 75% had researched illness on the internet. Physicians and nurses were ranked highest for there technical skill 90 ±16 and 87±17, respectively and lowest for their availability, 85±2 and 81±24, respectively. The services and care organization was ranked highest for other hospital staff interpersonal skills, 80±20 and lowest for hospital access, 70±25. Even though 87% of the population ranked there overall stay as very good or excellent there were differences seen between groups. Males were more satisfied with the information they received about care (p = 0.04), and their overall hospital stay (p = 0.03) than females. Patients treated by a medical oncologist were more satisfied with the information the received (p = 0.03) compared to other specialties. Married patients found access to facilities was better (p = 0.03) than unmarried patients. Those ≥ 65 were more satisfied with the exams, interest, and comfort of the nursing staff (p =.03) than their younger counterparts. HCAHPS (always rank) was higher than EORTC (excellent rank) for information (p <.0001), personnel listening ( p < 0.0001), and hospital cleanliness (p = 0.008), however no difference was seen in overall rating of care (p = 0.45). Conclusions: The majority of patients were satisfied with their care. Patients gender, marital status, age and the specialty of the physician were significant factors in determining satisfaction. Survey administration differences may contribute to difference between EORTC and HCAHPS. Hospital staff need to be cognizant of possible unintended bias towards various groups of patients.
Pattern of microbial organisms in radiation induced mucositis and dermatitis in head and neck squamous cell carcinoma (HNSCC) treated with radiation (RT)/chemo radiation (CTRT).
Authors: Venkatesulu Bhanu Prasad , Mallick Supriya , Ventrapati Pradeep , Roshan Vikas , Bhasker Suman , Rath Goura Kisor
Published: February 2017

210

Background: Mucositis and dermatitis complicated by bacterial and fungal infections are common in patients undergoing RT/CTRT. We intended to assess spectrum of microbial organisms in skin and oral swabs, rationality of antibiotics/anti-fungal (AB/F), toxicities, hospitalization and treatment delays. Methods: This was a prospective, single arm observational study conducted in a tertiary care hospital. 25 patients undergoing RT or CTRT from January 2014 to June 2014 were included. Patients were subjected to skin-wound and oral swab gram stain, potassium hydroxide mount, bacterial and fungal culture with sensitivity. Results: Median age was 54 years (30-69). Male: female ratio 1.5:1. Primary site: tongue 5 (20%), palate 5 (20%), tonsil, pyriform-sinus 4 (16%) each, buccal-mucosa, alveolus 2 (8%) each, EAC, nasopharynx, RMT one each (12%). 24 2D (96%) and 1 (4%) 3D planning. Feeding tube required for one (4%). 16 received concurrent cisplatin (40mg/m2 weekly), median 3 cycles. At median dose 48 (16-68 Gy) patients were referred for toxicities. Grade III,IV dermatitis were in 5(20%), 1(4%) respectively.Grade III,IV mucositis was 5(20%), 0(0%) respectively. Median laboratory parameters: hemoglobin 10.5, TLC 6350, albumin3.6 and globulin 2.8. Spectrum of organisms isolated is tabulated below. In GPC, specific isolate was Methicillin sensitive staphylococcus aureus 2, beta hemolytic streptococcus one. Four required i.v antibiotics. 3 received i.v ciprofloxacin 200mg BD and i.v metronidazole 500mg TDS, one required i.v cefoperazone-sulbactam 2 gm BD (7 days); rest 21 had adequate relief with topical antibiotics (metronidazole TDS) or antifungal (clotrimazole mouth paint TDS) alone for 7 days. Median duration of hospital stay was 10 days (2-16). Treatment interruption was in 6 ranging 6-10 days. Conclusions: Topical AB/F with adequate hydration can provide adequate symptom relief and avoid treatment interruption for mucositis and dermatitis. [Table: see text]
Venous thromboembolism: What pharmacists know? What do they need?
Authors: Rey Jean-Baptiste , Kreit Pierre , Sicard Jerome , Parent Damien , Jovenin Nicolas , Hettler Dominique , Nguyen Philippe , Ducrocq Jean-Luc
Published: February 2017

212

Background: Venous thromboembolism is frequent in cancer. Low molecular weight heparins (LMWH) are recommended for prevention/treatment of thrombosis in cancer. Community pharmacists are very often faced with patients' questions (dosage, tolerance, treatment duration). The aim of this study was to assess the community pharmacists' knowledge regarding 'thrombosis in cancer'. Methods: A web-questionnaire (built by a multidisciplinary group) was open between October and November 2013 to community pharmacists in Champagne-Ardenne region. Collected data were 1) pharmacy's general organization for cancer patients' management, 2) management of ambulatory patients with 'thrombosis and cancer' and 3) pharmacists' knowledge assessment through a simple case report: after an initial 10-days hospital prescription, what should a patient receive as anticoagulant treatment? Results: 180 (38%) community pharmacists answered the questionnaire. Among those, in 65%, the number of patients with cancer was 6-15/pharmacy. In 70% the number of patients with thrombosis and cancer was 1-10/pharmacy. In 93%, the pharmacists had no specific competency in oncology and/or supportive care. Moreover, 96% were not aware of the existence of national/international recommendations regarding 'thrombosis in cancer'. At last, only 49% gave the correct answer to the case report (LMWH). The most expressed needs were information, continuous education, and information booklets for patients. Conclusions: This regional questionnaire is currently extended to all French regions. Continuous education sessions are being put in place. Another questionnaire will be launched at the end of 2014 to assess education sessions' efficacy.
Outcome of patients malnourished at diagnosis of a metastatic lung adenocarcinoma.
Authors: Vansteene Damien , Hiret Sandrine , Senellart Hélène , Douillard Jean-Yves , Bennouna Jaafar , Darmaun Dominique
Published: February 2017

213

Background: The objective of this retrospective study was to assess the impact of malnutrition in patients treated in 2012 at the Integrated Center for Oncology René Gauducheau (Nantes, France) by palliative platinium based chemotherapy and pemetrexed for a lung adenocarcinoma. We studied toxicities of chemotherapy, overall survival of patients, nutritional support and outcome of the patients. Methods: We determined for these patients if they were malnourished or well-nourished at diagnosis (as defined by a weight loss > 5% in 1 month or > 10% in 6 months, or a body mass index ≤ 18.5 under 70 years old or < 21 after 70 years old, or hypoalbuminemia < 30 g/L under 70 years old or < 35 g/L after 70 years old). Results: Among the 48 patients eligible for study, 15 were not included because it was impossible to determine if they were malnourished or not; 14 patients were malnourished at diagnosis and 19 patients were well-nourished. Other than in cases of anorexia, malnourished patients didn’t experience more adverse effects of chemotherapy. Treatment response was equal in the two groups. The median overall survival was shorter for malnourished patients than for well-nourished patients (8 vs 23 months, p=0,0089, HR 3,747 ; 95% CI : 1,443 – 9,732). Nutritional support was given most frequently to malnourished patients than to well-nourished patients (64,3% vs 21,1%, p=0,0286) and care consisted of counseling for 7,1% of malnourished patients and 10,5% of well-nourished patients and oral supplements for 50% and 10,5% respectively. Enteral feeding was given to one malnourished patient and another one refused it. None received parenteral nutrition. At relapse, well-nourished patients received more lines of chemotherapy than malnourished patients (p=0,0377). Conclusions: Our results suggest that malnourished patients upon diagnosis don’t suffer more side effects from chemotherapy than well-nourished patients. Yet they have poorer overall survival and received less other lines of chemotherapy at relapse. Early nutritional care integrated to support care is required for patients with metastatic lung cancer.
Quality of life and adverse drug reaction measured in patients undergoing cancer chemotherapy.
Authors: Singh Harminder , Banipal Raja , Bala Ritu
Published: February 2017

214

Background: Cancer prevalence in India is estimated around 2.0-2.5 million, 0.7- 0.8 million new cases identified every year, and cancer deaths reported per year is 0.4-0.5 Million. The objective of this study was to analyze and compare patient-reported QoL (quality of life), and their physical/psychosocial symptom and adverse drug reaction in cancer patients. Methods: Study done by questionnaire EORTC QLQ-C30. Comparison among 3 distinctive groups (G) (varied number of Chemotherapy cycles) was done. ADR measured appropriately Results: 131 patients were recruited and QoL scoring GHS (global health status) and 4 items of symptom scale i.e. insomnia, pain, appetite loss, constipation, and financial difficulties attained a significance difference. GHS significantly improved in G3 as compared to G1, indicating that the patient overall health improved as the chemotherapy sessions progressed. Female patients had more ADR (mean 3.2/person) and G3 had more ADR (mean 3.96). Conclusions: QoL score didn’t show significant improvement in all areas (except insomnia, pain, appetite loss, constipation & financial difficulties), a judicious diagnosis with an appropriate treatment including chemotherapy may lessen the negative perception of cancer. [Table: see text]
Analgesic treatment and pain killer use in patients enrolled at Pain Control Center Hospice of Solofra (Italy).
Authors: Genua Geppino , Rizzo Luisa M , Fasano Mela , Fina P. Lino , De Vinco Elena , Strollo A. M. , Canzanella Sergio , Florio S. , Landolfi Vincenzo
Published: February 2017

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Background: We have evaluated the treatment procedures and the clinical outcome in terms of pain control on 163 consecutive patients enrolled from December 2012 to April 2014 at “Pain Control Center” of the Hospice of Solofra. Methods: The following characteristics have been evaluated: patient gender, mean hospitalization time, differentiation between cancer and non cancer patients (pt.), tumour type, medical weapon use, venous access type, parenteral feeding, transfer in intensive care units, pain killer use. Results: Of the 163 patients (96 males and 67 females, mean age 63.31 years, range: 31-90 years, mean hospitalization time: 29.85 days) 126/163 pt (77.30%) had tumour diseases and 37/163 pt. (22.69%) non cancer diseases. Cancer pt. had lung (24.6%), colo-rectal (17.46%), breast (4.76%), bladder (5.55%), gastric (5.55%), prostate (3.17), hepatocellular (4.76%), pancreas (3.96%), head and neck (4.76%), kidney (3.17%) and other site tumours (19.67%). Patients with tracheostomy were 14/163 (8.58%), with gastrostomy 11/163 (6.74%), with uretero and colostomy 21/163 (12.88%) and with active mechanical ventilator 5/163 (3.06%). The central venous accesses were already present at the moment of the hospitalization in 61/163 pt. (37.42%); during the hospitalization the central venous access were made on 48/163 (29.44%). Seventy-six out of 163 pt. (46.62%) received either total or partial parenteral feeding while 26/163 pt. (15.95%) received enteral feeding. Analgesic therapy with opioids was administered at 131/163 pt. (80.36%) as it follows: morphin in 18.32%; oxycodon/naloxon in 23.63%; codein-paracetamol in 9.16% and transdermic or transmucosal Fentanyl in 48.85% of the pt. The most intensively treated pts. were those with tracheostomy followed by uretero and colostomy. Conclusions: The results of the present study confirm the underestimation of the parenteral feeding and analgesic requirements by pts. with chronic diseases. Another interesting result of the present report is the good clinical benefit achieved with the use of oxycodon/naloxon associated or not with other pain killers. These results are on line with the guidelines that suggest the use of oral slow release opioids.
Social and emotional factors and decisions of advanced cancer patients (ACP) to enter an early-phase (EP) clinical trial.
Authors: Dohan Daniel Paul , Wiley James , Garrett Sarah B. , Trupin Laura , Hlubocky Fay J. , Daugherty Christopher , Reinert Anne , Munster Pamela N.
Published: February 2017

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Background: We explored how social and emotional factors shaped decisions by ACP to enter an EP trial. Methods: Mixed-methods longitudinal cohort study including validated surveys and open-ended interviews. ACP were recruited at an academic medical center with an EP trials program. Patients were eligible if treating oncologists deemed them likely to exhaust standard treatment in 6-12 months but before being offered EP study enrollment. Surveys measured symptoms, quality of life, decisional preferences, emotions, and demographics. 60 minute semi-structured interviews were audio recorded and transcribed. SAS (statistical) and Atlas.ti (thematic coding) were use for analysis. Results: Of 82 patients in the ACP cohort, 16% went on to initiate EP trial entry. No social and emotional factors were associated with EP initiation except ACP who reported both not “feeling down” and feeling “in control of things in your life” (Table) were more likely to initiate. In interviews, many EP initiates expressed hopefulness and a desire to actively respond to their illness. While none believed they could control their illness, some ACP attributed their sense of control over things to their relationship with their oncologist, and others attributed it to informational networks. Conclusions: A feeling of control and absence of depressive symptoms may be associated with ACP initiation of an EP trial. Further exploration of qualitative data documenting the dynamics of EP decision-making is needed. [Table: see text]
Impact of NCCN distress thermometer screening at new patient oncology visits in a large community cancer institute.
Authors: Sivendran Shanthi , Roda Patti , De la Torre Kristen , Newport Kristina Braine
Published: February 2017

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Background: Psychosocial distress can impact a patient’s quality of life and potentially impact timely and effective cancer management. The National Comprehensive Cancer Network (NCCN) developed a distress thermometer that includes a ten point scale of distress and checklist of psychosocial issues. In this analysis we compare rates of referrals to our support services prior to and post implementation of this tool in our community oncology practice. Methods: Data one year prior to and post implementation of the NCCN distress thermometer was retrospectively reviewed. The tool was implemented in July 2013 and administered to the patients by our clinical staff at the patient’s first visit. Based on this tool, the clinical staff offered referrals to social work, chaplaincy, nutrition, or financial counseling. Re-education on administration of this tool occurred in January 2014. In this study we compare support service referrals pre and post NCCN distress screening implementation and staff education. Results: From July 2012 to June 2013, 829 referrals were made to support services. Specifically, 39% of these referrals were to social work, 19% to chaplaincy, and 38% to nutrition. From July 2013 to May 2014, 1434 referrals were made to support services. Specifically, 37% of these referrals were to social work, 10% to chaplaincy, 20% to nutrition, and 34% to financial counseling. Referrals to social work were most impacted by implementation of the NCCN distress screening with a median increase from 26.5 (range 14-45) to 45 (range 32-68). Referrals to other support services were not impacted. Referrals to financial counseling were most impacted by the re-education process with a median increase from 38 (range 28-42) to 53 (range 42-58). Conclusions: Implementation of the NCCN distress thermometer allowed better identification of patients for social work and financial counseling interventions. This tool was less effective at increasing referrals to nutrition and chaplaincy. The need for these services may be better captured during the treatment period. Future investigation into this may include application of the distress tool during subsequent patient visits.
Evaluation of an online, skill-building, group intervention for patients with cancer: Pillars4Life.
Authors: O'Donnell Jonathan David , Abernethy Amy Pickar , Samsa Greg , Staley Tina , MacDermott Kristin , Smith Sophia
Published: February 2017

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Background: Psychosocial distress is common for those with cancer; new interventions are needed. Pillars4Life is an online educational program that teaches coping skills in a group format. What is the relationship between participation in the LiveStrong-funded Pillars4Life program and personal psychosocial outcomes? Methods: This was a longitudinal observational cohort study. Cancer patients participating in the Pillars4Life program were recruited from the 17 hospitals that received the LiveStrong Community Impact Award. Consenting participants participated in 10 weekly sessions and completed electronic surveys at baseline and 3 months. Patient reported measures included: distress [Distress Thermometer (DT), Patient Care Monitor (PCM)], depression [Patient Health Questionnaire 9 (PHQ9)], anxiety [Generalized Anxiety Disorder 7 (GAD7)], posttraumatic stress [PTSD Checklist-Civilian (PCLC)], despair (PCM), fatigue [Functional Assessment of Chronic Illness Therapy (FACIT)], and cancer-related wellbeing [Functional Assessment of Cancer Therapy-General (FACTG)] outcomes. Results: Patient participants (n=130) were: mean age 56±11 years; 87% female; 89% white; 61% married; 48% employed; 51% had breast cancer; and 63% were receiving treatment. Mean scores significantly improved from baseline to month 3 on all patient-reported outcome measures: DT (-0.9), PCM Distress (-3.0), PHQ9 (-2.3), GAD7 (-2.3), PCLC (-4.3), PCM Despair (-2.9), FACT-G (4.7), all p<.001; and FACIT-Fatigue (3.3, p=.001). Patients who reported distress at baseline (DT≥4; n=70) had clinically significant improvements (moderate to strong effect sizes ranged from 0.5 to 1.0 standard deviation units) in DT; PCM Distress, Quality of Life, and Despair; PHQ9; GAD7; PCLC; FACTG, among others. Conclusions: Participation in Pillars4Life was associated with statistically and clinically significant improvements on key psychosocial and quality of life patient-reported outcomes measures. Importantly, distressed patients experienced meaningful improvement.
Initial experience with an innovative pilot program evaluating a multidisciplinary approach to supportive care planning in a survivorship clinic setting.
Authors: Radice Lisa M. , Eagan Jeffrey , Michie Kathleen Y. , Pearson Marianne , Petit Joshua H.
Published: February 2017

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Background: The supportive care and rehabilitative needs of cancer patients are highly varied and complex, and optimal care planning often requires the provision and coordination of multiple modalities. To address these needs, an innovative model for multi-disciplinary evaluation and management within a survivorship clinic was piloted. Methods: Between November 2013 and May 2014, 50 patients who had completed cancer therapy with curative intent were seen in a multi-disciplinary survivorship clinic (MDSC) sequentially by an advanced practice practitioner (nurse practitioner or physician assistant), oncology social worker, and oncology rehabilitation therapist. Data regarding specific care planning resulting from this encounter, compliance with recommended therapies, and patient-reported satisfaction were collected. These data were compared against the remaining cohort of patients (N = 402) who completed curative intent cancer therapy in our cancer program during the same period. Results: Rate of referral for rehabilitation services (83.3% vs 13.9%, p < 0.01) and compliance with recommended therapy visits (85.7% vs 44.6%, p < 0.01) were significantly increased among patients seen within the MDSC pilot when compared with similar patients who were not seen in this setting. The number of referred therapy modalities was also increased among patients seen in the MDSC pilot, median 2 (range 1-3 modalities) vs 1 (range 1-2 modalities), respectively. Of patients who completed an assessment following the multi-disciplinary visit, 86% scored their overall experience as excellent which was the highest possible score. Conclusions: Patients seen within an innovative pilot program of multi-disciplinary survivorship care planning appreciated increased rates of referral for rehabilitation services, were referred for a greater number of therapy modalities, and were more compliant with recommended interventions than similar patients who were not seen in this setting. This patient cohort also reported high rates of satisfaction with the pilot program.