bluuebunny/crossref_metadata_2025 huggingface dataset:
Bone targeting agent treatment patterns and the impact of bone metastases on patients with advanced breast cancer in the US.
Authors: Henry David H. , Von Moos Roger , Body Jean-Jacques , Rider Alex , De Courcy Jonathan , Murray Grace , Bhowmik Debajyoti , Gatta Francesca , Arellano Jorge , Hechmati Guy , Roberts Zach , Qian Yi
Published: February 2017

93

Background: Bone is the most common site of distant metastasis in patients with advanced breast cancer. Bone metastases (BMs) often lead to skeletal-related events (SREs) and may result in debilitating bone pain which impacts a patient’s quality of life. Bone targeting agents (BTAs) reduce the incidence of SREs and progression of pain due to BMs. This study aims to understand real world patients’ experience of bone pain and to assess BTAs treatment patterns. Methods: Data were extracted from the Adelphi Breast Cancer Disease-Specific Programme (DSP), a cross-sectional survey of 98 US oncologists conducted from February to May 2015 in the USA. Each physician completed comprehensive record forms capturing the following information about the next 12 patients being treated for advanced breast cancer: Presence of BMs, patient’s pain state at diagnosis of BMs, current pain state, time since diagnosis of BMs, current analgesic use and reasons for prescribing BTAs. Results: Bone pain was more prevalent (p < 0.001) in patients with BMs (67% of 485) than those without BM (7% of 791). Mean time for pain assessment was 6.2 months after BM diagnosis. Among breast cancer patients with BMs and bone pain (n = 323), 98% required analgesic medications to manage the pain, including 40% (n = 130) who were treated with strong opioids (e.g., morphine, oxycodone, hydromorphone, or methadone). Of these patients, 100 (77%) had moderate/severe bone pain. Of the patients with BMs, 69% (n = 337) were treated with a BTA and treatment was initiated within 3 months of BMs diagnosis in 91% (n = 306) of them. The reasons for prescribing a BTA within 3 months of BM diagnosis were “bone pain” (32%), “high risk of bone complications” (25%), “prior history of bone complications”(18%), “number of BMs” (11%) and “location of BMs” (4%). Conclusions: Advanced breast cancer patients with BMs are more likely to experience bone pain, and three-fourths of the patients treated with strong opioids experienced moderate/severe bone pain.The majority of patients with BMs receive a BTA prescription for the reduction of bone pain and risk of bone complications.
Impact of breast cancer treatment on body mass index (BMI) over time.
Authors: Reinbolt Raquel E. , Pan Xueliang Jeff , Wandell Kaitlin K. , Pilarski Robert , Layman Rachel M. , Mrozek Ewa , Ramaswamy Bhuvaneswari , Wesolowski Robert , Lustberg Maryam B.
Published: February 2017

94

Background: Weight gain concerns breast cancer patients, can impact quality of life, may lead to therapy non-adherence, and is associated with increased recurrence risk and mortality. Early placebo-controlled trials did not identify a clear correlation between Tamoxifen (TAM) and weight gain; gain due to aromatase inhibitors (AIs) is not well characterized. We hypothesized that weight gain occurs more frequently than previously reported in breast cancer patients receiving endocrine therapy. Methods: This is a retrospective chart review investigating body mass index (BMI) change in women after breast cancer therapy. Patients with early stage breast cancer and whom had BMI and treatment data (at least 90 days) from 2003-2012 were identified in The Columbus Breast Cancer Tissue Bank. Patients were separated by treatment received: chemotherapy with and without endocrine therapy vs. endocrine therapy alone (including both TAM and AIs) vs. no other treatment. Results: A total of 970 subjects were included in the analysis. At diagnosis and/or treatment initiation, patients’ mean BMI was 29.2 ± 7.0 kg/m2; mean age 53.7± 11.6 years; and average length of therapy/follow up per patient, 1833 days (range 90-3,990). Patients who received an AI alone had significantly decreased BMIs during therapy (-0.65± 0.29 kg/m2, p = 0.025), whereas patients receiving chemotherapy alone, chemotherapy with TAM, or TAM followed by AI therapy, had significantly increased BMIs (0.51 ± 0.25, 0.73 ± 0.26, 1.01 ± 0.51 kg/m2; p = 0.039, 0.005, 0.045, respectively). Both older age and a higher BMI at diagnosis were associated with a significantly greater decline in BMI over treatment time (p < 0.001 and p < 0.001, respectively). In a multivariate regression model, after adjusting for age and initial BMI effect, the BMI change noted among different treatment groups was no longer significantly different (p = 0.43). BMI change was not statistically associated with treatment length (p = 0.26). Conclusions: Our review of a large, early stage breast cancer patient cohort showed no association between weight gain and endocrine therapy after adjusting for the effect of initial BMI and age at diagnosis. Additional study is needed to identify other factors impacting weight in this population.
Cancer-related insomnia: Evaluation by mobile technology.
Authors: O'Connor Brenda , Ui Dhuibhir Pauline , Walsh Declan
Published: February 2017

107

Background: Insomnia is difficulty with sleep onset, maintenance, early morning wakening or non-restorative sleep. Cancer prevalence is 30-75%. Daytime consequences include fatigue. It is under-reported and impairs quality of life. Measurement previously required sleep laboratories. Technology advances help real-time measurement in the natural environment. This study investigated the feasibility and acceptability of a wireless device to evaluate sleep in cancer. Methods: Prospective observational study: Stage A: 10 consecutive in-patient hospice admissions; Stage B: 20 consecutive community patients Sleep quality was rated by Insomnia Severity Index (ISI). Participants used a wireless non-contact bedside monitor (SleepMinder) for 3 nights. Acceptability questionnaires were completed by participant and nurse (Stage A) or family (Stage B).Descriptive statistics were generated by Microsoft Excel. Results: 30 participants with metastatic cancer were recruited. Median age: 63 years (47-84). Median Eastern Cooperative Oncology Group (ECOG) performance score: 2 (0-3). In-patient (n=10): In 50%, sleep onset was delayed >30 minutes. Median duration: 8 hours. Median awakenings per night: 1 (0-8). Median sleep efficiency (proportion of time in bed spent asleep): 89% (74-100%). ISI score correlated with sleep duration in 70%. Participants and nurses reported 100% device acceptability. Community (n=20): Sleep onset was delayed >30 minutes in 25%. Median duration: 8 hours. Median awakenings per night: 3 (0-10). Median sleep efficiency: 91% (46-100). ISI score correlated with sleep duration in 90%. Participants and family reported 100% device acceptability. Conclusions: (1)A wireless monitor effectively measures sleep in cancer in both inpatient and community settings, (2) High acceptability supports clinical use, (3) Subjective sleep quality reports correlate with device, and (4) Further research: evaluate sleep improvement interventions with device.
Knowledge and perceptions of palliative care among oncology outpatients.
Authors: McKie Gillian
Published: February 2017

118

Background: Palliative care is emerging as an integral component of oncology care. There is growing evidence of its benefits but providers struggle with how to integrate specialist palliative services for the oncology population. The purpose of this study was to measure patients’ knowledge and perceptions, and their intention to seek palliative services. This study helps inform and guide oncology and palliative providers in their efforts to bridge the gap for oncology patients. Methods: The study used a cross-sectional design. A convenience sample of adult oncology patients using ambulatory cancer services at a community hospital was surveyed using the Knowledge of Care Options (KOCO) and Perceptions of Palliative Care Instrument (PPCI). Clinical information was abstracted from their health records retrospectively. Descriptive statistics were used to describe all variables. The association between knowledge, perceptions, and intention was analyzed using Pearson’s r correlation and multivariate regression analysis. Results: The majority of the 139 participants enrolled were female (61.9%), white (76.7%), and had good functional status with ECOG of 0 or 1 (87.1%). Mean age was 63.4 years. The mean KOCO score was 84.4% although several items scored less than 70%. Overall intention to seek palliative care was low at 2.53 on a seven point scale; a majority of patients indicated that they were unlikely to seek palliative care. There was a positive correlation between overall perception and intention to seek palliative care in the next three months (r = 0.212, p = 0.02).In addition, patients with higher scores on perceived needs for palliative care were more likely to report an intention to seek palliative care (r = 0.308, p = 0.001). Conclusions: There remains a knowledge deficit about palliative care in the oncology population. Participants did not experience negative emotional or cognitive reactions in response to information about palliative care. Perceived needs were associated with intention to seek palliative care services. Routine screening for needs and effective educational strategies are needed to better integrate palliative and oncology care.
Is screening enough? Implications of a pilot utilizing standard screening criteria for early palliative referral.
Authors: Ramchandran Kavitha , Winget Marcy , Tribett Erika L , Anderson Bev , Morris Alison , Blayney Douglas W.
Published: February 2017

119

Background: Early integration of palliative medicine (PM) into cancer care improves outcomes including quality of life, care coordination and survival. Despite broad endorsement and established guidelines for integration of PM into cancer care, patients are not routinely or comprehensively screened for PM needs. Misconceptions and biases about PM impede screening, uptake and access. A set protocol or triggers for PM may be able to overcome these barriers. This study evaluated the feasibility of using a basic screening protocol using NCCN criteria for automatic PM referral with nurse navigators in gynecologic oncology at one academic medical center. Methods: All patients attending the gynecologic oncology clinic at Stanford Cancer Institute between June 2014 and February 2015 with an assigned nurse navigator (n = 120) were screened for palliative medicine needs using the NCCN guidelines at their new patient visit. A one-page screening tool was developed and nurses were trained to make referrals to PM based on positive screen results. Chart reviews were conducted to identify the percent of new patients screened, the percent of patients who screened positive based on NCCN criteria, and the percent of patients referred to PM. Results: 50% of the cohort of patients were screened using the protocol. Less than 5% percent were referred to PM. However, chart review revealed that forty percent of all patients met NCCN criteria for referral to PM. Referrals to other support services based on screening included oncology social work and survivorship. Conclusions: Implementation of a standard screening tool is not sufficient to ensure that palliative care needs are assessed, and that appropriate referrals are made. Automated mechanisms to make screening facile, as well as algorithms for assessment and intervention are critical to ensure that patients unmet physical and psychosocial palliative needs are identified and treated. Additionally addressing barriers such as branding of palliative medicine, and education of staff on primary palliative care skills such as pain management and therapeutic communication may be strategies to incorporate going forward.
Promoting palliative care access to persons with cancer: A model for mapping statewide services.
Authors: Dahlin Constance , Nyambose Joshua , Merriam Gail , Gene Cherline
Published: February 2017

127

Background: The CDC comprehensive cancer initiatives value comprehensive quality care within its mission and program development. Currently, over 75% of hospitals in the United States have palliative care services for cancer patients (CAPC 2011). In order to promote access to quality palliative care in the community outside the hospital, an evaluation is essential. The CDC model of comprehensive cancer care and prevention control structure is an appropriate mechanism to perform such an evaluation. From 2014-2015, the Massachusetts Comprehensive Cancer and Prevention Control Network Palliative Care Workgroup performed a survey to hospitals, home health agencies, hospices, long term care facilities, and community providers to determine palliative care services available to cancer patients across the state. Methods: Using the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines, a robust palliative survey tool was created by the Massachusetts Comprehensive Cancer and Prevention Control Palliative Care Workgroup. It was individualized to each of the following settings - hospitals, home health organizations, hospices, skilled nursing facilities, and community health agencies. Follow-up telephonic key informant interviews regarding palliative care services were conducted within the various settings, service organizations, and insurers. Results: The results of qualitative and quantitative data will be concluded in August. Initial results reveal significant disparities in access to palliative care across by geography and setting of care. Hospices and hospitals had the most access to palliative care services. Long term care settings and community health settings had the least access. Conclusions: Data reveals disparities in palliative care access within Massachusetts by geography, race, and setting of cancer care. This data will serve as the basis of regional networks to promote better access to palliative care for cancer patients across all settings. It is hoped this evaluation process will serve as a model for other states to perform a similar evaluation.
The Intensive Palliative Care Unit (IPCU): Changing outcomes for hospitalized cancer patients in an academic medical center.
Authors: Zhang Haipeng , Rickerson Elizabeth , Barysauskas Constance , Catalano Paul J. , Jacobson Joseph O. , Dalby Carole Kathleen , Lindvall Charlotta , Selvaggi Kathy J.
Published: February 2017

135

Background: Patients with advanced cancer often require complex symptom management. At Dana-Farber/Brigham and Women’s Cancer Center, the intensive palliative care unit (IPCU) admits oncology patients with uncontrolled symptoms throughout the trajectory of illness. A DNR/DNI is not required for admission. These patients are managed by an interdisciplinary team of palliative care clinicians who focus on symptom management and advanced care planning. The purpose of our analysis was to investigate goals of care outcomes and healthcare utilization after admission to the IPCU. Methods: We retrospectively reviewed patient, diagnosis, IPCU admission, and code status characteristics among 74 oncology patients admitted to the IPCU in August and September 2013. We examined the distribution of goals of care pre- and post-index IPCU admission. Results: A total of 67 IPCU patients received palliative chemotherapy and/or radiation while seven patients received curative intent treatment. All patients had documented goals of care discussion during the IPCU admission. Of the palliative intent treatment patients, 58% of patients were transferred to the IPCU from medical oncology and 42% were directly admitted. The median age was 64 (range: 25-90 years), and 57% were female. Forty-eight percent of the patients were diagnosed with metastatic lung, genitourinary, or gastrointestinal cancer. Eighty-seven percent of patients reported pain as the chief complaint and all patients documented multiple symptoms (median = two). Twenty-five patients (37%) experienced a change in code status from FULL to DNR/DNI. A total of eight patients died in the IPCU and 50% of these experienced a code status change during the index admission. Eighty-eight percent of patients were discharged alive. Of those, 49% were discharged to home hospice, general inpatient hospice, or an inpatient hospice facility. The risk of 30 day readmission was 4% (95% CI -1%-9%) adjusted for the competing risk of death. Conclusions: Our findings suggest the inpatient palliative care unit helps clarify goals of care, aids in appropriate hospice referrals, and decreases unnecessary hospital readmissions among advanced cancer patients.
Long-term collaboration for building sustainable palliative care in Belarus.
Authors: Slater Sarah , Doyle Kathleen
Published: February 2017

142

Background: The WHO and the Worldwide Palliative Care Alliance have published findings that only 10% of the 20.4 million people who need palliative care currently receive it. A major barrier to meeting that need is insufficient education of healthcare workers in palliative care. Over the last decade, palliative care has attracted significant interest from the government of Belarus, with the first adult hospice founded in 2005 and introduced palliative care into the National Healthcare Law in 2013. However, the country faces a shortage of healthcare providers trained in palliative care. We report on the experience of developing and implementing a palliative care curriculum in Belarus. Methods: We first conducted a needs assessment that examined physician knowledge of and attitudes toward palliative care, the legal status of palliative care, drug availability, and other topics. We utilized past in-country experience, a literature review, a questionnaire, and interviews with Belarusian colleagues. Based on the needs assessment, we developed, modified, and translated a 25-lecture curriculum that was comprehensive, at an adequate difficulty level, and culturally appropriate. A team of four clinicians taught the curriculum in Belarus over to an audience of physicians, and healthcare administrators. Results: The course was well-received—participants were satisfied, reported a better understanding of palliative care, and improved their skills and confidence in managing symptoms and discussing prognosis. Conclusions: We have continued our collaboration with our Belarusian colleagues. New government policies and have passed which promote palliative care. We subsequently held a web-based teleconference with members of the Ministry of Health as well has medical education administrators in Belarus to discuss the structure of palliative care programs in the United States and our model of palliative care education. A second in-person palliative care education workshop for both physicians and nurses is being planned for the fall of 2015. We hope that our experience provides encouragement and resources for the continued promotion of palliative care education and development worldwide.
“She would be flailing around distressed”: Addressing the hidden crisis in the home of patients being treated for cancer.
Authors: Calton Brook , Shepard Nancy , Keyssar Redwing , Thompson Nicole , Patel Kanan , Dzul-Church Virginia , Kao Helen , Ritchie Christine , Rabow Michael W.
Published: February 2017

147

Background: Metastatic cancer patients who have progressed on multiple lines of chemotherapy and/or have poor functional status are at risk for significant symptoms, ineffective treatments, and hospice under-utilization. Appreciating the full extent these patients’ struggles is challenging during brief oncology clinic visits. We describe Community Bridges (CB), a home-based palliative care program. Methods: The CB pilot featured a 3-person home-based palliative care MD, NP, and RN team. Patients with metastatic cancer and complex care needs ( > 3 chemotherapy lines, ECOG ≥ 3, history of missed PC clinic appointments, and/or clinical trial participation) were offered 2 months of serial home visits and phone support. Symptom severity, satisfaction, and caregiver burden were assessed. Results: 18 patients enrolled. Mean age was 66. At baseline, 79% of patients reported mild-moderate pain, 43% severe fatigue, 38% moderate-severe depression, and 65% poor-fair QOL. Half of patients died within the 2-month program or within 3 months later. 35% of patients enrolled in hospice while in CB, with a LOS of 10 days. Caregiver burden was high. 60% of patients (n = 6) and 100% of caregivers (n = 7) agreed CB provided services not otherwise available. All would recommend the program to others. Participants reported CB helped them navigate the medical system and reduce stress. Caregivers reported CB helped their loved ones regain control of care. The CB team noted key program strengths were accurately identifying the patients’ home needs, communicating findings to oncologists, and intervening quickly when patients were at the end of life and/or actively dying. Conclusions: CB met patients in their final stages, when they were experiencing heavy symptom burden, functional decline, patient/caregiver distress, and risk of death. The CB team was able to assess and respond to changing needs during key transitions points, and report the realities at home to help inform oncologists’ treatments. Although CB was not designed as a “crisis service,” it often served in that role. Home-based palliative care programs like CB may bridge the gap for patients desiring ongoing cancer treatment but in need end-of-life services.
APRN Palliative Care Externship: Potential impact on oncology nursing palliative care delivery.
Authors: Dahlin Constance , Coyne Patrick J. , Cassel Brian
Published: February 2017

149

Background: Understanding primary palliative care is essential for advanced practice nurses, no matter where they practice. Limitations resulting from the variability of APRN state practice acts, financial considerations, and expenses, challenge post-graduate education for APRNs. With the shortage of health care providers, it is necessary to consider innovative programs to offer this education. Although there are many palliative educational opportunities, there are few abilities to translate the education into practice. Few are focused on the APRN, particularly for community and rural practice where many oncology patients are located and receive care. Methods: The APRN Externship selected 48 externs who completed the week long course. Topics includes pain and symptom assessment and management; fostering communication skills; building understanding of community resources such as hospice, palliative care, and home care; incorporating palliative care into an oncology practice, introducing concepts of business and finance in palliative care; and developing of safe practice with policy, procedure, and guideline development with a focus on rural providers. Externs complete pre course and post course testing along with completing goals to improve patient care. Results: Through an IRB approved process, utilizing both quantitative and qualitative evaluation, we followed the effect of the externship on externs. Externs performed both pre-course as well as 1 month and 6 month post-course testing. They also completed a report on achievement of clinical goals to improve patient care delivery. Conclusions: APRN Palliative Externs reported positive effects from the externship experience to clinical practice. The qualitative and quantitative data has demonstrated sustained effect towards improving palliative care within advanced practice nursing. The APRN palliative externship model could serve as a model to promote better palliative care education for oncology APRNs thereby improving palliative care delivery within oncology nursing.
Frequency, types of interventions and changes in symptoms after consultation with Rapid Access Supportive Care Clinic (RASCC).
Authors: Yennu Sriram , Suravarapu Sruthi , Williams Janet L. , Stephen Saneese , Lu Zhanni , Bruera Eduardo
Published: February 2017

153

Background: ASCO recommends an integration of palliative care to oncology care so as to improve outcomes. Recognizing the importance our center created a pilot RASCC. The aim of the study was to determine the most frequent interventions by RASCC and symptom change at first follow-up visit. Methods: In this retrospective study all patients seen as a part of RASCC clinic (August 2012- June 2013) were reviewed. Pts with stage 4 NSCLC with oncologist estimated survival of ≤ 6 months were eligible. Delivery of standardized palliative care was ensured using Palliative Care Checklist and weekly meetings. Care followed a standardized management plan. Results: 156 patients were evaluable. The median age was 63, 56% were male, 74% were white. SDS scores improved at follow-up (Table 1). The most common interventions were counseling (including advance cancer planning), medication changes. At the initial consultation, all patients received counseling n = 176 (pts received counseling by more than one IDT member); among the medications, dose initiation and increase of analgesics/opioids n = 122, laxatives n = 123, antiemetics 66, appetite stimulants 18, corticosteroids 10, antidepressants 9, methylphenidate 8, gabapentin 8, neuroleptics 5, sedatives 0. Among analgesics, dose initiation/increased morphine, n = 53, hydrocodone 24, oxycodone 18, hydromorphone12, methadone and fentanyl 6, codeine 1, NSAIDS3. Conclusions: RASCC was associated significant improvement of symptoms and SDS scores at 1st follow-up and the most common interventions were counseling, medication changes related to pain. Further studies are needed. [Table: see text]
A home-based palliative care pilot program for patients with advanced cancer.
Authors: Seitz Rae , Miller Charles F. , Duick Michael , Eubanks Robert
Published: February 2017

164

Background: Advanced cancer care often lacks a comprehensive approach; in Hawaii most oncology practices do not have access to palliative care teams. This causes high use of acute care services and suboptimal symptom management. Hawaii Medical Service Association (HMSA) created a pilot program called Supportive Care in which home-based palliative care services are offered to members with advanced cancer with goals of improved clinical outcomes and decrease utilization of acute care services Methods: Patients must have stage III or IV malignancy and ECOG PS of 2 or greater. Palliative care services are provided by Medicare-certified hospice agencies, with interdisciplinary teams, 24/7 on-call capacity, and expertise in symptom management. Hospice agencies are paid by HMSA to provide intermittent home visits. DME and pharmaceuticals. Care is coordinated with the patient's treating oncologist and other care providers. Each patient may receive 90 days of Supportive Care services in a 12 month period. Services are suspended during hospitalization or placement in a skilled nursing facility. Results: Patients enrolled in this program utilized hospital services significantly less than other Medicare Beneficiaries during the end-of-life period, suggesting that complex medical and psychosocial needs can be met in the home environment. The table compares findings from cancer patients enrolled in Supportive Care during 2014 with the most recent data available from The Dartmouth Atlas of Health Care. Conclusions: Multiple studies show improved quality of life for cancer patients receiving palliative care. Supportive Care resulted in improved clinical outcomes. Anecdotal feedback indicates high satisfaction among patients, families, and providers. Research to collect data and quantify satisfaction continues. [Table: see text]
Association of timing of palliative care consult on quality care outcomes at a community based hospital.
Authors: Bharadwaj Parag , Yennu Sriram , Helfen Karen M , DeLeon Leo J , Kim Joe , Zimbro Kathie S , Thompson Douglas M , Bleznak Aaron D.
Published: February 2017

166

Background: Timing of palliative care (PC) consults in hospitalized patients can have an impact on outcomes. Aim: To study the impact of the timing of consults on length of stay (LOS) of PC patients in a community based hospital over a span of 1 year. Additional outcomes included mortality and readmission rates. Methods: We conducted a retrospective review of medical records of consecutive patients who were referred to PC during the time period (November 2012- October 2013). LOS of PC patients consulted within and after 48 hours of admission were analyzed. Based on the timing of consult, mortality ratio of the two patient groups were analyzed. In addition, we analyzed the 30, 60 and 90 day readmission rates pre and post PC consult. Results: The LOS of patients seen by PC within 48 hours (N = 353) of admission was 1.20 (variance from expected) versus after 48 hours (N = 187) of admission was 6.28 (variance from expected). The mean difference in LOS between the groups was 5.08 days. The mortality ratio of the two groups was 1.01 (within 48 hours) versus 1.10 (after 48 hours) (p = .131). In addition the decrease in the 30, 60 and 90 day readmission rate was 61.5%, 47% and 42.1% respectively. Conclusions: Early PC consults were associated with a decrease in LOS and readmission rates with no increase in mortality rate. Further studies are needed to validate these findings in the community setting.
Hot stone therapy in palliative care.
Authors: Parot-Monpetit Anny , Mironnet Stephanie , Monpetit Erik
Published: February 2017

179

Background: Massage therapy is a popular adjunct to cancer palliation. Hot Stone therapy, a massage method with hot lava stones, is an ancestral native Indian medicine practice. Since 2011, funds permit us to offer Hot Stone therapy as a new Complementary Medicine for inpatients in the oncology unit where Palliative Care is integrated early into oncologic care. We assessed the effect of Hot Stone therapy in patients with advanced cancer on symptom severity. Methods: The study took place at Hopital prive Oceane, a private setting in France, between May 1, 2014 and May 1 , 2015. After physician's check, one nurse who has training in stone therapy method provided massage. We assessed - overall patient's satisfaction - severity of nine common symptoms with Edmonton Symptom Assessment System (ESAS) before and after the massage. We reported - number of each symptom (%) experienced by patient before the massage - number of massages (%) with change score for analyses. Results: Of 156 massages, 113 were assessed (82 patients). Satisfaction rate is 100%. Rate of symptoms before massages: pain, 51%; fatigue, 88%; nausea, 21%; depression, 63%; anxiety, 79%; drowsiness , 72%; lack of appetite, 62%;dyspnea, 36%; no wellbeing, 93%. Decrease of 2 points in change score: pain (71%), fatigue (22%), nausea (25%), depression (42%), anxiety (64%), drowsiness (10%), dyspnea (37%), wellbeing (84%). None increase except in drowsiness (41%) which can be explained by more relaxed patients. No difference in lack of appetite. Conclusions: In our experience, Hot Stone therapy is a type of massage that help patient feel better. A decrease in some very common symptom in palliative care was observed. Stone therapy is a safe method and can be use by training caregivers to alleviate a wide range of cancer symptoms or side effects of treatment with a non-pharmacological approach. Actually, we develop a Hot Stone therapy program's training to offer more massages in our institution.
The Opioid Rotation Ratio (ORR) from transdermal fentanyl (TDF) to strong opioids in cancer patients.
Authors: Reddy Akhila Sunkepally , Yennu Sriram , Reddy Suresh K. , Wu Jimin , Liu Diane D , Bruera Eduardo
Published: February 2017

182

Background: Despite being the most frequently prescribed strong opioid by oncologists, there is a lack of knowledge of the accurate the opioid rotation ratio (ORR) from transdermal fentanyl (TDF) to other strong opioids in cancer patients. Opioid rotation (OR) from TDF to other strong opioids is performed very frequently in cancer patients for uncontrolled pain or opioid induced neurotoxicity (OIN). The aim of our study was to determine the ORR of TDF to other strong opioids, as measured by morphine equivalent daily dose (MEDD). Methods: In this ad hoc analysis, we reviewed 2471 consecutive patient visits to the supportive care center of a tertiary cancer center in 2008 for an OR from TDF to other strong opioids by a palliative medicine specialist. Information regarding demographics, Edmonton Symptom Assessment Scale (ESAS), and MEDD were collected in patients who followed-up within 6 weeks. Linear regression analysis was used to estimate the ORR between TDF dose and net MEDD (MEDD after OR minus MEDD of breakthrough opioid used along with TDF before OR). Successful OR was defined as 2-point or 30% reduction in pain score and continuation of the new opioid at follow up. Results: 47/2471 patients underwent OR from TDF to other opioids and followed-up within 6 weeks. The median age was 54 years, 53% were male, and 77% had advanced cancer. The median time between OR and follow up was 14 days. Uncontrolled pain (83%) followed by OIN (15%) were the most frequent reasons for OR and 77% had a successful OR with significant improvement in ESAS pain and symptom distress scores. In patients with OR and no worsening of pain at follow-up (n = 41), the median ORR (range) from TDF mg/day to net MEDD was 100 (12.5-217), TDF mcg/hour to net MEDD was 2.4 (0.3-5.2), and correlation of TDF dose to net MEDD was .60 (P < 0.0001). Conclusions: The median ORR from TDF mg/day to MEDD is 100 and from TDF mcg/hour to MEDD is 2.4. Further validation studies are needed.
A nurse communication training curriculum to integrate oncology and palliative care.
Authors: Wittenberg Elaine , Ferrell Betty R. , Goldsmith Joy , Paice Judith A.
Published: February 2017

19

Background: Quality nurse communication skills are essential to ensure psychosocial care for patients and families, enabling quality of life topics to be addressed across the cancer trajectory and throughout cancer decision-making. However, many oncology nurses are inadequately trained to address patient and family psychosocial concerns. This study describes the development and implementation of an oncology nurse educational program to improve communication about psychological, social, behavior, and spiritual topics. Methods: This interdisciplinary team of authors wrote and published a communication curriculum known by the acronym COMFORT. 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. With funding from the National Cancer Institute (R25CA174627), the curriculum covers the continuum of cancer care (diagnosis, treatment, survivorship, recurrence, and end of life) and four national courses are planned over the next four years. A pilot study of the two-day communication training course was conducted at one comprehensive cancer center with 27 oncology nurse leaders. Results: Course participants were predominantly female, averaging 19 years nursing experience and 15 years in oncology, and more than half had daily contact with patients and family. Course evaluations were overwhelmingly positive with high mean scores on clarity of presentation (4.82 out of 5), content quality (4.80), and value to clinicians (4.75). The presentation will include a summary of this innovative oncology nurse communication training curriculum aimed at achieving patient-centered communication across the cancer trajectory. Conclusions: This presentation introduces a communication training curriculum focusing on understanding the patient narrative, including the family caregiver, and to provide psychosocial and spiritual care. Improved communication is essential to quality psychosocial nursing interventions.
Efficacy of acupuncture (ACU) therapy for cancer-related pain management in oncology patients (pts).
Authors: Patel Jai Narendra , Miller Katherine , Symanowski James Thomas , Edelen Connie
Published: February 2017

196

Background: Cancer-related pain negatively affects symptom burden, morbidity, and mortality. Evidence suggests the use of ACU to relieve cancer-related pain. We investigated ACU efficacy and patient-specific factors associated with pain improvement. Methods: Medical charts were reviewed from oncology pts receiving ACU and concurrent palliative medicine management. Pre- and post-ACU pain scores, as assessed by the Edmonton Symptom Assessment Scale (ESAS), were measured at each session. Univariate logistic regression models, including an over-dispersion parameter to account for multiple observations per pt, were used to investigate the association between patient-specific variables (Table) and significant pain improvement, defined as a ≥ 2-point reduction in ESAS pain score, at each session. Results: A total of 122 ACU sessions from 53 pts were included in the analysis. Significant pain improvement was observed in 47% of all sessions (mean reduction 1.8). Baseline non-neuropathic pain was significantly associated with a higher odds of achieving pain reduction (OR 2.351; P = 0.047). Conversely, an opposite association was identified for baseline neuropathic pain (OR 0.421; P = 0.048). Age, stage, number of sessions and tumor type were not significantly associated with pain improvement, although several trends were noted (Table 1). Conclusions: ACU is an appropriate adjunct therapy for cancer-related pain, particularly for non-neuropathic pain. Larger studies to confirm patient-specific variables and further investigation into therapy related side effects will assist in determining a personalized approach to ACU therapy in the oncology population. [Table: see text]
Incorporation of a patient question prompt list into a pancreatic cancer pathway.
Authors: Ellis Peter G. , Lokay Kathleen , Krebs Melinda
Published: February 2017

20

Background: Metastatic pancreatic cancer is an aggressive disease affording a life expectancy of less than 6 months (Worni et al., 2013). Timely end-of-life discussions are critical. Patient question prompt lists (QPL) have been shown to facilitate discussions around distressing topics and increase patient satisfaction (Brandes et al., 2014; Clayton et al., 2007). We evaluated the use of a QPL embedded in a pancreatic pathway provided by Via Pathways (VP) to enhance communication between oncologists and patients with metastatic disease. Methods: VP are disease-specific decision support algorithms delivered in a web-based portal and used by oncologists at the point of care. Through a committee of oncologists and palliative care specialists, a QPL was developed and incorporated into the VP pancreatic pathway. The goal of the QPL was to empower patients to have informed discussions of available cancer therapies, treatment goals, and personal preferences. Users of the pathway were required to indicate if the QPL was used, then had to provide it to the patient. The QPL prompt was placed in the first line metastatic branch of the pancreatic pathway and piloted from 12/1/14 to 2/28/15. Following the pilot, users were surveyed through email. Results: Results are shown in the table. Conclusions: Based on the results, the pilot had limited success. Although there was an even distribution of those indicating the QPL was and was not provided to the patient, survey results suggested the majority of providers were unaware of the QPL. Our conclusion is that our approach must be less of a burden to the oncologist. Current focus is on automated delivery of advance care planning materials directly to the patient, removing that task from the oncologist workflow. [Table: see text]
Fractionation of palliative radiotherapy in metastatic breast cancer: Selection and survival.
Authors: Qian Yushen , Dudley Sara , Durkee Ben Y , Kumar Kiran , Chaudhuri Aadel , Pollom Erqi L. , Aggarwal Sonya , Horst Kathleen C. , Chang Daniel Tandel
Published: February 2017

201

Background: Various schedules of palliative radiotherapy (pRT) are prescribed for metastatic breast cancer (MBC) patients. Length of treatment can vary from a single day to three weeks. Single fraction pRT provides similar pain relief vs. multi-fraction pRT for bone metastases, but retreatment rates are higher. In the era of targeted and hormonal therapy, patients with MBC can survive many years after their initial diagnosis. We investigated whether patients with MBC who were prescribed single fraction pRT had poorer prognoses and experienced shorter survival than patients who were prescribed multi-fraction pRT. Methods: Patients at a single institution with MBC underwent pRT, with fractionation schedules including 8 Gy in 1 fraction (fx), 20 Gy in 5 fx, 30 Gy in 10 fx, 37.5 Gy in 15 fx between 2001-2015. 392 treatments were prescribed (109/241/29/13 in each regimen as above). Date of death was obtained from medical records, Social Security Death Index, or published obituaries. Patients who were alive or whose date of death could not be determined were censored at the date of their last encounter. Survival was calculated from the start of treatment to the date of death or censorship. Results: Patients treated with 37.5 Gy in 15 fx (MS 20 months, p = 0.002) or 30 Gy in 10 fx (MS 22 months, p = 0.03) experienced longer survival than patients treated with 8 Gy in 1 fx (MS 8 months). There was no significant survival difference between patients treated with 20 Gy in 5 fx (MS 18 months, p = 0.49) and patients treated with 8 Gy in 1 fx. There was no significant survival difference between patients treated by the three multi-fractionation schedules. Conclusions: MBC patients who were prescribed 37.5 Gy and 30 Gy lived longer than patients who were prescribed 8 Gy of pRT. No statistically significant difference was found between patients who were prescribed 20 Gy compared to 8 Gy, possibly due to the lower number of patients who received these regimens. Single fraction pRT was more likely to be prescribed to patients who would ultimately have shorter survival. More research is needed, ideally across multiple institutions, to explore the correlation between physician estimation of patient survival and selection of pRT regimen for patients with MBC.
Quality versus queasy: Trends in the use of antiemetics.
Authors: Nair Jayan , Curley Brendan F. , Fong Richard , Hwang Jimmy , Byrne Michael Thomas
Published: February 2017

203

Background: The American Society of Clinical Oncology (ASCO) launched the Quality Oncology Practice Initiative (QOPI) program in 2010, to promote quality cancer care. Subsequently, ASCO has influenced the use of the neurokinin 1 (NK1) receptor antagonists aprepitant/fosaprepitant through peer-reviewed publications and the Choosing Wisely Campaign. These agents increase cost and, via CYP3A4 inhibition, may lead to drug interactions. Here we report our survey results that explored prescribing patterns of these agents among QOPI-certified and non-certified oncologists. Methods: An anonymous online survey was distributed to oncologists in four states. Respondents were asked 12 questions about the use of aprepitant/fosaprepitant in their clinical practice. Responses were analyzed in aggregate using likelihood ratio Chi-square tests. P-values of < 0.05 are significant. Descriptive statistics describe differences between groups. Results: We analyzed 157 responses and excluded 10 respondents that did not identify themselves as medical oncologists. 62.1% of the practitioners practice in a QOPI-certified practice (90/145). Compared with non-QOPI practitioners, QOPI physicians are significantly more likely to use NK1 antagonists with intermediate/low emetogenicity regimens like weekly cisplatin for head & neck cancer (83.3 vs. 28.0%, p: < 0.001), cervical & bladder cancer (85.2 vs. 34.0%, p: < 0.001), and with CHOP ± rituximab for lymphoma (82.4 vs. 18.0%, p: < 0.001). Significantly, the majority of QOPI-certified physicians report using these agents for the sole purpose of earning/maintaining QOPI certification (81.4-85.4%). QOPI-certified physicians are also significantly more likely to appropriately prescribe NK1 antagonists with doxorubicin ≥ 60 mg/m2 (86.4 vs. 51.9%, p: < 0.001), cisplatin ≥ 50 mg/m2 (96.3 vs. 76.9%, p: < 0.001) and dacarbazine (84.6 vs. 55.8%, p: < 0.001). Conclusions: Although QOPI-certified physicians are significantly more likely to use NK1 antagonists than non-QOPI physicians, our findings indicate that their motivation is to satisfy QOPI guidelines instead of perceived necessity. A prospective study may be beneficial to further define the role of NK1 antagonists with intermediate/low emetogenicity regimens.
Prophylactic use of antidiarrheal agents to control diarrhea associated with lapatinib therapy in breast cancer patients.
Authors: Jamil Muhammad Omer , Rizwan Maira , Carpenter John T.
Published: February 2017

205

Background: Lapatinib causes diarrhea in about 40-50% of patients treated with it for HER-2 positive breast cancer. It is the major dose and treatment limiting toxicity of lapatinib. Methods: This is a retrospective review of a cohort of patients treated with lapatinib for HER2 positive breast cancer at the Kirklin clinic at the University of Alabama at Birmingham from January 1, 2009 through September 30, 2013. Loperamide 2-8mg before lapatinib dose was recommended for prophylaxis in patients who developed clinically significant diarrhea. Additional doses of loperamide were used if needed. Results: 44 eligible patients were identified, 7 had stage IA, 10 had IIA, 7 had IIB, 5 had IIIA, 5 had IIIB and 6 had stage IV disease. Median age was 52 years (28-72 years) with 75% Caucasians. Starting dose of lapatinib was 1000mg oral daily. Overall 33 patients experienced diarrhea. 14 had NCI grade I, 5 had grade II, 10 had grade III and 3 had grade IV diarrhea. Other side effects encountered included rash, nausea, vomiting, LFT elevation, fatigue and allergic reaction. 17/33 patients received prophylactic loperamide. Median treatment duration with lapatinib for all patients was 6 months, range 1-60 months for patients receiving prophylactic loperamide and 1-22 months for others. 12/17 patients who received prophylactic loperamide had early improvement in diarrhea to NCI grade I or less vs. 4/16 for others. 5/17 patients who received prophylactic antidiarrheals required dose reduction due to diarrhea vs. 8/16 for others. Grade III and IV diarrhea was more common in standard treatment patients (8 vs. 5). 14 patients did not complete expected treatment duration, 5 due to diarrhea, all of whom had not received prophylactic antidiarrheals. Conclusions: Our study suggests that the use of prophylactic antidiarrheal treatment with lapatinib is possibly an effective strategy in getting patient to their therapy goals without interruptions or dose adjustments. The discontinuation rate and dose reduction rate in our population is lower than previously reported. Larger prospective studies will be of interest to evaluate this strategy further. Similar strategy could be applied to other agents causing diarrhea.