bluuebunny/crossref_metadata_2025 huggingface dataset:
Acceptability among advanced cancer patients of creating legacy teaching videos.
Authors: Makowski Suzana , Wachholtz Amy , Fitch Christina , Doering Alex , Tjia Jennifer
Published: February 2017

232

Background: The beneficial effects of life story review and legacy activities on the mood and quality of life for adults with advanced illness is well described, including the creation of legacy videos for family gifting. It is unknown whether creating legacy videos with the intent of teaching future healthcare professionals about the “cancer patient” experience is acceptable, beneficial, or meaningful to patients. The study aim is to describe the acceptability and success of recruiting patients with advanced cancer to create teaching videos for healthcare professionals. Methods: Patients aged 18 and older were recruited from the outpatient oncology clinic, palliative medicine clinic, and inpatient service of an academic medical center in the Northeast. Eligibility included having a diagnosis of an unresectable advanced cancer, an ECOG score of 0-3, being English speaking, and not having active psychosis. Patients underwent in-person, digital video recorded interviews that followed a semi-structured interview guide. Interview questions addressed the lived experience of being a “cancer patient,” coping, and how the patient thought clinicians could provide better care to future patients. For each patient, we measured the Functional Assessment of Cancer Therapy - General (FACT-G), Hospital Anxiety and Depression Scale (HADS), Patient Dignity Inventory (PDI), Distress Thermometer, and study acceptability. Results: Recruitment is ongoing. To date, of 12 patients referred, 4 completed the video, and 3 completed the follow-up visit. On average, it takes six contact attempts (phone calls or text message threads) to schedule an appointment that resulted in a completed video. Each interview lasted about a 1-1.5 hours. Patients reported that they “really enjoyed the experience,” and “it had helped them process” their cancer experience. A common theme was the patient’s strong desire to help others by sharing their story. Conclusions: Patients with advanced cancer find recruitment and participation in an educationally-oriented legacy video project acceptable and potentially personally helpful.
Financial burden among survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.
Authors: Nipp Ryan David , Kirchhoff Anne C. , Fair Douglas Beaty , Kuhlthau Karen , Hyland Kelly , Perez Giselle Katiria , Armstrong Gregory T. , Nathan Paul C. , Oeffinger Kevin C. , Leisenring Wendy M. , Park Elyse R.
Published: February 2017

233

Background: Cancer diagnosis and treatment can be associated with crippling financial burden, but whether this extends long-term into survivorship is unknown. We sought to examine survivors’ out-of-pocket (OOP) medical costs and their effects. Methods: From May 2011-April 2012, we surveyed a randomly selected sample of cancer survivors from the Childhood Cancer Survivor Study to assess survivors’ 1) financial distress, 2) monetary insecurity and 3) cost-motivated health behavior in the past year. We estimated the proportion of survivors with high OOP costs (≥10% of their annual household income). To determine associations between high OOP costs and the 3 outcomes of financial burden noted above, we used logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI) for each of the outcomes, adjusting for sex, marital status, insurance, employment and income. Results: Of 1,101 mailed surveys, we received 698 (63% response) with a median age of 39 years (range 25-60) and 31 years from diagnosis (range 23-42). 9.3% (n=54) reported high OOP costs. Survivors with high OOP costs were more likely to report financial distress, monetary insecurity and cost-motivated health behavior. Conclusions: Adult survivors of childhood cancer may experience high OOP costs, resulting in significant financial burden. Our findings suggest that survivors’ OOP burdens not only influence their financial distress and monetary insecurities, but may also negatively impact their health behavior. [Table: see text]
Using clinical algorithms to identify psychosocial distress and other risk factors in cancer survivors.
Authors: Lewis-Patterson Paula A. , Palos Guadalupe R. , Gilmore Katherine Ramsey , Chapman Patricia , Jones Delrose , Bi Weiqi , Rodriguez Maria Alma
Published: February 2017

242

Background: Late effects, such as pain and fatigue, increase a cancer survivors' risk to psychosocial distress. Assessment and identification of distress and other risk factors can be integrated into survivorship care. Yet, clinical tools and processes needed to coordinate these efforts are severely limited. Here we describe the processes and metrics used to assess and document distress in the survivorship care plans (SCPs) of survivors diagnosed with colon and rectal cancers (CC and RC). Methods: Eligibility criteria for this longitudinal analysis included being: ≥ 18 years, diagnosed with a primary colon/rectal cancer, no evidence of disease ≥ 5 years, seen between 09/01/2011 - 8/31/2014, and alive at time of data abstraction. 117 survivors met these criteria and the first 50 sequential cases were included in this sub-analysis. Data were collected at Visits 1, 2, and 3 within specific time parameters. Data sources included the SCP, electronic medical records (EMRs), and CC/RC algorithms. Variables included demographic/clinical characteristics and standards of care (SOC) elements embedded in the algorithm related to distress, fatigue, pain, and social support. Compliance with SOC were measured using a “yes/no” response format. Results: Of 50 survivors, 58% were diagnosed with CC and 42% with RC. 52% were male, 64% Caucasian, 54% age 65-89 years, and 68% were 5-9 years from diagnosis. 52% of CC survivors were Stage IIIA-C or IV and 57% of RC were Stage 1-IIB. Documentation and metrics for each element indicated a total of 111 visits over the course of the analysis, 59% were CC and 42% RC. Provider's compliance rates (PCRs) were: distress (65%), fatigue (32%), pain (68%), and social support (46%). The pain element was not included in the CC algorithm. PCRs for each element varied by site. Evidence that providers followed algorithms' recommdendations to assess survivors current risk of distress was found in the EMRs, SCPs. Conclusions: We found cancer survivorship clinical algorithms and care plans can guide assessment, documentation, and monitoring of psychosocial assessment. Screening for risk factors to distress in cancer survivors can be done in real time and help identify at-risk survivors during their visit.
Clinical tools to enhance survivorship cancer.
Authors: Gilmore Katherine Ramsey , Palos Guadalupe R. , Lewis-Patterson Paula A. , Chapman Patricia , Jones Delrose , Bi Weiqi , Rodriguez Maria Alma
Published: February 2017

245

Background: Clear patient-centered recommendations for follow-up and health maintenance is a primary goal of ASCO’s model for survivorship and palliative care. The Commission on Cancer also sought to improve the quality of survivorship care by requiring accredited programs to implement survivorship care plans (SCPs) and treatment summaries by 2015. Our aim is to describe the SCP's components and metrics collected in 12 survivorship clinics of an academic cancer center. Methods: A multidisciplinary team was convened to develop clinical practice tools to guide providers on transitioning patients to a survivorship clinic. These tools were based on 4 IOM's domains: surveillance, risk reduction, late effects management, and emotional function.Algorithms are supported with a Passport Plan for Health (Passport) specifically designed for each disease. These clinical tools allowed clinicians to provide recommendations for each survivor. Tools were electronically available to survivors and their primary care providers. Descriptive statistics were used to summarize metrics in this analysis. Results: To date, 44 cancer-site specific algorithms and 19 Passports have been launched and used by clinicians in 12 survivorship clinics.Metrics collected are: a) number of Passports completed, b) providers’ completion of SCPs, and c) dates with counseling recommendations outlined in the treatment pathways. Since FY08, 25,912 Passports were distributed to 13,105 survivors. In FY14, 6,160 Passports were issued (80.7% provider completion rate). Passport completion varied by provider (7%-97%). Survivors were counseled for recommendations related to colonoscopy (97% of the time), skin screening (98%), mammogram (97%), gynecological screening (95%), and prostate screening (74%). Conclusions: Algorithms and SCPs serve as clinical tools to help providers and survivors manage physical and emotional issues. These tools increase standardization in the delivery of survivorship care, safety, quality, and promote communication among survivors and providers across clinical settings.
Improved clinical trial accrual using a communication tool: Best case/worst case—Clinical trials.
Authors: Campbell Toby Christopher
Published: February 2017

26

Background: Clinical trials are crucial to the development of new treatments that may improve survival and quality of life for patients. Cancer clinical trials are hampered by chronically low participation rates. A decision support intervention designed to facilitate a shared decision making discussion with cancer patients regarding chemotherapy options could help oncologists align patient preferences with treatment options, including clinical trials. We performed a retrospective chart review comparing lung cancer patients seen in our integrated onco-palliative care clinic (PC) with standard oncology care (SOC) patients for clinical trial participation as a means of assessing potential effectiveness of the tool. The PC clinic is staffed exclusively by the author who also developed the tool. The tool is a combination of a structured discussion paired with a paper diagram the patient takes home which details all the treatment options including best supportive care alone, standard chemotherapy, and a clinical trial. Methods: Charts of every patient seen in our institution with advanced lung cancer from July 2007-June 2011 were reviewed. Eligible patients were those who received any care at our center thus excluding patient seen only for a second opinion. Demographic, treatment details, survival, and hospice utilization data were obtained. There were five oncologists included the SOC group though the vast majority of patients were seen by two providers. All providers (PC and SOC) are academic physicians who work closely together, meet weekly, have clinic on the same day, share the same research staff and have the same promotion requirements. Results: 207 patients with advanced lung cancer were identified, 82 in the PC group. A significantly higher proportion of patients participated in therapeutic clinical trials in the PC group when compared to the SOC group (29% versus 19%, adjusted OR = 2.54, p = 0.014). No difference in overall chemotherapy utilization was seen between the groups. Conclusions: Our chart review provides initial evidence that the best case/worst case: clinical trials tool may help facilitate clinical trial participation in patients with advanced lung cancer who are exploring their options.
When patients decide to stop chemotherapy and choose symptom-focused care: Patients’ perspective and concerns.
Authors: Fridman Ilona , Nikolova Tanya , Glare Paul A. , Higgins E. Tory
Published: February 2017

28

Background: Patients often continue chemotherapy at the end of life, decreasing their quality of life without prolonging survival. Because humans tend to make emotional choices rather than rational ones when considering unpleasant options, patients are likely to reject hospice and other forms of symptom-focused care (SFC) when it could be beneficial for them. We explored patients’ perspectives on how they choose between continuing cancer treatment and SFC. Methods: Semi-structured interviews with 20 patients recruited from palliative care clinics at Memorial Sloan Kettering Cancer Center (MSKCC). Interviews covered patients’ decision-making process regarding further chemotherapy vs. SFC. Interviewees gave verbal consent, the MSKCC Institutional Review Board granting a waiver. Results: Two key conditions were identified as necessary for patients to choose SFC. First, the patient accepts that further chemotherapy is not going to be beneficial to them. Second, the oncologist endorses the transition to SFC. Preliminary analysis of treatment choices at the time of interview (see Table) also found many of those who expected they would benefit from further treatment experienced negative emotions when SFC was recommended. Conclusions: These data confirm the importance of raising prognostic awareness, and endorsing hospice. Further research should focus on developing communication techniques to recommend SFC in a way that helps patients who continue to want more treatment to calmly understand and consider carefully the advice being offered, rather than simply disliking it and quickly rejecting it. [Table: see text]
Factors that influence oncologists' decisions about administering late chemotherapy.
Authors: Bluhm Minnie , Connell Cathleen M. , Bickel Kathleen Elizabeth , Silveira Maria
Published: February 2017

31

Background: An estimated 20-50% of incurable cancer patients receive chemotherapy in the last 30 days of life, although there is little data to support this practice. Continued use of chemotherapy typically precludes hospice enrollment. It may also result in more symptoms, increased use of aggressive treatments, and worsening quality of life. Despite this, few studies have explored oncologists' rationales for administering chemotherapy during the last weeks of life. The purpose of this study is to examine factors that oncologists report influence their decisions about late chemotherapy. Methods: In-depth individual interviews were conducted with 17 oncologists using a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim. Transcripts were coded and content analyzed for themes and patterns in the data. Results: Participants reported three key findings. 1) Clinical factors drive oncologists’ late chemotherapy decisions when they point to clear treatment choices, along with patient preferences. When clinical factors are ambiguous, non-clinical factors become more salient. 2) Late chemotherapy is patient-driven. It is used to palliate physical and emotional symptoms and maintain patient hope, even when physical benefit is not expected. 3) Caring for dying patients is difficult and impacts oncologists and their treatment decisions. Difficulties that are cited as influences favoring treatment include: emotional exhaustion, difficulty communicating about stopping or not starting chemotherapy, an overwhelming sense of responsibility for life and death, feeling badly about the limits of oncology to heal, and prognostic uncertainty. Conclusions: Findings reveal a nuanced understanding of why it can be so difficult for oncologists to refuse chemotherapy treatment to patients near death. Doing so adds to the existing burden of caring for dying patients. This means that at times, oncologists prescribe chemotherapy to simply help everyone feel better, regardless of expected clinical benefits or costs. Future work is needed on the impact of caring for dying patients on oncologists and on supportive interventions that assist them in making optimal treatment decisions.
Structured outpatient palliative care family conferences to enhance early integration of palliative care in advanced cancer.
Authors: Santhosh-Kumar Cheruppolil R. , Gray Deborah , Struve Stephanie , Huibregtse Carol
Published: February 2017

36

Background: Integrating early palliative care with cancer treatment improves quality of life and survival. Effective communication among physicians, patients and their loved ones is crucial to end-of-life, hospice and palliative care discussions. To address the inherent challenges in these discussions, we implemented a structured outpatient palliative care family conference (OFC) program at our community cancer clinic. Methods: A team comprising a hematologist/oncologist, cancer nurse navigator and social worker developed a toolkit for conducting an OFC, recognizing that each family conference is a unique adaptive challenge. New patients with advanced malignancies and limited life expectancy (<12 months) were offered a 90-minute structured OFC attended by the care team, patient and family members and or friends. Pre and post-conference patient satisfaction surveys and other data were collected prospectively. Results: From March 2014 through May 2015, fortyOFC were conducted (16 female and 24 male patients, median age: 67 years). Diagnoses were advanced gastrointestinal (14), lung (12), hematologic (6) and other (8) malignancies. As a direct result of the OFC program, 18 patients ordered do-not-resuscitate bracelets, 15 completed advanced directives, 7 submitted paperwork for disabled parking permits, 7 were referred to hospice and 4 for rehabilitation therapy. Further results are shown in the table. Conclusions: Structured outpatient palliative care family conferences improve satisfaction of end-of-life discussions and facilitate integration of palliative care options. Enhanced communication between providers, patients and loved ones eases the challenges of such discussions. The OFC approach could be a model for integrating palliative care in community cancer clinics. [Table: see text]
Mind-body medicine epigenetic technique (MET) and EGR1 (zif268) gene expression.
Authors: Munoz Francisco Ventura
Published: February 2017

4

Background: This is a pilot study update on the potential of MET to up-regulate EGR1 gene expression in patients diagnosed with breast cancer. EGR1 gene expression is associated with learning and memory. Methods: The selection process for the study participants was nonrandom. The following was the eligibility criteria. 1. Inclusion Criteria: Breast Cancer, Stages II, III 2. Exclusion Criteria: Cognitively impaired, weak or ill. The study utilized two groups. Each group was assigned two research participants. Group One received one session of MET. Group Two received two sessions of MET. Each MET session was approximately 25-35 minutes in duration. Blood samples were taken at baseline and post-MET sessions to provide evidence in gene expression changes. For Group Two, the post-MET session blood draw was done 7 days after baseline. 1. Primary Endpoint: To determine whether MET can up-regulate EGR1 gene expression. 2. Secondary Endpoint: To determine whether there is a correlation between up-regulated EGR1 gene expression with up-regulated TP53 and TP53AIP1 gene expression. The blood samples were sent to genomics labs at the Childrens Hospital of Los Angeles and the University of Nevada Las Vegas for mRNA extraction and microarray analysis. The gene expression was measured by DNA microarray results using the “PrimeView gene chip” and “Partek Genomics Suite” statistical software. Results: For two participants in Group 1 and one participant in Group 2, there was biologically significant up-regulation in EGR1 gene expression. However, only one participant from Group 1 evidenced a biologically significant up-regulation of EGR1 gene expression along with a biologically significant up-regulation of TP53 and TP53AIP1 gene expression. One major limitation of these findings is the statistical insignificance of the results due to the small number of participants. Conclusions: This pilot study evidenced the up-regulation of EGR1 gene expression potentially due to MET and provided evidence for potential correlation between EGR1, TP53 and TP53AIP1 gene expression. TP53 and TP53AIP1 gene expression are known to induce apoptosis. This study also provided a foundation for a larger study with more participants.
Inpatient care at the end of life: A closer look.
Authors: Wiesenthal Alison , Lucca Bianchi Anabella , Dave Vinnidhy , Sidlow Robert , Seo Susan , Korenstein Deborah
Published: February 2017

43

Background: Goals of care discussions in the inpatient setting often focus on the limitation of cardiopulmonary resuscitation and Allow Natural Death (AND) directives; decisions regarding medication administration and further diagnostic studies may be missing from the conversation. De-prescribing at the end of life (EOL) can be emotionally complex for patients and their families, though data is emerging that quality of life may be enhanced by limiting unnecessary medications. Our study assessed care in the last 3 days of life for cancer patients who die in hospital. Methods: Retrospective chart review of all inpatient deaths at a tertiary cancer center between 12/1/2012 and 11/30/2014. The frequency of lab draws, administered medications, and subspecialty consultations during the last 3 days of life were recorded. Results: Of the 1,311 inpatient deaths during the two year study period, 44% had Palliative Medicine consultation. On average, Palliative Medicine was consulted 6.5 days before death, with a median consultation time of 3 days before death. Do not resuscitate (DNR) orders were active for over 80% of patients at the time of death, with an average DNR enacted 4.6 days prior to death (range 0-60 days). Medications most often provided at the end of life were analgesics, fluids, and antibiotics (See Table 1). Consistent with Quality Oncology Practice Initiative (QOPI) Measures, <1% of patients were treated with chemotherapy in the last 3 days of life. Most patients (85%) had laboratory tests in their final 3 days of life, with a mean of 21 orders per patient. Conclusions: Non-palliative services are often provided to hospitalized patients at the end of life. Careful consideration must be given to the potential benefits and harms of medical interventions at the EOL to improve quality of life for the dying patient. Further research is needed to understand the drivers behind the care provided at EOL to inform educational tools for clinicians. [Table: see text]
Impact of pancreatic cancer treatment on hospice utilization.
Authors: Wancata Lauren M , Yin Huiying , Wong Sandra L.
Published: February 2017

52

Background: There is an increasing incidence of pancreatic cancer over time, a cancer with a 5-year survival rate of only 7.2%.For patients with poor prognosis cancers, hospice is an important resource, but it is often not utilized or underutilized. Factors influencing hospice use are difficult to determine. We sought to evaluate the impact of pancreatic cancer treatment on hospice utilization. Methods: National Surveillance Epidemiology and End Results (SEER)-Medicare data was utilized to identify all incident cases of pancreatic cancer patients who died (2005-09, with follow up to 2011). Patients were stratified by primary treatment strategy: surgery, chemotherapy, or no treatment. Hospice utilization in the last 6 months of life, including average and median days enrolled in hospice and average time from diagnosis to hospice was evaluated. Results: 17,031 patients were identified, with 68.5% enrolling in hospice in the last 6 months of life. Patients undergoing surgery were less likely to enroll in hospice compared to patients not undergoing surgery (58.7% vs 69.4%, p < 0.0001). Interestingly, surgical patients spent on average 31.2 days in hospice (median 15.0 days) which was comparable to the non-surgical cohort (average 32.7 days, median 16.0 days; p = 0.32). Patients who received any chemotherapy spent an average of 29.2 days in hospice (median 15 days) compared to those who did not undergo chemotherapy, who spent an average of 34.5 days in hospice (median 16 days); p < 0.0001. While total hospice enrollment was equivalent between the chemotherapy and no chemotherapy cohorts (67.5% vs 69.1%), the time spent in hospice was significantly different (p < 0.0001). Patients not receiving any cancer-directed treatment enrolled in hospice at an average of 78.6 days (median 32 days) from diagnosis. Conclusions: Pancreatic cancer patients undergoing surgery enrolled in hospice to a much lesser extent than patients who did not have surgery. Patients not receiving cancer-directed treatment spend a relatively short time in hospice. Overall, hospice appears to be underutilized, and the majority of patients with this poor prognosis cancer are not realizing the full benefits of hospice.
Increased symptom expression among patients (PTS) with delirium admitted to an acute palliative care unit (APCU).
Authors: De la Cruz Maxine Grace , Yennu Sriram , Liu Diane D , Wu Jimin , Reddy Akhila Sunkepally , Bruera Eduardo
Published: February 2017

56

Background: Previous case reports found that delirium-induced disinhibition may lead to overexpression of symptoms. Our aim was to determine the effect of delirium on the reporting of symptom severity in pts with advanced cancer. Methods: We reviewed 329 consecutive pts admitted to the APCU without a diagnosis of delirium from Jan 2011-Dec 2011. Demographics, Memorial Delirium Assessment Scale (MDAS), ECOG, Edmonton Symptom Assessment Scale (ESAS) on 2 time points were collected. Pts who developed delirium and those who did not develop delirium during the entire course of admission were compared using Chi-Squared test and Wilcoxon rank-sum test. Paired t-test was used to assess if the change of ESAS from baseline to follow-up was associated with delirium. Results: 96/329 (29%) of pts developed delirium during their admission to the APCU. The median time to delirium was 2 days. There was no difference in the length of stay in the APCU for both groups. Table 1 shows the changes in the ESAS scores of the two groups from baseline to follow-up. Pts who did not have delirium expressed improvement in all their symptoms while those who developed delirium during the hospitalization showed no improvement in physical symptoms and worsening in depression, anxiety, appetite and wellbeing. Conclusions: Pts with delirium reported no improvement or worsening symptoms as compared to pts without delirium. Screening for delirium is important in pts who continue to report worsening symptoms despite appropriate management. [Table: see text]
Using a symptom observation chart for dying patients: Review of a service improvement tool.
Authors: Waterman Lauren Z , Varma Neha , Doherty Ambre , Cooper Max , Mason Louise D
Published: February 2017

57

Background: In July 2014, following judicial review, the Liverpool Care Pathway for Dying Patients was withdrawn from the UK. An individualised approach to care for dying patients was advised, laid out in “One chance to get it right”. To support this, a symptom observation chart was developed at BSUH, a UK teaching hospital with cancer centre. At the point where a patient is diagnosed as dying, this innovative tool replaces vital signs assessment tools and facilitates regular and rigorous assessment of symptoms. Additionally, it aims to improve communication between healthcare professionals (HCPs), by showing trends in symptoms over time, and to trigger urgent physician review if optimal comfort is not achieved. It has scoring and escalation prompts, similar to early warning score charts, using a red-amber-green system. Methods: 8 months after introduction, a self-completed questionnaire was distributed to HCPs. Questions related to demographic data, opinion on the chart using a 4-point Likert scale and a qualitative component. Results: 135 adequately completed questionnaires (of 150) were returned by ward nurses (61%), physicians (30%), nursing assistants (7%) and palliative care specialist nurses (3%). The majority "agreed" or “strongly agreed” that the chart was user-friendly (97%); not time consuming (98%); facilitated communication between staff of the multidisciplinary team (87%); prompted earlier intervention from physicians (83%); was useful to indicate poorly controlled symptoms (96%); had improved the symptom assessment of dying patients (91%); and had contributed to improvements in the overall care of dying patients (87%). Additionally, 86% of nurses felt the chart helped them know when to request an urgent physician review to optimise comfort. Only 51% felt they had received enough training in using the chart. These findings were also reflected in free text responses. Conclusions: The vast majority of HCPs found the chart easy to use and felt it improved overall care of dying patients. Therefore, the chart may be a valuable addition to Comfort Care Order Sets. Prospective research is warranted to further assess the chart. The chart will be visually presented. It may be adapted and reproduced with permission.
The role of pannexin 1 in chemotherapy-induced peripheral neuropathy (CIPN).
Authors: Sterman Adam , Hanstein Regina , Spray David C.
Published: February 2017

6

Background: CIPN is a debilitating side effect and dose limiting toxicity of anticancer drug therapies. CIPN induces pathological changes in dorsal root ganglia (DRG), leading to increased cross-talk between sensory neurons and satellite glial cells (SGCs), specifically ATP mediated SGC-neuron signaling. We therefore investigated CIPN in mice with neuron- or glia-specific deletion of the ATP-releasing channel Pannexin 1 (Panx 1). Methods: To induce CIPN, mice were given two i.p. oxaliplatin (oxa) injections two days apart. Controls received saline (sal). We used C57Bl6 wildtype and transgenic mice with neuron- or glia-specific Panx1 deletion (NFHcre or GFAPcre:Panx1F/F) and littermate controls (Panx1F/F), 7-11 per group. Tactile sensitivity of the hindpaws was assessed prior to and every week after injections for 3 weeks using von Frey filaments. The number of paw withdrawals to 10 stimulations with each filament and pain thresholds (corresponding to filament that elicits 8/10 responses) were recorded. Overall mouse condition was assessed using Open Field Tests. Results: C57Bl6 mice developed transient tactile hypersensitivity after oxa injection, which was most prominent at day 9 and ceased at day 21. Oxa-injected mice had lower tactile thresholds (at 9 days: sal 5.5±0.3g vs. oxa 2.7±0.4g, p < 0.001) and higher response rates to filaments compared to sal-injected controls (p < 0.05), but revealed no changes in any other behavior. Mice with glia-specific Panx1 deletion did not display significant tactile hypersensitivity at any time after oxa (tactile threshold at 9 days: sal 5.5±0.3g vs. oxa 5.8±0.2g), whereas oxa induced tactile hypersensitivity did occur in mice with neuron-specific Panx1 deletion (at 9 days: sal 6±0g vs. oxa 1.3±0g, p < 0.0001) and Panx1F/F littermates (at 9 days: sal 6.0±0g vs. oxa 1.3±0.1g, p < 0.0001). Conclusions: We found that oxaliplatin induces transient CIPN, but no other behavioral changes in wildtype mice. Deletion of the ATP-releasing channel Panx1 in glia, but not in neurons, prevented CIPN development. This points to a new molecule (Panx1) and a new cell type (glia) as potential novel targets for pain therapy.
Agreement between physician and patient performance status ratings in an outpatient setting.
Authors: Popovic Gordana , Pope Ashley , Harhara Thana , Swami Nadia , Le Lisa , Zimmermann Camilla
Published: February 2017

66

Background: Performance status (PS) scores are generally completed by physicians, although patient PS measures are increasingly available. The objective of this study was to assess agreement between physician-recorded Eastern Cooperative Oncology Group (ECOG) PS and a patient-rated measure of performance status based on the ECOG measure in an outpatient oncology palliative care clinic. Methods: Physicians recorded ECOG PS for every patient as part of routine clinical practice. Patients recorded their PS using a measure based on the ECOG, where 0 = normal with no limitations; 1 = not my normal self, but able to be up and about with fairly normal activities; 2 = not feeling up to most things, but in bed or chair less than half the day; 3 = able to do little activity and spend most of the day in bed or chair; and 4 = pretty much bedridden, rarely out of bed. Patients also completed the ESAS-CS measure. Medical and demographic data were abstracted from the patients’ charts. We examined correlation between physician and patient PS measures as well as factors associated with a difference in patient versus physician measures for 949 patients with a visit between August 1, 2013 and December 31, 2014. Results: Weighted Kappa statistics indicated moderate inter-rater agreement at 0.32 (95%CI: 0.28-0.36). On average, patients rated their ECOG higher by 0.31 (95%CI: 0.25-0.37, p < 0.0001); 40.7% of patients rated their PS worse, 41.9% the same, and 17.3% better than did physicians. Worst agreement was for ECOG 0 (5 of 25 patients rated 0 by physicians also rated 0 themselves, 20% agreement); the highest agreement was in those with physician-rated ECOG 3 (87/136 patients, 64% agreement). Older patients reported better PS than physicians (p = 0.002) while those with worse ESAS distress scores reported worse ECOG than physicians (p < .0001). Conclusions: Patients tend to rate their PS as worse than rated by physicians, particularly those with greater symptom burden. However, older patients tend to rate their PS as better. This could be due to age bias of physicians or due to older patients assessing their PS optimistically. Future research will assess the survival data of participants to assess correlation of PS assessments of each group with prognosis.
Development of a patient-reported outcome (PRO) instrument to facilitate timing of end-of-life (EOL) discussions in patients with advanced cancers.
Authors: Contreras Jose , Pecora Andrew , Schultz Eric V , Choi Kelly , Smith Augie , Paramanathan Dhakshila , Demarco Katie , Goldberg Stuart L.
Published: February 2017

74

Background: Honoring the wishes of terminally ill cancer pts is a prime responsibility of oncologists, however EOL discussions are frequently either never performed or delayed past the point of usefulness. Pts who discuss EOL issues with their medical team are more likely to avoid terminal hospitalizations, have improved emotional wellbeing and experience lower health care costs. Facilitators of timely EOL discussions including palliative care consultations would be beneficial. Methods: A 7-item PRO instrument “Living with Cancer” has been developed by COTA (Cancer Outcomes Tracking & Analysis) covering 4 domains: performance status, pain, burden (financial and time), and depression. Each item queried a domain (the pain I experience is: Non-existent, Mild, Moderate, Severe, Unbearable) yielding scores 0 to 4. A unique feature is that each item is multiplied by the pt’s assessment of the importance of the question (multiplier 1-4), yielding a maximum score 112. The pt’s physician (without knowledge of PRO responses) assigned opinions as to status (should continue treatment, beginning to discuss EOL, actively in EOL discussions). Results: 433 pts with advanced malignancies undergoing non-curative therapy completed the PRO instrument between February-March 2014 at the John Theurer Cancer Center. The median scores for pts deemed by their physician appropriate to continue non-curative treatments, contemplating EOL discussions and actively in EOL discussions were 14, 23, and 35 respectively. Results varied by tumor type, with larger differences among cohorts of lung, breast, GI malignancies, and considerable overlap among multiple myeloma pts. A score of > 28 indicated < 25% chance of being in the physician deemed continue therapy group and 40-60% chance of being in the physician determined EOL discussion categories. Conclusions: A 7-item PRO (that includes pt views of importance of each domain) was able to separate advanced malignancy pts into cohorts who their physicians deemed were at differing stages of EOL discussion appropriateness. A prospective study in lung cancer evaluating consultation rates by total score (encouraging discussions if > 28) is ongoing.
Quality of life and mood in patients with advanced cancer: Associations with prognostic understanding and coping style.
Authors: Nipp Ryan David , El-Jawahri Areej , Pirl William F. , Fishbein Joel , Moran Samantha M.C. , McCarty Caitlin , Eusebio Justin , Gallagher Emily R. , Park Elyse R. , Jackson Vicki A. , Greer Joseph A. , Temel Jennifer S.
Published: February 2017

76

Background: Patients’ prognostic understanding and coping styles influence their treatment decisions, but how these factors relate to their quality of life (QOL) and mood has not been well described. We sought to examine the associations of patients’ prognostic understanding and coping style with their QOL and mood. Methods: As part of an ongoing trial of early palliative care, we are assessing baseline QOL (Functional Assessment of Cancer Therapy-General), mood (Hospital Anxiety and Depression Scale), coping (Brief Cope) and prognostic understanding in patients within 8 weeks of diagnosis of advanced lung or gastrointestinal (GI) cancer. To determine associations, we used linear and logistic regression, controlling for patients’ age, sex, cancer type and marital status. Results: Of 300 participants (mean age = 64.7 years; 138 (46%) female), 132 (44%) had GI cancer and 168 (56%) had lung cancer. Using cutoff score > 7 for the HADS, 61 (20%) and 85 (28%) reported depression and anxiety. 138 (49%) reported their prognosis as terminal. A terminal perception of prognosis was associated with lower QOL and higher rates of anxiety. Emotional support, acceptance, and active coping styles were associated with better QOL and mood. Denial and self blame were associated with worse QOL and mood. Conclusions: These data demonstrate that acknowledging a terminal prognosis may be associated with greater physical and psychological distress, or conversely, patients with worse QOL and mood may better appreciate the gravity of their illness. Certain coping styles (self blame and denial) are associated with lower QOL and higher distress. Understanding the relationships among patients’ prognostic awareness, coping styles, QOL and mood will allow us to develop more effective supportive care interventions. Clinical trial information: NCT01401907. [Table: see text]
The utility of the surprise question in identifying patients most at risk of death.
Authors: Vick Judith B , Pertsch Nate , Hutchings Mathilde , Neville Bridget A. , Lipsitz Stu , Gawande Atul , Block Susan , Bernacki Rachelle
Published: February 2017

8

Background: Understanding the cancer patient’s prognosis in all illness phases is important. Evidence suggests that the “Surprise Question” (SQ) -- “Would you be surprised if this patient died within the next year?” -- may be useful in identifying those most at risk of death, but prior studies are limited by the relatively small number of patients and clinicians included. Methods: From July 2012 to October 2014, oncology clinicians at Dana-Farber Cancer Institute were invited to enroll in a randomized controlled trial on the impact of a structured intervention to improve conversations about end-of-life goals -- the Serious Illness Care Program. The SQ was asked about each patient seen by the enrolled clinician. We used a weighted propensity score approach to calculate adjusted proportions of survival at 6 months and 1 year, clustering by SQ clinician. To determine which variable was most predictive of death, we fit a multivariable Cox model, and found the variable that led to the largest increase in the Cox-regression goodness-of-fit c-statistic. Results: 81 oncology clinicians (59 oncologists, 18 nurse practitioners, and 4 physician assistants) enrolled in the study and we had complete data on 4617 patients: 3821 (83%) for whom the clinician answered “Yes” to the SQ and 796 (17%) for whom the answer was “No.” Propensity-adjusted 1-year survival for “Yes” patients was 93% (95%CI 91-96%) compared to 53% (95%CI 46-60%) for the “No” patients (p < 0.0001). The SQ was more predictive of patient death than type of cancer, age, cancer stage, or time since diagnosis. Sensitivity of the “No” response was 59% (95%CI 49-68%) and specificity was 90% (95%CI 86-93%). Positive predictive value was 49% (95%CI 45-54%) and negative predictive value was 93% (95%CI 90-95%). Conclusions: The Surprise Question identifies cancer-center patients at high risk of death within one year better than clinical variables such as cancer type, stage, patient age, or time since diagnosis.
Symptom burden, health-related quality of life, and treatment preference over time as reported by patients with metastatic colorectal cancer (mCRC).
Authors: Jones Amy Little , Bhavsar Nrupen Anjan , Abernethy Amy Pickar , Zafar Yousuf
Published: February 2017

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Background: Clinicians have difficulty predicting longitudinal changes in patient symptom burden and quality of life, and then how those changes might affect treatment preference. The primary aim of this pilot study was to investigate how self-reported symptom burden, quality of life, and treatment preference change over time in mCRC patients with limited life expectancy. Methods: Eligible mCRC patients had incurable disease, received chemotherapy at Duke or Duke Raleigh, were > = 18 years old, and spoke English. Patients were surveyed at each clinic visit and followed for up to 3.8 years on study. Measures included FACT-C (Functional Assessment of Cancer Therapy-Colorectal), PCM (Patient Care Monitor; a validated, 87-item review of systems survey; items measured on a 0-10 scale), and QQQ (Quality-Quantity Questionnaire; a validated, 8-item measure of cancer patient preference for quantity vs. quality of life; items measured on a 1-5 Likert scale). Demographic, disease, and treatment data were abstracted from the medical record. Results: The 56 patients were primarily male (68%) and Caucasian (79%) with a mean age of 55 at diagnosis of metastatic disease. Patients answered surveys a mean of 6.8 times each, with a median 364 days between first and last surveys. Over time, patients reported most symptoms improved or stayed the same (72%, n = 63 symptoms). Mean symptom scores that improved the most from first to last survey were fatigue (3.92 to 3.03) and nausea (2.1 to 1.4), while pain (1.9 to 2.5) and cough (0.4 to 0.7) worsened the most. Decision making about treatment preference also did not change over time, with mean QQQ scores from first survey (22, n = 28) to last survey (22, n = 16) remaining stable. Mean QQQ length and quality scores likewise were unchanged (12.9 to 12.8; 12.4 to 12.2 respectively). Conclusions: In this pilot study of mCRC patients with limited life expectancy, reported symptom burden scores remained stable or modestly improved over time, while preferences for quality vs. quantity of life remained stable. These findings suggest that patients with advanced cancer might perceive symptom burden differently over the course of their treatment.
Severity of and contributors to distress in patients with acute myeloid leukemia (AML) receiving induction chemotherapy.
Authors: LeBlanc Thomas William , Wolf Steven Paul , Davis Debra M. , Samsa Greg , Locke Susan C. , El-Jawahri Areej , Tulsky James A. , Abernethy Amy P
Published: February 2017

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Background: Distress screening is a recommended component of comprehensive cancer care, and is now required as a condition of cancer center accreditation by the American College of Surgeons Commission on Cancer. However, the etiology and severity of distress in patients with AML has not been described. Methods: We enrolled hospitalized patients with AML initiating induction chemotherapy, and assessed their distress levels weekly during their month-long hospitalization using the NCCN distress thermometer (DT). The DT is a validated (0-10), 11-point ordinal scale with an accompanying 39-item problem list. We analyzed data using descriptive statistics and Kruskal-Wallis tests. Results: Twenty-six patients provided complete data for analysis.Mean age of study participants was 58.7 (SD 12.2). Patients had high-risk disease characteristics including 13 (50%) being > 60 years old, 13 (50%) with high-risk cytogenetics, and 9 (31%) with relapsed disease. Distress levels were high during the first week of induction (median 5.5; IQR 2-8). The most frequent concerns were largely from the “emotional problems” section of the DT problem list, including: worry (77%), nervousness (62%), fears (54%), and sadness (54%). Physical problems like fatigue (69%) and sleep difficulties (58%) were also prominent. Median distress scores remained above the NCCN DT threshold for referral to support services (score ≥ 4) in weeks 2 and 3 (median scores: 4 (1-8) and 5.5 (2-7), respectively), but improved to 2 (1-6) in week 4. Nervousness and worry were significantly improved at week 4 (p < 0.01), but sadness persisted in 32% and fatigue in 60% of patients at the 4th assessment. Problems with eating and with diarrhea were also still prominent in week 4, at 48% and 36% respectively. Conclusions: Distress is prominent among inpatients with AML receiving induction chemotherapy, with frequent psychological concerns upfront, and persistent symptom distress in later weeks of therapy. These findings underscore the burden of unmet palliative care needs among hospitalized patients with AML. Interventions are needed to address psychological and physical distress in this population.
Evaluating the utility of the QUAL-EC in the clinical care of patients with advanced cancer.
Authors: Wilkinson Anne , Slatyer Susan , Nowak Anna , Pienaar Cathy , Tandon Anil , Wallace Mark
Published: February 2017

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Background: We piloted the Quality of Life at the End of Life (QUAL-E) in Australian palliative care in-patients (N=52) and demonstrated feasibility, acceptability and face validity. An unexpected finding was the potential for the QUAL-E to prompt psycho-social-spiritual discussion when conducted as an interview, indicating opportunities for enhanced support. For this study, we compared a 17-item QUAL-E-Cancer (QUAL-EC) to the Distress Thermometer Screening Tool (DT) and participants’ experience when the QUAL-EC was conducted as an interview. Methods: A cross-sectional, mixed methods design was used. Convenience sampling recruited patients (N=50) with advanced cancer and a prognosis of less than 12 months from a tertiary hospital. Participants completed the DT, followed by the QUAL-EC which was digitally recorded as an interview. Results: Correlational and thematic analysis found that 39.6% of participants reported severe distress (score ≥7) while 40% reported moderate distress (score 4-6) on the DT. Levels of distress significantly correlated with two QUAL-EC domains: symptom control (r=0.52, p<0.001) and preparation for end of life (r=0.32, p<0.05). Qualitative analysis identified six themes: the health care team; family issues; approaching death; worry; coping and QUAL-EC experience. Feasibility: completion of the QUAL-EC ranged from 3-14 minutes (M=7.37 minutes, SD 3.05 minutes). Acceptability: Participants overwhelmingly found the questions to be clear and did not find the questions hard to understand, hard to answer or stressful. Ninety percent of participants agreed or strongly agreed that they were glad they took part. Conclusion. Patient distress was associated with either symptom burden or concerns about their family/loved ones. Conclusions: When distress is identified on screening, the QUAL-EC offers good potential for nuanced, versus vague assessment of globalised distress (e.g., DT) as an aid in targeting patient-centered clinical/psycho-social interventions.