bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum and tissue monocyte differentiation in PSA value 4–10 ng/mL prostate cancer and benign prostatic hyperplasia
Authors: Guo Yuanyuan , Liu Beibei , Liu Jianmin , Wang Sheng , Wang Rui , Chang Rui , Sun Wenyan , Ma Tantu , Li Qingwen
Published: November 2018

Increased serum prostate-specific antigen (PSA) level is closely associated with prostate cancer; however, there is still no reliable method for distinguishing prostate cancer from benign prostatic hyperplasia (BPH) when the PSA level is between 4 and 10 ng/mL. In this study, we detected the inflammatory cell counts in serum and prostate tissues in prostate cancer and BPH patients. The results showed that the monocyte counts in both serum and prostate tissues were obviously less in patients with prostate cancer than that in those with BPH, which indicates that monocyte may be associated with development of prostate cancer and it is possible to increase positive finding for prostate cancer with 4–10 ng/mL PSA concentration by detecting and analyzing monocyte count in serum and tissue simultaneously.
Professional Soccer Players’ Return to Play and Performance After Operative Repair of Achilles Tendon Rupture
Authors: Trofa David P. , Noback Peter C. , Caldwell Jon-Michael E. , Miller J. Chance , Greisberg Justin K. , Ahmad Christopher S. , Vosseller J. Turner
Published: November 2018

Background:

The majority of Achilles tendon ruptures are sports related; however, no investigation has examined the impact of surgical repair for complete ruptures on professional soccer players.

Purpose:

To examine the return to play, playing time, and performance of professional soccer players following Achilles tendon repair.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Union of European Football Associations (UEFA) and Major League Soccer (MLS) athletes who sustained a primary complete Achilles tendon rupture and were treated surgically between 1988 and 2014 were identified via public injury reports. Demographic information and performance-related statistics for the identified athletes were recorded for the season before surgery and 2 seasons after surgery and were compared with information for matched controls. Statistical analyses were used to assess differences in recorded metrics.

Results:

A total of 24 athletes with Achilles ruptures met inclusion criteria, 17 (70.8%) of whom were able to return to play. On average, players had 8.3 years of professional-level experience prior to sustaining an Achilles rupture. Among athletes who returned to play, no differences were found in the number of games played or started, minutes played, or goals scored 1 year postoperatively compared with the year prior to injury. However, 2 years postoperatively, these athletes played 28.3% ( P = .028) fewer minutes compared with their preoperative season, despite starting and playing in an equivalent number of games. Matched controls had baseline playing time and performance statistics similar to those of players. However, controls played and started in significantly more games and played more minutes at 1 and 2 years compared with players ( P < .05). No differences were found in goals scored at any time point.

Conclusion:

This is the first investigation examining the effect of an Achilles repair on the career of professional soccer players. This is a difficult injury that most commonly occurs in veteran players and prevents 29.2% of players from returning to play despite surgical management. Additionally, athletes able to return to play were found to play fewer minutes 2 years postoperatively compared with their baseline as well as playing less at 1 and 2 years postoperatively compared with uninjured matched controls. The reduction in playing time following an Achilles repair has significant implications for professional players and teams.
Pupil Responses of Adults With Traumatic Brain Injury During Processing of Speech in Noise
Authors: Koelewijn Thomas , van Haastrecht José A. P. , Kramer Sophia E.
Published: November 2018

Previous research has shown the effects of task demands on pupil responses in both normal hearing (NH) and hearing impaired (HI) adults. One consistent finding is that HI listeners have smaller pupil dilations at low levels of speech recognition performance (≤50%). This study aimed to examine the pupil dilation in adults with a normal pure-tone audiogram who experience serious difficulties when processing speech-in-noise. Hence, 20 adults, aged 26 to 62 years, with traumatic brain injury (TBI) or cerebrovascular accident (CVA) but with a normal audiogram participated. Their pupil size was recorded while they listened to sentences masked by fluctuating noise or interfering speech at 50% and 84% intelligibility. In each condition, participants rated their perceived performance, effort, and task persistence. In addition, participants performed the text reception threshold task—a visual sentence completion task—that measured language-related processing. Data were compared with those of age-matched NH and HI participants with no neurological problems obtained in earlier studies using the same setup and design. The TBI group had the same pure-tone audiogram and text reception threshold scores as the NH listeners, yet their speech reception thresholds were significantly worse. Although the pupil dilation responses on average did not differ between groups, self-rated effort scores were highest in the TBI group. Results of a correlation analyses showed that TBI participants with worse speech reception thresholds had a smaller pupil response. We speculate that increased distractibility or fatigue affected the ability of TBI participants to allocate effort during speech perception in noise.
Why Is Tinnitus a Problem? A Qualitative Analysis of Problems Reported by Tinnitus Patients
Authors: Watts Emily J. , Fackrell Kathryn , Smith Sandra , Sheldrake Jacqueline , Haider Haúla , Hoare Derek J.
Published: November 2018

Tinnitus is a prevalent complaint, and people with bothersome tinnitus can report any number of associated problems. Yet, to date, only a few studies, with different populations and relatively modest sample sizes, have qualitatively evaluated what those problems are. Our primary objective was to determine domains of tinnitus problem according to a large clinical data set. This was a retrospective analysis of anonymized clinical data from patients who attended a U.K. Tinnitus Treatment Center between 1989 and 2014. Content analysis was used to code and collate the responses of 678 patients to the clinical interview question “Why is tinnitus a problem?” into categories of problems (domains). We identified 18 distinct domains of tinnitus-associated problems. Reduced quality of life, tinnitus-related fear, and constant awareness were notably common problems. Clinicians need to be mindful of the numerous problem domains that might affect their tinnitus patients. Current questionnaires, as well as being measures of severity, are useful clinical tools for identifying problem domains that need further discussion and possibly measurement with additional questionnaires. The domains identified in this work should inform clinical assessment and the development of future clinical tinnitus questionnaire.
Emotional Responses to Pleasant Sounds Are Related to Social Disconnectedness and Loneliness Independent of Hearing Loss
Authors: Picou Erin M. , Buono Gabrielle H.
Published: November 2018

The purpose of this study was to evaluate the relationship between emotional responses to sounds, hearing acuity, and isolation, specifically objective isolation (social disconnectedness) and subjective isolation (loneliness). It was predicted that ratings of valence in response to pleasant and unpleasant stimuli would influence the relationship between hearing loss and isolation. Participants included 83 adults, without depression, who were categorized into three groups (young with normal hearing, older with normal hearing, and adults with mild-to-moderately severe hearing loss). Participants made ratings of valence in response to pleasant and unpleasant nonspeech sounds, presented at a moderate overall level in the laboratory. Participants also completed questionnaires related to social disconnectedness and loneliness. Data were analyzed using multiple regression with questionnaire scores as dependent variables. Independent variables were age, gender, degree of hearing loss, perceived hearing handicap, number of depressive symptoms, mean valence rating in response to unpleasant sounds, and mean valence rating in response to pleasant sounds. Emotional responses to pleasant sounds explained significant variability in scores of both social disconnectedness and loneliness. Depressive symptoms also explained variability in loneliness scores. Hearing loss was not significantly related to social disconnectedness or loneliness, although it was the only variable significantly related to ratings of valence in response to pleasant sounds. Emotional responses to pleasant sounds are related to disconnectedness and loneliness. Although not related to isolation in this study, hearing loss was related to emotional responses. Thus, emotional responses should be considered in future models of isolation and hearing loss.
School Climate, Student Engagement, and Academic Achievement: A Latent Variable, Multilevel Multi-Informant Examination
Authors: Konold Tim , Cornell Dewey , Jia Yuane , Malone Marisa
Published: November 2018

This study tested the authoritative school climate theory that schools characterized by high structure and student support have greater levels of student engagement and that these factors are associated with higher academic achievement, as indicated by school graduation rates and school performance on state-mandated testing. The model was tested through a multilevel multi-informant structural model on a statewide sample of 60,441 students and 11,442 teachers in 298 high schools. Consistent with the authoritative school climate model, both structure and student support were associated with higher student engagement in schools. Moreover, student engagement was directly associated with academic achievement and operated as an intervening factor. Results provide new evidence that an authoritative school climate is associated with high school academic achievement.
Health Equity Curricula Within Health Policy and Management Concentrations in U.S. Public Health Graduate Programs
Authors: Gonzales Gilbert , Quinones Nicole , Martin Marie
Published: November 2018

Achieving health equity is a national priority in the United States and having a public health workforce equipped to make health policy and administrative decisions that reduce disparities is needed. We examined 50 schools that offered an on-campus Master of Public Health and are accredited by the Council on Education for Public Health with concentrations or tracks in health policy and management (HPM). Nationally, only 6 (12%) HPM tracks required students to take a course in health equity and/or disparities. Of the optional courses offered within HPM tracks, 30.5% were focused on specific health conditions, and 28% were focused on broadly defined inequities. A smaller portion of health equity courses covered topics in sexual and reproductive health (5.1%), women and gender (3.4%), immigration (1.7%), and LGBTQ populations (1.7%). If health equity is to be achieved in health policy and management, educating all students earning a Master of Public Health in HPM tracks on these issues and equipping them with competencies to effectively tackle health inequity is a starting place.
Two Lines: A Valid Alternative to the Invalid Testing of U-Shaped Relationships With Quadratic Regressions
Authors: Simonsohn Uri
Published: November 2018

Many psychological theories predict U-shaped relationships: The effect of x is positive for low values of x, but negative for high values, or vice versa. Despite implying merely a change of sign, hypotheses about U-shaped functions are tested almost exclusively via quadratic regressions, an approach that imposes an arbitrary functional-form assumption that in some scenarios can lead to a 100% rate of false positives (e.g., the incorrect conclusion that y = log( x) is U shaped). Estimating two regression lines, one for low and one for high values of x, allows testing for a sign change without a functional-form assumption. I introduce the Robin Hood algorithm as a way to set the break point between the lines. This algorithm delivers higher power to detect U shapes than all the other break-point-setting alternatives I compared with it. The article includes simulations demonstrating the performance of the two-lines test and reanalyses of published results using this test. An app for running the two-lines test is available at http://webstimate.org/twolines .
Molecular mechanisms of carfilzomib-induced cardiotoxicity in mice and the emerging cardioprotective role of metformin
Authors: Efentakis Panagiotis , Kremastiotis Georgios , Varela Aimilia , Nikolaou Panagiota-Efstathia , Papanagnou Eleni-Dimitra , Davos Constantinos H. , Tsoumani Maria , Agrogiannis Georgios , Konstantinidou Anastasia , Kastritis Efstathios , Kanaki Zoi , Iliodromitis Efstathios K. , Klinakis Apostolos , Dimopoulos Meletios A. , Trougakos Ioannis P. , Andreadou Ioanna , Terpos Evangelos
Published: November 2018

Carfilzomib (Cfz), an irreversible proteasome inhibitor licensed for relapsed/refractory myeloma, is associated with cardiotoxicity in humans. We sought to establish the optimal protocol of Cfz-induced cardiac dysfunction, to investigate the underlying molecular-signaling and, based on the findings, to evaluate the cardioprotective potency of metformin (Met). Mice were randomized into protocols 1 and 2 (control and Cfz for 1 and 2 consecutive days, respectively); protocols 3 and 4 (control and alternate doses of Cfz for 6 and 14 days, respectively); protocols 5A and 5B (control and Cfz, intermittent doses on days 0, 1 [5A] and 0, 1, 7, and 8 [5B] for 13 days); protocols 6A and 6B (pharmacological intervention; control, Cfz, Cfz+Met and Met for 2 and 6 days, respectively); and protocol 7 (bortezomib). Cfz was administered at 8 mg/kg (IP) and Met at 140 mg/kg (per os). Cfz resulted in significant reduction of proteasomal activity in heart and peripheral blood mononuclear cells in all protocols except protocols 5A and 5B. Echocardiography demonstrated that Cfz led to a significant fractional shortening (FS) depression in protocols 2 and 3, a borderline dysfunction in protocols 1 and 4, and had no detrimental effect on protocols 5A and 5B. Molecular analysis revealed that Cfz inhibited AMPKα/mTORC1 pathways derived from increased PP2A activity in protocol 2, whereas it additionally inhibited phosphatidylinositol 3-kinase/Akt/endothelial nitric oxide synthase pathway in protocol 3. Coadministration of Met prevented Cfz-induced FS reduction and restored AMPKα phosphorylation and autophagic signaling. Conclusively, Cfz decreased left ventricular function through increased PP2A activity and inhibition of AMPKα and its downstream autophagic targets, whereas Met represents a novel promising intervention against Cfz-induced cardiotoxicity.
Impact of comorbidities and delay in diagnosis in elderly patients with pulmonary hypertension
Authors: Ginoux Marylise , Turquier Ségolène , Chebib Nader , Glerant Jean-Charles , Traclet Julie , Philit François , Sénéchal Agathe , Mornex Jean-François , Cottin Vincent
Published: November 2018

Patient age at diagnosis of pulmonary hypertension is steadily increasing. The present study sought to analyse clinical characteristics, time to diagnosis and prognosis of pulmonary hypertension in elderly and very elderly patients.

A study was conducted in a French regional referral centre for pulmonary hypertension. All consecutive patients diagnosed with pre-capillary pulmonary hypertension were included and categorised according to age: <65 years (“young”), 65–74 years (“elderly”) and ≥75 years (“very elderly”).

Over a 4-year period, 248 patients were included: 101 (40.7%) were young, 82 (33.1%) were elderly and 65 (26.2%) were very elderly. The median age at diagnosis among the total population was 68 years. Compared with young patients, elderly and very elderly patients had a longer time to diagnosis (7±48, 9±21 and 16±32 months, respectively; p<0.001). Patients ≥75 years also more often had group 4 pulmonary hypertension. The median overall survival was 46±1.4 months, but was only 37±4.9 months in elderly patients and 28±4.7 months in very elderly patients. Survival from the first symptoms and survival adjusted to comorbidity was similar across age groups.

Patient age should be taken into account when diagnosing pulmonary hypertension as it is associated with a specific clinical profile and a worse prognosis. The difference in prognosis is likely to be related to a delay in diagnosis and a greater number of comorbidities.
A new hybrid technique for modeling dense star clusters
Authors: Rodriguez Carl L. , Pattabiraman Bharath , Chatterjee Sourav , Choudhary Alok , Liao Wei-keng , Morscher Meagan , Rasio Frederic A.
Published: November 2018

The “gravitational million-body problem,” to model the dynamical evolution of a self-gravitating, collisional N-body system with ∼106 particles over many relaxation times, remains a major challenge in computational astrophysics. Unfortunately, current techniques to model such systems suffer from severe limitations. A direct N-body simulation with more than 105 particles can require months or even years to complete, while an orbit-sampling Monte Carlo approach cannot adequately model the dynamics in a dense cluster core, particularly in the presence of many black holes. We have developed a new technique combining the precision of a direct N-body integration with the speed of a Monte Carlo approach. Our Rapid And Precisely Integrated Dynamics code, the code, statistically models interactions between neighboring stars and stellar binaries while integrating directly the orbits of stars or black holes in the cluster core. This allows us to accurately simulate the dynamics of the black holes in a realistic globular cluster environment without the burdensome $N^{2}$

N
2

scaling of a full N-body integration. We compare models of idealized globular clusters to identical models from the direct N-body and Monte Carlo methods. Our tests show that can reproduce the half-mass radii, core radii, black hole ejection rates, and binary properties of the direct N-body models far more accurately than a standard Monte Carlo integration while remaining significantly faster than a full N-body integration. With this technique, it will be possible to create more realistic models of Milky Way globular clusters with sufficient rapidity to explore the full parameter space of dense stellar clusters.
Impact of a mature palliative service for patients with lung cancer admitted to the ICU.
Authors: Smith Brian James , Jermstad Suzanne , Yun Susan , Goodman Judie R.
Published: November 2018

102

Background: In 2012 ASCO made the clinical recommendation for patients with stage IV solid organ cancer to receive palliative care consultation (PCC) at the time of detection. This was intended to increase utilization and effectiveness of palliative care. In this study, we estimate the proportion and impact of late "brink of death" PCC for patients with stage III-IV lung cancer admitted to the ICU of a hospital with a Joint Commission approved palliative care program. Methods: Retrospective review of patients with advanced lung cancer (stage III-IV) admitted to ICU in 2015-17. IRB approval was obtained. There were no exclusion criteria within this population. Areas assessed were age, stage, reason for admission, interventions, disposition, length of stay, days in the intensive care unit, palliative care consultation, code status, and documented end of life discussion. Results: A total of 13 patient met inclusion criteria. They were 38% male 62% female with a mean age of 67 years (SD: 14.9). All had prior diagnosis of advanced lung cancer and 92% were stage IV. The most common indication for admission was sepsis (38%). Less than half (46%) had a PCC, and fewer (31%) had a documented end of life care discussion. Even in the minority of patients with PCC, 33% received the PCC on day of death. Full code status was maintained in 77%. 53% expired during admission with only 57% of those that died having palliative care discussion. Conclusions: Even in a mature TJC certified PCC program, less than half of these terminally ill patients received a PCC. There is a chasm between ASCO's goal of early PCC and the reality of palliative care utilization in ICU admitted patients with advanced lung cancer. A possible solution is to initiate triggered palliative consultation for this high mortality population upon admission, with possible expansion to other terminally ill groups. In a world of electronic medical records, it should be possible to arrange a system to flag these patients for direct review by the palliative team to determine appropriateness and then notify the primary team in order to coordinate care.[Table: see text]
Barriers to widespread implementation of patient-reported outcome platforms for cancer patients.
Authors: Park Jungyeon , Chaves Júlia Carolina Almeida
Published: November 2018

107

Background: Patient-reported outcome (PRO) platforms for cancer patients have shown to be effective in improving overall survival, quality of life, and adherence to medication in studies. However, due to controlled environments and limited regional scope, they do not shed light on the barriers for widespread PRO implementation. This study aims to identify such barriers by studying user demographics and usage patterns of an existing free Brazilian PRO mobile app. Methods: From Dec. 2016 to Jul. 2018, 1,246 cancer patients voluntarily registered on the mobile app downloadable on Google Play Store. Patients could report symptoms, physical activity, hours of sleep, weight, fever, overall well-being, and reasons for gratitude on the app. Other features included alarms for medications and a record of patients' hospitals and medical staff. Data collected by the app were analyzed for primary outcomes of user demographics and app usage patterns. Results: Out of the 1,246 registered patients, 44.1% were between the ages of 20 and 49 while only 11.3% were over the age of 65. Half of the patients never logged symptoms, and only 3.2% recorded symptoms more than 10 times. Physical activity, hours of sleep, and weight were each reported by less than 2% of patients. Surprisingly, 37.7% of patients recorded reasons for gratitude a mean of 3.2 times (SD = 10.3), more than the mean 2.9 times (SD = 8.6) that patients reported symptoms. Reporting overall well-being was the most used feature with 50.3% of patients having used it at least once with a mean of 3.9 times (SD = 17.2). Conclusions: Compared to closed short-term small-scale studies, patients engaged significantly less with the unrestricted open-access PRO platform, in particular geriatric patients. This is a significant barrier to widespread implementation as PRO's efficacy relies on consistent patient reports, and as cancer is more common among the elderly. These issues may be due to lack of guidance and supervision from medical/non-medical staff, absence of education on PRO's purpose, or access to technology caused by regional cultural differences. Further research on the cause of and solution for low patient engagement is needed for successful implementation in less-guided environments.
Prevalence of palliative care consultations in phase I pediatric oncology trials.
Authors: Cuviello Andrea Joan , Beri Andrea , Boss Renee D , Shah Nirali N. , Widemann Brigitte C. , Wiener Lori
Published: November 2018

108

Background: In 2015 the Psychosocial Standards of Care Project for Childhood Cancer published 15 evidence-based standards for pediatric psychosocial care for children with cancer and their families. One standard endorses incorporation of palliative care to “reduce suffering throughout the disease process, regardless of disease status”. Patients enrolling on phase I studies represent a unique cohort within pediatric oncology, as they generally represent a patient population that has not responded to standard therapies and a chance of cure is limited. Phase I trials, primarily designed to test safety and feasibility, offer a low chance of therapeutic benefit and high risk of death. This study aims to define the prevalence of palliative medicine consultation for phase I patients. Methods: A retrospective chart review of pediatric patients enrolled in a National Cancer Institute (NCI) Pediatric Oncology Branch Phase I clinical trial between 2015-present, using the NIH Biomedical Translational Research Information System (BTRIS). Palliative Care Consult Notes, Advance Directive information, diagnoses and medications were captured. Results: We reviewed the records of 126 phase I patients; 66% were male, 47% were >18 years, 67% had relapsed/refractory leukemia, and 46% are now recorded as deceased. Palliative medicine was consulted in <20% of patients; all consultations were for symptom management, primarily pain control (91%). Only 9% of patients had an advance directive prior to enrollment at the NCI. During therapy at the NCI, an additional 20% of patients completed an advance directive, just over a third (35%) of which were patients who received palliative medicine consultation. Conclusions: Palliative care was infrequently consulted in a highly vulnerable patient population where survival outcomes are poor and disease or therapy side effects are substantial. Efforts to increase the use of palliative care services in this population may improve the quality of life for children and families. Future directions include working to standardize the involvement of palliative medicine for pediatric patients enrolling onto phase I clinical trials.
Facilitated access to medical specialist care: The novel approach to support informal hospice caregivers—Analysis of caregivers’ needs and satisfaction.
Authors: Wojtacki Janusz , Janowicz Anna , Krakowiak Piotr , Łabuć Agnieszka
Published: November 2018

11

Background: Real life observations suggest hospice caregiving may result in physical health deterioration of family caregivers; they are less likely to participate in health-related initiatives and frequently don’t benefit from the most optimal medical care. Data reporting caregivers’ medical needs are rather scarce. Methods: The estimation of needs for specialist medical care aimed at family caregivers was carried out based on the activity called Open Day of Health Prophylaxis (ODHP – free consultations with specialists, ultrasound examinations and mammography) held annually at Rev. Eugeniusz Dutkiewicz SAC Hospice, Gdańsk, Poland during three consecutive years (2014 - 2018). In total, 715 medical consultations (median: 3 per caregiver, range: 1 - 6), 172 ultrasound, and 31 mammogram examinations were provided). The level of satisfaction expressed by the ODHP participants was also analyzed. Demographic, medical data, and involvement in the caregiving were analyzed based on consultation cards and questionnaires presented to all ODHP participants (307 total participants). Results: In total, 186 persons replied (60.59%), 103 of them fulfilled study inclusion criteria (currently or within the last 6 months providing personal care of a chronically ill person for minimum 12 hours per week), 82 (79.61%) of responders were women, most of advanced age (median: 67 years; range: 29 - 91). The vast majority (95.31%) estimated ODHP as valuable initiative. According to 52.23% ODHP completely fulfilled caregivers’ needs and expectations, 45.57% were partly satisfied, and for 2.13% the activity did not meet their expectations. The most common reason for dissatisfaction in the response was both lack of communication and access to specialists, as well inability to initiate other diagnostic tests. All responders indicated the expedient nature of ODHP activity. Conclusions: Facilitated access to medical specialists care in is well received form of support for family hospice caregivers. There is indication of a need for systemic solutions to the problems of medical care for long-term caregivers.
Analysis of prescription pattern of the fentanyl citrate sublingual tablets according to liver or kidney function abnormality of cancer patients.
Authors: Oh Sang-Bo , Oh So Yeon
Published: November 2018

119

Background: Many advanced cancer patients eventually develop liver dysfunction or renal insufficiency during the course of their disease. However, there is limited evidence for optimally safe drug for pain control in these situation. To estimate the safety of fentanyl citrate sublingual tablets (FSTs) in kidney or hepatic dysfunction, we analyzed whether the total prescription dose or prescription period of FSTs is associated with their liver function test (LFT) or estimated glomerular filtration rate (eGFR). Methods: We retrospectively enrolled consecutive cancer patients who prescribed FSTs at least once from July 2015 to June 2017. Results: Total 611 patients were identified. Median age was 63.6 (18-89) years. Total dose of prescribed FSTs is vary widely among pts; mean 23330 ± 42111 mcg, median 8400 mcg. About kidney function, eGFR could be calculated in 523 patients (85.6%). In 80 pts (15.3%), eGFR is below 60 mL/min/1.73 m2. The total dose of prescribed FSTs have no significant correlation with grade of CKD. The duration of prescription of FSTs was shorter in patients with eGFR < 60 in compared to those with eGFR ≥60; median 42 days versus 66 days (p < 0.001). On the other hand, 535 pts (87.6%) have result of LFT prior to be prescribed FSTs. Significant LFT abnormality is found in 158 pts (29.5%). The total dose of prescribed FSTs have weak negative correlation with LFT level (p < 0.001). The total dose of FSTs is significantly lower in pts with G3/4 LFT abnormality in compared to those with normal or G1/2 LFT abnormality. The duration of prescription of FSTs was significantly shorter in patients with G3/4 liver dysfunction in compared to those with normal or G1/2 liver dysfunction; median 30 days versus 83 days (p = 0.002). In the multivariate analysis, both G3/4 LFT and decreased eGFR are significant factors for shorter duration of prescription by the Cox proportional hazard model. Conclusions: When cancer patients have renal insufficiency or significant liver dysfunction, FSTs were used in a smaller dose for a shorter period of time. We need prospective study on the efficacy and safety of FSTs in cancer patients with liver dysfunction or renal insufficiency.
Prevalence and usage patterns of opiates in patients with lung, breast, and head and neck cancer.
Authors: Westbrook Kyle Andrew , Ahn Chul , Khan Saad A.
Published: November 2018

120

Background: Prescription opiate abuse is a declared public health emergency, involved in 17,536 deaths in 2015. We don’t know how many cancer patients died from prescription opiates and there is little published data about their prescribing patterns. Methods: Using the UTSW tumor registry, we analyzed all prescriptions for 6424 lung/breast/head and neck cancer patients undergoing therapy including radiation from 2009-2016; patient demographics, cancer information, treatment modality, concurrent medicines, substance abuse history, and survival. Chi-square tests were used to investigate if higher rates of opiate use were seen in those who receive chemotherapy, actively smoke or use alcohol, have head and neck cancer. Results: Opiate use was highly prevalent in cancer patients with 2902/4307 (67%) of women and 1597/2112 (76%) of men requiring opiates. Hydrocodone was the most common opiate at (out of 6424 total) 67%, followed by morphine 12%, fentanyl 9%, oxycodone 7% and hydromorphone 6%. Gabapentin was prescribed to 18.7% of women and 15.9% of men; 494/6424 (8%) patients had 3 or more different opiates prescribed; those who were given gabapentin had a higher rate of 3 or more opiates 249/1241 (20%). Those with current alcohol use required opiates 2001/2643 (76%) compared to those with no alcohol use 2101/3145 (67%) (p<0.0001); while active smokers used opiates 1033/1366 (76%) compared to never smokers 1859/2815 (66%) (p<0.0001). Head and neck patients at 1529/1982 (77%) had higher opiate use than those with breast 1913/2932 (65%) or lung cancer 1061/1510 (70%) (p<0.0001). Patients receiving chemotherapy with their radiation required opiates 696/850 (82%) compared to those who got no chemotherapy 3807/5574 (68%) (p<0.0001). In patients with a radiation course lasting >4 weeks, 8.8% received opiates 12 months after completion of their therapy. Conclusions: More than 70% of cancer patients use opiates after radiation; significantly higher rates of opiate use are seen in those who receive chemotherapy, actively smoke, use alcohol, or have head and neck cancer. Patients treated with radiation for >4 weeks have high rates of opiate use a year after treatment completion.
Toxicity following palliative radiation therapy for painful metastatic bone lesions.
Authors: Jenkins Mikayla , Waddle Mark Raymond , Kaleem Tasneem , Stross William C , Malouff Timothy D , DeVries Matthew , Pacitti Delaney , May Jackson , Patibandla Aditya , White Launia , Spaulding Aaron , Naessens James , Miller Robert Clell
Published: November 2018

126

Background: Palliative radiation treatment (pRT) is a common and effective treatment for patients with symptomatic bone metastases. However, patients receiving RT for bone metastases often may have a poor performance status and are more likely to experience toxicity during or after treatment. This study aims to investigate the number and type of toxicity event occurring during or after pRT for bone metastases. Methods: Patients treated with RT for bone metastases at Mayo Clinic from 2007 to 2016 were included in this study. Demographic, disease, treatment, and toxicity information were collected. Specifically, toxicity events were identified as emergency department (ED) visits and inpatient hospitalization (IH) within 90 days, breaks in treatment >4 days, and excessive 30 day financial toxicity defined as standardized Medicare costs >1 standard deviation above the mean. RT treatment was compared by dose and fractionation via descriptive statistics. Results: A total of 538 patients treated with pRT were identified, 124 receiving 8Gy x1, 204 receiving 4Gy x5, and 210 receiving 3Gy x10. Patients with breast and prostate cancer were most likely to be treated with 3Gy x10 and patients with GI and Lung cancer were most likely to be treated with 8Gy x1. A description of the patient characteristics and toxicities are shown in Table 1. For 8Gy x1, 4Gy x5, and 3Gy x10 breaks in treatment were rare (0%, 2%, and 3.3%), ED visits (15%, 24%, & 28%), IH (12%, 23%, & 19%), and financial toxicity (13%, 18%, & 21%) were common. A total of 22.6%, 27.5%, and 38.6% of patients were alive two years following pRT from each group. Conclusions: Toxicity during or shortly after pRT of bone metastases is common. This study confirms that additional steps should be taken to monitor and mitigate toxicity in this vulnerable patient group. [Table: see text]
The integrated care service: Impact of a multidisciplinary supportive care service for medical oncology patients in a NCI-designated cancer center.
Authors: Zachariah Finly , Morse Denise , Kinsey Lucia , Koczywas Marianna , Salgia Ravi , Caiazza Sara , Thornhill Austin , Loscalzo Matthew J. , Schnaitmann Natalie , Irish Terry , Prudhomme-Hunter Jill , Banh Dung , Mooney Stefanie , Banerjee Chandana , Patel Purvi , Buga Sorin , Brown Susan , Thomson Brenda , Trisal Vijay , Dale William
Published: November 2018

134

Background: Palliative care (PC) has shown benefits to inpatient length of stay (LOS), symptom burden reduction, utilization decrease, and time on hospice. It has shown less impact on the rate of hospice referrals. We assessed the impact of an integrated care model on these outcomes. Methods: From Jan-July, 2018, the Department of Supportive Care Medicine collaborated with medical oncology (med onc), nursing and administration to create the Integrated Care Service (ICS). Multi-disciplinary rounds include med onc, supportive care (PC, social work, spiritual care, psychiatry, psychology, hospice liaison), nursing, case management, nutrition, and physical and occupational therapy. The admission criteria include: 1) Later-stage disease; 2) Non-curative intent therapy; 3) High distress burden; and 4) Poor prognosis. The ICS was designed to have geographic co-location, morning PC and med onc rounds, multidisciplinary rounds, and post-acute management. The ICS was compared with other med onc patients (non-ICS) and Mantel-Haenszel Chi-Square statistical significance (p<0.05) was calculated using Epi Info StatCalc. Results: In 6 months, 190 med onc patients (pts) were admitted to ICS versus 537 non-ICS pts. Compared with non-ICS, the ICS pts had a higher Case Mix Index (1.81 vs. 1.56) and metastatic disease incidence (95% vs. 78%, p=0.008). Discharge to hospice was higher from ICS versus non-ICS (23% vs. 7%, p=<0.001), and average time on hospice increased from 9 to 15 days. No chemotherapy was given in the last two weeks of life to any pts on ICS (0 vs. 6 non-ICS pts). Length of stay (LOS) was higher on ICS as compared to non-ICS (8.45 vs. 5.26 days) and readmission rates were similar (12% vs. 13%). Conclusions: For medical oncology pts in a comprehensive cancer center, the ICS, an integrated, multidisciplinary supportive care service, significantly improved discharge rates to hospice, increased LOS on hospice by almost a week, avoided patients receiving chemotherapy, and maintained similar readmission rates. LOS was higher for complex ICS patients as compared to non-ICS. Based on this pilot, the ICS is planning for expansion to include hematology and surgical services.
The cost implications of palliative radiation therapy dose and fractionation for painful metastatic bone lesions.
Authors: Waddle Mark Raymond , Kaleem Tasneem , Stross William C , Malouff Timothy D , Jenkins Mikayla , Pacitti Delaney , DeVries Matthew , Patibandla Aditya , May Jackson , White Launia , Spaulding Aaron , Naessens James , Ma Daniel , Keole Sameer R. , Miller Robert Clell
Published: November 2018

145

Background: Palliative radiation treatment (pRT) is used for symptomatic bone metastases (mets). Several fractionation schedules show equal efficacy for pain relief, and ASTRO’s Choosing Wisely recommends 8Gy x1, 4Gy x5, or 3Gy x10. This study aims to investigate the cost implications of pRT for bone mets. Methods: Patients (Pts) treated with pRT for bone mets at Mayo Clinic from 2007 - 2016 were included in this study. Costs for all services were subdivided into RT and total costs at 30 & 90 days (30D & 90D). Standardized costs were obtained from the Mayo Clinic Cost Data Warehouse and Medicare reimbursements were assigned to all services with cost to charge adjustments and 2017 GDP Implicit Price Deflator for inflation. Cost means were compared via the Kruskal-Wallis test. Results: 538 pts were treated with pRT, 124 receiving 8Gy x1, 204 receiving 4Gy x5, and 210 receiving 3Gy x10. Pts with breast and prostate cancer were most likely to be treated with 3Gy x10 and pts with GI and lung cancer were most likely to be treated with 8Gy x1. RT costs at 30D were $1,497, $1,891, and $1,982 (p=0.03) and RT costs at 90D were $2,602, $2,753, and $3,032 (p=0.08) for initial RT regimens of 8Gy x1, 4Gy x5, and 3Gy x10. Total costs of care at 30D were similar from $15,969 - 17,687 (p=0.6) and total costs at 90D were similar from $22,361 - 23,219 (p=0.7) between arms. A total of 23%, 28%, and 39% of pts were alive 2 years following pRT from each arm (p=0.07). Conclusions: This is the first study of its kind to analyze actual treatment costs for the three most common pRT regimens in bone mets. Single fraction RT was most used for pts with poor prognoses and was associated with lower RT costs at 30D, but similar RT costs at 90D, possibly due to retreatment. RT choice had no impact on overall costs of care at 30D or 90D. pRT remains of high value, representing only 11-13% of total costs.[Table: see text]
Patients’ education about a new service available at Memorial Sloan Kettering Multidisciplinary Clinic for frail patients with central nervous system cancers.
Authors: Pentsova Elena , Purisic Irma , Zavolas Stephanie , Skakodub Anna , Nevel Kathryn Sara , Kaley Thomas Joseph , Lin Andrew , Daras Mariza , Gavrilovic Igor T. , DeAngelis Lisa Marie , Ruppert Lisa Marie
Published: November 2018

146

Background: A multidisciplinary clinic (MDC) is a pilot project in the MSK Department of Neurology designed to improve quality of care and patient satisfaction. The MDC enables the patient to receive coordinated care from multiple providers (eg a physical therapist, physiatrist, nutritionist, social worker, case manager, spiritual advisor, and neurologist) in one location in one longer visit. This approach is new, and few patients (pts) have had the opportunity to experience the MDC. We hypothesized that giving the patient information about the MDC will increase the MDC volume. Methods: This is a prospective quality improvement study from June 14, 2018 to July 20, 2018 conducted in four Neuro-Oncology clinics. Pts with primary or metastatic central nervous system (CNS) cancers were identified prior to the visits in their regular oncology clinic. Pts were asked if they were interested in receiving verbal or written information (brochure) about the MDC. For each patient, we recorded if they agreed to receive information, what information they received, and whether they scheduled an appointment at the MDC. We also recorded patient demographics, CNS cancer type, and whether they were accompanied by caregivers. Results: We approached 41 pts. Of the 41 pts, 31(74%) were accompanied by caregivers. Median patient age was 58 (range, 24-79) years. 26 (62%) were female. CNS cancers were primary brain tumors in 31 (76%) and brain metastases in 10 (24%). 27 (64%) of 41 pts agreed to receive both verbal information and a brochure. The remaining 14 (36%) pts did not want to receive more information about the MDC; of these, one patient didn’t take a brochure, 2 pts resided out of the country, and one patient said all needs had been addressed. Within 4 weeks of this pilot study four (15%) of 27 pts scheduled an appointment in the MDC clinic for upcoming dates. Conclusions: Among our pts with CNS tumors visiting their oncologists, 64% were willing to receive information about the MDC, four (15%) made an appointment with the MDC. More study is needed to facilitate education about and access to the MDC; to identify potential barriers; and to obtain longer follow-up.
Development and validation of the palliative care preferences scale (PCPS).
Authors: Perry Laura M , Kazan Adina S , Rogers James Louis , Hoerger Michael
Published: November 2018

151

Background: Research has not thoroughly examined patient-level factors such as perceptions that could contribute to underutilization of palliative care, which may be due in part to a lack of existing measures for this purpose. Therefore, this investigation aimed to develop and validate a 9-item measure called the Palliative Care Preferences Scale (PCPS-9), which was comprised of three subscales: emotional, cognitive, and behavioral. Methods: Data were collected in three separate online studies of individuals with cancer (study 1: N = 633; study 2: N = 462) or one of the following non-cancer serious illnesses: COPD, heart failure, or kidney failure (study 3: N = 248). Analyses assessed various psychometric properties of the scale in cancer and non-cancer patients, including internal consistency reliability, confirmatory factor analyses (CFAs), multigroup CFAs, and convergent validity associations with related constructs. Results: Across all three studies, results supported the internal consistency reliability for the total scale (αs from 0.76 to 0.83) and subscales: emotional (αs from 0.83 to 0.84), cognitive (αs from 0.60 to 0.77), behavioral (αs from 0.87 to 0.91). CFAs supported the three-factor model of the PCPS-9 (CFI ≥ 0.97, NNFI ≥ 0.96, RMSEA ≤ 0.07, SRMR ≤ 0.04), and a multigroup CFA supported the generalizability of its factor structure across cancer and non-cancer serious illness subgroups (ΔCFIs ≤ 0.006, ΔRMSEA ≤ 0.003). Finally, convergent validity analyses in studies 2 and 3 found that the PCPS-9 was significantly associated with related constructs, including a separate measure of palliative care preferences ( ps < 0.001) and a measure of palliative care knowledge ( ps < 0.001). Conclusions: Findings support the overall reliability and validity of the PCPS-9 in cancer and non-cancer serious illness samples and have implications for increasing palliative care utilization via clinical care and future research efforts.
Nurses and health care assistants: Evaluation of attitude towards the care of patients who are terminally ill with cancer.
Authors: Lopane Diego , Pavesi Carlotta , Arcanà Concetta , Morazzoni Gaia , Lopane Diego , Ferrari Stefano , Giuffrè Santina , Poggio Chiara , Banfi Daria , Lamiani Giulia , Saetta Annalisa , Rimassa Lorenza , Santoro Armando
Published: November 2018

158

Background: Terminally ill cancer patients (pts) are often hospitalized in the last 3 months of life, and a large number of them die in hospital. They require specific care provided by a team of health professionals with expertise in palliative (PC) and end-of-life care (EoLC). The aim of this analysis is to investigate the attitudes of nurses (Ns) and health care assistants (HCAs) towards terminally ill patients in a Cancer Center (CC). Methods: From July to November 2017 we applied the Frommelt Attitudes Toward Care of the Dying FORM-B Scale (FATCOD) to Ns and HCAs working in a CC, situated in a metropolitan area in Italy. FATCOD is a validated tool in its Italian version, composed of 30 questions investigating 6 specific areas: Fear (Fe), Communication (Co), Relationship (Rs), Care of the family (CoF), Family as Caring (FaC), Active Care (Ac). Each question has 5 answer options: strongly disagree, disagree, don’t know, agree, strongly agree, with scores from 1, negative, to 5, positive attitude. The total score ranges from 30 to 150. Results: We administered 116 questionnaires, 102 (87.9%) were completed. 81 Ns were involved (79.4%, 31/50 males/females) and 21 HCAs (20.6%, 4/17 males/females). The median age of Ns was 39 years (range 20-50) and 43 for the HCAs (range 30-50). The median duration of employment was 10 years for both groups (range 0-20). The median score achieved by both groups was 110.3 (range 78-140). Ns obtained a score of 112.1 (range 98.7-125.5), HCAs of 103.4 (range 89.4-117.7). Our analysis shows a positive attitude in both groups across 3 areas ( FaC, CoF, AC) and a negative one in others (Fe, Co, Rs), with a statistically significant concordance between the 2 groups (p=0.0037). Conclusions: Data shows NS and HCAs negative attitude in 3 important areas, with scores below the average results reported in literature. Based on our results, we proposed some intervention strategies. We organized periodic meetings with our psychologists. Our Institution introduced the PERCS ( Program to Enhance Relational and Communication Skills) and specific programs in medical and nursing schools of our university, favoring the earliest approach to PC and EoLC. We also provided seminars in PC to Ns and HCAs working in the CC.