bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and safety of rolapitant for prevention of chemotherapy-induced nausea and vomiting (CINV) in non–anthracycline/cyclophosphamide (AC)-based moderately emetogenic therapy (MEC).
Authors: Powers Daniel , Hesketh Paul Joseph , Schwartzberg Lee Steven , Modiano Manuel R. , Arora Sujata , Schnadig Ian D.
Published: February 2017

209

Background: Rolapitant, a novel NK-1 receptor antagonist, showed efficacy in CINV prevention in patients (pts) receiving MEC (anthracycline/cyclophosphamide (AC) and other regimens) in a global phase 3 trial. Recent anti-emetic guidelines consider AC based regimens to be highly emetogenic. In this post hoc analysis, the efficacy and safety of rolapitant was assessed in Cycle 1 in pts receiving non-AC MEC, and in the subset of pts receiving carboplatin-based MEC. Methods: In a double-blind, active-controlled study, pts were randomized to oral rolapitant 180 mg or placebo 1–2 hours before MEC. All pts received granisetron 2 mg oral on days 1-3 and oral dexamethasone 20 mg on day 1. Complete response (CR = no emesis + no use of rescue medication), no emesis, and no nausea were assessed in overall (0-120 h), acute (0-24 h), and delayed ( > 24-120 h) phases. Results: CR was significantly (P < 0.01) higher with rolapitant than active control in overall and delayed phases in the carboplatin subset and in all 3 phases in the non-AC population (Table). No emesis rates were significantly (p < 0.05) higher with rolapitant in the carboplatin subset in the overall phase. No nausea rates were significantly (P < 0.05) higher with rolapitant in the overall and delayed phases in carboplatin-based MEC. Incidences of treatment-related AEs in Cycle 1 with rolapitant vs. active control were 11.3% vs. 6.7% in the carboplatin-based subset. Most common AEs with rolapitant and active control were constipation, fatigue, and headache. Conclusions: Rolapitant was superior to active control in preventing CINV in pts receiving non-AC MEC, including in the subgroup receiving carboplatin. Rolapitant was well tolerated with low incidence of AEs. Clinical trial information: NCT01500226. [Table: see text]
A novel patient-aimed visual tool to aid in decision making in oncology.
Authors: Zanartu Cristian , Camacho Fernando J. , Martin Benjamin
Published: February 2017

21

Background: With up to 15% of Medicare patients receiving chemotherapy during the last two weeks of life, improving specialist-patient communication is a priority. The Help-Hurt Tool (2015) is a very simple patient-language visual aid for decision-making. It consists of two scales, a blue one labeled “from 1 to 5 how much could this therapy help me” and a red one with the same statement ending in “…hurt me”. The tool is held by the specialist and shown to the patient while arrows are moved to a particular point below each scale. That way, two values are given to the patient for the degree of benefit and of harm respectively expected from an offered treatment. Each number corresponds to an outcome in patient-language (i.e. a ‘help’ score of 2 is “small chance of making me feel better...” and of 4: “big chance of making me live at least a year longer”. A ‘hurt’ score of 2 is “likely non-dangerous side effects” and of 5: “likely life threatening therapy”). Methods: Feasibility study in an oncology clinic at an urban area in New York. Adult cancer patients without dementia whose disease had progressed through a previous treatment and were being offered a new line of therapy were enrolled. Results: Thirty encounters were enrolled. The tool was successfully used in 29 of them (96.7%); one patient was confused and could not follow at all. In more than 70% of encounters patients stated that the tool helped them understand their disease and treatments (‘helpful’: 32.3%, ‘very helpful’: 38.7%), and in 90% of encounters patients stated wanting to be approached with a tool like this again. Importantly in 60% of encounters patients were able to recall either the Help or Hurt score, and in 33.3% of encounters both values were perfectly recalled by patients. In 83.3% of encounters oncologists declared that the tool had a positive effect (‘helpful’ (40%) or ‘very helpful’ (43.3%)) in their interactions with the patient. Conclusions: This first-of-its-kind tool is promising for enhancing communication between specialists and patients at the time a therapy is being offered. Future steps for this tool would include a randomized trial to explore if its use can further affect outcomes like use of chemotherapy in the last two weeks of life, earlier hospice enrollment and quality of life, among others.
Efficacy and safety of rolapitant for prevention of chemotherapy-induced nausea and vomiting (CINV) over multiple cycles of highly or moderately emetogenic chemotherapy (HEC, MEC).
Authors: Rapoport Bernardo Leon , Schwartzberg Lee Steven , Chasen Martin Robert , Powers Daniel , Arora Sujata , Navari Rudolph M. , Schnadig Ian D.
Published: February 2017

210

Background: The long-acting neurokinin-1 receptor antagonist (NK-1 RA) rolapitant has demonstrated efficacy for CINV prevention in patients receiving HEC and MEC during Cycle 1. The efficacy and safety of rolapitant was examined during subsequent cycles 2–6 in a pooled analysis. Methods: In 4 double-blind, active-controlled studies, patients were randomized to oral rolapitant 180 mg or placebo 1–2 hours before chemotherapy. All patients received active control: 5HT3 receptor antagonist + oral dexamethasone. Patients completing Cycle 1 could receive the same anti-emetic treatment in subsequent cycles. On Days 6-8 of subsequent cycles, patients self-reported the incidence of emesis, or of nausea interfering with normal daily life following Day 1 of chemotherapy. Results: A greater proportion of patients on rolapitant than on active control reported no emesis or interfering nausea separately for each subsequent cycle. Results of individual studies and pooled analysis are shown in the Table. During cycles 2-6, the incidence of treatment-related adverse events (AEs) was similar for rolapitant (5.5%) and control (6.8%). The most common treatment-related AEs were similar in both arms: constipation (rolapitant: 1.2%; control: 0.8%) and fatigue (rolapitant: 1.3%; control: 1.8%). Conclusions: Rolapitant was superior to active control in reducing CINV when administered over multiple cycles of moderately or highly emetogenic chemotherapy, with no increase in toxicity. Clinical trial information: NCT00394966 - NCT01500213 - NCT01500226 - NCT01499849. [Table: see text]
Laser therapy for radio-induced oral mucositis and skin dermatitis: Oral medicine, radiotherapy and oncology shared experience from the University of Trieste.
Authors: Gobbo Margherita , Guglielmi Alessandra , Ottaviani Giulia , Rupel Katia , Zacchigna Serena , Ciriello Francesca , Beorchia Aulo , Di Lenarda Roberto , Biasotto Matteo
Published: February 2017

213

Background: Oral mucositis (OM) and dermatitis (RD) are serious side effects of radiotherapy (RT), often leading to its suspension, need for analgesics and enteral/parenteral nutrition. Laser-therapy is becoming a recommended option for mucosal lesions and has also been tested for skin affections. This prospective study investigates the effect of Laser-therapy (HPLT) on RT-induced OM and proposes an off-label use of HPLT to treat RD in breast-cancer patients and in RT-treated anal-carcinoma patients Methods: 53 cancer patients, during/after RT and/or chemotherapy, affected by OM, were treated with HPLT during 4 consecutive days (970nm, 2,5W, 35-6000Hz, 240s). Assessment of OM (WHO-SCALE: Grading objective Scale), pain (VAS: Visual Analogue Scale), functional ability, subjective parameters, site/severity of OM were recorded weekly for 21 days. 27 breast-cancer patients and 2 anal-carcinoma patients affected by RD were treated by HPLT every other day for 2 weeks (970nm/660nm, 2-1000Hz, 6W, 480s) and monitored weekly for one month for grade, discomfort, itching and bleeding. Results: Regarding OM, regressive improvement of WHO- SCALE from day 7 on, and of VAS from day 2 on (p < 0.000) was registered. All patients’ functional capacity improved on day 4 (p < 0.05). All subjective parameters improved on day 14 (p < 0.001) except voice, which improved on day 21 (p < 0.000). Ulcerations’ dimension and erythema’s severity decreased in all sites (p < 0.05). Regarding breast and anal RD, after 6 HPLT’s sessions, complete and progressive resolution of pain, bleeding and itching was registered (p < 0.002). All patients referred maximum satisfaction for receiving HPLT. Conclusions: Regardless of OM grade/site and of kind/site of tumor, HPLT was effective in healing OM. Moreover, HPLT resulted an innovative and highly effective therapy for RD, both in breast and anal lesions. To establish an effective treatment strategy for OM and RD is of paramount importance to improve life-quality of patients but can also be beneficial for the continuation of cancer therapy. Consequently, HPLT may become integral part of everyday-practice in the management of RT adverse effects.
Quality of life and depression during hospitalization for hematopoietic stem cell transplantation to predict quality of life and post-traumatic stress disorder symptoms at 6 months post-transplant.
Authors: El-Jawahri Areej , VanDusen Harry , Traeger Lara , Fishbein Joel , Keenan Tanya , Greer Joseph A. , Pirl William F. , Jackson Vicki A. , Eusebio Justin , Gallagher Emily R. , Spitzer Thomas R. , Ballen Karen K. , McAfee Steven L. , Dey Bimalangshu , Chen Yi-Bin Albert , Temel Jennifer S.
Published: February 2017

215

Background: Patients undergoinghematopoietic stem cell transplantation (HCT) experience a steep deterioration in quality of life (QOL) and mood during hospitalization for HCT. The impact of this deterioration on patients’ long-term QOL and post-traumatic stress disorder (PTSD) symptoms is unknown. Methods: We conducted a prospective longitudinal study of patients hospitalized for HCT. At baseline (day-6), day+1, day+8, and 6 months post-HCT, we assessed QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation [FACT-BMT]) and mood (Hospital Anxiety and Depression Scale [HADS]). We used the PTSD Checklist to assess for PTSD symptoms at 6 months. We used multivariable linear regression models to identify predictors of QOL and PTSD symptoms at 6 months post-HCT. Results: We enrolled 97% (90/93) of consecutively eligible patients undergoing autologous (n = 30), myeloablative allogeneic (n = 30), or reduced intensity allogeneic (n = 30) HCT. Overall, patients’ QOL at 6 months (mean FACT-BMT: 110, 95%CI [104-116]) recovered to baseline pre-transplant values (mean FACT-BMT: 110, 95% CI [107-115]). At 6 months, 28.4% of participants met provisional diagnostic criteria for PTSD, and 43.3% had clinically significant depression. In multivariable regression analyses adjusting for baseline QOL, mood, other covariates, change in QOL and depression scores during hospitalization for HCT predicted impaired QOL (DQOL β = 1.13, P < 0.0001, D HADS-depression β = 2.51, P = 0.001) and PTSD symptoms (DQOL β = 0.50, P < 0.0001, DHADS-depression β = 1.22, P < 0.0001) at 6 months post-HCT. Conclusions: While patients’ overall QOL at 6 months post-HCT returned to baseline values, a significant proportion met provisional diagnostic criteria for PTSD and depression. The decline in QOL and increase in depressive symptoms during hospitalization for HCT were the most important predictors of long-term QOL impairment and PTSD symptoms. Future studies should evaluate whether interventions to improve QOL and reduce psychological distress during HCT may improve long-term QOL and reduce the risk of PTSD symptoms.
Addressing psychiatric needs in an adult comprehensive cancer center.
Authors: Underwood Jody A. , McDonald Elaine , Higginbotham Kathleen , Korber Susan F.
Published: February 2017

218

Background: The Rhode Island Hospital Comprehensive Cancer Center (RIH-CCC) sought to develop collaboration between psychiatry and social work to ensure comprehensive mental health care for the Centers’ adult patients. New patients are screened for distress using the NCCN Screening Tool for Measuring Distress. The NCCN Distress Thermometer measures patient’s distress using a 0-10 scale and documents the contributing psychosocial factors. The Cancer Center, in collaboration with psychiatry, developed standards for follow-up care. Those patients who indicate their distress as 4-7 are contacted by social work within 3 business days. The patients who identify their distress as 8-10 have social work follow up within 1 business day. Methods: The RIH-CCC mental health team consists of 4 full time clinical social workers and 2 psychiatrists. The social workers receive the patient’s distress scale after which they complete a comprehensive psychosocial assessment and develop a plan of care based on the urgency and complexity of the required interventions. The patients who require psychiatric evaluation are scheduled by the social work team to meet with the RIH-CCC psychiatrist for further assessment and evaluation. Results: Data was analyzed for the quarter of November 2014 to January 2015. The Center evaluated 1033 new patients. Of those, 119 completed a distress thermometer indicating a level of distress greater than 4 (average score of 6.6). Of the 119 patients seen by social work, 88 (74%) were in need of follow up care which often included further assessment by the on-site psychiatrists. Conclusions: Depression is estimated to occur in approximately 25-30% of adult cancer patients. Untreated and undiagnosed distress can have an adverse effect on cancer treatment. Our Centers’ results indicate that a significant number of those patients who identified as distressed were in need of further psychiatric evaluation and treatment. The strong collaborative relationship between on-site psychiatry and clinical social work promote early access and intervention to this challenged population.
PI-REAL: A study of informed consent (IC) communication in real-time during phase I clinical trial encounters.
Authors: Sharma Manish , Hlubocky Fay J. , Ratain Mark J. , Siegler Mark , Daugherty Christopher
Published: February 2017

22

Background: Advanced cancer patients (ACP) in phase I clinical trials are unable to recall significant elements of IC, yet the actual verbal and non-verbal content of trial discussion between oncology fellows and ACP consenting in real time to such trials has not been well described. Methods: Phase I Communication in Real Time Fellow-ACP Encounters (PI-REAL) study is an evidence-based intervention designed to improve communication about phase I clinical trial IC. ACP completed follow-up questionnaires after new patient visits to assess understanding of IC elements, such as research purpose. Video recordings were analyzed using CanCode for verbal and non-verbal skills associated with IC elements. Results: To date, 61 ACP-fellow clinical encounter video recordings were available for analysis. Average length of encounters: 45.4 min (range: 5.7-87.8 min). ACP demographics included: median age 60y (33-83); 55% male; 89% Caucasian; 55% median income > $60,000. Fellows were coded as verbally disclosing: 1. Purpose of phase I trial as dose-determining in 49% of encounters; 2. Physical risks of trial in 75% of encounters; 3. Potential benefits (e.g. improved QOL) gained by ACP participation in trial in 70% of encounters; 4. Alternatives to trial entry (e.g. other trials, palliative/supportive care) in 55% of encounters. A significant association existedbetween coded fellow empathic statements and ACP subsequently recalling the purpose of the trial as dose-determining, with 72% of subjects who heard empathic statements identifying “dosage” compared to 10% of subjects who did not (72% v. 10%, p < 0.05). Regarding non-verbal skills, fellows: leaned toward ACP in 64% of encounters; observed ACP face directly in 72% of encounters; had relaxed body posture in 55% of encounters; and displayed responsive facial expressions in 77% of encounters. Conclusions: Empathic statements by fellows appear to be associated with improved ACP understanding of Phase I trial research purpose as dose-determining. Additional encounters continue to undergo video recording and analysis.
Distress management in advanced gastrointestinal cancer patients.
Authors: King Anna M. , Estrada Cynthia , Marcusen Carol P. , Glaser Susan , Dorff Tanya B. , Barzi Afsaneh
Published: February 2017

221

Background: Living with advanced-stage gastrointestinal cancer is a life-altering experience; patients (pts) have pain, fatigue, eating difficulties in addition to their financial challenges and spiritual crisis. As a result, high rates of distress are commonly reported in this population. The aim of this pilot study was to develop a collaborative model for psychosocial assessment and intervention to improve patient quality of life and reduce perceived distress. Methods: The Improving Mood – Promoting Access to Collaborative Treatment (IMPACT) model was utilized to address distress in these pts. Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Screen (GAD-7), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ C30) were utilized by nurses to screen and flag pts who are experiencing distress. Follow-ups included PHQ-9 and GAD-7 at 2, 6, and 10 weeks and EORTC-QLQ C30 at 10 weeks. Interventions include brief-therapy, education and resource coordination by a social worker, and psychotropic medication prescribed by an oncologist. Results: Between November of 2014 and May of 2015, 65 pts were screened; 15 screened positive and 7 of them were initiated with services, while the remaining 8 declined intervention. The majority of pts who declined were male. Of the 9 receiving intervention, 2 screened negative but provided verbal endorsement of distress. Also, 3 pts receiving intervention were discharged home on hospice and expired before 10 weeks. Three pts reached the 10 weeks time point and of those, one patient reached a 50% reduction in PHQ-9 score by 10-weeks. Each patient required an average 4 hours of staff time for delivery of referral to services and psychotherapy. Conclusions: This model of care can be delivered with a moderate amount of staffing. Though, over a 7 month period, data collected from pts did not suggest a significant decrease in distress. Many pts were found to be consumed by intersecting elements such as other medical concerns, financial stressors and low priority of depression management. Also, disease course impacted accurate measurement of distress. It is suggested for future intervention with oncology pts to control for these factors.
The well-being of adult children while caring for a parent in home hospice: Evaluation of an automated remote monitoring and coaching system.
Authors: Mooney Kathi , Berry Patricia , Blaz Jacquee , Donaldson Gary
Published: February 2017

222

Background: Health and well-being often deteriorates for family caregivers providing home hospice care. This includes adult children managing multiple demands while supporting their parent to remain at home. Automated remote monitoring of patient symptoms has shown promise in home cancer care and could be extended for monitoring and supporting the wellbeing of adult child caregivers (ACC) providing care to their parent at home. Methods: In a RCT, 97 ACCs were monitored using a telephone based automated reporting and coaching system, and randomly assigned to the ACC care intervention (Rx) (N = 51) or usual care (UC) (N = 46). All ACCs were asked to call the system daily reporting presence and severity (0-10 scale) of their own fatigue, poor sleep, depressed mood, anxiety and interference with normal activities. The Rx ACCs received automated tailored coaching based on reported patterns of moderate to severe symptom levels and alert reports were also sent to their hospice nurse. Results: ACCs were females (78%) with a mean age of 51. There were no differences between groups on any demographic or baseline measures. Utilizing negative binomial modeling, Rx ACCs had significantly fewer days/week of moderate-severe symptoms overall (.6 vs 2.4, p < .001) and for each individual symptom (all p < .001). Among those attempting to maintain work, Rx ACCs were able to work 80% of work days and UC ACCs worked 68% of work days. Six weeks after their parent’s death, there was a statistical trend (p = .07) for Rx ACCs to be less depressed than UC ACCs (11.94 vs 18.04). This is a clinically significant finding as UC ACCs’ CESD scores were at the clinically actionable level ( > 16) for referral for evaluation of depression. Rx ACCs’ CESD scores had dropped an average of 1.37 points below their baseline whereas UC ACCs’ scores had increased an average of 3.86 points from baseline at 6 weeks post death. Conclusions: Automated remote monitoring and coaching for adult child family caregivers offers impressive benefit in reducing the physical burden and psychosocial distress of caregiving during and after parental hospice care. Clinical trial information: NCT02112461.
Clergy religious beliefs and ICU utilization at the end of life.
Authors: Balboni Michael , Sullivan Adam , Quinones Rebecca , Vanderweele Tyler J. , Balboni Tracy A.
Published: February 2017

223

Background: High religious community spiritual support is associated with greater aggressive interventions at the end of life (EOL). At EOL, half of U.S. patients are visited by clergy. The relationship of clergy religious beliefs about EOL care to dying congregants’ EOL medical decisions is unknown. Methods: This is an NCI-funded study of 1,665 U.S. clergy randomly-selected from a comprehensive database of 368,408 U.S. congregations and administered a survey 8/2014-2/2015; 1,005 responded (60%). Clergy reported endorsement of religious beliefs about congregants’ EOL care (RBEC), including miracles, sanctity of life, divine sovereignty, and redemptive suffering. Clergy reported on their last experience in spiritual caregiving to a dying congregant, including congregant’s care location in the final week. The primary outcome was any ICU care in the final week of life. Multivariable analyses (MVA), controlling for clergy age, gender, race, region, and congregational income, assessed the relationship of clergy RBEC to any congregant ICU care in the last week. Results: Most (86%) clergy affirmed belief in a miraculous cure; 54% agreed that the congregant should accept every medical treatment out of religious obligations. A minority of clergy affirmed that belief in divine sovereignty relieved congregants of future medical decisions (28%) and that they should endure medical procedures because suffering is God’s test (27%). In MVA, higher RBEC scores were associated with a greater likelihood of any ICU utilization in the last week (AOR=1.28, p=.02), with belief in divine sovereignty being the strongest predictor (AOR 2.1, p=.005). Predictors of having greater RBEC scores included being Hispanic (AOR=3.35, p<.001) or black (AOR=3.0, p<.001), as compared to white, and being Pentecostal (AOR=3.54, p<.001) or Evangelical (AOR=2.12, p<.001) as compared to clergy self-identified as liberal. Conclusions: A majority of clergy endorse religious beliefs regarding their dying congregants’ EOL medical care; these beliefs are associated with greater ICU care in the final days of life for congregants. Future research is needed to determine religiously-consistent approaches to clergy EOL education to mitigate aggressive interventions at the EOL.
Effect of training on the self-efficacy of informal caregivers of colorectal cancer patients.
Authors: Havyer Rachel D. , van Ryn Michelle , Wilson Patrick , Griffin Joan M.
Published: February 2017

226

Background: Patients undergoing cancer treatment often need support from an informal caregiver to help manage symptoms. Self-efficacy (SE) in caregiving refers to confidence in being able to care for the patient’s needs. Low SE has been associated with increased caregiver burden and mental health symptoms, which in turn, can affect the quality of informal care provided. The objective of this study was to examine the relationship between caregiver training received from cancer care providers and SE in caregivers of patients with colorectal cancer (CRC). Methods: Caregivers of CRC patients diagnosed in 2009 were invited to complete a self-administered questionnaire. Caregivers were asked about specific patient problems (pain, bowel, fatigue, medications, and other). Caregiver perceptions of training adequacy and SE were assessed on a problem specific basis. The patient’s stage of disease was obtained from cancer registry data. Associations between training and SE were examined for each problem using multivariate logistic regression and adjusted for age, relationship to patient, race, care burden, level of education, stage of disease, perception of patient’s health, and general confidence as a caregiver. Results: 417 caregivers completed the survey (70% response rate), of whom 374 (90%) were female and 284 (68%) were the patient’s spouse/partner. The number of caregivers reporting inadequate training for CRC-related problems were pain 77 (38%), bowel 80 (38%), fatigue 121 (48%), medication 65 (26%), and other 101 (40%). The odds of having low SE were significantly higher among those with perceptions of inadequate training across the following CRC-related problems: pain, 10.10 (3.36, 30.39); bowel, 5.04 (1.98, 12.82); fatigue, 8.45 (3.22, 22.15); managing medications, 9.00 (3.30, 24.51); and other, 3.87 (1.68, 8.93). Conclusions: This study showed a significant association between caregiver training and SE in a cross-sectional study. Given that the perception of inadequate training among caregivers was common, further exploration of the longitudinal impact of training on caregiver SE should be done to identify interventions to help improve the experience of cancer caregivers.
Caregiver symptom burden assessment using the Edmonton Symptom Assessment System (ESAS): A preliminary report.
Authors: Tanco Kimberson , Vidal Marieberta , Arthur Joseph Anthony , Hui David , Chisholm Gary B. , Bruera Eduardo
Published: February 2017

227

Background: Regular assessment of caregiver symptom burden during patient visits would allow prompt referral for their care. The ESAS is a multidimensional tool used in patients but not caregivers. The objectives of this study were to determine the feasibility of the ESAS in assessing caregiver symptoms defined as completing 9/12 items, assess caregiver-reported usefulness of its completion, determine the association of symptom scores between patients, caregivers and various clinical and psychosocial factors, and determine concurrent validity with the Zarit Burden Interview-12 (ZBI-12). Methods: A prospective study of 90 patient-primary caregiver dyads in an outpatient Supportive Care Center in a cancer center was conducted. The 12 item ESAS-FS was completed by the dyads with other measures of clinical and psychosocial factors [demographics, cancer diagnosis, co-morbidities, caregiving activities, prognostic index and patient’s performance status]. Results: The ESAS is a feasible tool to assess caregiver symptom burden with 90/90 caregivers [100%] completing at least 9/12 items; 66/90 caregivers [73%] found ESAS useful to report their symptom burden. A significant association was found between ESAS scores of caregivers and patients in depression [p < 0.01], psychosocial items [depression, anxiety, well-being, financial distress, spiritual pain; p < 0.01], and total symptom distress scores [p < 0.01]. Caregiver employment status [p = 0.03] and total caregiver activities [p = 0.04] were significantly associated with total caregiver ESAS scores. There was no significant association between patient and caregiver co-morbidities [p = 0.08], prognostic index [0.07] and performance status [p = 0.26] to total caregiver ESAS scores. Caregivers recommended certain physical symptoms such as pain and nausea may be eliminated. Concurrent validity with ZBI-12 was not achieved [r = 0.53, p = 0.74] suggesting that ESAS measured different caregiver dimensions. Conclusions: The ESAS is a feasible tool to measure caregiver symptoms and was found useful by caregivers. Further research is needed to modify the ESAS based on caregiver’s recommendations and further psychometric studies need to be conducted.
Distress themes encoded in narratives of the “last day”: A study among surviving caregivers.
Authors: Walsh Elizabeth Paige , Riessman Catherine , Mathew Paul
Published: February 2017

23

Background: Survey studies have determined the prevalence of dissatisfaction among survivor caregivers related to end of life care. Toward improvement in care at EOL, we hypothesized that novel themes of distress would be identified in narratives of the “last day” from the recently bereaved. Methods: Extended narrative accounts of patients’ last day of life were collected from adult, English-speaking, caregivers (n=5) present at the death of a cancer patient. Interviews (45-120 minutes) featured open-ended questions prompting the subject to share an account of the last day, their care and coping experience. Interviews were conducted and transcribed by the author and analyzed thematically. Results: A theme of distressed communication with health care providers [HCP] could be identified in narrative segments in all 5 interviews, linked to transitions such as changes in treatment or clinical status. Narrative fragments exemplary of distress arising from communication are presented. I. A pain crisis so severe “she asked God to take her.” “I am ready to call the nurse practitioner…and she wouldn’t allow it... She doesn’t want to be a burden.” II. “I said, I don’t want you telling him directly anything. I want you to tell me first so we can go in together and tell him…the right way” including an option to “spend time together.” Soon after, the physician “came rushing into the room and as if we’d never had the conversation…, OK, we’re going to take you to the ICU.” III. “I had asked the nurse…to make sure that she had her clothes on when the funeral parlor came.” It was “important to me for her dignity.” The nurse responded: “they just cut the clothes off anyhow.” IV. “Now you’re going to pull chemo out of your hat? Look at him!...He doesn’t want to leave us but he’s ready to go.” “After we said no to chemo, [his doctor] never came near S again.” Conclusions: This pilot study of last day narratives obtained from surviving caregivers points toward a high prevalence of distress content relating to impaired communication with HCP with consequences including uncontrolled pain, conflict, perceived loss of dignity and abandonment. These data indicate the need for larger-scale studies focused on the content and style of bidirectional communication at the EOL.
Cancer-related communications and symptom burden in couples coping with advanced lung cancer.
Authors: Milbury Kathrin , Lopez Gabriel , Tsao Anne S. , Bruera Eduardo
Published: February 2017

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Background: Although effective communications regarding symptoms may decrease distress and patients and their spouses, families tend to experience barriers to open communication. The purpose of this cross-sectional survey study is to examine the role of cancer-related communications in symptom burden in families coping with advanced non-small cell lung cancer. Methods: Couples were approached while waiting for their routine visit at the thoracic center. 25 patients (58% female; 78% white; mean age: 62.7 years; 72% stage III; 2.3 months post diagnosis) and their spouses completed measures of cancer symptoms (ESAS), psychological distress (BSI), and illness communication (CCAT_PF). Results: Dyadic analyses using multi-level modeling revealed that patients generally rated their own symptom burden significantly lower compared to spouses rating patient symptoms (P < .0001). However, this discrepancy in perceptions of symptoms was a function of cancer communication (P < .001) so that the more couples communicate about cancer-related issues (e.g., treatment decision making) the more they agreed regarding symptom burden. Importantly, a discrepancy in symptoms ratings was significantly related to spouses’ depressive symptoms (P < . 01) so that the greater the discrepancy, the greater spouses depression. Lastly, more effective cancer communication was related to lower cancer symptoms in patients (P < .05) as well as depression (P < .01) and anxiety (P < .05) in both patients and spouses. Conclusions: These findings highlight the importance of effective cancer communication in reducing symptom burden in couples coping with advanced lung cancer. Behavioral interventions that target communication skills taining may improve symptom management in patients and reduce psychological distress in spouses.
Assessment of distress among breast cancer survivors following primary treatment.
Authors: Neerukonda Anu Radha , Messina Catherine , Reagan Lisa , Stevens Michelle M. , Nemesure Barbara
Published: February 2017

240

Background: Although elevated levels of distress have been well documented among cancer patients receiving active treatment, the magnitude of and contributors to distress in cancer survivors are yet to be well established. The purpose of this investigation was to evaluate the presence of distress among breast cancer survivors (BCS) and to investigate demographic, psychosocial, tumor and treatment related variables that may be associated with distress in this population. Methods: A retrospective chart review was done that includes 81 female BCS, 21 years or older, who received care at the Stony Brook Cancer Center Survivorship Clinic and completed the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) form between October 2012 and June 2014. Descriptive statistics were used to describe the demographic, psychosocial, tumor and treatment characteristics for the study sample and logistic regression models were used to evaluate the relationship between elevated distress and the factors outlined above. The regression results are presented as odds ratios (ORs) and 95% confidence intervals (CIs). Data were analyzed using SPSS version 21. Results: Approximately one-half of BCS (50.6%) reported a clinically significant distress level (4 or higher). Those who were on an anxiolytic or anti-depressant medication tended to have higher levels of distress (OR: 3.10; 95% CI: 0.90-10.74; P = 0.07) and age greater than 60 years at the time of diagnosis was negatively correlated with distress (OR: 0.24; 95% CI: 0.07-0.84; P = 0.03). BCS with clinically significant distress (4 or greater) reported more problems in the emotional domain components of the DT, whereas patients with low distress (less than 4) reported more problems on the physical domains. Conclusions: Findings from this study indicate that more than half of BCS experienced distress during the survivorship phase, which frequently manifested as emotional and physical problems. Although preliminary, these data suggest the need to develop targeted screening strategies for early recognition and interventions to alleviate distress in this population.
Prospective study to evaluate impact of support group participation in women with gynecological cancer.
Authors: Garrick Andrea , Pyrzak Adam , Campbell Jeff , Rungruang Bunja Jane , Sadek Ramses F. , Ghamande Sharad A.
Published: February 2017

243

Background: Unlike breast cancer support group literature, there is no data in women with gynecologic cancers who have different perspective about their disease and therapy. We have a well-established (10 years old) active grass root level support group unique to women with gynecologic cancers that meets monthly. Our goal was to investigate perceived benefits of support group participation. Methods: We developed a prospective questionnaire to evaluate the CSRA Gynecologic Oncology Support Group (CGOSG) participant’s perceived effects of attending the group on their side effects and disease status. The questionnaire was distributed to patients attending CGOSG meetings over a 4 month period. 47 surveys were collected for analysis; Wilcox rank sum test was used as appropriate. Results: The common cancers were 52% ovarian, 26% endometrial and 62% were currently on therapy. The 3 top reasons that patients attended CGOSG were physician driven (28%), to meet other women with the same diagnosis (26%) and to learn more about their cancer (22%). The top 3 expectations of patients were emotional support (28%), bonding/companionship (21%), and cancer education (14%). The top 3 concerning physical side effects from their cancer or therapy were fatigue (21%), memory loss (14%), and peripheral neuropathy (14%). Patients with more than 5 visits reported that CGOSG participation improved their most concerning physical side effect (fatigue) with a median score of 7.5 ± 4 out of 10. The top 3 concerning emotional side effects identified were fear of recurrence (26%), living with uncertainty (20%) and defining a new sense of normal (15%). Patients reported the CGOSG improved their most concerning emotional side effect (fear of recurrence) with a median score of 9 ± 2 out of 10. Patients with more than one visit, not on treatment reported a higher quality of life score (p = 0.001) and perceived a positive impact on cancer therapy (p = 0.02) compared to patients on treatment. Conclusions: This is a first of a kind attempt to understand the impact of a well-organized support group on women with gynecological cancers which indicates that these women struggle with fear of recurrence and uncertainty, but are able to find some solace.
Housestaff perspectives on end-of-life training during medical school and residency.
Authors: Schmit Jessica Marie , Meyer Lynne , Duff Jennifer Michelle , Close Julia Lee
Published: February 2017

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Background: Participating in end-of-life discussions and delivering bad news is integral to oncology practice. Poor communication skills can negatively impact a patient’s understanding and acceptance of their disease process, increase their anxiety, and lead to anger and depression. Hematology/Oncology fellowship training (HOFT) programs may assume incoming fellows are capable of doing this well. A study by Hebert et al. revealed 37% of HOFT programs provide little to no formal training in this area. Our study sought to assess housestaff preparedness and comfort with end-of-life (EOL) discussions. Methods: An email survey was sent to 787 residents and fellows at a single institution in February 2015. Housestaff were queried as to extent of training, experience, supervision and comfort with EOL communication in both medical school and residency. Results: 176 surveys (22.4 %) were returned.During Medical School: Many housestaff (55.1%) reported “little” to “no” classroom training on EOL discussions. Most, 85.1%, reported having five or fewer EOL discussions. Most encounters (78.6%) were supervised by an attending or resident. Only 45.5% felt “somewhat” to “fully prepared” to have EOL discussions when graduating medical school. During Residency: Housestaff reported even less classroom training on EOL discussions: 88.2% reported “little” to “no training”. EOL discussions were more common: 51% reported more than 10 EOL conversations with patients. The level of supervision decreased: only 38.6% reported encounters were mostly supervised. Most housestaff (75%) feel comfortable with having EOL discussions at their current level of training. Conclusions: Despite increased awareness regarding the importance of EOL discussion education, it remains an area that a significant number of medical students and housestaff receive little to no training. EOL discussions by housestaff are frequently unsupervised, reducing opportunities for improvement via feedback. Competence in delivering bad news is an important skill for hematologists/oncologists. Our findings support the previously published perception of HOFT program directors that additional training and resources in delivering bad news is needed.
Is laser biostimulation safe even when performed in neoplastic fields?
Authors: Ottaviani Giulia , Zacchigna Serena , Gobbo Margherita , Rupel Katia , Guglielmi Alessandra , Bussani Rossana , Di Lenarda Roberto , Biasotto Matteo
Published: February 2017

3

Background: Oral mucositis and skin dermatitis induced by oncological therapies can impair patients’ functional capacity and quality of life. Laser therapy has been proposed as an effective treatment for both conditions, although with an unclear mechanism. Laser irradiation seems to enhance mitotic activity of epithelial cells, fibroblasts and collagen fibres, but are we sure that it does not stimulate neoplastic cells as well? Two different mice models have been ad hoc created to investigate whether laser therapy can be safely performed even on neoplastic areas. Methods: First model: 4-NQO chemical carcinogen was administered to 50 mice for 16 weeks. During the 17th week, 25 mice were subdued to 4 daily laser therapy sessions (970nm, 2.5W/cm2, duty cycle 50%, 2Hz, 180J/cm2), while 25 mice were used as controls. Afterwards, animals were sacrificed to perform histological analysis. Second model: Melanoma cells were implanted in 48 mice at the dorsal subcutaneous level. A tumour mass developed at the site of injection and mice were homogeneously divided into 4 groups according to tumour size: 3 groups were subject to different laser protocols (660nm, 100mW/cm2, CW, 3J/cm2; 800nm, 1W/cm2, CW, 20J/cm2 and 970nm, 60mW/cm2, CW, 6J/cm2) for 4 consecutive days, while the fourth group was used as control. All animals were euthanized to measure tumour volume and weight, and to quantify tumour invasiveness through immunohistochemistry (CD68 and Melan-A). Results: First model: the number/extension of dysplastic/neoplastic areas did not increased after laser irradiation (p<0.05). Unexpectedly, while carcinomas are normally surrounded by dysplastic tissue displaying different degrees of cells alterations, laser treated carcinomas appeared as insulated lesions surrounded by healthy epithelium. Second model: tumour growth and weight and neoplastic cells infiltration were lower in all laser groups compared to the controls (p<0.05). Conclusions: The above-presented results may also prove that laser therapy can be safely performed to treat oral mucositis and skin dermatitis even in patients with active oncological disease. A key-role of the immune system may explain the peculiar behaviour of carcinomas and melanomas in response to laser irradiation.
Oncologists’ discussions of treatment goals and prognosis during clinic visits with African Americans with advanced cancer.
Authors: Eggly Susan , Hamel Lauren M. , Chou Wen-ying Sylvia , Thai Chan L. , Debono David Joseph , Chapman Robert , Albrecht Terrance Lynn , Penner Louis
Published: February 2017

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Background: The National Academy of Medicine recommends that cancer patients be informed of their prognosis to enable informed treatment decisions, but research shows few patients receive this information. This problem is greater for minorities, who experience poorer quality clinical communication and end-of-life care relative to white patients. This study describes patient-oncologist discussions about treatment goals/prognosis during clinic visits with African American patients. Methods: Data were from a larger study of communication between African Americans and medical oncologists at two cancer hospitals in Detroit, MI. The present study included video recordings/transcripts of clinic visits with patients with Stage III (n=20) or IV (n=6) cancer and their oncologists (n=9). Two investigators read the transcripts independently to determine whether treatment goals and/or prognosis were mentioned; disagreement was resolved through discussion. Discourse analysis was conducted to describe interactional strategies oncologists used to discuss or avoid discussing these topics. Results: Treatment goals were discussed during most visits (n=24; 92.3%); prognosis was discussed less frequently (n=19; 73.1%). Oncologists often used vague language to describe prognosis (e.g. prognosis is a bit worse in your case). Only one visit included a clear survival estimate. Oncologists used clear language when the goal was cure, but when describing other goals, they often used technical terms (e.g., reduce the risk of recurrence); imprecise terms (e.g., keep the cancer in check); and emphasized uncertainty (e.g., these lesions are suspicious). Oncologists missed opportunities to further explain or elicit patient questions or preferences by directing the discussion to the urgency and details of treatment. Conclusions: Oncologists used ambiguous language to discuss treatment goals/prognosis and missed opportunities to discuss patient perspectives or other options, including palliative care. Interventions are needed to improve communication about these important topics, especially among minority patients with advanced cancer.
Exploring the preferences for place of death among cancer patients and their family caregivers.
Authors: Vidal Marieberta
Published: February 2017

40

Background: Understanding the preferred place of death (POD) for advanced cancer patients (Pts) is very important when they are approaching the end of life. Meeting the preferences of Pts is considered an important palliative care (PC) outcome. Prior studies reported that more than 80% of Pts with terminally ill cancer prefer to die at home. In many countries such as the UK, Italy, Greece, South Korea and Japan home deaths have been falling, but in some states of the US and Canada there are indications of a reversal of trends. Dying at home may be more difficult for Pts in severe physical and psychosocial distress, or when there are social or financial difficulties. The purpose of this study was to determine POD preference among PC Pts in the outpatient center (OC) and the palliative care unit (PCU). Methods: A sectional anonymous questionnaire was administered to advanced cancer Pts and caregivers (PCU patients and OC) between August 2012 and September 2014. PCU Pts responded when there was no delirium and the primary caregiver responded when the patient was unable to respond. In the case of outpatients dyads (patient and caregiver) were assessed. Results: Overall 141/216 (65%) preferred home death. PCU patients preferred home death less than outpatients. Patient and caregiver agreement regarding preferred place of death was 86% (p <0.001). The preferred POD was the same as one month ago for 82/99 (83%) PCU Pts and 111/116 (96%) outpatients, with significant difference between groups (p=0.002). Conclusions: Although home is the preferred POD in advanced cancer Pts, a substantial minority prefer hospital death or no difference. Patients admitted to the PCU have a higher preference for hospital death in comparison to the outpatients, likely reflecting more severe distress because they already tried home care. Pts and caregivers agree on POD in most cases. Personalized assessment of POD preference for both patient and caregiver is needed. [Table: see text]