bluuebunny/crossref_metadata_2025 huggingface dataset:
The conversion ratio from intravenous (IV) hydromorphone to oral (PO) opioids in patients with cancer.
Authors: Reddy Akhila Sunkepally , Dost Sara , Vidal Marieberta , Stephen Saneese , Baumgartner Karen , Wu Jimin , Liu Diane D , Yennu Sriram , Bruera Eduardo
Published: February 2017

197

Background: Inpatients with cancer frequently undergo conversions from IV to PO hydromorphone (HM) or opioid rotation (OR) from IV HM to another PO opioid prior to discharge. Currently used conversion ratios (CR) between IV and PO HM range from 2-5 and opioid rotation ratios (ORR) between IV HM and oral morphine equivalent daily dose (MEDD) range from 10-20. This large variation in ratios may lead to uncontrolled pain or overdosing. Our aim was to determine the accurate CR from IV to PO HM and ORR from IV HM to PO morphine and oxycodone (measured as MEDD). Methods: We reviewed records of 4745 consecutive inpatient palliative care consults in our institute during 2010-14 for patients who underwent conversion from IV to PO HM or OR from IV HM to PO morphine or oxycodone. Patient characteristics, symptoms and opioid doses were determined in patients successfully discharged on oral opioids without readmission within 1 week. Linear regression analysis was used to estimate the CR or ORR between the 24 hour IV HM mg dose prior to conversion to PO and the oral opioid mg dose used in the 24 hours prior to discharge. Results: Among 394 eligible patients on IV HM, 147 underwent conversion to PO HM and 247 underwent OR to oral morphine (163) or oxycodone (84). Mean age was 54 years, 39% were male, and 95% had advanced cancer. Median time between conversion to PO and discharge was 2 days. In 147 patients the median CR (IQR) from IV to PO HM was 2.5 (2.1-2.7) and correlation of IV to PO dose of HM was .95 (P < .0001). The median CR was 2.5 in patients receiving < 30mg of IV HM/day and 2.1 in patients receiving ≥ 30mg of HM/day (P = .004). In 247 patients the median ORR (IQR) from IV HM to MEDD was 11.5 (10-13) and correlation of IV HM to MEDD was .93 (P < .0001). The median ORR was 11.5 in patients receiving < 30mg of IV HM/day and 9.9 in patients receiving ≥ 30mg of HM/day (P = .0004). ORR from IV HM to MEDDs obtained from morphine (11) and oxycodone (12.1) were significantly different (P = .0023). The CR and ORR were not significantly impacted by other variables. Conclusions: The median CR from IV to PO HM is 2.5 and ORR from IV HM to MEDD is 11.5. This implies that 1 mg IV HM is equivalent to 2.5 mg PO HM and 11.5 mg MEDD. HM may cause hyperalgesia at doses ≥ 30 mg/day and thereby requires a lower ORR to other opioids.
Time trade-offs in advanced ovarian cancer.
Authors: Wenzel Lari B. , Mukamel Dana B , Cohn David E. , Havrilesky Laura , Wright Alexi A. , Lipscomb Joseph , Sparks Lisa , Ladd Heather , Osann Kathryn
Published: February 2017

20

Background: Most women with advanced ovarian cancer develop recurrence and die within five years of diagnosis. This creates a clinical imperative to discuss tradeoffs between the risks and benefits of treatment options. The purpose of this study is to examine the experience of ovarian cancer patients presented with a decision aid leading them through a time-tradeoff (TTO) exercise to guide choice of therapy. Methods: Newly diagnosed advanced ovarian cancer patients (N = 64) participated in a study evaluating the effectiveness and usefulness of a Patient-Centered Outcome Aid (PCOA). This i-Pad based interactive aid included an exercise during which patients evaluated personal tradeoffs between longer survival and adverse events associated with chemotherapy, in consultation with providers. Patients were educated about potential side effects, asked to rank their concerns about each side effect, and then asked: “Now that you have thought about and ranked the side effects, we ask you to think about the worst side effect for you as it relates to survival in good health. Would you be willing to go through 6 months of your worst side effect, if it gave you 5 years of good health?” There was a forced choice (Yes vs. No); then the tradeoff question was repeated with decreasing survival times: i.e. 3 years, 1 year, and 9, 6, 5, 4, 3, 2, and 1 months. Results: Of the 61 patients who responded to the TTO question, 52% required 1 or more years of good health to endure 6 months of their worst side effect. Among the non-neoadjuvant patients (N = 50), 18% indicated they would trade 6 months of the worst side effect for 1-2 months of additional life in good health, however 56% would require 9 months or more. While 95% of patients found it easy to rank order concerns about side effects, 75% considered the TTO question difficult to answer. Conclusions: Decisions aids which incorporate tradeoffs must be designed with sensitivity to differential health literacy levels, and the extremely personal nature of this decision.
Patterns of radiation therapy technology use in the treatment of bone metastases.
Authors: Chan Matthew , Olson Robert Anton , Lefresne Shilo , McKenzie Michael R.
Published: February 2017

211

Background: In recent years, there has been a transition from two-dimensional radiation therapy (2DRT) planning towards more advanced techniques such as three-dimensional conformal radiation therapy (3D-CRT), volumetric modulated arc therapy (VMAT), and stereotactic body radiation therapy (SBRT). Our study aim was to analyze these trends in the treatment of bone metastases. Methods: All patients aged 18 and older who had received palliative intent RT for bone metastases between 2009-2014 and referred to any 1 of 6 regional cancer centers in British Columbia, Canada were reviewed. Summary statistics were used to describe radiation technique patterns. Logistic regression modeling was used to assess the influence of demographic, clinical, and health services variables on receipt of types of RT. Results: We identified 8,059 patients and 15,832 courses of RT; overall, 97.9% of courses were achieved by 2DRT and 2.1% by 3D-CRT, VMAT, or SBRT. Despite the low overall use of advanced techniques, its use was significantly higher in all subsequent years compared to 2009 (p < 0.05 for all years). The median age for patients treated with 2DRT was 67.0 (19-99) versus 66.0 years (19-93) for advanced techniques. There did not appear to be a statistically significant difference in age at the time of treatment start (OR 0.99; 95% CI 0.981-1.00, p < 0.05). Compared to lung cancers, thyroid (OR 9.9; 95% CI 5.197-18.724, p < 0.001) and kidney cancers (OR 3.9; 95% CI 2.508-5.911, p < 0.001) were significantly more likely to be treated with advanced techniques, while breast (OR 0.90; 95% CI 0.621-1.306, p = 0.58) and prostate cancers (OR 0.93; 95% CI 0.613-1.410, p = 0.73) were not any more likely. Compared to the Vancouver center, all other treatment centers in the province were utilizing advanced techniques less frequently. Patients were also more likely to complete RT with 2DRT than with advanced techniques (98.3% versus 95.8%, p < 0.05). Conclusions: The vast majority of treatment of bone metastases is still done by 2DRT in British Columbia. Despite these overall statistics though, a trend towards increasing use of more advanced techniques was observed.
The inclusion of palliative care in initial treatment planning for women with gynecologic cancer and the use of advanced directives.
Authors: Regn Rachel , Robinson William , Robinson William R.
Published: February 2017

23

Background: To determine differences in Advanced Directive (AD) utilization among women with gynecologic cancer at a facility with a functioning Palliative Care (PC) program, vs those in a facility without access to a PC program. Also, to identify possible ethnic differences or relationships to other PC needs to AD utilization. Methods: 95 subjects with gynecologic cancer were prospectively identified, 30 from an inner-city academic facility (Site A), and 65 from a suburban community facility in the same metropolitan area. (Site B) All patients received treatment from board-certified oncologists. All subjects were approached by Master’s trained Social Workers at presentation with a diagnosis of cancer and asked to complete a standardized, validated questionnaire (modified Distress Thermometer (DT)) to determine their palliative care needs and whether they had an AD prior to treatment (baseline), and 6 months later. Completed questionnaires were collected and data was depersonalized and analyzed by the authors. Statistical differences were assessed using standard methods. Results: Site A patients were younger (56.3 vs 61.5 years) less likely to be Caucasian (12/30, 40% vs 40/65, 61.5%) and less likely to have private insurance (10/30, 33.3% vs 41/65, 63%). The presence of AD was similar in both sites at baseline. (8/65, 12.3% vs. 4/30, 13.3%) At 6 months, Site B patients were more likely to have an active AD. (50/65, 77.0% vs 5/30, 16.7%) No differences were seen based on ethnicity (Caucasian vs. Black) at either baseline or 6 months. No differences were seen based on the stage or type of gynecologic cancer. No relationship between AD utilization and any other PC needs (as recorded by DT) were identified. All differences were significant at a p < 0.05. Conclusions: Advanced Directive utilization is uncommon in women diagnosed with gynecologic cancer in the facilities analyzed. Subsequent creation of an AD is strongly associated with the presence of a PC program. PC programs have multiple benefits for gynecologic cancer patients, and should be offered routinely as part of the initial treatment plan.
Psychological distress and communication with children about a parent's advanced cancer: A mixed-methods study.
Authors: Hailey Claire Emery , Yopp Justin M , Deal Allison Mary , Mayer Deborah , Reeder-Hayes Katherine Elizabeth , Hanson Laura C , Grunfeld Gili , Rosenstein Donald L , Park Eliza M
Published: February 2017

236

Background: Cancer affects 1.6 million parents with dependent children in the United States, many of whom experience heightened distress related to the impact of their illness on children. Palliative medicine and oncology providers frequently recommend open communication with children. However, there is little empirical research on the relationship between illness-related communication with children and parental psychological distress. The objective of this study was to explore the association between parental psychological distress and communication with children about a parent’s advanced cancer. Methods: This was a cross-sectional, mixed-methods observational study of patients with stage IV solid tumor malignancies who had at least one dependent biologic or adopted child. Participants completed the Hospital Anxiety and Depression Scale (HADS) and a semi-structured interview. Reports of illness-related communication with children were categorized as “minimal,” “partial,” or “full.” We conducted linear regression models to evaluate the association between extent of communication and HADS scores. Results: Of the 42 parents, 7 participants (17%) had minimal illness-related communication with their children, 13 (31%) had partial communication, and 22 (52%) had full communication including discussion of their prognosis. HADS Anxiety scores, but not HADS Depression scores, were higher with greater extent of communication (4.1 vs. 7.6 vs. 10.4, p = 0.003), even when controlling for performance status and children’s age. Conclusions: In this pilot study, parents who had more extensive communication with children about their advanced cancer and prognosis also reported more symptoms of general anxiety. Palliative and supportive care interventions should address psychological distress relevant to parenting and should provide guidance for communicating with children.
Female cancer patients’ awareness and role in family-based medical decision making mode in Confucian area.
Authors: Li Xing , Xing Yan-Fang , Lin Qu , Wei Li , Dong Min , Ma Xiao-kun , Chen Zhan-hong , Chen Jie , Ruan Dan-yun , Lin Ze-Xiao , Wang Tian-tian , Wu Dong-hao , Wu Xiang-yuan
Published: February 2017

237

Background: Medical decision making of Chinese patients was family based, especially for female cancer patients. However, few studies have systematically investigated female patients. We aimed to illustrate the determinant of female cancer patients’ role in decision making. Methods: A total of 286 adult female cancer patients were included in this study between September 1st 2013 and December 31st 2013 from 13 leading general hospitals across China. A questionnaire was given to the oncologists in charge to evaluate each patient concerning the interaction between family and cancer patients, patients’ awareness of disease and participation in medical decision making in mainland China. In this study, the family statuses of patients were ranked as superordinate (one who was the major decision maker in family), equality (one discussed important issues with family members and made decision with consensus of family members), and subordinate (those who usually don’t be involved in significant family issues). Results: Among the 286 cancer patients, only 29 (10.1%) patients made decision themselves. 221 (77.3%) patients delegated decision making to their family. The rest of 36 (12.6%) patients were involved in decision making. Patients with nonlocal insurance, which meant they traveled to the major cities for advanced medication, were inclined to let their family members make decision for them. Patients’ family status significantly determined their participation in medical decision making. Female patients as superordinate family members (4.5%), tend to play a positive role in medical decision. By contrast, patients with subordinate role in family (66.4%) persistantly play a passive role in medical decision making. Violation of medical recommendation increased according to the severity of patients’ prognosis. Cancer progression (90.6%), financial expense (65.7%) and life expectancy (94.1%) was always hidden from female patients by their families, especially for those with incurable disease. Conclusions: Medical decision making of female Chinese cancer patients was mainly family based. Female patients’ awareness of disease and participation in medical decision making was still needs improvement.
Experience of patient death and subsequent bereavement by members of the oncology team in the outpatient setting.
Authors: Easton Eve
Published: February 2017

244

Background: Working with cancer patients is considered inherently stressful with high levels of burnout reported. There is limited research that focuses on the multidisciplinary team as a whole; research to date tends to focus on patient death from the perspective of the bedside oncology nurse, the physician or social worker. With the focus on those disciplines individually, thereby ignoring the centrality of the multidisciplinary nature of oncology care and excluding fundamental team members who provide care and are potentially impacted by the death of the patient. What is evident in current research is that long term meaningful relationships are developed between members of the multidisciplinary team and patients, with the consequences and implications of unresolved or unacknowledged grief being well documented as burnout and compassion fatigue. It is suggested that better support, acknowledgement of patient death and grief has implications for individual staff wellbeing, for staff training, support and the healthcare system, all of which have impact on the quality of patient care, improve retention, decrease burnout and compassion fatigue. The aim of this research is to explore the experience of death and subsequent bereavement from the perspective of those healthcare professionals who provide direct patient care at an outpatient oncology clinic. Methods: A qualitative study using a phenomenological approach was conducted to explore multidisciplinary team members experiencing regarding patient death and subsequent bereavement in the outpatient oncology setting. Individual interviews were conducted with 11 members of staff from 5 oncology teams based in the outpatient clinic of a magnet designated hospital. Results: Qualitative analysis yielded the following themes: insight, mortality, relationships, communication, grieving and bereavement, training and education, support and coping. Conclusions: To understand how patient death affects team members who provide patient care and support mechanisms used. Participants identified a need for acknowledging patient death in the work environment and had multiple suggestions for creating a supportive environment.
Association between abdominal adiposity, muscle mass, and metabolic syndrome in survivors of testicular germ cell cancer.
Authors: Thein Kyaw Zin , Osai William , Tu Shi-Ming , Pagliaro Lance C. , Kim Jeri , Yeung Sai-ching J.
Published: February 2017

250

Background: Testicular germ cell tumor survivors (TGCTSs) contend with treatment side effects for decades after cure, and many have metabolic syndrome (MTS), a modifiable cardiometabolic risk factor. Because reliably predicting MTS could prompt interventionreducing risk, we analyzed clinical data and body composition in computed tomography (CT) scans to identify associations. Methods: In a retrospective review of 196 TGCTSs treated at a single institution from 1970 to 2007, we collected patient (pt) demographics, clinical data, body fat composition measures, and evidence from CT scans from baseline through posttreatment. NIH Image J was used to analyze cross-sectional CT images and measured subcutaneous adipose tissue, visceral adipose tissue, and skeletal muscle. Visceral fat-to-muscle ratio (VMR), visceral-to-subcutaneous fat ratio (VSR), and change in VMR and VSR from baseline to 3 to 5 years posttreatment (ΔVMR and ΔVSR) were calculated. We also gathered posttreatment glucose, blood pressure, lipid data, and body weight and height measured at time of scans. The 2001 U.S. National Cholesterol Education Program Adult Treatment Panel III guideline defined MTS. Univariate and multivariate logistic regression analyses identified associations. Results: Of the 167 pts included in the final analysis, 37.7% had MTS, 76.6% were white, and 68.9% had chemotherapy. Pts with MTS had significantly higher VMRs (p = .007) and VSRs (p = .021) than those without. Pts receiving chemotherapy and radiotherapy were significantly more likely to have MTS (p = .044 and p = .037). A multinomial logistic regression model including year of diagnosis, age, race, tumor histology, treatment, VSR, and VMR identified the association of high VMR and VSR with MTS; ΔVMR and ΔVSR were not statistically significant predictors. Conclusions: Body composition analyses identified VMR and VSR as significant predictors of MTS.
Impact of support group participation in women with gynecologic cancer.
Authors: Garrick Andrea , Pyrzak Adam , Hu Fengjiao , Sadek Ramses F. , Wheatley Donna , Rungruang Bunja Jane , Ghamande Sharad A.
Published: February 2017

252

Background: Unlike breast cancer support group literature, there is no data in women with gynecologic cancer who have different perspectives about their disease and therapy. We have a well-established, 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 an original 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 which was distributed to patients attending CGOSG meetings. 47 surveys were collected for analysis; Wilcox rank sum test was used as appropriate. Patients were also administered the validated FACT-G questionnaire addressing physical well-being (PWB), emotional well-being (EWB), social well-being (SWB), and functional well-being (FWB). 33 surveys were collected, and t-tests were conducted using FACIT SAS scoring program. Results: In the original questionnaire, the 2 top reasons that patients attended CGOSG were physician driven (28%) and to meet other women with the same diagnosis (26%). The most concerning physical side effect from their cancer or therapy was fatigue (21%), and patients with more than 5 visits reported that CGOSG participation improved their fatigue with a median score of 7.5 ± 4 out of 10. The most concerning emotional side effect was fear of recurrence (26%), and patients reported the CGOSG improved their 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. Among patients who took the validated FACT-G questionnaire, those on active treatment had a lower PWB than patients not on therapy (p = 0.01). The mean subscale scores were PWB 21.99, SWB 24.26, EWB 20.08, FWB 20.92 with patients faring best in social well-being. 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 but are able to find some solace.
Symptom burden and distress in patients with cancer in Africa.
Authors: Weru John K.
Published: February 2017

255

Background: Cancer has become a significant public health problem in Africa but still most diagnoses are made late, Sitas et al (2006). The need for palliative care is significant due to the late contact with health care providers and the many symptoms they present with. No study has been undertaken to assess symptomatology for these patients in Africa. Objective: To study the prevalence of symptoms in patients with cancer in an African setting. Methods: Symptom studies from records of patients with cancer referred to the Palliative Care Services at the Aga Khan University Hospital, Nairobi in 6 months. Symptoms charted on Edmonton Symptom Assessment Scale. Results: 42 patients were referred to the service in this period. All the patients reported > 3 symptoms which cut across the physical, social, psychological and spiritual concerns. The most common symptoms were pain in the physical dimension (90%) as reported by the patient. Fatigue was reported by (93%).Family wellbeing was the main worry in psychological dimension (95%). 94 % reported social disconnect due to the diagnosis, job losses and huge cost of health care. 96% suffered from the existential question of why me and worry about the future. Conclusions: Cancer has become a major burden to patients, families, societies and nations in Africa. Patients suffering from this illness experience a myriad of symptoms which require holistic approach to care. Social wellbeing remains a major concern for patients with cancer in Africa.
Survivor pain: Experience at an oncology palliative care clinic.
Authors: Zanartu Cristian , Emond Lisa , Wojtaszczyk Ann
Published: February 2017

260

Background: As of January 2014 there are an estimated 14.5 million cancer survivors in the United States. In observational studies of cancer survivors up to 40% report chronic pain. Opioids remain an important and effective treatment for active cancer pain. For survivors, however, we must take into account the paucity of data supporting long term benefits of opioids on pain and functional outcomes, and extensive evidence of potential harms. We present data from our palliative care clinic where we have established a nuanced approach to pain management in this population, which includes risk mitigation, consistent education, emphasis on non-pharmacological and non-opiate medications, and attempts to down-taper opioid analgesics when feasible. Methods: Retrospective, observational chart review of 62 patients identified as cancer survivors, who have been managed for pain, at an academically affiliated palliative care clinic embedded in the oncology department. Demographic information, baseline and latest visit pain scores and functional assessments, as well as pain regimen data were collected. Means for pain and functionality scores were compared for those patient’s with differing opioid regimens and nonpharmacological treatments. Results: Of the 62 patients reviewed, 48 were tapered off opioid medication. In the patients who were tapered off opioid medications, 8 (16%) showed an increase in average pain scores, 11 (22%) showed no change in average pain scores, and 29 (60%) showed improvement in average pain score. Conclusions: In 82% of the patients whose opioid medications were decreased, average pain scores either remained the same or actually improved over time. This is encouraging data to support the theory that decreasing opioids in cancer survivors does not worsen pain control in the majority of that population.
A novel risk stratification model for patients with brain metastasis: Incorporating with physiological signals.
Authors: Wang Yu-Ming , Ho Tsung-Ying , Huang Eng-Yen , Wang Chong-Jong
Published: February 2017

38

Background: Brain metastasis (BM) develops in 10%-40% of patients with malignancies. Survival expectancy is critical for choosing an optimal treatment for BM patients. Previous reports have proposed different risk stratification systems based on clinical and image-related factors. Heart rate variability (HRV), a physiological factor, has also been reported as a novel prognosticator for BM patients. In this study, we proposed a novel risk stratification model for BM patients by incorporating HRV signals. Methods: Patients with BM referred to our department for palliative RT were prospective recruited. Those who were not suitable for HRV evaluation were excluded for analysis. A 5-minute ECG was acquired before treatment started for each patient for subsequent HRV signal analysis. All patients underwent WBRT for 30-37.5 Gy in 10-15 daily fractions. Local boost to gross intracranial tumors were performed selectively. The primary end-point for this study was overall survival (OS). Survival analysis was carried out by Kaplan-Meier method and factors were compared by log-rank test and cox-regression. A novel risk stratification model combining HRV index SDNN and KPS was proposed. Results: Total 62 patients were recruited from Jan 2010. The median follow-up time was 40.7 months for patients who were still alive. Only 1 patient (1.6%) met the criterion of RPA class I. The median OS for all patients was 4.5 months. Univariate and multivariate analysis revealed that SDNN ≥ 10ms and KPS ≥ 70 were independent survival prognosticators. For a selected group of patients (n = 29, Group 1, SDNN ≥ 10ms and KPS ≥ 70) the median OS was 9.9 months, which is significantly higher than the rest 33 patients (Group 2) as of 2.4 months. The 3-month/6-month OS rate in Group 1 and Group 2 were 82.8%/72.4% and 36.4%/24.2% (p < 0.001). Conclusions: Using physiological factors for risk stratification is novel. Our results demonstrated that a group of patients with potential longer survival could be selected by using HRV index and KPS. This group of patients should be considered differently in treatment selection. Further studies are warranted to validate our findings and improve the quality of care in patients with BM.
Attitude and support to inform clinical predictions of survival in patients with advanced cancer.
Authors: Fairchild Alysa M. , Ma David L , Paulson Kim , Ghosh Sunita , LeGuerrier Bronwen , Chu Karen P , Severin Diane , Huang Fleur , Watanabe Sharon , Huot Ann , Amanie John , Patel Samir , Nijjar Tirath , Wiebe Ericka , Danielson Brita Lavender , Debenham Brock J
Published: February 2017

39

Background: Tumour factors (eg primary site, size) helpful in prognostication in early stage cancer may be less important than patient factors, such as Karnofsky performance status (KPS), later in the disease trajectory. We evaluated the utilization of the parameters attitude (ATT) and psychosocial support (PSS) in predicting remaining lifespan by two experienced multidisciplinary teams (MDT). Methods: After clinical assessment of consecutive patients, a quantitative clinical prediction of survival (CPS) was made prospectively, independently and anonymously by each health care provider (HCP). HCP recorded up to 4 factors (free-text) influencing their CPS. The Palliative Radiation Oncology (06/2010-12/2014) and Palliative Care (06/2012-01/2014) teams participated. Demographics, disease information, and date of death were abstracted. Summary statistics (means, standard deviations, and proportions) were calculated. Estimates for actual survival (AS) were obtained. Wilcoxon tests compared continuous variables and chi-square tests were used for categorical variables. Results: 2,582 predictions were made by 11 disciplines for 881 unique patients over 1,054 clinic visits. Median age was 66 years, 58.6% were male and 37.3% had lung cancer. KPS, when recorded, was ≥ 70 at 46.3% of visits. Cognitive status was below expected for 174/460 visits. Mean AS was 177 ± 190 days and mean CPS was 258 ± 300 days. The median number of factors cited was 4 (range 0-4), with disease extent most common. ATT and PSS as perceived by the HCP influenced 6.7% and 5.8% of CPS respectively, varying across disciplines (p < 0.0001). Overall, mean CPS was significantly longer when ATT (337d vs 252d; p < 0.0001) or PSS (310d vs 254d; p < 0.004) was quoted. CPS estimates by Nursing and Students were longer when ATT was mentioned (both p < 0.004). Students’ CPS were longer when PSS was described (p = 0.048). Mean AS was also longer when ATT (259d vs 178d; p < 0.0001) or PSS (224d vs 181d; p = 0.03) were cited overall, as well as within the Nursing, Student and Pharmacist groups (all p < 0.05). Conclusions: Attitude and available psychosocial support as evaluated by MDT appeared to correlate with both clinical prediction of survival and actual survival in this cohort.
Patients' perception of palliative treatment objectives.
Authors: Elsayed Ahmed Gamal , Tirona Maria R. B. Tria
Published: February 2017

43

Background: Palliative chemotherapy and radiation are often used in patients with advanced stage of cancer. To weigh the risks and the benefits of this treatment, patients need to be adequately informed about all treatment aspects including the side effects and potential benefits. Unfortunately, many patients are not well informed about the goal of their treatment, and many are under the impression that this treatment can be curative. Methods: This is a prospective survey based study that enrolled 46 patients with stage IV disease of all solid malignancies, who are being treated with palliative intent at the Edwards Comprehensive Cancer Center. Patients were given a questionnaire designed to test their level of knowledge of their current treatment goals, and to evaluate the efforts of health care team to educate patients. Results: 35% of patients had lung cancer, 34% had GI cancer, 14% had breast cancer and 13% had GU cancers. 37% of patients were under the impression that they are receiving curative treatment, 28% were not sure about the goals of the treatment, while only 35% of patients understood that the treatment was not curative. 91% of patients received written educational material. 93% of patients chose personal communication with the physician as their preferred method of getting educated about their disease. Conclusions: Our data shows that most of the patients at our local cancer center who are actively receiving treatment with palliative intent are satisfied with amount of time spent with physician and have received written educational material. Despite these efforts, a majority of patients are still not clear on the treatment goal. Most patients chose personal discussion as the preferred method of education. Hence, physicians on staff were informed about the results and further emphasis on treatment goal during counseling is being undertaken. [Table: see text]
ICU deaths in patients with advanced cancer: Criteria to decrease potentially inappropriate admissions and analysis of advance planning discussions.
Authors: Nasir Syed Sameer , Weir Alva B
Published: February 2017

47

Background: A significant number of advanced cancer admissions to intensive care unit (ICU) are inappropriate, as they do not prolonged survival. No clear consensus criteria for reasonable admissions of advanced cancer patients have been developed. Methods: We established four criteria for ICU admissions in advanced cancer patients: post procedure complication, recent cancer diagnosis, good performance status and life expectancy of > 6 months. We reviewed charts of all patients who died in the ICU at a university-affiliated hospital between 2005-2010. We then identified advanced cancer patients and looked for presence or absence of these criteria. We also reviewed evidence of advance planning discussions (APDs), prior to ICU admission to evaluate their benefit in preventing inappropriate admissions. Results: 421 deaths occurred in ICU between 2005-2010. 52 patients had advanced cancer. 27% were diagnosed with cancer one month or less prior to admission. 40% had ECOG performance status of 0-1. 27% had life expectancy of more than 6 months and 15% were admitted for post procedure complications. Overall, 37% did not satisfy any of our reasonable criteria at the time of ICU admission. In our chart review for evidence of APDs, 31% had completed APDs prior to ICU admission. 47% of patients who did not satisfy any of our reasonable admission criteria had APDs indicating desire for limited medical intervention. Patients lacking both reasonable admission criteria and APDs were 15%. Conclusions: Incorporating proposed admission criteria in ICU admission guidelines may prevent significant number of inappropriate, advanced cancer admissions to the ICU, thus avoiding ineffective, aggressive interventions and delay in timely access to high-quality hospice and palliative care. Our data confirms other data in suggesting that a simple increase in numbers of APDs would not likely change significantly the numbers of inappropriate ICU admissions. [Table: see text]
Decision of palliative chemotherapy in late-stage cancer: The doctor-patient relationship and the decision-making process as seen by an oncologist.
Authors: Scotte Florian , Pechard Marie , Krakowski Ivan , Tournigand Christophe , Viallard marcel-Louis
Published: February 2017

48

Background: We conducted a literature review on the administration of palliative chemotherapy in cancer patients at advanced stage. We wondered about ethical tensions encountered by the oncologists during the decision process to meet or not the patients' demand to have access to a palliative chemotherapy at a late stage of the disease. Methods: We conducted a multicenter, qualitative study of senior oncologists in university hospitals and cancer centers in France, by carrying out interviews with eleven oncologists. Results: The study are consistent with the literature showing that factors are in favor of treatment continuation: the patient's age, his desire to continue treatment and his life expectancy. The decision making process of chemotherapy discontinuation is marked by uncertainties, personal representations of the doctor and subjectivity in front of the objective facts that could make this decision difficult. The working conditions in cancer care and the valuation of the chemotherapy prescription can impact the decision. The constant medical progress in oncology make more complex the decision of stopping specific treatments. This study showed the singularity of the doctor-patient relationship in oncology. This can explain the difficulty to stop chemotherapy. Conclusions: The oncologist can use the collegiality which are necessary for decision to limit specific treatment. The objective is to propose the adequate care to the patient in all its dimensions. Some actions can be proposed to improve our practice: early use of palliative care for patients, analysis of practices and training to deal with uncertainty and the limits of possibilities in clinical practice.
Emotional disclosure in home hospice cancer care: Implications for spouse caregiver bereavement.
Authors: Reblin Maija , Ellington Lee , Clayton Margaret , Caserta Michael , Lund Dale , Mooney Kathi
Published: February 2017

54

Background: Evidence shows the benefit of positive and negative emotional disclosure for family caregivers (CG), but little is known about the impact of emotional disclosure at end of life. We assessed the effect of CG and hospice nurse disclosure during home visits on CG anxiety and depression in bereavement. Methods: As part of a larger study, nurse visits to 95 spouse CGs of cancer home hospice patients were audio recorded. An adapted Roter Interaction Analysis System was used to identify emotional disclosure: CG and nurse positive emotion (humor, gratitude), CG distress, and nurse emotional response (reassurance, validation). CGs completed demographics at hospice enrollment, and HADS anxiety scale, and Geriatric Depression Scale (GDS) at enrollment, and 2, 6 and 12 months after patient death. Growth curve analysis was conducted to predict HADS and GDS trajectories, controlling for CG gender, total talk, anxiety and depression at enrollment. Results: Average spouse CG age was 65; 60% were female and 98% were white. There were no GDS effects for CG expression of distress or nurse emotional response. Higher CG positive emotion talk predicted higher GDS at 2 months (B = .18, p < .01), but a significant decline of GDS over time (B = -.08, p = .03). There were no effects for CG emotional disclosure on anxiety. However, more nurse emotional response predicted lower anxiety at 2 months (B = -.10, p = .02) which did not significantly change over time. More nurse positive emotion did not impact anxiety at 2 months, but predicted lower anxiety over time (B = -.04, p = .04). Conclusions: Emotional disclosure during cancer hospice visits was associated with spouse CG bereavement trajectories. CG positive emotion talk may signal increased potential for depression early in bereavement, but appears to lessen over time. CGs who express more positive emotion, which includes humor, gratitude and savoring the moment, may be more sensitive to loss, but appear to recover in time. Nurse expression of reassurance and validation, and of positive emotions seems to be effective in addressing and normalizing CG anxiety during bereavement. These findings have potential implications for communication interventions.
Survival benefits among patients with end-stage renal disease receiving dialysis versus no dialysis.
Authors: Dahbour Ibrahim Nayef , Abdelrahim Maen , Page Valda D , Zhou Shouhao , Shen Chan , Yennu Sriram , Zhao Bo , Manzano Joanna-Grace Mayo , George Marina Ciny , Nates Joseph L. , Moss Alvin Howard , Pai Rima , Abudayyeh Ala
Published: February 2017

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Background: Retrospective study of the outcomes of Stage IV Cancer Patients with End Stage Renal disease Receiving Dialysis and comparing the survival benefits among the patients who received Hemodialysis versus who didn’t at a Comprehensive Cancer Center. Methods: Retrospectively review all patients admitted to MDACC from 2005-2014 and diagnosed with stage IV solid tumor admitted with Acute kidney injury and a nephrology consult were included (N = 903) 19.82% received dialysis (n = 179) versus 80.17% did not receive dialysis (n = 724). The main endpoints of the study to be evaluated would be survival & hospital death. Results: Kaplan-Meier overall survival curve of the dialysis group vs the non-dialysis p-value < 0.001 indicating that patients who underwent dialysis had a poorer overall survival. This was further explored in a multivariate model where at any given time; a patient who underwent a dialysis is 1.318 times as likely to experience a death as a patient who did not undergo a dialysis with the same other clinical factors. The association between dialysis and death in hospital was explored using multivariate model indicated dialysis (odds ratio = 3.339, 95% CI (2.212, 5.04), p < 0.001, ICU (odds ratio = 2.624, 95% CI (1.905, 3.613), p < 0.001), and a lower serum albumin level (p < 0.001) are factors associated with a higher probability of death in hospital. Matched sample where evaluated using propensity score matching & Weighting and the dialysis group still shows a significant negative effect on Overall Survival with (p = 0.003). ICU patients Subset Analysis & SOFA Score: 49.9% had ICU visits in our database with SOFA scores (37.9% were dialyzed). Using propensity score weighting method, the estimated hazard rate is 0.892 with 95% CI (0.775, 1.027) and p = 0.113, showing NO evidence that dialysis is a prognostic factor for ICU patients after controlling SOFA score. In the ICU cohort, the median survival time for dialysis 18 days (95% CI: 14-23) and no dialysis 19 days (95% CI: 15-25). Conclusions: We can conclude that Dialysis when offered to advanced cancer patients does not improve mortality. Creating a hemodialysis prognostic tool relevant to cancer population would be of great benefit to Nephrologists, Oncologist and patients.
Clinical and health care setting of patients admitted at Pain Control Center Hospice of Solofra: A feasibility model of end-of-life care in the Avellino province of Italy.
Authors: Genua Geppino , Fasano Carmela , Rizzo Luisa M. , Strollo A. M. , De Vinco Elena , Landolfi Vincenzo , Altieri Elena , Ferrante Mario Nicola Vittorio , Canzanella Sergio , Servillo Giuseppe , Genua Lucia , Zampi Maddalena , D'Onofrio Gaetano
Published: February 2017

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Background: The Pain Control Center Hospice of Solofra (Italy) is managed with a mixed public / private, the first experience in the Campania region.We have evaluated the treatment procedures and the clinical outcome to make a comparison by between 123 evaluable patients in palliative care in 2015 and 232 evaluable patients in the biennium 2012-2014. Methods: The following characteristics: patient gender, mean hospitalization time, differentiation between cancer and non cancer patients, medical weapon use, venous access type, enteral and parenteral feeding, pain killer use,Karnofsky scale. Results: the average age is nearly overlapping being 70.5 yr vs 70.69 yr; average length of stay in hospice 24.33 days vs. 27.52 days; 79.67% had cancer vs 73.70%, while the non-cancer 20.32% vs 26.30%; 55.26% died in hospice vs 71.98%, while 44.7% were discharged home vs 24.56%; the performance status according to Karnofsky scale before admission to hospice 23.1% had index rating (%)- 50, 10.56 -40, 52.03%-30, 35.7%-20, 23.1%-10. 8.9% had ostomy vs 13.79%; 4.4% were carriers of PEG vs 6.3%; the central venous access already implanted at admission in 32.52% vs 26.72%; enteral feeding was administered in 23.7% vs 13.79% and parenteral feeding in 52.84% vs 46.98%; analgesic therapy with more opiates was already present on admission in 48.78% vs 40.94% with prevalence of trans TD formulations. Analgesic therapy was administered during the hospitalization in 66.66% vs 81.89%. 14.28% of cancer patients in 2015 have received morphine treatment vs 15.3%, 22.11% oxycodone / naloxone vs 19%, 58.16% trans-dermal fentanyl vs. 34%, 14.7% have supplements onset fentanyl, 2.4% with tapentadol vs na, 15.30% tramadol vs 9%, 4.2% codeine vs 15.3%. Conclusions: This report is a feasibility model of end of life-care in the Avellino province submitted to the public administrative control with the private organization supporting House Hospital Onlus. The present study shows gradual improvement of the knowledge of palliative care by the family doctors and the population of a territory with peculiar topography and induces public health authority to improve the care offered.
Breakthrough cancer pain (BTcP) and quality-of-life outcomes.
Authors: Stati Valeria , Spinelli Gian Paolo , Gozzi Elisa , Rossi Belardino , Tomao Silverio
Published: February 2017

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Background: Breakthrough cancer pain (BTcP) is frequent in patients with advance solid tumors and is always associated with worsening of the quality of life (QoL). There are few studies in the literature on the effect of BTcP treatment on QoL. The aim of this analysis was to provide a qualitative evaluation of the effect of BTcP therapies considering different fentanyl formulation(nasal spray, lollipop or buccal tablets) on the QoL of treated patients. Methods: In our study, we enrolled patients with different advanced solid cancer treated with active and/or palliative therapies. All patients included have a baseline analgesis therapy and showed frequent BTcP episodes during the day. The patients were evaluated with a simultaneous care control (medical oncologist, palliativist, psychologist and nurse) every week for four consecutively weeks after initiating treatment with BtcP medicaments. A questionary about BtcP and QoL evaluation (QoL-BTcP scale) was administered. It was also completed by an interview during periodic visit. The main parameters investigated were frequency of BTcP, cancer pain value (NRSscale), fentanyl formulation for BTcP (nasal spray, lollipop or buccal tablets), time of onset of cancer pain relief and adverse events correlated with use of BTcP medicaments. At each simultaneuous care evaluation the authors evaluated the impact of BTcP medicaments on psychologic aspects using a validated Anxiety, Depression and health status Scale integrated to QoL-BTcP questionary (QoL-BTcP scale). Results: A total of 35 patients with > 2 BTcP episodes/die were enrolled (50% from 2 to 4 episodes, 45% from 5 to 6 episodes and 5% for those patients with more than 6 episodes). QoL-BTcP scores showed significant improvement in the QoL in terms of depression and other psychologic aspects in the first two subgroups (from 2 to 6BTcP episodes). The QoL-BTcP scale was worse in more depressed patients and in those patients at the end of life. Conclusions: QoL-BTcP scale is a reliable and valid instrument for measuring QoL correlated to efficacy and tolerability of BTcP drugs. Results provide some suggestions for the development of programs to evaluate QoL in patient with cancer pain and implement BTcP interventions among cancer survivors.