bluuebunny/crossref_metadata_2025 huggingface dataset:
Guideposts for Inserting Intercuneiform Joint Arthrodesis Screws: Analysis Using Multiplanar Reconstructed Computed Tomography
Authors: Maenohara Yuji , Matsumoto Takumi , Chang Song Ho , Hirose Jun , Tanaka Sakae
Published: November 2018

Intercuneiform arthrodesis is often required for various midfoot pathologies; however, intercuneiform screw insertion is not easy due to the complicated anatomical structure of cuneiforms. This study aimed to determine the advisable screw entry point and direction using intraoperatively detectable landmarks. The computed tomography (CT) scan data of feet were reformatted using OsiriX software multiplanar reconstruction. First, based on the data of 10 CT scans of normal feet, we determined the advisable screw entry point at the upper one-third in the dorsoplantar direction and center in the anteroposterior direction on the medial aspect of the medial cuneiform and insertion direction toward the outermost point of the base of the fifth metatarsal in the axial plane and parallel to the plantar surface in the coronal plane. Second, we examined the accuracy of these newly designed guideposts in the simulation using other CT scan data of the other 27 normal feet and 12 flat feet. The simulated screw trajectory penetrated the mid three-fifths of all three cuneiforms in 97% of the normal feet and 92% of the flat feet with no cases of cortical wall violation.

Levels of Evidence: Level V: Expert opinion
Complementary and Alternative Medicine in Chronic Rhinosinusitis: A Systematic Review and Qualitative Analysis
Authors: Jin Andy J. , Chin Christopher J.
Published: November 2018

Background

Complementary and alternative medicine (CAM) is frequently used in the treatment of chronic rhinosinusitis (CRS) in developed countries. With a plethora of CAM therapies available, their effectiveness and safety are poorly understood in the context of CRS.

Objectives

This article aims to critically appraise the evidence for CAM use in CRS through a systematic review of current literature that investigate the effects of CAM on symptoms and clinical status of adults with CRS.

Study Design

Systematic review and qualitative analysis.

Review Methods

A comprehensive systematic review of the literature was conducted by the authors using 5 databases from inception to July 2017: CINAHL, Cochrane, Embase, PubMed, and SCOPUS. Inclusive medical subject headings and keywords consisted of, but were not limited to, sinusitis and complementary therapies, naturopathy, or traditional Chinese medicine. PRISMA guideline was followed. Using templates by Cochrane Public Health Group and Newcastle-Ottawa Scale, each author extracted data, assessed bias, and computed minimal clinically important difference. Any conflicts were resolved through discussion.

Results

In total, 7 of 7141 articles from 1995 to 2016 were included. Three randomized controlled trials and 4 observational studies were organized into 4 categories of CAM: naturopathy, Chinese medicine, homeopathy, and others. Limited evidence supported the use of Pimpinella anisum and crenotherapy for CRS. Data available on Chinese medicine, homeopathy, and liposomal therapy in CRS were inconclusive due to inherent flaws in the studies.

Conclusion

Overall, there is very limited evidence to support the use of CAM in the treatment of CRS. No significant adverse effects have been found. Given its widespread use, more rigorous data from high-quality research are needed before it can be routinely recommended.
Opportunistic screening models for high-risk men and women to detect diastolic dysfunction and heart failure with preserved ejection fraction in the community
Authors: Gohar Aisha , Kievit Rogier F , Valstar Gideon B , Hoes Arno W , Van Riet Evelien E , van Mourik Yvonne , Bertens Loes C , Boonman-Winter Leandra J , Bots Michiel L , Den Ruijter Hester M , Rutten Frans H
Published: November 2018

Background

The prevalence of undetected left ventricular diastolic dysfunction is high, especially in the elderly with comorbidities. Left ventricular diastolic dysfunction is a prognostic indicator of heart failure, in particularly of heart failure with preserved ejection fraction and of future cardiovascular and all-cause mortality. Therefore we aimed to develop sex-specific diagnostic models to enable the early identification of men and women at high-risk of left ventricular diastolic dysfunction with or without symptoms of heart failure who require more aggressive preventative strategies.

Design

Individual patient data from four primary care heart failure-screening studies were analysed (1371 participants, excluding patients classified as heart failure and left ventricular ejection fraction <50%).

Methods

Eleven candidate predictors were entered into logistic regression models to be associated with the presence of left ventricular diastolic dysfunction/heart failure with preserved ejection fraction in men and women separately. Internal-external cross-validation was performed to develop and validate the models.

Results

Increased age and β-blocker therapy remained as predictors in both the models for men and women. The model for men additionally consisted of increased body mass index, moderate to severe shortness of breath, increased pulse pressure and history of ischaemic heart disease. The models performed moderately and similarly well in men (c-statistics range 0.60–0.75) and women (c-statistics range 0.51–0.76) and the performance improved significantly following the addition of N-terminal pro b-type natriuretic peptide (c-statistics range 0.61–0.80 in women and 0.68–0.80 in men).

Conclusions

We provide an easy-to-use screening tool for use in the community, which can improve the early detection of left ventricular diastolic dysfunction/heart failure with preserved ejection fraction in high-risk men and women and optimise tailoring of preventive interventions.
The Making of Microcelebrity: AfreecaTV and the Younger Generation in Neoliberal South Korea
Authors: Song Hojin
Published: November 2018

This article follows a recent thread of work on microcelebrity on social media and examines live streaming broadcasting jockeys (BJs) on AfreecaTV and their self-branding strategies in the South Korean context. As the nature of media platform influences self-branding tactics of microcelebrity, this article focuses on analyzing the text of popular live streaming and the chats among the viewers and BJs. Using the framework of authenticity, I argue that popular microcelebrities of AfreecaTV present a self-branding tactic of staged personae that are often exaggerated and aggressive rather than presenting self as intimate and ordinary figures who interact immediately with their fans. Staged personae are presented in conjunction with the viewer as the aggressive interaction in the chat rooms between the BJ and the audience strengthens exaggeration and aggressiveness. In the context of neoliberal self-care, I also argue that the making of microcelebrity on AfreecaTV is distinctly shaped by the larger generational culture of yingyŏ. The focus on unproductive work, idleness, and momentary entertainment among BJs and the viewer represents their rejection to neoliberal self-care, which has long been a key tool of personal success and prosperity in the context of neoliberal Korea.
The Effects of Group Size and Time on the Formation of Online Communities: Evidence From Reddit
Authors: Panek Elliot , Hollenbach Connor , Yang Jinjie , Rhodes Tyler
Published: November 2018

These studies examine the influence of group size and the passage of time on two characteristics of online communities: dispersion of participation in group discussions and active member turnover from month to month. We used multilevel analysis to examine the dynamics of user contributions to discussions on Reddit, a popular website that hosts large-group discussions, across 30 groups over 6 years. As groups grow in size, participation becomes more highly concentrated among fewer members while turnover decreases. As time passes, participation becomes more widely dispersed while group member turnover increases. An increase in group member turnover appears to be the result of both a maturation effect (as each group ages, turnover increases) as well as a cohort effect (groups formed at a later date have higher turnover than groups formed earlier). We can conclude from these results that as time progresses and groups become larger, they become less community-like, but in different ways.
Adipose tissue transplant in recurrent folliculitis decalvans
Authors: Tedesco Marinella
Published: November 2018

Folliculitis decalvans is a rare clinical disorder classified as primary neutrophilic scarring alopecia with a slight preference for the male gender. Here, we report the use of autologous fat transplantation as a source of stem cell therapy for hair re-growth assisted by inflammatory action of the fat itself in a female patient. The patient underwent adipose transplantation in April and September 2017. After treatments, the patient had no new pustules and no longer had pain or burning sensation in the affected area. The hair has re-grown at the periphery area of alopecia appearing stronger and shinier.
Entrepreneurship in a Non-Profit Healthcare Organization
Authors: Narapareddy Vijaya , Berte Erica
Published: November 2018

Columbus regional health (CRH), a not-for profit organization located in Columbus, Indiana, evolved from a traditional local hospital to an award-winning regional community health-care provider by embracing the concept of innovation and its systematic implementation. The “A” case includes a detailed account of the innovation journey undertaken by CRH and the impact of the devastating flood in 2008. On the other hand, this second (“B”) case deals with WellConnect, an innovative health-care venture that CRH considered for investment in 2013. This new health-care concept was aimed at providing differentiated health-care services in downtown Columbus, away from CRH's main satellite campus. Students, thus, have the opportunity to step into CRH's President and CEO, Jim Bickel's shoes to decide the feasibility of investing $1.5 million in WellConnect based on a thorough assessment and synthesis of multiyear data provided in the case, including community demographic, income and poverty data, competitor information, and CRH's select financial statistics. This case tested in several undergraduate and graduate courses was received well. A unique aspect of this case is that it can be used in online as well as traditional face-to-face classes.
Optimizing the use of a nutrition screening tool for oncology patients.
Authors: Parrales Carol , Alencar Maritza Cardena , MacIntyre Jessica , Trivedi Chinny , Araujo Patricia
Published: November 2018

101

Background: Oncology infusion centers play a crucial role in detection of malnutrition. In one month, the Sylvester Comprehensive Cancer Center chemotherapy infusion center in Miami (SCCC CTU) treats over 400 oncology patients. Research shows that 40-80% of patients with a cancer diagnosis are malnourished (Isenring et al., 2006). In April, 1.89% of patients seen at the Miami CTU were referred to an oncology nutritionist. The goal was to increase the percentage of patients referred by 2% by June through adequate screening and referral. Methods: SCCC Miami CTU nursing staff’s knowledge on the use of the Malnutrition Screening Tool (MST) and the referral process were assessed through a survey. The survey also functioned as an educational instrument. Additionally, one-on-one discussions about the referral process were conducted with the SCCC CTU nurse practitioners. Results: The survey was available to CTU RNs with a 35% completion rate. Results portrayed that 82.35% were aware of the MST screening tool; however, 88.25% were unaware of the appropriate code to refer patients to nutritionist. Therefore, if nutritional consults were placed, it was unlikely that the nutritionist would receive the request. Identified obstacles included having to call a provider to initiate a consult, lack of time for proper assessment and the availability of a nutritionist. Conclusions: Although results did not yield a significant increase of referrals through the use of the appropriate code, there was a 1.22% increase on the overall referrals placed. Lack of training and knowledge on the MST, improper use of the referral code, and the intricacy of the workflow, were contributing factors to the inadequacy in screening and referral process. Participation of all staff in education initiatives and interventions should be a vital component in improving quality care of oncology patients. [Table: see text]
Establishing a denominator for palliative care quality metrics for patients with advanced cancer.
Authors: Anand Sidharth , Glaspy John A. , Roh Lily , Khandelwal Vilay , Wenger Neil , Ritchie Christine , Walling Anne Margaret
Published: November 2018

104

Background: Measurement and feedback of palliative care quality metrics for patients with advanced cancer is an important aspect of supporting a shared mental model for the early integration of palliative care within the oncology clinic. Accurately identifying the subset of advanced cancer patients within a population of cancer patients is critical to the development of quality improvement activities; however, there is not a methodology of identifying these patients in real time. Methods: We evaluated two main approaches to identifying patients with advanced cancer among active cancer patients defined as patients who were seen by an oncologist at least twice in the last 6 months and who had received chemotherapy or radiation at least once in the last two years. These approaches included: 1) Pattern matching of words indicating advanced cancer (e.g. metastatic, advanced) in oncology notes, radiology imaging and problem lists and 2) ICD-10 codes. To determine the final set of ICD-10 codes for the second approach, we used a conceptual model of the meaning of advanced cancer (evidence of distant metastasis and/or poor prognostic cancer with > 50% mortality rate at 5 years) and iterative chart review. In order to test our final definitions, we randomly selected 588 charts of patients with active cancer who see one of 64 oncologists in our health system. These charts were abstracted by an oncologist to establish a gold standard for advanced cancer. We evaluated the sensitivity and specificity of our approaches to identify advanced cancer patients compared to this gold standard. Results: We found that the methods used to identify patients using pattern matching had a specificity of 76% and a sensitivity of 80%. Using our final ICD-10 algorithm we achieved a specificity of 93% and a sensitivity of 68%. We improved our sensitivity to 74% while maintaining our specificity at 92% when we excluded oncologists who predominantly see hematological malignancies. Conclusions: We achieved high specificity and reasonable sensitivity for an advanced cancer quality metric denominator using an ICD-10 algorithm within an academic oncology practice. This will help inform quality improvement efforts locally and beyond.
Integrating the ENABLE early palliative care approach in community cancer centers: Results of an implementation trial.
Authors: Bakitas Marie , Dionne-Odom J Nicholas , Pisu Maria , Azuero Andres , Babu Dilip Sankar , Gansauer Lucy Jean , Bearden James D. , Swetz Keith M , Minchew Leigh , Sullivan Margaret Murray , Wells Rachel , Taylor Richard A. , Turkman Yasemin E. , Ramsey Thomas , Zubkoff Lisa
Published: November 2018

114

Background: Despite national guidelines recommending early palliative care (EPC) for individuals newly-diagnosed with metastatic cancer, it is rarely available in rural community cancer centers serving underserved populations. We conducted the first implementation trial of EPC in rural cancer centers using the evidence-based ENABLE (Educate, Nurture, Advise, Before Life Ends) model of early, concurrent oncology palliative care. Methods: Mixed methods case study of a 4-year American Cancer Society-funded 4-site, implementation trial using a virtual learning collaborative in AL and SC. Guided by the RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework, we gathered qualitative and quantitative data via monthly reports and yearly in-person site visits using: 1) a RE-AIM Self-Assessment Tool completed by site staff to measure reach, adoption, implementation, and maintenance; 2) EPC General Organizational Index (GOI) to measure capacity for EPC services and implementation progress; and 3) field notes from site interviews and final reports. Results: Across the 4 sites, 62 patients (range: 4–31; mean: 15) and 46 caregivers (range: 2–22; mean: 12) participated. Baseline patient characteristics included: mean age of 58, 70% female, 17% Black or minority, 57% some college or college, 49% rural dwelling, and 57% non-gynecologic cancer. Sites enrolled at least 58% of the patients they planned to enroll (range: 58%–100%; average: 84%), of which 44% received 100% of ENABLE content and nearly 60% received two-thirds. Reasons for not completing all six sessions included death, unrecorded contacts, or lost to follow up. Longitudinal GOI scores indicated a trend of improved capacity for EPC services at three of the four sites. Qualitative data from site lead interviews revealed administrative (presence or lack of palliative ‘champions’), clinical (having adequate training), and economic (reimbursement) implementation barriers and facilitators. Conclusions: This pilot implementation study demonstrated feasibility and areas to enhance implementation in a larger comparative effectiveness trial to enhance scaling and spreading EPC in community practices.
Integration of palliative care consultation for patients with malignant bowel obstruction in gynecologic oncology: Qualitative approach to understand provider perspectives.
Authors: Hoppenot Claire , Chor Julie , Hlubocky Fay J. , Yamada Seiko Diane , Lee Nita Karnik
Published: November 2018

116

Background: Gynecologic oncologists’ (GO) approaches to palliative care team (PCT) consultation for managing patients with malignant bowel obstruction (MBO) from recurrent gynecologic cancer remains unknown. Methods: GO practicing in a large metropolitan area underwent semi-structured interviews exploring their approaches to PCT involvement at the time of diagnosis of a MBO and factors leading to specific recommendations. Interviews were analyzed using theoretical and open coding qualitative analysis. Results: 15 GO completed interviews. They were in academic (93%), urban (67%) settings and at a range of timepoints in their career. GO expressed mixed feelings regarding PCT consultation for their patients with MBO. Many were comfortable managing symptoms (pain, nausea) and limited consultations to uncontrolled symptoms. Others involved PCT for ongoing support regardless of symptom severity. GO were less likely to involve PCT to help with goal-setting discussions. Many GO held a “the earlier the better” stance, preferring to involve PCT in the outpatient setting. At a high-risk decision-point, such as MBO, these physicians felt that PCT consultation was overdue. In this setting, most participants reserved PCT consultations only for patients who were not surgical candidates. Barriers to PCT consultation for women with MBO centered around GO concerns that involving another team fragments care. Participants feared involving PCT would complicate patients’ experiences by requiring additional appointments, suggesting potential abandonment from their GO, and including an additional, potentially conflicting, source of information. Many GO mentioned they chose gynecologic oncology for the continuity of care and leading role in a patient’s cancer care. Conclusions: Overall, GO expressed comfort involving PCT outside of critical decision-points, yet were reticent to involve PCT at the time of MBO due to concerns of requiring the patient to deal with another team. Early incorporation of the PCT through a standardized co-management system in a GO outpatient clinic may improve communication and reduce barriers to PCT involvement.
Patient-reported barriers for accessing supportive care among patients with metastatic cancer treated at a public cancer center in Mexico.
Authors: Alcalde Castro Mirza , Chavarri Guerra Yanin , Ramos-Lopez Wendy Alicia , Covarrubias-Gómez Alfredo , Sanchez Sofia , Quiroz Paulina , Navarro-Lara Africa , Medina-Campos Andrea , Contreras-Garduño Sergio , Moreno-García María Luisa , Pérez-Montessoro Viridiana , Goss Paul E. , Soto Perez De Celis Enrique
Published: November 2018

124

Background: Although referral to supportive care (SC) services improves quality of life in patients with cancer, several barriers can hamper access to SC, particularly in developing countries with limited resources. We studied patient-reported barriers for accessing SC in a cancer center in Mexico City, and factors associated with those barriers. Methods: Patients with metastatic cancer enrolled in a randomized clinical trial of patient navigation to improve access to SC in a public cancer center in Mexico City (NCT03293849) were included. At baseline, sociodemographic and clinical characteristics were collected, and patients answered a survey in which they reported barriers to obtain cancer treatment and SC. We analyzed the frequency of reported barriers using descriptive statistics, and explored if sociodemographic factors were associated with a higher likelihood of reporting any barrier. Results: 134 patients were included between 08/17 and 04/18. Median age was 60 years (range 23-93; 51.5% male); 89.5% lived in urban areas; 42.5% had less than high school education; 12% had formal employment; and 27.3% had no insurance coverage. 61% had gastrointestinal, 16 % genitourinary, and 23 % other tumors. Home-to-hospital time was < 2 hours (h) in 60%, 2-6 h in 27%, and ≥6 h in 13%. 47.7% of the patients reported a household income of less than 630 USD/month. The mean number of reported barriers was 1.96 (Standard Deviation 1.77). 78% identified at least one barrier to care, and 35% reported ≥3 barriers (range 1-8). The most commonly reported barriers were: financial burden (47%), beliefs about treatment (28%), lack of transportation (22%), fear (19%), home-to-hospital distance (16%), patient-provider communication (13%), employment (9%), and caregiving for other people (3%). Patients living in rural areas more often reported home-to-hospital distance as a barrier than those living in urban areas (69 vs 11%, p < .01). Conclusions: Most patients with metastatic cancer seen at a cancer center in Mexico identified at least one barrier to cancer care, with some reporting up to 8. Many of the reported barriers are potentially modifiable through patient navigation or SC interventions.
Opioid education for early gynecologic oncology practitioners, filling a much-needed gap.
Authors: Hokenstad Alexis Noel , Lefkowits Carolyn , Phippen Neil T. , Bunch Kristen Paige , Wheeler Lindsay , Kumar Amanika
Published: November 2018

131

Background: Gynecologic oncologists report a lack of knowledge and comfort with palliative care topics including opioid management, despite their clinical importance. The objective of this study is to evaluate the impact of an online opioid educational module among gynecologic oncologists. Methods: A 25-minute video module was developed to provide an overview and example cases for opioid initiation, titration, and conversion. Fellows and early career gynecologic oncologists were invited to participate in a 24-question online survey addressing demographics, palliative care education in training, and preparedness and opioid-related knowledge. After viewing the module, participants completed a post-intervention survey, which was comprised of the same six knowledge-based questions and an assessment of the module. Responses were anonymous. A 3 month follow up survey will be sent to assess knowledge retention. Results: A total of 38 participants completed the initial and post-module survey, including 14 residents, 12 fellows, and 12 candidate members. Nineteen (50%) respondents had been previously taught to calculate a 24-hour oral morphine equivalent (OME) and to titrate opioids, but only 7 (18%) had received formal teaching on opioid rotation. Twenty four (63%) participants rated the quality of teaching overall in their fellowship as good, very good, or excellent, but only 15 (39%) rated palliative care education as at least good. Eleven (30%) respondents had a palliative care rotation in fellowship. Knowledge scores improved from pre-module to post-module, 49.5% correct answers compared to 74.6% (p<0.001). Thirty five (92%) of respondents were satisfied or very satisfied with this module and are interested in additional palliative care modules. Conclusions: A single online palliative care education module was associated with significantly improved participant knowledge on opioid management. Over 90% of respondents were satisfied with the module demonstrating an opportunity for improvement in palliative care education in gynecologic oncology via online education.
Multidisciplinary approach to endobronchial HDR brachytherapy as an alternative to external beam radiation for palliating malignant airway obstruction.
Authors: AL-Halabi Hani , Bechara Rabih , Snyder Will , Harpool Kristyn , Schantz Patricia , Law Tony , Shakibnia Lily , Swanson John , Cavanaugh Sean Xavier
Published: November 2018

132

Background: Concerns over the safety of high-dose-rate (HDR) endobronchial brachytherapy (EBB) has limited its widespread use in palliating pulmonary airway obstruction. Morbidity following EBB is commonly attributed to fatal hemoptysis and fistula formation. We implemented a procedure to deliver EBB under general anesthesia to minimize procedure risks, while maintaining treatment effectiveness. We hereby report outcomes of consecutive patients treated using this approach to palliate airway obstruction. Methods: We retrospectively reviewed charts of consecutive patients treated with EBB. Treated patients had obstructive lesions >2cm distal to the carina and central structures, who were deemed candidates for EBB by a multidisciplinary team of interventional pulmonologists (IP) and radiation oncologists (RO). All patients were treated under general anesthesia. Bronchoscopy and localization of target lesions was performed by IP. HDR catheters carrying a marker wire were advanced past obstructive lesion. CT simulation was performed to confirm catheter placement, and perform CT-based 3D treatment planning. A dose of 6 -7 Gy/fraction was prescribed at 1 cm from catheter surface. Results: 25 patients (ages 29 -71, mean 52 years) were treated with EPP. 5 had previously received external beam radiation (EBRT) and 3 had concurrent EBRT and EPP. Overall, a total of 76 EBB treatments were performed, with a median of 3 weekly fractions per patient (range 1-6) to total dose of 18Gy. There were no incidences of major bleeding (>50 mL) or fatal hemoptysis in the 30 days following EPP. Moreover, there were no cases of severe (Grade 3 or higher) CTCAE toxicity reported. After a median follow up of 30 months (range 4-42) only 1 out of 17 patients treated with EPP alone required additional EBRT for airway obstruction, 12 months following EPP. Conclusions: Our data suggest the safety and efficacy of an expert multidisciplinary approach to palliating pulmonary airway obstruction using EPP. This approach provides effective palliation of airway obstruction and decreased the need for additional EBRT in majority of treated patients.
Outpatient acupuncture effects on patient self-reported symptoms in oncology care: A retrospective analysis of real-world data.
Authors: Lopez Gabriel , Garcia M. Kay , Liu Wenli , Spano Michael , Underwood Susan , Williams Janet L. , Moguel Rocio , Li Yisheng , Dibaj Seyedeh , Bruera Eduardo , Cohen Lorenzo
Published: November 2018

135

Background: Increased access to complementary therapies such as acupuncture at academic medical centers has created new opportunities for management of cancer and cancer treatment related symptoms. Methods: Patients presenting for acupuncture treatment during calendar year 2016 at an outpatient integrative medicine clinic in a comprehensive cancer center were asked to complete a modified Edmonton Symptom Assessment Scale (ESAS; 16 symptoms, score 0-10, 10 worst possible) before and after each visit. ESAS subscales analyzed included global (GDS; score 0-90), physical (PHS, 0-60), and psychological distress (PSS, 0-20). ESAS symptom score change pre/post treatment and from baseline visit to first follow up were evaluated by paired t-test. Results: Of 375 participants [mean age 55.6, 68.3% female, 73.9% white, most common cancer diagnosis of breast (32.8%) and thoracic/head&neck (25.9%)], 73.3% had at least one follow-up treatment [mean 4.6 (SD 5.1) treatments]. Highest/worst symptoms at baseline were poor sleep (3.92), fatigue (3.43), well-being (3.31), and pain (3.29). Statistically significant reduction/improvement (pre/post) was observed for all ESAS symptoms and subscales for the initial treatment (p <0.001). Hot flashes had the highest mean reduction (-1.93), followed by fatigue (-1.72), numbness/tingling (-1.70), and nausea (-1.67). Clinically significant reductions were also observed for ESAS subscales of GDS (-12.2), PHS (-8.5), and PSS (-2.6). For symptom change from initial treatment to first follow-up (pre/pre), statistically and clinically significant improvement was observed for spiritual pain (-1.10; p<0.001) and ESAS subscale of GDS (-6.09; p=0.048). Clinical response rates (reduction ≥1) on follow-up were highest for symptoms of spiritual pain (58.9%), dry mouth (57.8%) and nausea (57.3%). Conclusions: Outpatient acupuncture was associated with immediate and longitudinal significant improvement across a range of symptoms commonly experienced by individuals during cancer care. Further research is needed to better understand frequency of treatments needed in clinical practice to help maintain benefit.
Financial burden at end of life: Findings from interviews with caregivers of patients with cancer.
Authors: McDermott Cara L. , Engelberg Ruth , Ramsey Scott David , Curtis J. Randall , Woo Cossette , Starks Helene
Published: November 2018

14

Background: Studies have described financial burden during and after cancer treatment, but little data are available on financial burden to patients and caregivers at end of life. We conducted a qualitative study with bereaved caregivers and discussed the impact of cancer-associated medical and nonmedical costs on family finances. Methods: From October-December 2017, we audio-recorded semi-structured phone interviews with 35 adults who were primary caregivers for a family member who died with cancer (July-December 2016). We asked about ability to meet costs of care. Drawing from previous studies, we defined substantial financial burden as incurring debt, selling assets or draining savings to meet health care costs. Two analysts coded transcripts using qualitative content analysis and summarized results as major themes. Results: Patients ranged from 30-88 years old, caregivers 34-85. Most caregivers were white (91%), female (63%) and spouses (89%). Ten patients (29%) were insured commercially, 24 (69%) had Medicare, and one (2%) had Medicaid. Ten caregivers (29%) reported substantial financial burden, irrespective of patients’ insurance coverage. Issues associated with substantial financial burden were: 1) insurance hurdles: “my husband’s dying and…I have to run interference with insurance companies, which is frustrating;” 2) limited financial resources: “It is hard when…you really don't have a lot of savings because…you never really made a lot of money” and 3) financial burden that continues after the patient’s death : “I went broke, basically, looking after my parents.” “We lost two incomes and we had to live on our savings.” Three other caregivers noted their family did not experience financial burden because they switched health insurance plans or had a supplemental insurance plan. Conclusions: In this pilot study of caregivers of advanced cancer patients, a substantial portion of commercially insured patients and Medicare enrollees with limited savings and income reported financial burden associated with cancer treatment and end-of-life care that persisted after the patient’s death. Future research is needed to determine best ways to mitigate financial burden among patients and their survivors.
Potential Medicare beneficiary out-of-pocket cost reductions through use of biosimilar filgrastim-sndz over reference filgrastim among patients with lung cancer: A simulation model analysis.
Authors: Balu Sanjeev , Puckrein Gary , Xu Liou , Ryan Alan , Campbell Kim
Published: November 2018

140

Background: G-CSFs are utilized to lower the incidence of febrile neutropenia (FN) in patients with cancers treated with chemotherapy. In 2015 filgrastim-sndz was the first biosimilar to be approved and launched in the US. Limited data exists on the impact of biosimilars on patient out-of-pocket (OOP) expenditures. The objective of this simulation model is to estimate potential OOP cost savings through use of filgrastim-sndz (FIL-S) over reference filgrastim (FIL-REF) from a Medicare lung cancer patient perspective. Methods: An Excel simulation analysis was conducted among lung cancer patients treated with biosimilar FIL-S or FIL-REF (identified through HCPCS codes). Data from the 2016 Medicare Limited Data Set was used to populate the model. Average Medicare payment to the provider and beneficiary OOP responsibility per claim of either FIL-S or FIL-REF were calculated. The average OOP reduction per claim for a FIL-S beneficiary relative to a FIL-REF beneficiary was multiplied to a hypothetical FN prevalent population of 100,000 beneficiaries (average of 10 claims per beneficiary) to estimate the potential OOP savings. Results: Data from 525 FIL-S and 621 FIL-REF claims were analyzed. The average Medicare allowed charge amount per claim for a FIL-S beneficiary was $381.7 versus $419.1 for a FIL-REF beneficiary, while corresponding average Medicare payments to the provider were $299.3 and $327.4, respectively. On an average, OOP responsibility for a FIL-S beneficiary was lower compared to a FIL-REF beneficiary ($76.4 vs. $85.0) leading to a cost saving per claim of approximately $8.60. When extrapolated to 100,000 beneficiaries (1,000,000 claims), the overall cost saving was projected to be around $8.6 million. Conclusions: Our simulation model estimated potential OOP Medicare lung cancer beneficiary savings of around $8.6 million, based on a hypothetical population of 100,000 FN beneficiaries, with the use of biosimilar FIL-S over FIL-REF. Further real-world analyses are required to evaluate the true cost savings potential with the use of biosimilars over reference biologics.
A review of phase III clinical trials of CDK4/6 inhibitor combination therapy in premenopausal women.
Authors: Yardley Denise A.
Published: November 2018

141

Background: Clinical guidelines for the treatment of hormone receptor–positive (HR+), HER2− advanced breast cancer (ABC) are similar regardless of menopausal status, except for the role of ovarian suppression. However, breast cancers in premenopausal women frequently have an aggressive phenotype and a distinct underlying disease biology unaffected by ovarian suppression. Methods: We compared published trial designs, baseline characteristics, and efficacy and safety results of Phase 3 trials of cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors including premenopausal women with HR+, HER2− ABC. Results: The MONALEESA-7 trial (NCT02278120) investigated ribociclib (or placebo) with a nonsteroidal aromatase inhibitor or tamoxifen + goserelin ovarian suppression in premenopausal women with ≤1 line of prior chemotherapy for ABC (N = 672); 40% had de novo metastases. Median progression-free survival (PFS) was 23.8 vs 13.0 months with ribociclib (n = 335) vs placebo (n = 337). In the PALOMA-3 trial (NCT01942135), 108 of 521 patients were premenopausal and treated with palbociclib (n = 72) or placebo (n = 36) + fulvestrant + goserelin; 75% had prior endocrine therapy (ET) or chemotherapy for ABC. Median PFS in the palbociclib vs placebo group was 9.5 vs 5.6 months. Adverse events common to both ribociclib and palbociclib ( > 30%) were neutropenia, leukopenia, and nausea. The MONARCH 2 trial (NCT02107703) evaluated abemaciclib (or placebo) with fulvestrant in 669 women with no prior chemotherapy for ABC (38% had 1 line of ET for ABC). In the premenopausal subset (abemaciclib, n = 72; placebo, n = 42; all with ovarian suppression), abemaciclib prolonged PFS (hazard ratio, 0.415 [95% confidence interval, 0.246–0.698]). Conclusions: While trial and patient characteristics differed substantially, safety and efficacy established in the MONALEESA-7 trial of premenopausal women and premenopausal subsets of the PALOMA-3 and MONARCH 2 trials support the activity and use of CDK4/6 inhibitor combination therapy in these patients. The treatment benefit observed in these trials was consistent with that in Phase 3 trials of postmenopausal women with HR+, HER2− ABC treated with CDK4/6 inhibitor combination therapy.
Caregiver training for a therapeutic alliance in palliative home care.
Authors: Lopane Diego , Pavesi Carlotta , Arcanà Concetta , Bonelli Beatrice , Ferrari Stefano , Lopane Diego , Giuffrè Santina , Poggio Chiara , Saetta Annalisa , Rimassa Lorenza , Santoro Armando
Published: November 2018

15

Background: Caregiver (CG) presence and efficiency are crucial in providing a palliative home care (PC) program. The Aims of this study were: 1. to investigate educational needs expressed by caregivers (CGs) of advanced cancer patients (pts) in home care service (HCS) of our Institution; 2. to develop a guide to support PC team; 3. to evaluate the impact of this tool on CGs skills. Methods: Based on published data, we identified 3 areas of interest (therapy administration (TA), care, symptoms management) and 17 specific topics: mobilization, hygiene, skin/mouth care, dysphagia, xerostomia, bowel function, diuresis/urinary catheter care, feeding, and some symptoms. We then prepared a guide with clear information regarding each topic. We mainly focused on symptoms, in particular on pain. We elaborated instructions on TA and administration routes (techniques for subcutaneous (SC) injection/infusion with elastomeric pump). Use of short tips, images, pictures, and cartoons made the guide very accessible. From July to September 2017 the guide was provided to 24 CGs, 8 (33%) men, 16 (66%) women. 12 CGs (50%) were pts’ partners, 10 (41.6%) son/daughter, 1 relative (4.1%), 1 formal CG (4.1%). Several educational interventions (EI) were adopted to reinforce learning according to the pt conditions and CGs’ needs. The effectiveness of EI was retrospectively assessed from clinical records. Results: We offered 218 EI to 24 CGs, with an average of 9 per CG, and within a range of 6-13 per CG. Topics most frequently addressed were: SC injection technique (100%), skin care (21 CGs, 87.5%), pain care (21 CGs, 87.5%), feeding (20 CGs, 83.3%), mobilization techniques (17 CGs, 70.8%). We also performed 16 EI repetitions on 11 CGs (45.8%) on ≥1 topics: 4 for mobilization, 2 for pain, dysphagia, SC injection, feeding, bowel function, 2 for other topics.Assessment of EI effectiveness showed great CG receptivity, with 93% of interventions followed by a change in CG behaviour thereafter. Conclusions: The proposed intervention, the use of a simple guide to reinforce EI, is feasible, well accepted and appears to improve CG’s ability in providing home PC. Based on these results, we added a section dedicated to EI for CGs into the new electronic record of our HCS, introduced since January 2018.
Quality of life and psychological distress in patients with acute myeloid leukemia (AML).
Authors: Markovitz Netana , Waldman Lauren , Carp Julia , Traeger Lara , Abel Gregory A. , Greer Joseph , Fathi Amir Tahmasb , Steensma David P. , LeBlanc Thomas William , DeAngelo Daniel J. , Wadleigh Martha , Hobbs Gabriela , Brunner Andrew Mark , Amrein Philip C. , Stone Richard M. , Temel Jennifer S. , El-Jawahri Areej
Published: November 2018

154

Background: Older patients with AML face difficult treatment decisions as they can be treated either with multi-drug ‘intensive’ chemotherapy requiring a prolonged hospitalization, or ‘non-intensive’ chemotherapy. Although clinicians often perceive intensive chemotherapy as more burdensome, studies comparing older patients’ quality of life (QOL) and psychological distress while receiving these treatments are lacking. Methods: We conducted a longitudinal study of older patients (≥ 60 years) newly diagnosed with AML receiving intensive (i.e. 7+3: cytarabine/anthracycline combination) or non-intensive (i.e., hypomethylating agents) chemotherapy at two tertiary care hospitals. We assessed patient’s QOL [Functional Assessment of Cancer Therapy-Leukemia], and psychological distress [Hospital Anxiety and Depression Scale [HADS]] at baseline and 2, 4, 8, 12, and 24 weeks after diagnosis. We compared the proportion of patients in each group reporting clinically significant depression or anxiety (HADS subscale cut off ≥ 7) and used mixed linear effects models to compare QOL and psychological distress longitudinally between groups. Results: We enrolled 75.2% (100/133) of eligible patients within 72 hours of initiating intensive (n = 50) or non-intensive (n = 50) chemotherapy. Baseline QOL, depression, or anxiety symptoms did not differ between the groups. At baseline, 33.33% (33/100) and 30% (30/100) of the overall cohort reported clinically significant depression and anxiety, respectively, with no differences between groups. At 4 weeks, 41.98% (34/81) of patients in the overall cohort reported clinically significant depression, with no differences between groups. In mixed linear effects models, there were no differences in QOL (β = -0.71, SE = 1.12, p = 0.527), depression (β = 0.24, SE = 0.20, p = 0.226), or anxiety (β = -0.16, SE = 0.19, p = 0.386) symptoms over all time points. Conclusions: Older patients with AML receiving intensive and non-intensive chemotherapy experience similar QOL and high rates of psychological distress. These findings underscore the need to develop supportive care interventions for older patients with AML, regardless of their initial treatment strategy.
Impact of glioblastoma (GBM)-related cognitive dysfunction (CD) on caregiver burden: Preliminary results from multi-site study in the U.S.
Authors: Au Trang H. , Bauer Hillevi , Menon Jyothi , Willis Connor , Iacob Eli , Ma Junjie , Watanabe Alexandre , Nelson Ryan , Korytowsky Beata , Singh Prianka , Marshall Alexander , Willmarth Nicole , Nghiemphu Phioanh Leia , Dovek Laura , Peters Katherine B. , Balajonda Bea , Cohen Adam Louis , Colman Howard , Stenehjem David D. , Brixner Diana I.
Published: November 2018

16

Background: GBM is a largely incurable, highly aggressive cancer with high incidence of CD. Caregivers face heightened stress with loved one’s limited life expectancy and additional duties. To better understand this unique group, a survey tool was developed to examine effect of CD on caregiver burden. Methods: Four of 10 planned academic centers are enrolling towards achieving 200+ completed surveys. The survey was developed step-wise: 1) literature review of primary brain tumors, Alzheimer’s disease, and dementia to identify domains; 2) focus groups with neurooncologists and American Brain Tumor Association advocates to narrow domains; 3) caregiver interviews to verify selected domains; 4) single-site pilot study to confirm content (n=20). Dyads with caregiver survey and respective patient’s clinical data are created as possible. Results: Complete data from 31 caregivers and 28 dyads enrolled at Huntsman Cancer Institute, University of Utah and University of California, Los Angeles are currently available. Response rate was 88% for caregivers and 90% for patients. Among caregivers, 87% were patient spouse/partner, 84% female, average age 56 years, 42% currently employed, 32% have no additional help, and 26% are primary caregivers for others. Patients were male (74%), average age 59 years, not working (84%), and being treated for initial diagnosis (67%). Proportion of caregivers performing ≥ 1 caregiving task, i.e. meal preparation, doubled from before to after diagnosis (48% vs. 97%). The majority of caregivers (90%) perceived memory problems in a loved one over last 14 days. Trouble remembering recent events or things interfered with 71% of caregivers’ daily life "somewhat", "quite a bit", or "very much". When ranking effect of CD on caregiver’s general quality of life on a scale of 0 (none) to 10 (significant), 60% and 23% of caregivers indicated ≥ 5 and ≥ 8, respectively. Caregivers’ responses to survey satisfaction questions showed only 23% feel enough is being done to understand caregiving in GBM and 76% were satisfied overall with the survey. Conclusions: Caregivers are affected daily and significantly by GBM-related CD. Results will be updated at time of presentation.
Eating-related distress in patients with advanced cancer cachexia and family members: A survey in palliative and supportive care settings.
Authors: Amano Koji
Published: November 2018

163

Background: Few studies have investigated nutrition impact symptoms and eating-related distress among advanced cancer patients and their family members. This is an anonymous questionnaire survey to explore the severity of nutrition impact symptoms and the prevalence of eating-related distress among advanced cancer patients and their family members in palliative and supportive care settings. Methods: The questionnaires for patients and their family members have been preliminarily developed by the authors. We have chosen 16 common symptoms of advanced cancer, i.e., 9 symptoms of the ESAS-r and 7 symptoms of the PG-SGA. Each questionnaire concerning eating-related distress consists of 12 items. Results: A total of 140 out of 147 patients responded (95.2%). They were classified into two groups: 1) Non-cachexia/Pre-cachexia (n = 57) and 2) Cachexia/Refractory cachexia (n = 83). The top 3 out of 16 symptoms in all patients were feeling of well-being, lack of appetite, and tiredness. Significant differences between the two groups were observed in 5 symptoms: pain (p = 0.005), nausea (p = 0.005), diarrhea (p = 0.001), abnormal taste (p = 0.017), and difficulty swallowing (p = 0.002), respectively. Concerning eating-related distress, significant differences between the two patient groups were observed in all items except for 2, and those between the two family member groups were observed in all items. The mean numbers of items in which patients/family members answered positively were significantly higher in Cachexia/Refractory cachexia group (p < 0.001, respectively). Conclusions: Advanced cancer patients with cachexia have greater nutrition impact symptoms than those without cachexia, and patients with cachexia and their family members have higher eating-related distress than those without cachexia.