bluuebunny/crossref_metadata_2025 huggingface dataset:
Is cranial multi-detector computed tomography imaging valuable for stature estimation in Egyptian population?
Authors: Adel Rana , Ahmed Hala Mohamed , Hassan Osama A. , Abdelgawad Ehab A.
Published: November 2019

Background and objectives

Stature estimation is an initial and essential component of any medico-legal investigations. However, it becomes more challenging when only skull remains are available. So, the goal of this study is to assess stature estimation using cranial multi-detector computed tomography (MDCT) images in a sample of the Egyptian population.

Methods

This clinical study was conducted on 150 Egyptian subjects underwent cranium MDCT with age ranged from 21 to 60 years. The measurements used were maximum cranial breadth, minimum frontal breadth, upper facial breadth, bizygomatic breadth, orbital height, orbital breadth, parietal chord, bimastoidale, maximum cranial length, basion-bregma height, cranial base length, and basion-prosthion length.

Results

The results revealed that stature and craniofacial measurements of males were significantly higher than those of females, all measurements were significantly positively correlated with stature in pooled cases, but the correlation coefficient differs in separate sex. Simple linear regression for stature estimation showed that the least standard error of estimate (SEE) values for the regression equations obtained when using bizygomatic breadth in pooled cases (7.9 cm) and in males only (5.7 cm), while in females using parietal chord had the least SEE (6.8 cm). Using multiple and stepwise regression analysis reported lower SEE values than simple linear regression analysis.

Conclusion

On the basis of this study, it is concluded that the cranial measurements obtained from MDCT images have limited utility in stature estimation among Egyptians, but could be used as an alternative method in cases where the best predictors, such as long bones, are not available.
Effects of Tai Chi and Qi Gong group class participation on self-reported symptoms in cancer patients and caregivers: A preliminary report.
Authors: Lopez Gabriel , Narayanan Santhosshi , Christie Amie J , Powers-James Catherine , Garcia M. Kay , Liu Wenli , Gomez Telma I , Wu Jimin , Williams Janet L. , Li Yisheng , Bruera Eduardo , Cohen Lorenzo
Published: November 2019

100

Background: Tai chi and qi gong are movement-based, mind-body approaches offered as part of an integrative oncology program at a comprehensive cancer center. We explored the effects of tai chi and qi gong group class participation on cancer patient and caregiver self-reported symptoms. Methods: Patients and caregivers attending a tai chi and/or qi gong group class completed the Edmonton Symptom Assessment Scale (ESAS) immediately before and after participation. The ESAS assessed 10 symptoms (scale 0-10, 10 worst possible); ESAS subscales analyzed included global (GDS), physical (PHS), and psychosocial (PSS). Descriptive statistics; Chi-Squared test, Fisher’s exact test, Wilcoxon rank-sum test and Wilcoxon signed-rank test were used for data analysis. Results: 304 participants (Oct 2017-April 2019; 184 patients, 120 caregivers; 72% women, 60% white; mean age 58) were included in the analysis. For patients (symptom reduction by class type: tai chi -4.5 SD 7.6; qi gong -6.1 SD 7.9) and caregivers (tai chi -3.7 SD 6.3; qi gong -4.0 SD 7.8), both class types contributed to clinically and statistically significant improvement (ESAS GDS decrease ≥3; p’s ≤0.0001) in global distress. Patients (-2.07 SD 5.49) and caregivers (-2.34 SD 3.71) participating in tai chi experienced clinically and statistically significant improvement in physical distress (ESAS PHS decrease ≥2; p’s ≤0.0001). For the individual symptom of well-being, we observed clinically and statistically significant improvement for caregivers participating in qi gong (-1.2 SD 2) and patients participating in tai chi (-1.0 SD 1.8) (p’s ≤0.0001). For fatigue, patients (-1.4) and caregivers (-1.0) participating in qi gong experienced clinically and statistically significant improvement (p’s ≤0.0001). Conclusions: Patients and caregivers participating in both class types experienced significant improvement in physical and global distress. Additional research is warranted to learn more about how differences in class content (tai chi vs qi gong) and participants may contribute to observed differences in symptom change.
Frequency and severity of pain in hospitalized cancer patients at a tertiary cancer center.
Authors: Dalal Shalini , Reddy Akhila Sunkepally , Arthur Joseph Anthony , Haider Ali , Dev Rony , Williams Janet L. , Sobti Rahul , Tanco Kimberson Cochien , Bruera Eduardo
Published: November 2019

103

Background: Recent regulations in response to the opioid crisis has presented unforeseen challenges in treating cancer patients with pain, such as frequent opioid shortages and clinicians moving away from prescribing opioids. This is especially concerning in cancer hospitals where a significant proportion of patients experience pain. Understanding the current frequency and severity of pain in hospitalized cancer patients are key hospital quality indicators, and will help in directing appropriate pain initiatives and resources. We aimed to determine the frequency, severity and changes in pain severity experienced by hospitalized cancer patients. Methods: The institutional electronic database was used to extrapolate pain scores for all cancer patients discharged over one year. The proportion of hospital-days with pain overall, on admission, and discharge is reported. A severe-pain day was a hospital-day with ≥ 1 severe pain score. A moderate-pain day was a non-severe pain day with ≥ 1 moderate pain score. Results: A total of 17097 unique patients accounted for 30056 hospital-days. Overall, the proportion of severe-, moderate-, mild-, and no pain-days was 29%, 23%, 10%, and 37% respectively. The monthly pain reports (Table) demonstrates no significant difference in pain frequency or severity over time. As compared to the first hospital-day, the proportion of severe pain days on discharge decreased from 33% to 16% (p <0.01) (Medical service 28% to 16%; Pediatrics 12% to 6%, Surgical 45% to 17%). Moderate- to-severe pain days decreased from 54% to 39% (p<0.01). Conclusions: A significant proportion of hospitalized cancer patients experience moderate-to-severe pain. Comprehensive assessment of the multiple dimensions of pain and strategies for early management are needed to reduce the number of moderate and severe pain days in the inpatient setting. [Table: see text]
A pilot study of oncology massage to treat chemotherapy-induced peripheral neuropathy (CIPN).
Authors: Lopez Gabriel , Eng Cathy , Overman Michael J. , Ramirez David Luis , Liu Wenli , Beinhorn Curtiss M , Sumler Pamela A , Prinsloo Sarah , Chen Minxing , Li Yisheng , Bruera Eduardo , Cohen Lorenzo
Published: November 2019

111

Background: Short- and long-term toxicity of platinum compounds and taxanes includes development of CIPN. With an increased interest regarding the role of complementary approaches for symptom control, we investigated massage therapy for symptomatic relief of chronic CIPN. Methods: This pilot study evaluated the optimum treatment schedule and initial efficacy of a standardized Swedish massage technique to treat lower extremity (LE) CIPN. Inclusion criteria: LE neuropathy attributed to oxaliplatin, paclitaxel, or docetaxel, no other history of attributable causes; self-reported neuropathy score ≥3, 0-10 scale; ≥ 6 months since last chemotherapy treatment; age ≥ 18. Patients (pts) were randomized to one of four groups: 1) LE massage 3 times (3X) week for 4 weeks; LE massage 2X week for 6 weeks; 3) head/neck/shoulder (control) massage 3X week for 4 weeks; or 4) control massage 2X week for 6 weeks. Massage completion rate was examined and symptoms of CIPN measured with the Pain Quality Assessment Scale [PQAS (Range: 0-10); subscales of SP (surface pain), DP (deep pain), and PP (paroxysmal pain)] at baseline and at 10 weeks. Results: 71 pts fulfilled inclusion criteria: 77.5% women; 57.7% (breast cancer), and 42.3% (GI cancer); mean age 60.3 y/o (range: 40-77). Average length of time since the end of chemotherapy was > 3 yrs. Mean massage completion rates (max = 12) were 8.9 (SD 4.2) for 3X week and 9.8 (4.0) for 2X week with no statistical differences. There were no statistically significant differences in PQAS scores at follow-up between site-specific massage groups (lower extremity vs controls). Pts who had massage 3X week reported statistically and clinically significantly improved PQAS scores versus those who had massage 2X week (change scores: PQAS-SP: -2.3 vs. -0.6, p = 0.001; PQAS-DP: -2.1 vs. -0.9, p = 0.008; PQAS-PP: -2.3 vs. -1.0, p = 0.025), with sustained improvement in the 3X week group, but minimal change in the 2X week group. Conclusions: We observed sustained reduction in pts with long-term CIPN up to 6 weeks after treatment completion for the more intensive 3X week massage group, regardless of treatment site. A large-scale efficacy trial is warranted to validate the role of oncology massage therapy for CIPN. Clinical trial information: NCT02221700.
Relationship of physical function to outcomes in autologous hematopoietic stem cell transplantation.
Authors: Caveney Joseph , Kanate Abraham Sebastian , Hobbs Gerald , Swisher Anne
Published: November 2019

116

Background: Physical function is an important consideration for autologous hematopoietic stem cell transplantation (auto-HSCT) but it is often judged subjectively rather than tested. This study examined the ability of functional test results to predict key transplant outcomes versus subjective rating. Methods: Patients receiving outpatient auto-HSCT performed a pre-transplant 2-minute walk test (2MWT), isometric handgrip testing, 5-times sit-to-stand test (5XSST) and timed up and go test (TUG). Karnofsky Performance Status (KPS) score was assigned by the treating oncologist. At day 100 following auto-HSCT, charts were extracted for age, gender, diagnosis, total number of hospital days, and days of platelet and neutrophil recovery. Predictions were determined through stepwise regression analysis. Results: Data from 37 patients (24 M, 13 F) were analyzed. The most common diagnosis was multiple myeloma. One patient expired prior to day 100. KPS was weakly correlated with all functional tests (spearman rho values 0.15 to 0.27, p values 0.07 to 0.32). KPS did not predict # hospital days (p = 0.53), neurophil recovery (p = 0.22) or platelet recovery (p = 0.51). In contrast, there was a trend for 5XSTS to predict # hospital days (p = 0.10), although predictive ability was low (R2 = 0.07). TUG was the best predictor of platelet recovery (p = .021), followed by 2MWT (p = 0.23) (R2 = 0.10). KPS did not predict any outcome measure, and none of the variables predicted neutrophil recovery. Conclusions: KPS does not correlate well with physical function testing nor does it predict key auto-HSCT short-term outcomes. While not a major contributor to hospitalization days or blood count recovery time, 5XSST and TUG appear to have potential to predict transplant outcomes. Future testing with larger samples is needed to determine the impact of physical function on long-term auto-HSCT outcomes.
A placebo controlled, randomized, double-blinded trial of olanzapine for the treatment of chronic nausea and/or vomiting, unrelated to chemotherapy/radiation.
Authors: Navari Rudolph M.
Published: November 2019

118

Background: Patients with advanced cancer experience substantial nausea/vomiting. Methods: Eligible patients had advanced cancer without receiving chemotherapy/radiation for the prior 14 days and chronic nausea (>3, 0-10, VAS) that had been present for >1 week and/or vomiting >5 times during the prior week. Patients were randomized, in a double blind manner, to receive olanzapine (5 mg) or a placebo, orally, days 1-7. Prior to starting treatment (Day 1) and daily for 7 days (Days 2-8), patients recorded the intensity of their appetite, nausea, fatigue, sedation, and pain using a numerical VAS, and the number of emetic episodes/24 hours. The primary study endpoint was the change in VAS nausea scores from baseline to the last treatment day. Nausea change scores were compared between arms using a Wilcoxon rank sum test. Results: Thirty patients were enrolled in the study. No patient reported any apparent adverse event or excess sedation. Data are shown in the table. Conclusions: Olanzapine 5 mg/day significantly decreased nausea and emesis in this patient population. [Table: see text]
Treatment of central and spinal cord neuropathic pain with Scrambler Therapy.
Authors: Smith Thomas J. , Kamson David , Mealy Maureen A , D'Amato Steve
Published: November 2019

127

Background: Central pain caused by spinal cord or brain injury tends to be severe and refractory despite aggressive treatment, such as in thalamic pain syndrome, neuromyelitis optica spectrum disorder (NMOSD) and other forms of transverse myelitis, and spinal cord gliomas. Methods: We reviewed our experience with treatment of these relatively rare maladies with Scrambler Therapy, a noninvasive form of neuromodulation. Results: One transverse myelitis patient got substantial relief lasting months (Mealy M, Int J MS Care. 201), leading to the NMOSD trial. In a small, sham-controlled randomized trial, NMOSD patient pain scores were reduced in the ST arm from 5 to 1.5 at 30 days, P< 0.01, while the sham treatment gave no relief. (Neurology, resubmitted) Of three patients with pain due to thalamic strokes, surgery and/or radiation, treatment gave over 50% relief long-term in 2 of 3 (D’Amato S, A A Pract. 2018). In the one spinal cord glioma patient, pain in her index finger was reduced from 8-10/10 to 1-2/10 and treatment is ongoing. All successfully treated patients reported marked relief of allodynia and hyperalgesia, in addition to pain relief as reported previously (Marineo G, JPSM 2012). Conclusions: Scrambler therapy is a promising treatment modality for patients with these individually rare but collectively common forms of central pain. It has allowed return to more normal function in most patients, with reductions in pain medication use. Pictures of electrode placement and treatment plans will be shown, allowing others to do this safe and often effective treatment. Clinical trial information: NCT03452176.
Knowledge and attitudes of permanent chemotherapy-induced alopecia among health care providers.
Authors: Stoehr Jenna Rose , Kosche Cory , Choi Jennifer N.
Published: November 2019

142

Background: Reports of permanent chemotherapy-induced alopecia (PCIA) are increasing in the field of oncodermatology, but there is a dearth of information regarding how it is recognized and managed by health care providers (HCPs) across different medical specialties. Methods: An electronic survey was distributed to HCPs (resident physicians, attending physicians, and nurse practitioners) in the departments of dermatology, oncology, and general internal medicine (GIM) within one Midwestern hospital system. Results: Of the 62 participants (response rate: 13%), there were 19 from dermatology, 20 from oncology, and 23 from GIM. Responses were analyzed with descriptive statistics, and chi-square and ANOVA tests. There was a significant difference in the number of subjects that had heard of PCIA prior to starting the survey (Derm: 79%, Onc: 30%, GIM: 22%, p<0.05). A larger percentage of dermatology and oncology HCPs knew the correct definition of the condition (alopecia persisting >6 months) than GIM (42% and 45% vs. 17%) and significantly more had encountered patients with the condition (47% and 45% vs. 17%). More providers in dermatology and GIM knew how to diagnose PCIA compared to oncology (84% and 83% vs. 70%). Dermatology HCPs were the only participants who had attempted to treat patients with PCIA. Most providers across the three specialties believed that patients would accept PCIA treatment that was topical, oral, injectable, and required frequent administration or monitoring, but not treatment that was expensive or high risk. A majority of HCPs surveyed (94%) agreed that the diagnosis of PCIA is important. However, there was a significant difference in the confidence of HCPs in diagnosing and managing PCIA. A minority of dermatology providers (2/19) specified that they would refer to an alopecia or oncodermatology specialist, while the majority of oncology and GIM providers would refer to dermatology. Conclusions: The results of this survey identify knowledge gaps about PCIA amongst health care providers. Therefore, education and multidisciplinary engagement should be pursued in order to improve awareness, diagnosis, referral, and management of PCIA as part of survivorship care.
Supporting family caregivers: Needs beyond direct caregiving.
Authors: Holland Diane E. , Vanderboom Catherine E. , Griffin Joan M. , Dose Ann Marie , Wild Ellen M. , Ingram Cory J. , Loyo Lopez Jorge
Published: November 2019

16

Background: Family caregivers have been shown to have their own unique challenges when caring for someone with advanced cancer. These challenges may be more pronounced among rural caregivers. We present early lessons regarding caregiver needs from an intervention study that provides teaching, guidance, and counseling to rural family caregivers of individuals who received palliative care in the hospital and transitioned home. Methods: A randomized clinical trial is underway to test the efficacy of a care model that focuses on supporting rural family caregivers’ medical needs, self-care, and direct caregiving needs. We have developed a nurse-led, technology-enhanced intervention for family caregivers delivered over 8 weeks after hospital discharge of those receiving palliative care consults. The intervention includes video and phone visits between a palliative care nurse and caregiver. Caregiver needs and nurse strategies are documented using a standardized terminology in an electronic datafile. Results: Preliminary data from 21 family caregivers of individuals with advanced cancer who completed the intervention to date indicate caregivers personally had an average of 2.2 chronic conditions (up to 10) and were taking an average of 3.14 (up to 11) medications. In addition to challenges providing direct care, caregivers reported difficulty managing stress or depression (7/21; 33.3%); issues related to grief (6/21; 28.5%); inadequate sleep and rest (6/21; 28.5%), low or no income or uninsured medical expenses (5/21; 23.8%); and interpersonal challenges within families and with friends (5/21, 23.8%). Conclusions: Preliminary data from our study suggest that assessing the caregiver’s individual needs related to well being and self-care as well as direct caregiving is imperative to delivering caregiver support services that can improve the ability of family caregivers to provide care for their loved ones with advanced cancer. Clinical trial information: NCT03339271.
Loneliness among cancer caregivers: The current state of the science.
Authors: Gray Tamryn , Azizoddin Desiree Rachel , Nersesian Paula V.
Published: November 2019

19

Background: A cancer diagnosis can profoundly affect both patients and their caregivers. Providing care to a loved one with cancer places demands on caregivers that may result in changes to caregivers’ daily routines and disruptions to their social relationships, which may contribute to feelings of loneliness. Though caregivers’ psychosocial challenges have been extensively examined, loneliness—a determinant of health—has not been well-studied in this population. In this narrative review, we described the current state of the science related to loneliness among cancer caregivers, methods to assess loneliness, and recommended strategies to mitigate loneliness in cancer caregivers. Methods: We used evidence from peer-reviewed articles listed in PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Articles were reviewed for the following inclusion criteria: (1) published in English, (2) caregivers of cancer patients, (3) loneliness as a study variable, and (4) peer-reviewed with no restriction on timeframe of publication. Caregivers were defined as relatives, friends, or partners who provide most of the care for someone with cancer. Results: Eighteen studies met inclusion criteria and were included in the analysis. Caregivers’ experiences of loneliness can contribute to negative effects on a caregiver’s social, emotional, and physical well-being. Social support interventions may not be sufficient to address this problem. Existing recommendations to help address loneliness include cognitive and psychological reframing, one-on-one and group therapy, befriending, resilience training, and technology-based interventions. Conclusions: As a condition of growing importance, loneliness can lead to poor outcomes in social, emotional, and physical health when left unaddressed. Limited understanding regarding loneliness in cancer caregivers poses a two-fold problem that has the potential to impact patient and caregiver outcomes. Future efforts should include intervention development to address loneliness as a determinant of health in this unique population, especially given the pivotal role of caregivers in providing care and impacting health outcomes for people with cancer.
Empowering interpreters to partner in palliative care (PC) conversations: Effect of a dialogue-based curriculum.
Authors: Abrahm Janet Lee , Goldhirsch Jessica
Published: November 2019

21

Background: Effective communication across cultural and linguistic barriers during breaking bad news, DNR, and EOL conversations requires professional medical interpreters skilled in PC communication and clinicians skilled in working with interpreters. But interpreters are rarely included in meetings preceding these conversations, or made aware of the patient’s prognosis or the emotionally-charged subjects likely to arise. They may know the patient and family, cultural norms, and identify the decision makers, but often do not feel empowered to offer this crucial information to clinicians. To be effective cultural brokers, interpreters must be trained in PC terminology and feel empowered to contribute. Methods: A six-session curriculum: Palliative Care Dialogues with Interpreters, facilitated by an experienced PC social worker (SW) and physician, was delivered to medical interpreters from Brigham and Women’s Hospital and Dana-Farber Cancer Institute. The curriculum included links to relevant materials, and structured 1-hour sessions including role-plays on: Initiating and managing a pre-encounter conference; Family meetings; Terms used in PC meetings; Family meetings to discuss code status and end of life-prolonging therapies; Cultural Mediating; Interpreting for SWs and chaplains (with SW and chaplains doing role plays); and Experiencing being a cultural mediator in End of Life Care. 41 participants completed a 23-question pre- and post-course survey on their confidence in interpreting these conversations. Results: There was a highly significant improvement in interpreter post-course confidence ( N = 41. p=1.4080 x 10−11). Facilitated dialogues enabled interpreters to assert concerns, share knowledge, and practice new behaviors in a “safe” space, behaviors they reported they then used in clinical practice. Dialogues provided clinicians an opportunity to learn about the challenging linguistic, cultural and emotional experiences of medical interpreters. Conclusions: Facilitated and well-structured dialogues, including didactics, discussions and roleplaying caused highly significant improvements in interpreter confidence in interpreting PC conversations.
Determinants of cancer patients revealing their own cancers to minor children: A cross-sectional web-based survey in an online cancer community.
Authors: Terada Tatsuto , Kosugi Kazuhiro , Nishiguchi Yohei , Miura Tomofumi , Fujisawa Daisuke , Uehara Yuko , Kawaguchi Takashi , Izumi Kayo , Takehana Jun , Matsumoto Yoshihisa
Published: November 2019

23

Background: It is extremely stressful and difficult for cancer patients to tell their children that they had cancer. However, few small studies have been conducted to assess the characteristics of patients who told their children of their cancer. This study aimed to explore determinants of patients who revealed to their minor children that they had cancer. Methods: This was a sub-analysis of a cross-sectional web-based survey. Cancer patients with minor children were recruited from an online community and were asked to answer a questionnaire. Subjects diagnosed with cancer and whose eldest children were aged < 18 years were enrolled. Binomial logistic regression analysis was performed to assess the determinants of patients who revealed to their minor children that they had cancer. Results: Overall, 313 subjects were eligible [19.2% male; mean age (SD), 42.1 years (5.57)]. The commonest primary cancer site was the breast (32.9%), followed by gynecological organs (12.1%) and colorectal region (11.2%). Among the patients, 218 (69.6%) revealed their cancer to their children. In a multivariate analysis, children’s age > 6 years significantly correlated with parents revealing to their children that they had cancer compared to children’s age < 6 years [children aged 12–17 years: odds ratio (OR), 27.2; 95% confidence interval (CI), 9.52–77.93; p < 0.001; children aged 6–11 years: OR, 10.39; 95% CI, 4.53–23.86; p < 0.001]. In the subgroup analysis, children’s age, male patients with children aged 0–5 years (OR, 7.11; 95% CI, 1.14–44.22; p = 0.036), and female children aged 6–11 years (OR, 3.85; 95% CI, 1.1–13.51; p = 0.035) correlated with the parents revealing to their children that they had cancer. Conclusions: The decision to reveal parent’s cancer to minor children was affected by children’s age and gender of patients and their children.
Patient-provider communication and decision making in palliative radiotherapy.
Authors: Chen Jie Jane , Roldan Claudia Sofia , Nichipor Alexandra N. , Balboni Tracy A. , Krishnan Monica Shalini , Revette Anna , Hertan Lauren Michelle , Chen Aileen B.
Published: November 2019

24

Background: Patient-provider communication may impact patient satisfaction and engagement in decision-making. We aimed to understand patient preferences on radiation therapy (RT) discussions and to identify how to better communicate RT information. Methods: We conducted semi-structured interviews with 17 patients receiving palliative RT for lung or bone metastases at a single institution from 9/2016 to 10/2018. Patients’ answers about RT decision-making and communication were transcribed verbatim and analyzed qualitatively. We reviewed patients’ medical records to obtain demographic and clinical data. Results: The median age of patients was 64 years (range: 21-82). Most patients had metastatic cancer at diagnosis (53%) and had received prior palliative chemotherapy (71%) or RT (88%). The most common palliative RT course was 30 Gy in 10 fractions. Themes that impacted patients’ decisions to proceed with RT included trust in physicians (41%), desire to minimize pain or improve quality of life (35%), and a perceived lack of alternatives (35%). Most patients (76%) described the RT decision-making process as straightforward or logical. All patients reported receiving information from a physician on reasons to consider RT, while only 53% recalled discussions on reasons not to consider RT. Nearly all patients (88%) preferred shared patient-provider decision-making regarding cancer treatment; two patients (12%) preferred to be the main decision-maker. When discussing technical aspects of RT, 65% of patients reported that providers shared information on intensity of RT and number of treatments. Although 82% of patients reported that the provider was the sole decision-maker for the intensity of RT or number of treatments, all patients were satisfied and would not have wanted to be more involved in this decision. Conclusions: Trust in physicians, desire to minimize pain, and perceived lack of alternatives impact patients’ decisions to proceed with RT. Patients were more likely to remember physicians discussing reasons for RT as opposed to reasons not to consider RT. Most patients prefer shared decision-making regarding cancer treatment initiation but prefer physicians to make the decisions regarding RT treatment intensity.
Cultural disparities in end-of-life choices and advanced care planning in cancer patients.
Authors: Katiyar Vatsala , Vohra Ishaan , Malapati Sindhu Janarthanam , Singh Sunny , Lingamaneni Prasanth , Mackie Orlanda , Shariff Ruhi
Published: November 2019

3

Background: Integration of palliative care early in treatment of malignancy improves quality of life and curbs non-beneficial end of life care. However, there are differences in utilization of palliative services based on cultural background. We aim to identify such differences in a safety net hospital with adiverse patient population. Methods: This is a single institution retrospective study of adults with cancer who had inpatient palliative care encounter (PCE) between 2012-2017. A representative sample of 130 patients from 7 major ethnicities was included. Statistical analysis was performed using STATA. Results: Only 8.4% of all patients had a preceding outpatient PCE. Very few patients had advance directives prior to PCE (range 0-30% for individual ethnicities). As a reflection of their challenging social situation, 5.3% were homeless, 76.1% lived in someone else’s home, <10% had English as primary language (except Caucasian American and African American.) Healthcare utilization in the last 3 months of life varied widely between groups- maximum was in African American and Hispanic patients with ≥3 emergency room visits in 30% and 25% respectively. Table with time to important endpoints and setting of death is attached. Conclusions: Palliative service was involved very late in care, with most having significant challenges to complex care discussions including lack of social support and language barrier. Setting of death (ICU versus home) varied by ethnicity, and some groups had high utilization of aggressive end of life care. Understanding the underlying cultural intricacies leading to these choices will help physicians better navigate care and should be a future focus of study. [Table: see text]
Results from a focus group evaluating TrialTALK, a designed conversation to facilitate cancer treatment shared decision making.
Authors: Campbell Toby Christopher , Kennedy Erin , Schmocker Selina
Published: November 2019

34

Background: Cancer treatment decision making involves timely, high-risk, shared decision-making conversations between patients, their families, and their oncologists. These conversations are a prime target for a carefully designed, easy to interpret approach to facilitate preference-sensitive decision-making. The TrialTALK approach has two core elements: a verbal approach and a pen & paper diagram. The diagram includes the diagnosis with prognostic implications, available treatment options along with estimates for efficacy and anticipated impact on daily life. The verbal conversation corresponds to the diagram and includes a phrase to encourage deliberation and empathic responses. Here, we report the results of a focus group conducted in Toronto comparing two approaches to a cancer decision making conversation. Methods: Our focus group was comprised of 9 patients, all with incurable malignancy. They observed a live reading of an actual transcript of a cancer treatment decision making conversation between a patient and oncologist who presented three options: observation, chemotherapy, and a clinical trial. The investigators re-organized the conversation, reusing as many words as possible, into the TrialTALK framework. No new information was introduced. After watching each scene, participants discussed and rated the conversation for information needs and indicated the decision. Results: Three (33%) said rated the standard conversation as meeting their informational needs while 7/9 (78%) reported needs were met by the designed approach. Decision making preferences following the conversations are shown in the table. Patients reported feeling the physician in the designed conversation was more prepared; they felt greater trust and confidence; they valued the paper diagram; they felt more empowered and engaged in the decision. Conclusions: A designed conversation may improve patient understanding, influence decision making, while also enhancing the patient-physician relationship. Clinical trial information: NCT03656276. [Table: see text]
Development and implementation of “advanced cancer shared care letters” to improve shared care between oncologists and family physicians.
Authors: Watanabe Sharon , Bond Camille , Tan Amy , Tang Patricia A. , Karim Safiya , Kerba Marc , Biondo Patricia , Simon Jessica , Sinnarajah Aynharan
Published: November 2019

37

Background: Optimal care of patients living with advanced cancer requires a collaborative approach between oncologists and family physicians (FPs), starting early in the disease trajectory. We developed and implemented “advanced cancer shared care letters” to improve communication, collaboration and role clarity amongst providers. Methods: A physician-to-physician standardized “advanced cancer shared care letter” for colorectal cancer was created at a Canadian tertiary cancer center with input across stakeholders. The letter is ordered by the oncologist when they determine a patient to have advanced (i.e. incurable) cancer. The letter outlines components of shared care, division of responsibilities, monitoring for complications, responding to oncological emergencies, and consultation services such as palliative care. A cover sheet is provided for FPs to return to confirm their involvement, indicate their comfort level with providing a palliative approach to care (e.g. advance care planning, managing symptoms) and ask questions. Letters were piloted in two gastrointestinal (GI) oncology outpatient clinics for two months, and then implemented in the seven remaining GI clinics over two months. Metrics were collected for five months to evaluate implementation. Results: Over 5 months, 76 shared care letters were ordered; in 5 cases, no FP was identifiable. Cover sheets were returned by 39/71 FPs (55%). Content returned included prognosis questions, goals of care conversations, supportive services available in their practice and those in use by the patient, capacity to manage symptoms (e.g. opioid prescribing), and requests to engage palliative care services. Implementation challenges included frequent change in clerical staff and management, electronic chart challenges and variable adoption. Conclusions: The shared care letter provides a useful mechanism for FPs and oncologists to share information. It increases communication and care coordination between typically siloed providers, to enhance patient experience. A similar letter is provided to patients and we are now developing a shared care letter that is generalizable for any type of advanced cancer.
Billed palliative care services and end-of-life care in patients with hematologic malignancies.
Authors: Rao Vinay , Olszewski Adam J. , Egan Pamela , LeBlanc Thomas William , Belanger Emmanuelle
Published: November 2019

43

Background: Patients (pts) with hematologic malignancies (HMs) often receive aggressive care at the end of life (EOL), leading to lower quality of life. Early palliative care (PC) may improve EOL care, but its benefits are less established in HMs than in solid tumors. We sought to describe the use of billed PC services (BPCS) among Medicare beneficiaries with HMs and associated EOL quality measures. Methods: Using the linked SEER-Medicare registry, we studied Medicare beneficiaries diagnosed with leukemia, lymphoma, myeloma, myelodysplastic syndrome, or myeloproliferative neoplasm who died from 2001-2015. We described trends in the use of BPCS (identified by codes in clinician encounter claims). Among pts surviving >30 days from diagnosis, we compared baseline characteristics and EOL care quality metrics for pts with and without “early BPCS” (initiated >30 days before death). Results: The proportion of pts ( N=139,191, median age 81 years) with any BPCS increased from 0.4% in 2001 to 13.3% in 2015. Median time from first BPCS encounter to death was 10 days and 84.3% occurred during hospital admissions. Use of early BPCS was rare (from 0.2% in 2001 to 4.3% in 2015, with 28% of all first BPCS occurring early) and more frequent in acute leukemia, among black pts, those with higher comorbidity indices or poor performance statuses, and those receiving chemotherapy. Receipt of early BPCS was associated with improved EOL care quality metrics (see Table). Conclusions: Use of BPCS among Medicare beneficiaries with HMs has steeply increased in recent years, but most encounters still occur within days of death. Early BPCS are associated with better EOL care quality metrics similar to those observed in solid tumors. Our results support the need for prospective trials of early PC for pts with HMs. [Table: see text]
A survey of palliative care clinicians’ weekly self-care practices.
Authors: Bruera Eduardo , Anderson Aimee Elizabeth , Williams Janet L. , Liu Diane D.
Published: November 2019

59

Background: Recent evidence suggests that clinician burnout exceeds the national average in the Palliative Care workforce. MD Anderson’s Palliative Care service has therefore implemented measures to reduce stress and burnout and support engagement and health, including a 13-item, evidence-based Palliative Clinician Self Care Checklist. To improve the checklist, we conducted a survey to understand clinicians’ perception of the list and its items, and the frequency with which clinicians were able to achieve each item. Methods: The survey was administered electronically to Palliative Care medical professionals, including physicians, advanced practice providers, and counsellors. We collected demographic information in addition to survey items. We asked respondents to rate their perception of the usefulness of each of the 13 items, and how often they achieved each item. We also asked participants to rate their satisfaction with their professional life, and to respond to questions related to burnout. Results: The response rate to the survey was 32/39 providers contacted (82.0%), including 15 physicians, 10 APPs, and 7 counsellors. Items most often rated as useful or very useful were meeting with friends (93.7%), achieving a personal self-care goal (90.7%), and meeting with family (90.3%). Items least often rated as useful or very useful were visual arts (46.9%), reading literature (59.4%), and art, movies, or theater (65.7%). Items most reported as achieved most weeks or every week were meeting with friends (84.4%), achieving a personalized self-care goal (81%), and avoiding a personal item of maladaptive coping (81%). Visual arts (28.1%), art, movies, or theater (37.6%), and literature (43.8%) were least reported to be achieved most weeks or every week. All respondents reported some degree of satisfaction with their professional life. However, 25% of respondents reported feeling burned out once a week or more. Conclusions: While checklist items that respondents achieved least frequently were those that they perceived as least useful, some items perceived as most useful were not achieved as frequently. Future studies will focus on measures to facilitate providers’ ability to practice and access self-care measures.
OCM community oncology palliative care program: Sites of patient care in last 180 days before hospice or death by cancer types.
Authors: Akhtar Adil Jamal , Sheth Karna , Margolis Jeffrey H. , Maxwell Karma , Scott-Barney Tammy , Muskovitz Andrew A. , Howard George , Zekman Richard Philip , Qamruzzaman Yusuf , Ballouz Samer , Stortz Lexi , Fabbiano Maria , Folbe Mitchell , Ibrahim Mohammed
Published: November 2019

69

Background: Michigan Health Professionals (MHP) participates in Oncology Care Model (OCM). A community oncology program for early and timely involvement of palliative care (PC) was launched in 2017 to achieve OCM goals of high quality, cost-effective, coordinated care. Previously, we showed that early enrollment in PC increased hospice utilization, decreased hospitalization and outpatient facility cost in last 30-days of death or end of OCM episode. PC improved quality of care in OCM patients. This study aims to see the effect of PC by patient care setting in the last 180-days before hospice or death. Methods: Retrospective claims review was performed with PC patients referred from September 2017 – December 2018. Last 180-days was defined by the entry into hospice, patient death, or OCM claim limit (12/31/2018), whichever was first to occur. OCM claims were analyzed by Integra Connect. Patient care setting utilization, in days (LOS), was identified for FACILITY: inpatient, skilled nursing, outpatient facility (ER, observation, etc.), physician office, and HOME HEALTH: home health agency visits. When no claim was found within the last 180-days, the patient was assumed to be at home or with no-care (HOME). Results: PC-Engaged patients had lower LOS in FACILITY + HOME HEALTH care settings and more days at HOME vs PC declined or unable to reach (average difference of 14 days). PC-Engaged patients had lower LOS in FACILITY + HOME HEALTH vs. matched PC-not referred patients who died or entered hospice (average difference of 26 days). In lung cancer, PC-Engaged patients had lower LOS in FACILITY + HOME HEALTH vs. PC declined or unable to reach (average difference of 27 days). In pancreatic cancer, PC-Engaged patients had lower LOS in FACILITY + HOME HEALTH vs. PC declined or unable to reach (average difference of 17 days). Conclusions: Patients who are PC-Engaged spent more time at home and less time in facilities over the last 6 months before end-of-life. Patients who were referred to PC with advanced lung and pancreatic cancer showed the most opportunity for impact with PC engagement. Study was limited by OCM claims available as of June 2019. Results may be refreshed as more data becomes available.
Risk factors associated with suicide in patients with prostate cancer in the United States.
Authors: Konda Manojna , Sharma Rohan , Mariam Roy Arya , Verma Rashmi
Published: November 2019

84

Background: For a patient, receiving a diagnosis of cancer can be quite challenging and is often associated with depression and increased suicidal ideation. Previous studies have indicated that the risk of suicide in cancer patients is twice that of general population. Prostate cancer is the most common cancer in men. It has also been found to be associated with highest rates of suicide in genitourinary malignancies. We sought to evaluate the incidence and identify risk factors associated with suicide among men with prostate cancer. Methods: Patients with prostate cancer between the years 1973 and 2016 were identified in the Surveillance, Epidemiology, and End Results database (SEER). Multivariate logistic regression analysis was performed to identify independent risk factors for suicide death only on variables that were statistically significant in univariate statistical analysis. Results: In 1,307,625 patients with prostate cancer, 3,435 patients had committed suicide. Younger age (≤50 vs > 70: OR = 4.73 , P < 0.0001; 51-70 vs > 70: OR = 1.93, P < 0.04), Caucasian race (OR: 3.61, P < 0.0001) and not undergoing surgery (OR: 1.33, P < 0.0001) were significantly associated with increased risk of suicide. Furthermore, patients with < 1 year since the diagnosis of prostate cancer were also found to be associated with increased risk of suicide death ( < 1 vs > 5 years: OR = 1.46, P < 0.0001). Conclusions: Addressing mental health in patients with prostate cancer is an important issue. We found that several factors such as younger age, Caucasian race were significantly associated with risk of suicide. Patients who did not undergo surgery likely had advanced disease, which could explain their increased risk of suicide. Patients with < 1 year since the diagnosis of prostate cancer are more vulnerable and at increased risk of suicide which emphasizes the necessity of identifying and treating patients at risk of suicide as early as possible. It is vital that health care providers recognize these patients and offer them appropriate support.
Impact of the Oncology Care Model (OCM) on pain management: A retrospective cohort analysis.
Authors: Ciner Aaron , Norrell Jacqueline , Kurz Renee , Silk Ann W.
Published: November 2019

86

Background: Pain is a common symptom among patients with cancer and impacts performance status and quality of life. The OCM was implemented at Rutgers Cancer Institute of New Jersey (RCINJ) in July 2016 with the goal of improving many quality metrics in cancer care including documentation of pain and a plan of care for pain. Hypothesis: Documentation of pain and a plan of care for pain improved after implementation of the OCM at RCINJ. Improved documentation would correlate with a decrease in reported quantitative pain scores. Methods: Data from patients enrolled in OCM during its first year of implementation (post OCM) was compared to data from a control cohort the preceding year (pre OCM). The initial progress note and EMR flowsheet in each year were reviewed to determine pain documentation. For patients reporting a pain score ≥ 1 on a 0-10 scale, the association between documentation of a plan of care and improvement in quantitative pain score on a subsequent visit was analyzed using Chi square testing. Results: A total of 260 patient charts were analyzed. A quantitative pain score was documented in 99% of patients in the pre OCM group and 100% in the post OCM group. For those with a pain score ≥ 1, documentation of a plan of care increased from 43% to 55% after OCM implementation. Patients whose charts contained documented plans of care for pain were less likely to have decreased pain scores at a subsequent visit (51% vs 76%). Conclusions: (1) Documentation of a quantitative pain score was completed in nearly all patients before and after the implementation of OCM. (2) There was a non-statistically significant increase in documentation of plan of care for pain after OCM implementation. (3) Documentation of a plan of care was not associated with a decreased pain score at a subsequent visit. This may be the result of small sample size or related to progressive cancer-related pain or inadequate pain intervention.

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