bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating patient out-of-pocket (OOP) costs associated with attendance at a prostate cancer supportive care program.
Authors: Wu Eugenia , Hedden Lindsay , Bryan Sterling , Arsovska Olga , Vivar Michaela , Sundar Monita , Goldenberg Larry , Higano Celestia S. 
Published: November 2019

108 Background: The Prostate Cancer Supportive Care (PCSC) Program at the Vancouver Prostate Centre (VPC) services address the physical and psychological needs of men and their partners from the time of PC diagnosis onwards. The study objective was to assess the level of patient out-of-pocket (OOP) expenditure associated with attending the PCSC services, which are otherwise free of charge, and determine whether OPP varies by specific clinical or sociodemographic characteristics. Methods: All men with PC seen at the VPC are invited to enroll in this study. Before or after any clinic and/or education appointment, pts completed a cost evaluation survey. Demographic data was collected from the PCSC Program registration forms and VPC electronic medical records. Results: Between 16-Apr-18 and 06-Sep-18, 207 men enrolled in the study and completed the survey. OOP expenses were highly skewed, with the majority of study participants spending less than $20 for each visit to the program, median (median $10, SD 80.0). Majority (93.6%) experienced either no or minimal financial burden, while 5.3% experienced moderate and 1.1% experienced substantial financial burden associated with their attendance at the program. Forty-four participants (22.1%) had to take time away from work to attend a PCSC service, on average this was 275 minutes, and 13.6% of them (2.9% of the total study sample) considered not participating because of difficulty getting the necessary time off. The average travel time (72.9 minutes) associated with a visit to the program was also highly skewed (median 45.0, SD 210.6). Using a simple linear regression, longer travel was associated with higher cost (t=8.30, p<0.0001), however, longer travel was unrelated to cost burden (F=0.35, p=0.79). Conclusions: OOP expenditure as well as associated burden is very minimal for the majority of participants. From a programmatic standpoint, a reasonable number of participants (22%) had to take time away from work. Bi-variate results show no relationship with personal income, OOP expenditure and financial burden.
Antiemetic efficacy of intravenous (IV) NEPA in patients with breast cancer (BC) receiving anthracycline/cyclophosphamide (AC) chemotherapy.
Authors: Schwartzberg Lee S. , Aapro Matti S. 
Published: November 2019

115 Background: The complexity of administering multi-agent prophylactic antiemetic combinations required to prevent chemotherapy-induced nausea and vomiting (CINV) may contribute to poor guideline adherence seen in multiple studies. NEPA, a combination antiemetic of an NK1 receptor antagonist (RA) [netupitant (oral)/fosnetupitant (IV)] and 5-HT3RA, palonosetron, offers 5-day CINV prevention with a single dose. Unlike other IV NK1RAs, the fosnetupitant solution does not require a surfactant, emulsifier, or solubility enhancer and contains no allergenic excipients, thereby minimizing infusion-related toxicities that have been reported with other NK1RAs. This study previously reported the safety of IV NEPA in BC patients receiving repeat cycles of AC; there were no infusion-site or hypersensitivity reactions related to IV NEPA reported. The efficacy results of this study are the focus of this presentation. Methods: This was a Phase 3b, double-blind safety study in females with BC naïve to highly/moderately emetogenic chemotherapy. Patients were randomized 1:1 to receive a single 30-min infusion of IV NEPA or a single oral NEPA capsule on Day 1 prior to AC. Oral dexamethasone was also given to all patients before AC on Day 1 only. Complete response (CR: no emesis, no rescue) and no significant nausea (NSN: < 25mm on 100mm VAS scale) rates were calculated daily during the 5 days (0-120 h) post-AC in Cycle 1. No formal statistical comparison between groups was planned. Results: 402 total patients were included in the analysis. Most patients were white (93%) with ECOG status of 0 (75%); the mean age was 55 years. Comparable CR and NSN rates were seen for IV and oral NEPA during each of the 5 days post-AC. Conclusions: As a simplified single-dose formulation, IV NEPA showed high response rates in BC patients receiving AC, with favorable safety as no treatment-related infusion-site/hypersensitivity reactions were reported. Clinical trial information: NCT03403712. [Table: see text]
The efficacy and the incidence of drowsiness with different modified administrations of olanzapine in preventing chemotherapy induced nausea and vomiting.
Authors: Qian Yu , Wang Jun , Wu Yuan , Dong Shuang , Hu Sheng , Luo Chenggang , Wei Shaozhong , RAN Fengming 
Published: November 2019

121 Background: Olanzapine is now widely used for preventing chemotherapy-induced nausea and vomiting (CINV). The recommended oral administration is 10 mg at bedtime. However, drowsiness is one of common side effects of olanzapine. Several modified administrations of olanzapine, such as dose reduction and early taken are being tried in clinical practice to avoid drowsiness. Methods: We retrospectively reviewed 500 patients who used olanzapine for CINV from January 2018 to January 2019 in our department. Eligible criteria include patients who used the constant administration of olanzapine for at least four days to prevent acute and delayed CINV. Patients were grouped into three groups according to three different administrations of olanzapine as full dose (10mg), half dose (5 mg), and early taken (10 mg, six hours before bedtime). Eligible patients were randomly selected in each group as a ratio of 1:1:1. The frequency of CINV, the incidence of drowsiness and the duration of olanzapine administration were collected and compared. Results: There are 267 patients met the criteria and 48 patients in each group. The median frequency of CINV per day in all 144 patients was 3, 1, 1 on day 1 to 3 after chemotherapy respectively. The frequency of CINV was not different among three groups. The incidence of drowsiness was 38%, 20%, and 23% in full dose, half dose and early taken groups (P < 0.05). The median days of administration were 5, 10 and 6 days in full dose, half dose and early taken group, respectively. Conclusions: Modified administration of olanzapine, both by dose reduction and early taken, could have similar effect in preventing CINV but reduced the incidence of the side effect as drowsiness. Further study should be done to explore the proper administration of olanzapine in preventing CINV.
Treatment of neoplastic fever and sweats in two cancer patients with oxybutynin.
Authors: Smith Thomas J. , Yarchoan Mark , Leon-Ferre Roberto Antonio , Tucker Wendy , Loprinzi Charles L. 
Published: November 2019

128 Background: Treatment for neoplastic fevers and sweating (NFS) is usually accomplished successfully with non-steroidal drugs (NSAIDs) such as naproxen, but such therapies may be contraindicated in some patients due to drug interactions, bleeding diathesis, renal disease, or cirrhosis. Options for treating NFS in such patients are limited. Methods: We report the first use of oxybutynin (OxyB), commonly used for hyperhidrosis and increasingly used for hormonally mediated hot flashes (Smith TJ, NEJM 2018; Leon-Ferre R, SABCS 2018, under review in JNCI Cancer Spectrum, for NFS in NSAID-ineligible or refractory patients. Results: Two patients with NFS were treated. The first was a 70 year old (yo) woman with cholangiocarcinoma with 3 months of NFS for whom naproxen was ineffective and who was starting chemotherapy. Within 2 hours after 2.5 mg OxyB q12h her sweating was gone, and her fever, which had been up to 100.4F, never resumed. The second was a 52 yo male with cirrhosis and hepatocellular carcinoma who was prescribed 2.5 mg q12h OxyB with lysis of his fever within hours and cessation of his sweating. To date, over one month has passed with no reduction in efficacy. Conclusions: OxyB may be a successful treatment modality for patients with NFS who cannot be treated with or are refractory to NSAIDs. Further research is warranted to ensure stability of results over time and to monitor for side effects.
The efficacy of palliative radiation therapy in the treatment of recurrent and metastatic ovarian cancer.
Authors: Butala Anish , Patel Roshal , Jones Joshua Adam , Taunk Neil 
Published: November 2019

129 Background: Ovarian cancer is the 2nd most common gynecologic malignancy with surgery and platinum-based chemotherapy as the mainstay of initial treatment. However, ovarian cancer has generally high rates of recurrence and metastasis after primary therapy. For patients with progressive or symptomatic disease, radiation therapy (RT) can be utilized as an effective option for palliation. Methods: A retrospective review was conducted of patients treated with palliative RT for symptomatic or recurrent ovarian cancer between 2015-2019 at a single institution. 17 women were identified who received 20 courses of RT. Response was classified as complete response (CR), partial response (PR), and progressive disease (PD). Overall response rate (ORR) was the sum of CR and PR. Results: Median age at RT was 57 (range 36-76). Histologic subtypes were high grade serous (65%), low grade serous (12%), clear cell (12%), and other (12%). The most common indications were pain (65%), bleeding (30%), and asymptomatic progression (20%). 18 of 20 RT courses were delivered to soft tissue or nodal metastases. RT techniques included 2D/3D (60%), IMRT (30%), and SBRT (10%). Dose ranged from 20-60 Gy in 3-28 fractions. 20 Gy in 5 fractions (25%) and 30-31 Gy in 10 fractions (25%) were most common. Of the 16 RT courses for symptomatic disease, clinical ORR was 87.5% within 3 months of RT (50% PR and 37.5% CR). 3 treatments had sustained response beyond 3 months. 2 developed PD. Of 11 RT courses with follow-up imaging, radiographic ORR was 36.1% (27% PR and 9.1% CR) within 3 months of RT. 1 had sustained PR beyond 3 months. Of the 10 RT courses for symptomatic high grade serous histology, PR and CR was seen in 50% and 40% of patients within 3 months (90% ORR). Conclusions: Palliative RT offers high rates of clinical response for symptomatic patients with metastatic ovarian cancer within 3 months of treatment delivery. Rapid clinical response rates were particularly favorable for those with high grade serous histology. RT should be considered as a standard palliative option for patients with symptomatic ovarian cancer metastases. Further prospective studies are warranted to establish the optimal timing, dose, and relation to chemosensitivity in this setting.
Opioid usage patterns among Medicare pancreatic cancer patients according to palliative care utilization.
Authors: Lu Zhanni , Ganduglia Cazaban Cecilia M , LeonNovelo Luis G. , Yennu Sriram , Giordano Sharon H. , Zhao Hui 
Published: November 2019

14 Background: Opioid pharmacotherapy is used to manage moderate and severe pain in palliative care (PC). Pain affects 80% pancreatic cancer patients older than 65 years. We assessed the opioid utilization patterns in Medicare patients with pancreatic cancer whom did not use PC (NPC), used community-based PC (CBPC) or used hospital-based PC (HBPC). Methods: We assessed opioid use, types, dispensed days, opioid uptake rates, doses (measured by morphine equivalent doses (MEDs)), and related adverse events (AEs) after pancreatic cancer diagnosis in Medicare beneficiaries selected from the SEER-Medicare database between 2007 and 2013 using the log-binomial, generalized linear mixed, and Cox proportional hazards modeling. Results: 16,106 patients were identified (median age: 78 years; female: 55.2%), of whom 8.3% used CBPC and 19.6% used HBPC. PC users were more likely to use opioids (CBPC: 72.2% vs. HBPC: 63.4% vs. NPC: 56.3%, P<.001). The most commonly prescribed opioid type in NPC, HBPC and CBPC users was fentanyl (54.1%), hydromorphone (27.7%) and morphine (26.1%). Compared to other study patients, CBPC users had shorter median dispensed days per prescription (CBPC: 3 days vs. HBPC: 4 days vs. NPC: 4 days, P<.001) but higher median MEDs per prescription (CBPC: 25 mg vs. HBPC: 25 mg vs. NPC: 0.13 mg, P<.001). Adjusting for demographic and clinical factors, no significantly different uptake rates of opioids were determined in PC users compared to NPC users (CBPC: RR, 1.02, P=.057; HBPC: RR, 1.002, P=.783). HBPC users had higher adjusted daily MEDs than CBPC and NPC users 3 months after diagnosis (135.1 mg/d vs. 126.5 mg/d vs. 65.7 mg/d, P<.001). CBPC users had higher adjusted daily MEDs than HBPC and NPC users 3 months before death (164.3mg/d vs. 155.6 mg/d vs. 92.1 mg/d, P=.0002). CBPC users had lower but HBPC users had higher adjusted hazard ratios of delirium (CBPC: HR, 0.95, HBPC: HR, 1.26, P<.001) and drowsiness (CBPC: HR, 0.94, HBPC: HR, 1.53, P<.001) than NPC users. Conclusions: Older pancreatic cancer patients using PC tended to use opioids and consumed higher opioid doses. CBPC users had lower risks of opioid-related delirium and drowsiness. The factors of the opioid use variations need to be assessed.
Serious illness communication practices in glioblastoma care at an academic medical center.
Authors: Reed-Guy Lauren , Alexander Tyler D. , Biggiani Gregory , Miranda Stephen P. , O'Connor Nina 
Published: November 2019

28 Background: Glioblastoma (GBM) is an aggressive primary brain tumor with a disease course marked by both cognitive and physical decline. Early conversations about end-of-life (EOL) preferences are important given the average life expectancy of 14 months. Little is known about patterns of communication in GBM. Objective: To describe current practices surrounding EOL conversations in GBM patients at an academic medical center. Methods: We reviewed the medical records of 240 patients treated for GBM at the University of Pennsylvania who died between 2017 and 2019. We systematically identified and characterized EOL conversations, as defined by documented discussions of prognosis, goals of care, EOL planning and/or code status. Results: Patients in this study were predominantly male, white, privately insured and had relatively high performance status (median KPS 80 at initiation of therapy). Median survival was 487 days and 96% of patients received both chemotherapy and radiation. Nearly all patients (96%) had at least one EOL conversation documented. The median number of documented conversations per patient was 4. The first EOL conversation occurred at a median of 24 days after diagnosis (range 0 to 3,883) and 362 days before death (0 to 2,401). The last EOL conversation occurred at a median of 32 days before death (0 to 1,514). EOL conversations took place earlier among older patients, with each additional year of age at diagnosis associated with a first conversation 8 days earlier (95% CI: -12 to -4 days; p<0.01). At least one EOL conversation occurred at an outpatient visit for 89% of patients; 33% had conversations during hospital admissions; and 38% had EOL conversations via telephone. Medical oncology was the most common specialty to document EOL conversations (89% of patients), followed by palliative care (19%), radiation oncology (13%) and neurosurgery (10%). Conclusions: EOL conversations appear to have occurred relatively early and often, but further work is needed to evaluate the quality of documented discussions and to determine whether this pattern is unique to this single center or widespread. The variety in provider specialty and conversation setting reflects the complexity of the care environment in GBM.
Motivation to engage in communication skills training by oncology specialty.
Authors: Portman Diane , Otto Amy , Thirlwell Sarah , Lubrano di Ciccone Barbara , Reblin Maija 
Published: November 2019

29 Background: The present study aimed to assess oncology fellows’ motivation to participate in communication skills training by specialty. Methods: Oncology fellows attending communication skills training were invited to participate in program-evaluation research. Before each workshop, participants provided demographic information and completed subjective communications skills and motivation questionnaires. Following the workshop, the subjective communication skills survey was repeated. Results: Fifty physician trainees participated. Half were female. Most were first-year fellows (81%), White/Caucasian (56%), non-Hispanic (92%). Mean age was 32 years ( SD= 3.63). Motivation for attending the workshop was most commonly external regulation (e.g., required participation; M= 5.66, SD= 1.38), followed by identified regulation (e.g., belief the workshop will be helpful; M= 4.30, SD= 1.26) and intrinsic motivation (e.g., interest in topic; M= 3.76, SD= 1.15). Amotivation was less common ( M= 2.47, SD= 1.35). All scales rated 1-7. A one-way ANOVA revealed significant differences in levels of identified regulation ( F(4,44) = 3.26, p= .020) and external regulation ( F(4,45) = 3.47, p= .015) between fellows of different specialties. Post-hoc comparisons revealed that Hematology Oncology fellows reported significantly lower levels of identified regulation than Hospice & Palliative Medicine fellows ( M difference = -1.35, p= .024). Hematology Oncology ( M difference = 1.60, p= .012) and Surgical Oncology fellows ( M difference = 1.67, p= .043) both reported significantly higher levels of external regulation than Hospice & Palliative Medicine fellows. However, there were no significant differences between specialties with regard to post-workshop preparedness or pre-post change in preparedness ( ps > .05). Conclusions: There is opportunity to create targeted interventions to improve physician motivation to participate in communication skills education by matching messaging to each specialty’s motivation type.
Genomic profiling: Shared decision making and emotional well-being among patients with metastatic genitourinary cancers.
Authors: Bergerot Cristiane Decat , Bergerot Paulo Gustavo , Philip Errol James , Salgia Meghan , Salgia Nicholas , Dizman Nazli , Hsu Joann , Pal Sumanta K. 
Published: November 2019

31 Background: Little is known regarding patients’ beliefs concerning genomic profiling (GP) and its potential association with emotional well-being. We examined essential components of shared decision-making in the context of GP and their relationship to symptoms of anxiety (SAnx) and of depression (SDep) among patients with metastatic genitourinary cancers. Methods: Patients were recruited from a single institution after receiving a standardized dialogue about GP from their oncologist. Patients were included if they had received GP in the context of routine clinical care, and assessed across a range of perceptions related to GP (e.g., communication, expectations, risks associated, reasons and hopes), SAnx (PROMIS-Anxiety) and SDep (PROMIS-Depression). The Kruskal-Wallis test was used. Results: Seventy patients with incurable genitourinary cancers (60% kidney, 21% prostate and 18% bladder cancers) were surveyed. Patients reported that information about GP was presented clearly (95%), comprehensively (94%), accurately (92%), and compassionately (98%), and most felt they possessed a good understanding of GP (78%). No significant differences emerged between patients with or without SAnx or SDep. Patients reported similar reasons for pursuing GP, including to help guide treatment decision making and to follow their physician’s suggestion. Notably, those with SAnx or SDep were more likely to report a desire for information that could help predict their disease outcome (20% and 33%) compared to patients without SAnx or SDep (0%) (P < 0.05). Those with SDep tended to report a desire for GP to improve their treatment response compared to those without SDep (42% vs. 21%, P = 0.04). Compared to those without SDep, patients with SDep were more likely to report a belief that GP could reveal a cure to their disease (73% vs. 50%, P = 0.01). Conclusions: Our findings reinforce the importance of effective counselling in the context of complex medical decision-making. SAnx and SDep may be associated with erroneous beliefs or expectations the role of GP in treatment. Given the complexity of GP, interventions are needed to enhance patients' understanding of these tests and therapeutic implications.
Timing is everything: Improving the frequency, timeliness, and effectiveness of goals of care conversations for oncology patients in Manitoba.
Authors: Carpenter-Kellett Tara , Gingerich Joel Roger , Czaykowski Piotr , Loader Alissa , Bucher Oliver 
Published: November 2019

4 Background: Advanced care planning (ACP) in oncology requires effective communication and coordination. Early and regular ACP discussions are endorsed by ESMO and can help facilitate quality, patient-centered care. Methods: An ACP curriculum was created at CancerCare Manitoba that included health care provider (HCP) engagement, HCP and patient education, improved ACP clinical workflow, and improved ease of ACP documentation in the medical record. We evaluated the occurrence and frequency of ACP discussions before implementation of the ACP curriculum using a random sample of 100 adult patients diagnosed with stage IV solid tumors in Manitoba, Canada during 2014. We compared this group to a similar group of patients from 2017 after ACP curriculum implementation. Differences between the two cohorts were tested using Chi-square and Fisher’s Exact tests. The time from a patient’s first clinic visit with an oncologist to their first ACP conversation was described using cumulative incidence curves with K-sample tests used to test for significant differences between the 2014 and 2017 cohorts. Results: Of the 200 patients selected, 153 were assessed at our provincial cancer center (76 in 2014 and 77 in 2017). The median age for this group was 68. 59% were male. 56% received at least 1 line of chemotherapy. ACP documentation increased from 29% in 2014 to 42% in 2017 (p = 0.10). Between 2014 and 2017, initial ACP discussions occurred at: Initial visit (18% vs. 41%), disease progression (27% vs. 31%) and referral to palliative care (55% vs. 28%). After curriculum implementation ACP documentation occurred earlier in the patient’s cancer journey (p = 0.04). Conclusions: After implementation of an ACP curriculum at our cancer center, ACP discussions occurred more often and earlier, but the difference was only significant for earlier ACP discussions. Even after ACP curriculum implementation, a significant proportion of patients did not have ACP documented in their patient record. Understanding and overcoming barriers related to ACP at our institution will be critical for further ACP documentation improvement.