bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.