bluuebunny/crossref_metadata_2025_split huggingface dataset:
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. [Table: see text]
New model of care for patients with central nervous system cancers.
Authors: Pentsova Elena , Nevel Kathryn Sara , Konig Franchesca , Sibilla Maryann , Skakodub Anna , Manne Malbora , Errante Mimma , Gordilo Milagros , Rawlins-Peters Gayle , Jean-Charles Dominique , Zankowsky Anastasia , Gilman Jody , Kelly Brian , Zavolas Stephanie , Goldman Hannah , Syrkin Grigory , Diamond Eli L. , DeAngelis Lisa Marie , Ruppert Lisa Marie , Carver Alan 
Published: November 2019

87 Background: Patients (pts) with primary or metastatic central nervous system (CNS) cancers often have multiple physical, psychosocial, and spiritual needs. Likewise, neurological impairments can transform pts’ relationship dynamics with caregivers. These issues, along with prognosis and end of care planning, are difficult to address within a single outpatient oncology clinic. Methods: The Neurological Multidisciplinary Care Clinic (MdCC) at Memorial Sloan Kettering Cancer Center was a pilot study from 8/2017 to 6/2019 to foster a new model of care for complex pts with CNS cancers to identify and address their needs. Twice a month between 8/2017- 6/2019, a team comprised of a neurologist, nurse, physiatrist (RM), physical therapist, social worker (SW), case manager (CM), dietitian (RD), and chaplain (C) saw patients with neurological deficits and KPS ≤80. Within a 3 hour-visit, providers rotated in to see patients and their caregivers. Since 11/2017 participants completed validated surveys on unmet needs, financial strain, and home equipment prior to their visit, and satisfaction surveys afterward. Descriptive statistics were used to analyze results. Results: Eighty-two pts with advanced cancer were seen: 40 were female, median age 59. Of these 82 pts, 66 had primary CNS cancers, predominantly high-grade glioma/glioblastoma (79%). Over 60% had never seen a CM, RM, RD or C prior to MdCC. Seventy-eight pts (95%) received symptom management recommendations. Prognosis/coping with cancer was discussed with 75 pts (91%) which increased signed health care proxy forms by 16% and DNR orders by 6% at time or within a month post-MdCC. New/updated physical therapy was ordered for 50 pts (61%), orthotics for 10 (12%), and new equipment for 14 (17%). Forty-nine pts completed a satisfaction survey: of these, 96% were highly satisfied, and would recommend MdCC to others. Conclusions: Pts’/caregivers’ unmet needs were effectively identified and addressed within a single MdCC visit. The presence of several providers through MdCC allows for the assessment of pts’/caregivers’ needs and coping skills in real time. The MdCC also facilitates discussing pts’ goals of care, assessing their support system, and implementing a safe patient-centered plan of care.
Patient-reported symptom profiles: A tool to direct palliative care referral.
Authors: Kaufmann Tara L. , Hsu Jesse Y. , Getz Kelly D. , Kamal Arif , DeMichele Angela 
Published: November 2019

93 Background: Both routine PRO monitoring and specialty palliative care are associated with a survival benefit in advanced cancer patients, yet the integration of these efforts has not been described. As PRO collection becomes standard of care, there is a need to understand how PROs may be leveraged to identify patients who could benefit from palliative care referral. Methods: We applied latent profile analysis (LPA) to PROs from a national palliative care registry collected from 2008 – 2017 on 745 solid tumor patients at the time of initial outpatient palliative care visit. LPA is an established method to identify unobserved groups from variables of interest. We used patients’ responses to 11 questions across 4 palliative care domains (9 ESAS items and 2 items for social and existential distress) to generate “PRO profiles” and examined their clinical and demographic correlates using multinomial logistic regression. Results: Four PRO profiles were identified using 9 ESAS items (Table). Young age, metastatic disease, and tumor type (including breast, GYN, GI) differed across PRO profiles compared to lung. Patients with PPS < 70% were 4.5 times more likely to be in the High vs. Low symptom profile compared to those with PPS > 70%. Subgroup analyses showed correlation of social and existential distress PROs with Mood and High profiles. Conclusions: Cancer patients referred to outpatient palliative care can be differentiated into clinically meaningful PRO profiles using brief, routinely collected data in the real-world setting. PRO profiles provide richer data on patient needs compared to prognosis estimates or cancer stage, and synthesize big data for use in clinical practice and epidemiologic research. PRO profiles should include comprehensive palliative domains and be tested as screening thresholds for palliative care referral. [Table: see text]
Living with multiple myeloma: A life disrupted.
Authors: LeBlanc Matthew Roger , LeBlanc Thomas William , Bryant Ashley Leak , Pollack Kathryn Ilonka , Bailey Chip , Smith Sophia Kustas 
Published: November 2019

95 Background: Multiple myeloma (MM) an incurable cancer of the plasma cells is the second most common hematologic malignancy. Over 30,000 new diagnoses and over 12,000 deaths are attributed to MM annually in the United States. Dramatic improvements in survival over the past fifteen years have been fueled by the rapid introduction of new therapies and resulting changes in treatment patterns. Extended survival coupled with complex and ongoing treatment contributes to significant disruptions to daily living. Therefore, the purpose of this study was to explore the many ways that a MM diagnosis disrupts and interferes with a person’s life in the current treatment era. Methods: A cross sectional qualitative descriptive study was conducted to explore the impacts of MM diagnosis and treatment on patients’ lives in the era of novel MM treatment. Semi-structured one-hour interviews were conducted at the Duke Cancer Center with MM patients and MM clinicians to explore MM’s impact on patients’ lives. Results: Fifteen MM patients and ten MM clinicians were interviewed between September 2017 and September 2018. Themes arose around ways that a MM diagnosis and treatment had far reaching and serious impacts on patients’ lives. Four major themes emerged: ‘Impacts on Social Life and Hobbies’, Maintaining Employment’, ‘Financial Pressure’, and ‘Relationship Stress'. Conclusions: The care of MM patients has made great strides as new and more effective treatments have extended survival for many patients. Health care at its best endeavors to reduce suffering as well as extend life. This study highlights the far-reaching impacts MM has on all aspects of patients’ lives. Understanding how a myeloma diagnosis and its treatment may interfere in patients’ lives could inform the development of interventions that target management strategies to limit these negative impacts.
The development and implementation of a gynecologic cancer survivorship tool.
Authors: Carter Jeanne , Abu-Rustum Nadeem , Saban Sally , Chen Ling Y. , Vickers Andrew , Billanti Gabriela , Connors Nicole A , Broach Vance , Brown Carol L. , Chi Dennis , Gardner Ginger J. , Goldfrank Deborah J. , Jewell Elizabeth Lin , Leitao Mario M. , Long-Roche Kara C. , Mueller Jennifer Jean , Sonoda Yukio , Zivanovic Oliver 
Published: November 2019

98 Background: To assess the implementation and use of an electronic survivorship tool to enhance patient/clinician communication and intervention of survivorship concerns in women treated for gynecologic cancer. Methods: The clinical survivorship tool was developed using evidence-based data, multidisciplinary expert input, and patient feedback. The tool is composed of 17 questions encompassing 6 main categories: gynecologic health (abnormal bleeding/pain), lymphedema, vaginal/vulvar dryness, sexual health concerns, menopause (hot flushes, sleep difficulties), and bowel/urinary issues. The electronic tool was piloted and incorporated into clinic for endometrial and cervical cancer patients. Patients were introduced to the tool at their first postop visit and emailed an introduction form before their 3-month follow-up visit. The form could be completed at home or at the time of scheduled visit. Results: From 6/1/18 to 6/1/19, 1269 patients were eligible to complete at least one survivorship tool survey. Compliance rates increased over the year and reached 67% (1,015/1,525 assigned surveys completed) with the addition of clinic coordinator, staff and nurse training; the initiation of daily emails screening for survey respondents; clinic coordinator feedback and modification of screening emails; and the addition of nurses to daily screening emails. Of those who completed surveys between 01/1/19 and 06/1/19, the most common survivorship concerns noted were bowel (48%, n=484) and urinary function (35%,n=352) issues, menopausal symptoms such as trouble sleeping (33%, n=333) and hot flashes (25%, n=249), lower extremity symptoms (heaviness 17%, n=175; swelling 17%, n=171; numbness 17%, n=171), and vaginal dryness (26%, n=263), with actionable items of education and referrals, as needed. Conclusions: This survivorship tool enhanced the ability of healthcare providers to identify, monitor, and address survivorship concerns over the continuum of care. Patients and healthcare providers found this tool to be clinically feasible with potential to promote communication and education to enhance clinical care. Our multidisciplinary approach and training were key to implementation success.
Elevated HbA1c Is Associated with Altered Cortical and Trabecular Microarchitecture in Girls with Type 1 Diabetes
Authors: Mitchell Deborah M , Caksa Signe , Joseph Taïsha , Bouxsein Mary L , Misra Madhusmita 
Published: November 2019

AbstractContextSkeletal fragility is a significant complication of type 1 diabetes (T1D), with an increased risk of fracture observed starting in childhood. Altered bone accrual and microarchitectural development during the critical peripubertal years may contribute to this fragility.ObjectiveTo evaluate differences in skeletal microarchitecture between girls with T1D and controls and to assess factors associated with these differences.DesignCross-sectional comparison.ParticipantsGirls ages 10–16 years, 62 with T1D and 61 controls.ResultsAreal bone mineral density (BMD) measured by dual-energy x-ray absorptiometry did not differ between girls with and without T1D. At the distal tibia, trabecular BMD was 7.3 ± 2.9% lower in T1D (P = 0.013), with fewer plate-like and axially-aligned trabeculae. Cortical porosity was 21.5 ± 10.5% higher, while the estimated failure load was 4.7 ± 2.2% lower in T1D (P = 0.043 and P = 0.037, respectively). At the distal radius, BMD and microarchitecture showed similar differences between the groups but did not reach statistical significance. After stratifying by HbA1c, only those girls with T1D and HbA1c &gt; 8.5% differed significantly from controls. P1NP, a marker of bone formation, was lower in T1D while CTX and TRAcP5b, markers of bone resorption and osteoclast number, respectively, did not differ. The insulin-like growth factor 1 (IGF-1) Z-score was lower in T1D, and after adjustment for the IGF-1 Z-score, associations between T1D status and trabecular microarchitecture were largely attenuated.ConclusionsSkeletal microarchitecture is altered in T1D early in the course of disease and among those with higher average glycemia. Suppressed bone formation and lower circulating IGF-1 likely contribute to this phenotype.
Establishing neuronal diversity in the spinal cord: a time and a place
Authors: Sagner Andreas , Briscoe James 
Published: November 2019

ABSTRACT
The vertebrate spinal cord comprises multiple functionally distinct neuronal cell types arranged in characteristic positions. During development, these different types of neurons differentiate from transcriptionally distinct neural progenitors that are arrayed in discrete domains along the dorsal-ventral and anterior-posterior axes of the embryonic spinal cord. This organization arises in response to morphogen gradients acting upstream of a gene regulatory network, the architecture of which determines the spatial and temporal pattern of gene expression. In recent years, substantial progress has been made in deciphering the regulatory network that underlies the specification of distinct progenitor and neuronal cell identities. In this Review, we outline how distinct neuronal cell identities are established in response to spatial and temporal patterning systems, and outline novel experimental approaches to study the emergence and function of neuronal diversity in the spinal cord.