bluuebunny/crossref_metadata_2025_split huggingface dataset:
Problems following treatment for cancer: Building a picture and pathways for Manchester Cancer (UK) 2015-2018.
Authors: Higham Claire Emily , Wilby Lindsey , O'Rourke Claire , Makin Wendy 
Published: November 2019

145 Background: Greater Manchester Cancer (GMC) is the cancer program for Greater Manchester’s (GM) devolved health and social care system. 13 tumor-specific (TPB’s) and 7 cross-cutting (inc Living With and Beyond Cancer (LWBCPB)) pathway boards were formed to support this. Aims:The LWBCPB tasked the TPB’s to describe late consequences of treatment, define current care pathways/resources and highlight service gaps. Methods: Questionnaires were sent to all TPB’s. Returned questionnaires (11/13) from 2015-18 were analysed quantitatively (Excel) and qualitatively (Nvivo). Results: Frequent cross cutting long term effects were fatigue(9/11 TPB’s), psychological distress(7/11), sexual dysfunction(6/11), memory loss(5/11), neuropathy(5/11). Management strategies were described; eg, for fatigue; specific workshops(11/11), verbal +/- written advice(7/11), referral to other HCP(6/11). Tumour specific long term effects included a mix of clinical and psychosocial issues; with all TPB’s providing information to patients; only 6/11 to Primary Care. Limited evidence was given for active screening for long term effects. Resources offered included national websites, charities, local services and support groups. For specific clinical issues eg cardiac; referral was mainly to local services; despite identification of clinicians with an interest in LWBC offering specialist services within GM. Lack of resource was the commonly cited reason for absence of care pathways. Identified gaps in current approaches to management were; lack of access to specific resources(11/11) (psychology(7/11), specialist nurse(2/11), hospice care(2/11); inequity of access to resources(7/11); need for specific pathways and referral guidance(3/11). Conclusions: Long term consequences of cancer treatments are cross-cutting. GMC PB’s are an opportunity to use these baseline data to define and implement locally appropriate LWBC pathways including optimal referral, screening and communication with primary care.
Unintended consequences of screening for anxiety and depression among survivors of pediatric, adolescent, and young adult (P-AYA) cancer.
Authors: Jacobs Linda A. , Blauch Abigail N. , Pucci Donna A. , Palmer Steven C 
Published: November 2019

148 Background: Screening for psychosocial issues has been mandated to identify survivors in need of assistance and improve outcomes. Although screening identifies some individuals at risk for difficulties, many who screen positively ultimately decline intervention. Moreover, screening has the potential to "miss" patients who desire intervention but screen negatively for psychosocial need. We explored these issues among a sample of adult survivors of P-AYA cancer. Methods: Survivors of P-AYA cancer > 2 years from end of treatment completed an assessment including the Hospital Anxiety and Depression Scale (HADS) and desire for assistance with Anxiety and Depression following a survivorship visit. HADS subscale scores of > 8 indicated at least mild symptoms. Results: Participants (N = 237) were predominately white (89%), college educated (76%), single (63%), and had an annual income of > $60,000 (69%). A plurality had diagnoses of leukemia (30%) or Hodgkin's lymphoma (29%) treated 17 years previously. Treatment included surgery (35%), chemotherapy (91%), XRT (59%), and BMT (17%). Anxiety (M = 6.02; SD = 3.07) and depression (M = 2.54; SD = 2.85) scores were low and below the cutpoint of 8 (all t < -7.8; p < .001 ), although 21% and 9% screened positively for anxiety or depression, respectively. Screening positive for anxiety was associated with a desire for intervention (X2 = 20.77; p < .001 ), while screening positively for depression was not (p > 0.05). Among those screening positively for anxiety, 50% desired intervention, while among those screening positively for depression only 38% desired intervention. Moreover, among those desiring intervention for anxiety or depression, 36% and 68% screened negatively for symptoms, respectively. Conclusions: Many P-AYA survivors screening positively for anxiety or depression do not desire intervention. As well, screening would exclude between 36%-68% of those desiring intervention, representing a missed opportunity to potentially improve outcomes. Screening without assessing desire for intervention likely over identifies individuals who do not desire help while missing a relatively large number of those who do wish for assistance.
Perceptions of prognosis and goals of care in patients receiving radiation therapy.
Authors: Roldan Claudia Sofia , Chen Jie Jane , Nichipor Alexandra N. , Balboni Tracy A. , Krishnan Monica Shalini , Revette Anna , Chen Aileen B. , Hertan Lauren Michelle 
Published: November 2019

30 Background: We aimed to gain insight into the experiences and perceptions of patients with advanced metastatic cancer surrounding palliative radiation therapy (RT). Methods: In-depth structured interviews were conducted from 9/2016 to 10/2018 with 17 patients with bone or lung metastases receiving their first course of palliative RT. Patient answers about understandings of goals of care and disease prognosis were recorded and analyzed through qualitative content analysis. Medical records were reviewed to obtain demographic and clinical data. Results: The median age of patients was 64 years (range: 21-82). The median survival from time of metastatic diagnosis was 17.6 months (range: 1-46). When asked about goals of RT, qualitative analysis revealed that half (53%) linked receiving palliative RT to improving their quality of life, however 35% believed RT would completely get rid of their tumor. Words that were used commonly throughout patient answers included alleviating pain (41%), cure (29%), and reducing tumor growth (24%). All patients reported they received their information about goals of care from their medical teams. When asked about prognosis, 53% said prognosis had been discussed with them, whereas 76.5% said they were interested in information about prognosis. When asked “What do you believe lies ahead?,” about half (47%) expressed uncertainty about the future, while others (41%) were focused on the next steps in treatment. In the patients interested in learning more about their prognosis, there was a strong preference for this information to come from their medical teams. Conclusions: More than half of patients accurately identified the goal of RT as improving their quality of life, however some patients believed that the palliative RT would cure their tumor. This highlights the ongoing gap in patient provider communication and the need for improvement in this area. Inaccurate perceptions of goals of treatment and prognosis may motivate some patients to pursue unnecessarily aggressive treatments, which could affect quality of life without improving survival. Referrals to radiation oncologists present a potential opportunity to reopen discussions on goals of care and prognosis to adjust patient expectations.
Shared decision making about opioid therapy for cancer patients: Do patients and providers take the same factors into consideration?
Authors: Silveira Maria J. , Giannitrapani Karleen F , Fereydooni Soraya , Azarfar Azin , Glassman Peter , Becker William , Lorenz Karl 
Published: November 2019

32 Background: Many patients with cancerpain are appropriately managed on long-term opioid therapy (LTOT), but are at similar risk of overdose and addiction as are patients with non-cancer pain. Whether to commence opioids for cancer pain is often a shared decision between patient and provider. Little is known about this process. Methods: Semi-structured interviews with 20 cancer patients on LTOT and 20 interdisciplinary providers who prescribe LTOT from two VA medical centers. Transcripts were coded and analyzed using constant comparison to find common themes. Results: Providers and patients largely weighed the risks and benefits of LTOT similarly, except in the case of cancer patients with past/present substance use disorder (SUD). In those cases, providers felt the risks outweighed the benefits, while patients felt the benefits outweighed the risks. Generally, patients considered pain relief their overarching concern. Other factors that impacted their risk/benefit calculus included: personal/family experience with opioids and the opinions of trusted providers. Only rarely did patients defer decision making to providers. Factors that impacted the risk/benefit calculus of providers included: disease status, patient goals, patient characteristics, and providers' past experiences/biases. Of note, patients with past opioid exposure generally viewed their experience with opioids as positive, and usually anchored their risk assessment for opioids relative to those of chemotherapy. Patients also expressed that they would prefer to spend less physician time discussing LTOT and more time discussing cancer treatment instead. Conclusions: Patients and providers often agree on when it is appropriate to use LTOT for cancer pain. In cases where they disagree, providers are well advised to explore and address patients’ fears about the adequacy of pain management without opioids, as well as their lived experience with opioids. Patients are comfortable having such discussions with physician extenders in order to reserve face-to-face physician time to discuss cancer treatment instead.
Predictors of transfer to different facility at discharge in patients admitted with metastatic solid malignancy: Five-year National Inpatient Sample (NIS) database analysis.
Authors: Singh Sunny R K , Malapati Sindhu Janarthanam , Kumar Rohit , Thanikachalam Kannan , Alkhatib Yaser 
Published: November 2019

38 Background: Improvement in cancer treatment has led to an increase in prevalence of metastatic malignancy (met-Ca) with a rise in healthcare utilization secondary to this. We aim to identify predictive factors for transfer at discharge to another non-acute facility, such as nursing home and sub-acute rehab. Methods: This is a retrospective cohort analysis of NIS database (from years 2010 to 2014.) Inclusion criteria was any admission of adults (≥18 years) with met-Ca (identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes.) Patients transferred in from a different acute care hospital or another type of health facility were excluded. Primary outcome was transfer upon discharge to a different facility (transfer out) excluding acute care hospital. Statistical analysis was done using STATA. Results: There were 3,204,631 admissions with met-Ca, 15.3% (n= 490,735) had transfer out. Of these, 50.6% were females, 69.6% Caucasians and mean age was 70.9 years. On multivariate regression analysis, African Americans had higher odds for transfer out versus Caucasians (OR 1.06 p <0.005). Admission type- weekend vs weekday and elective vs non elective were also associated with this outcome (OR 1.08 p<0.005 and OR 0.56 p<0.005). Odds ratio for other predictors are shown below (p value <0.005 for all). Conclusions: Age, race, increased length of stay, cancer type, hospital size and teaching status, admission type and insurance type had a significant predictive value for transfer out after discharge in patients with met-Ca. A future area of exploration is the development of a scoring system to predict risk of transfer to a different facility at discharge- this will allow early mobilization of resources for these patients with complex healthcare needs. [Table: see text]
Capturing patient advance directives status in a community oncology practice using an electronic patient-reported outcomes (ePRO) system.
Authors: Buzaglo Joanne S. , Skinner Karen , Stepanski Edward , Decker Veronica , Schwartzberg Lee S. 
Published: November 2019

5 Background: The American Society of Clinical Oncology recommends that providers encourage early advance care planning with their patients; yet, many cancer patients do not have advance directives (ADs). A potential reason for low AD rates is inadequate communication between the provider and patient. To address this gap, we developed an outpatient clinic AD initiative for any stage cancer patients via an ePRO system. The AD module was designed to ensure patients are aware of ADs and to assess whether or not the patient had ADs, specifically a Living Will and/or a durable power of attorney and their interest in receiving information about ADs. The study purpose was to assess patient AD status at the patient’s initial visit to an oncology clinic. Methods: This study used a retrospective, observational design that involved use of PRO data collected via the Patient Care Monitor (PCM), a web-based ePRO system linked to electronic medical record data. All study data were collected as part of routine clinical care. All patients at an initial visit to an oncology clinic completed the PCM survey, including the AD module, via a handheld e-tablet. Results: Overall, 18,239 patients completed the AD module (mean age 62; 32% male/68% female; 55% married; 60% White, 36% Black). One third of all patients (30%) reported having an AD at the time of the initial visit to the oncology clinic, specifically 11% indicated having a Living Will and 19% a durable power of attorney. The remaining two-thirds (70%) indicated either NOT having an AD (58%) or not knowing if they had an AD (12%). Patients with ADs were more likely to be older (M= 69 v. 59 yrs) and White (77% v 20% Black) ps < .0001. Of the patients without ADs, 10% requested more information on ADs. These patients were more likely to be older (M= 61 v. 58 yrs), female (68% v 32%), Black (54% v 40% White) and non-married/non-partnered (53% v 47%); ps < .005. Conclusions: This study demonstrates that the majority of patients do not have ADs at the time of an initial visit to a community-based oncology practice. Using an ePRO system can be an innovative and non-threatening way to identify unmet needs of patients and link them to resources for developing advance directives.
Timing of referral for palliative radiation therapy and length of hospital stay.
Authors: Nagatsuka Moeko , Hughes Ryan T. , Glenn Chase , Brown Doris R. 
Published: November 2019

57 Background: Palliative radiation therapy (PRT) offers effective symptomatic relief to cancer patients. Increased focus on quality of care and healthcare efficiency necessitate a better understanding of the temporal relationships between consultation for/initiation of PRT and length of hospital stay (LOS). This study aims to assess whether durations from admission to PRT consult/PRT initiation affect LOS. Methods: In an institutional review of patients who received PRT as inpatients between January 2017 and December 2018, 67 met inclusion criteria. Duration of time from admission to consultation or start of PRT were categorized using various thresholds. LOS was compared across groups using the Wilcoxon rank sum test and factors were evaluated as predictors of LOS using bivariate linear regression. Results: PRT was given for pain (37%), neurologic deficits/brain metastases (31%), and respiratory symptoms (19%). Multiple sites were treated in 31%; treatment sites included spine (45%), non-spine bone (27%), chest (22%), abdomen/pelvis (12%), brain (10%) and soft tissue (6%). At admission, patients had known metastases (66%), no prior cancer diagnosis (19%), or known primary cancer (15%). Median LOS was 12 days (IQR 7-18) for all patients. There was a significant difference in LOS for patients referred for PRT within 3 days of admission versus greater than 3 days (11 v. 21 days, p < 0.01). This difference was slightly greater using a threshold of 4 days (11 v. 25 days, p < 0.01) and 5 days (11 v. 26 days, p < 0.01), both of which remained significant when analyzing only patients with prior cancer diagnosis (n = 54). There was no difference in LOS using a threshold of 1 or 2 days. As a continuous variable, duration from admission to PRT was associated with LOS (OR 2.40, p < 0.01). Similar patterns were noted when analyzing by time from admission to PRT start. Conclusions: Earlier radiation oncology consultation for PRT is associated with shorter LOS in patients treated with PRT for symptomatic malignancy. Further research is needed to better define this relationship and improve systematic processes to facilitate early consultation and treatment. A palliative radiation oncology clinic was recently developed to address these issues at our institution.
Palliative care referral patterns of adolescent and young adult patients at a comprehensive cancer center.
Authors: Lockwood Bethany , Ntukidem Olanipekun Lanny , Ehrman Sarah , Lustberg Maryam B. , Bhatnagar Bhavana , Klemanski Dori 
Published: November 2019

63 Background: Adolescent and young adults (AYA) diagnosed with cancer have distinct physical, developmental and psychosocial needs that are often unmet during oncology treatment. Such needs are further intensified for AYA patients with an advanced cancer diagnosis. Palliative Care (PC), specialized care for patients and families with serious illness, can address these needs throughout the disease trajectory including symptom management, supportive communication, and advance care planning. The incorporation of PC remains suboptimal despite evidence that palliative services can improve quality of life. In an effort to identify strategies to advance access to PC for the AYA population at our institution, the referral pattern to PC was studied. Methods: A retrospective chart review was performed to identify referral patterns to PC in the AYA population (ages 18-39) from July 2017 through June 2019 at a National Cancer Institute designated comprehensive cancer center. Descriptive statistics were utilized to summarize referral patterns and trends. Results: In the past 2 years, 1,894 AYA patients established oncology care at our institution. The most common AYA cancer diagnoses included hematologic 20.8% (n=944), thyroid 10.8% (n=490), brain 9.9% (n=451) and breast 9.1% (n=414). There were 311 (16%) referrals placed to PC, mostly in the inpatient setting (81.4%). Less than half (43%) of the inpatient referrals had a post-discharge follow-up appointment in the PC clinic. Multiple disease-specific service lines were represented including leukemia (40%), colorectal (14.5%), sarcoma (9%) and breast (9%). Quarterly volumetric trends remained static over the 2 years (average number of referrals: 54/quarter). The average age at cancer diagnosis in the AYA population was 30 years and 32.7 years (range 19-39) at time of PC referral. This was consistent with the average length of time from initial diagnosis to PC referral of 2.8 years. Conclusions: Comprehensive oncology care in the AYA population should include PC. Yet, involvement of PC in the AYA population during oncologic treatment was limited. Future research will investigate optimal models of integrative PC to address the unique needs of AYA cancer.
Embedded model palliative care (PC) at a community oncology practice in central Nebraska.
Authors: Kathman Cindy , Copur Mehmet Sitki , Price Penny , Edwards Carrie , Jonglertham Pornchai , Springer Carlene R. , Vacek Colleen , Reiners Debra , Hiller-Payne Brandy , Lounsbury Anita , Wagner Tabatha , Lauder Robin , Wilson Patricia , Mueller John , Molnar Sally , DeGodt Heidi , Arbogast Jessica , Muske Chandra , Robbins Leslie , Peterson Tonya 
Published: November 2019

64 Background: PC combined with cancer care has been shown to improve patient outcomes and caregiver satisfaction while lessening unnecessary health care utilization. 85% of cancer patients receive their oncology care in the communities they live. Establishing a viable and sustainable outpatient PC service in the community oncology setting is challenging and rare nationwide. We present our 18-month PC services since its implementation at Morrison Cancer Center, a community oncology practice. Methods: Cancer patients were referred to PC by oncologists for symptom management, psychosocial support, and Advanced Care Planning (APC). PC visits were provided at the oncology clinic, home, nursing home, or hospital by our PC team (APRN, Social Workers, Chaplain and RN's). Palliative Care Prognostic Index (PPI), time to PC consultation, proportion of patients --on chemotherapy, switching to hospice care, receiving chemotherapy within the last 30 days of life, visiting ER and/or being admitted to hospital within the last 30 days of life-- were studied. Results: Over an 18-month period 72 patients were referred for a total of 470 visits. Lung, pancreas, gastroesophageal, and head and neck cancers were topmost sites. PC referrals per quarter increased from an initial 4 to an 18 at 18 months. Mean time from diagnosis to PC referral was 5.6 months (range: 1-36). Referral reasons included symptom management/support (58%), goals of care (50%), and/or predetermined triggers (15%). Mean PPI score was 50% (range 30-70). All patients had ACP. While 83% of patients were able to continue on active cancer treatment, only 5% received chemotherapy within the last 30 days of life, and 4 % had two or more ER visits with or without a hospital admission. Eventually, 17% of PC patients transitioned to hospice care. Conclusions: A PC program fostering expert symptom management, seamless communication, and trusting relationships between oncologists, palliative care team, and patients, without prematurely stopping active cancer treatments, is feasible and can be incorporated into a community oncology practice as demonstrated by the growth and success of our program. Our model may set an example for similar practices in the community oncology setting.