bluuebunny/crossref_metadata_2025_split huggingface dataset:
Another hospital admission through the emergency room? Looking for a fragility pattern in advanced cancer patients.
Authors: Velutti Laura , Marinello Arianna , Cammarota Antonella , Grimaudo Maria Susanna , Saetta Annalisa , Giuffrè Santina , Lopane Diego , Digiacomo Nunzio , Provasoli Chiara , Gonçalves Pereira Frederico , Cullia Luca , Villa Elisabetta , Poggio Chiara , Ferrari Stefano , Pavesi Carlotta , Giordano Laura , Rimassa Lorenza , Santoro Armando 
Published: November 2019

65 Background: Cancer patients (pts) are often treated with anticancer therapy (CT) even in the last months of life and are often hospitalized through an access to the emergency room (ERa). This is frequently the time when a palliative care (PC) service starts, or when pts die. Methods: We performed a retrospective analysis of pts admitted to our Oncology Unit through an ERa. We evaluated: pts’ characteristics, histology, date of diagnosis, sites of metastases, comorbidities, previous CT and radiotherapy (RT), imaging procedures and other exams in the last 90 days (90d), previous ERa and admissions for supportive care (SC), including transfusions, parenteral/enteral nutrition, high-cost antibiotics, in the last 90d. Pts were divided into 2 fragility groups: less fragile (LF), candidate after discharge to further CT or follow-up, and more fragile (MF), pts candidate to PC or who died in the Oncology Unit. Results: From August 2017 to May 2018 441/756 pts (58.3%) were admitted through an ERa: women/men 219/222, median age 65.4 years (y), range (r) 18.9 - 89.7. 328 pts had visceral metastases, 287 pts had ≥1 comorbidity, 318 pts received ≥1 line of CT (r 1-8), 121 pts received ≥1 RT (r 1-5), 240 pts had ≥1 prior admission for SC (r 1-6), 224 pts had an ERa (r 1-6) and 141 pts had ≥1 hospitalization for SC (r 1-4) in the last 90d, 386 pts received ≥1 diagnostic exam in the last 90d (r 1-12). Pts were grouped as follows: LF/MF 236/205. Differences between the 2 groups were: pts ≥70 y 31% in LF, 40% in MF, p=0.047; visceral metastases 70.1% in LF, 85.1% in MF, p<0.001; ≥1 line of CT 64% in LF, 81% in MF, p<0.001; ≥1 RT 23% in LF, 32% in MF, p=0.036; admissions for SC 47% in LF, 62.9% in MF, p<0.001; ERa in the last 90d 39% in LF, 64% in MF, p<0.001; admissions for SC in the last 90d 24.4% in LF, 39.4% in MF, p=0.004. No other differences were observed between the 2 groups. Conclusions: We identified a MF profile: pts ≥70 y, with visceral metastases, ≥1 line of CT and ≥1 RT course for advanced disease, ≥1 prior hospitalization for SC, ≥1 ERa and ≥1 admission for SC in the last 90d. The identification of this fragility profile may help oncologists timely offer a PC program to advanced stage pts. This could prevent some ERa and hospital admissions close to the end of life.
Understanding of palliative care among members of the public.
Authors: Wong Joanne Liu , Blake Christopher , Swami Nadia , Pope Ashley , Hannon Breffni , Rodin Gary , Le Lisa W , Zimmermann Camilla 
Published: November 2019

71 Background: The World Health Organization (WHO) defines palliative care (PC) as an approach that improves the quality of life of patients and their families facing life-threatening illness. However, the public may be unaware of this definition. We assessed the Canadian public’s knowledge and attitudes toward PC before and after being provided the WHO definition. Methods: We engaged a health research firm to distribute a cross-sectional survey to members of the Canadian public. Eligible participants were >18 years of age, could comprehend English or French, and were currently residing in Canada. We assessed participants’ knowledge of and attitudes towards PC before and after reading the WHO definition of PC. Results were analyzed using the Wilcoxon Signed-Rank test. Results: Of 1518 participants (52% female), 45% (676/1518) stated they knew what PC was and could explain it, 32% (488/1518) knew about PC but could not explain it, 13% (198/1518) had heard of PC but did not know what it was, and 10% (156/1518) had never heard of PC. Of those who had heard of PC, 58% (784/1362) agreed PC is the last resort when other treatments have failed, 64% (877/1362) agreed PC means being close to death, and 67% (914/1362) believed PC meant being at “the stage that you can no longer take care of yourself”. Before reading the WHO definition, 56% (774/1362) agreed/strongly agreed that referral to PC would make them feel afraid; after reading the definition, this percentage was reduced to 41%, and degree of fearfulness was reduced in 46% (p<0.0001). Fifty-nine percent (898/1518) stated they did not know, prior to reading the WHO definition, that PC could be involved early in the course of illness, and 45% did not know PC could be provided together with other treatments aimed at prolonging life. Eighty-nine percent (1344/1518) felt the PC definition helped them to better understand what PC is, and 91% believed that Canadians should be made aware PC can be included early in the course of a patient’s illness. Conclusions: More than half of respondents had limited knowledge of PC and believed it was synonymous with end-of-life care. Provision of the WHO definition improved understanding and allayed fears of PC. Public educational initiatives may improve understanding and increase acceptance of PC.
Oncologists’ perspectives on medical marijuana for the elderly.
Authors: Azizoddin Desiree Rachel , Enzinger Andrea Catherine , Wright Alexi A. , Yusufov Miryam , Hong Fangxin , Tulsky James A. , Campbell Eric G , Pirl William F. , Nayak Manan , Braun Ilana 
Published: November 2019

78 Background: Cancer patients are increasingly using medical marijuana (MM) to manage symptoms and treatment side effects. Although cancer disproportionately affects the elderly, little is known about oncologists’ attitudes toward MM in this population. We surveyed US oncologists’ beliefs about the benefits of MM for older adults, and examined their associations with oncologists’ perceptions of MM efficacy and safety. Methods: 232 out of 400 randomly selected U.S. oncologists (63% response rate) completed a cross-sectional survey about their beliefs and recommendations regarding MM for cancer patients. Using Chi-square tests, we examined associations between oncologists’ demographics, their perceptions of geriatric MM use, as well as beliefs about comparative effectiveness of MM for cancer related symptoms, and comparative risks of MM to prescription opioids. Results: Among 232 oncologists included in this cohort, 109 (47.0%) reported that MM had at least some benefit for elderly cancer patients, 66 (28.4%) responded it was rarely or never beneficial, and 57 (24.6%) reported not knowing. There were no significant associations between oncologists’ beliefs about MM’s benefit for older adults and their sociodemographic characteristics. Those who believed MM was beneficial for the elderly were significantly more likely to report that MM was at least as effective as standard treatments for the following indications: coping (58.3% vs. 26.6%), appetite (83.3% vs 58.5%), depression (46.3% vs 25.0%), and nausea (66.7% vs 33.9%), respectively ( p < 0.001). In contrast, oncologists’ beliefs about MM for the elderly were not significantly associated with perceptions of the comparative risks of MM ( p > 0.05). Conclusions: In this nationally-representative sample of US oncologists, about half thought MM was beneficial for older adults with cancer. Oncologists’ support of MM for older adults was associated with perceptions of MM’s efficacy but was not associated with perceptions of MM’s risks. More research is needed regarding the safety and efficacy of MM to guide oncologists’ recommendations about its use in older adults.
Psychosocial outcomes and care utilization among rural and nonrural cancer patients.
Authors: Usher Angela E , Bell Janice , Beckett Laurel A , Joseph Jill G , Zebrack Brad J. , Meyers Frederick J. 
Published: November 2019

79 Background: Approximately 20% of people diagnosed with cancer in the U.S. travel from rural areas to urban cancer centers for treatment. Rural cancer patients face unique challenges which may contribute to greater psychosocial distress when compared to urban-dwelling patients. While up to half of all cancer patients screen positive for psychosocial distress, only 25-44% of distressed patients utilize psychosocial care. Patients from rural areas may face greater barriers to utilization of psychosocial care compared to patients from urban areas. To date, few studies have focused on these concerns. Methods: Three-years of data were collected from newly diagnosed patients screened between 2015 and 2017, including the Patient Health Questionnaire-2 and the NCCN Distress Thermometer (n = 4,865). Adjusted multi-variable logistic regression, chi-square, and negative binomial regression were used to assess relationships among psychosocial outcomes and care utilization, rurality, and distance to treatment in driving miles, controlling for socio-demographic and clinical covariates. Distance to treatment based on driving miles computed in ArcGIS v10.5. Stata v15 was used for all statistical analyses, significance set at ≤.05. Results: Higher odds of depressive symptoms were detected among people living in rural areas compared to urban areas. The odds of psychosocial distress were higher in patients from rural areas and further distances from treatment compared to local distance. Patients from rural areas had lower odds of psychosocial care utilization compared to patients in urban areas. Distance to treatment had independent effects, over and above rurality, for lower odds of psychosocial care utilization. Conclusions: Distance to treatment and rurality appear to be risk factors with independent effects on depressive symptoms and psychosocial distress and appear to be associated with lower odds of psychosocial care use among cancer patients with self-reported distress when compared to patients from urban and local areas. Findings support improved detection of and response to patient reported psychosocial outcomes, and further research designed to better understand the mechanisms underlying the reported associations.
Cognitive dysfunction in patients with cancer pain (CP): A multicenter cross-sectional study from China.
Authors: Lin Rongbo , Zhao Shen , Zhu Hongyu , Lei Yan , Wen Xiaofang , Deng Yamei , Ruan ShuFang , Hu Tingting , Huang Wei , Han Min , Wang Jianyi , Hu Yuqiong , He Xiaohua , Ke Xi , Wu Guangfeng , Luo Huiyu 
Published: November 2019

81 Background: Pain is one of the most common symptoms in cancer patients and often has a negative impact on patients’ functional status and quality of life. Cognitive dysfunction can impact the assessment and treatment of pain. Taking analgesics may worsen the cognitive dysfunction. The study of the prevalence of cognitive dysfunction and the association with analgesics in the CP patients is rare in China. This study aimed to investigate the prevalence of cognitive dysfunction in Chinese CP patients and analyze the related factors. Methods: A total of 220 Chinese CP patients in 9 first-grade hospitals received the following assessment: the functional assessment of cancer therapy-cognitive function (FACT-Cog) and numerical rating scale (NRS), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). ANOVA and multiple linear regression analysis were performed to explore the related factors. Results: A total of 220 Chinese CP patients received the assessment: The overall incidence of cognitive dysfunction in CP patients was 33.64%, with an average cognitive function score 105.93±21.39. The total cognitive function score and each dimension were negatively correlated with the pain, depression, and anxiety levels. The analgesics did not affect the cognitive function of CP patients. Sleep and smoking history were two key factors influencing the cognitive function. Conclusions: An effective management of pain, depression, anxiety, sleep, and smoking are recommended to protect the cognitive function of patients under CP stress. It is safe and reliable to regularly use the analgesics for CP patients. Clinical trial information: NCT03641820.
Effect of corounding versus consult service for cancer inpatients on staff outcomes of teamwork and job satisfaction.
Authors: Goh Seow Lin , Koh Audrey Xuan Rui , Neo Patricia Soek Hui , Yang Grace Meijuan 
Published: November 2019

85 Background: Traditionally, palliative care in most hospitals is delivered through consult-based services i.e relying on the primary physician to initiate a referral to a palliative care specialist. Supportive and Palliative Care Review Kit (SPARK) is a newly developed integrated model of care that involves a Palliative Consultant and an Advanced Practice Nurse (APN) co-rounding with the oncologist to provide bedside palliative care advice alongside the oncology team. Methods: To evaluate the effect of this new model on staff outcomes of teamwork and job satisfaction, a survey was conducted in March 2018 before the new SPARK model was started and 1 year later in March 2019. The survey was adapted from the Primary Care Team Dynamics Survey and Physician Worklife Survey, with higher scores indicating better outcomes. Categorical variables were analysed using chi-square test and continuous variables were analysed using student’s t-test. Results: Before the new SPARK model was started in March 2018, email invitations were sent to 89 oncology and palliative care physicians. Fifty five complete responses was received (61.8% response rate). A year after the new SPARK model was started, email invitations were sent to 23 oncology and palliative care physicians who had experienced the new model of care, of which 8 complete responses were returned (34% response rate). There was no significant differences in demographics between the two time points and in the total and domain scores between before and after SPARK. In the ‘personal time’ domain of the physician worklife survey, scores were better after SPARK (73.8± 6.68) compared to before SPARK (68.4 ± 8.70). This may be due to increased independence experienced by the APN co-rounding with the oncology team. The flexibility in team-rounding creates more personal time allowing the APN to be involved in other non-clinical tasks. Conclusions: While there were no statistically significant differences in the overall work experience, team dynamics and job satisfaction one year after the SPARK model, this may be due to small sample size.
Telemedicine: A new survivorship visit model.
Authors: Corcoran Stacie , Kenny Sheila 
Published: November 2019

89 Background: The number of cancer survivors in the United States is expected to approach 22 million by the year 2029. With an annual Survivorship Program visit volume exceeding 16,000, this comprehensive cancer center developed an innovative approach to delivering survivorship care to meet the growing demand for comprehensive follow up care. Institutional space, patient convenience and visit compliance are also factors in considering alternatives to traditional ‘brick and mortar’ visits. Methods: Patients are seen in our Autologous Bone Marrow Transplant (BMT) Survivorship Clinic at 6, 12- and 24-months post-transplant. A pilot was developed targeting patients scheduled for a 6-month visit, where patients are often struggling with treatment sequelae, managing other medical appointments, and returning to work and life after transplant. Patients were offered a telemedicine visit instead of an in-person clinic visit with the survivorship advanced practice provider (APP). The Survivorship APP and administrative staff were trained on the use of monitors and technologic means to connect patient to provider. Eligible patients had to have an institutional portal account and speak English. They were contacted by phone to assess interest, and if they agreed, instructions were provided via secure institutional portal reviewing device and connectivity requirements. Results: The telemedicine visit components included: review of home medication list, interval history and review of systems, screen for late treatment effects, lab result review, treatment summary and care plan review including risk of secondary cancer and screening recommendations, health promotion counseling, primary care physician recommendations and immunization status. Of 26 visits scheduled, 22 were successfully completed. Challenges to completing the visit will be described and include poor connectivity and patient location at the time of the scheduled visit. Conclusions: Despite some minor challenges, patients described good satisfaction with telemedicine citing visit comprehensiveness and convenience. As a result of the successful pilot, telemedicine visits are being expanded to include survivorship patients who are 24 months post BMT.
Is cancer pain associated with employment and cost concerns for individuals with cancer?
Authors: Halpern Michael T. , de Moor Janet S. , Yabroff K Robin 
Published: November 2019

94 Background: Pain is frequently reported by individuals with cancer. While the adverse effects of pain on quality of life are well-established, it is unknown if pain is associated with patients’ concerns about employment and cancer costs. Methods: We used data from the Medical Expenditure Panel Survey (MEPS) 2016 Experiences with Cancer Supplement including cancer diagnosis, pain level over the past 7 days, employment changes, and cost concerns. Respondents diagnosed with cancer at age > 18 (excluding non-melanoma skin cancer) with non-missing pain information were included. Sampling weights were used in analysis to provide nationally representative estimates. Results: Among 875 eligible respondents with cancer (weighted total of 1.3 million individuals), pain was reported by 57% (severe pain by 12%). The likelihood of pain was significantly associated with age, gender, race/ethnicity, education, cancer site, insurance, and time since treatment. Controlling for these factors, individuals reporting pain were significantly more likely to take time off from work (odds ratio [OR] 1.76); change to a less demanding or part time job (OR 1.91); not pursue promotions (OR 1.39); retire early (OR 3.06); and feel less productive (OR 2.35). Individuals with pain were significantly more likely to have uncovered medical expenses (OR 1.28); be in debt (OR 2.68); and be unable to cover medical bills (OR 1.46). These individuals were significantly more likely to worry about paying medical bills (OR 1.94); to delay medical treatment (OR 4.30), follow-up care (OR 2.20), and mental health care (OR 4.11); and were less likely to receive necessary medical care (OR 0.50). Despite these, concerns, they were significantly less likely to discuss out-of-pocket costs for cancer care (OR 0.86) or cancer treatments (OR 0.96) with a healthcare provider. Conclusions: Cancer pain is associated with increased cost and employment concerns but with a lower likelihood of discussing costs with healthcare provider. Interventions are needed to address financial hardship among this high-risk population.
Physical Activity and Cardiometabolic Risk Factor Clustering in Young Adults with Obesity
Authors: DIPIETRO LORETTA , ZHANG YUQING , MAVREDES MEGHAN , SIMMENS SAMUEL J. , WHITELEY JESSICA A. , HAYMAN LAURA L. , FARO JAMIE , MALIN STEVEN K. , WINSTON GINGER , NAPOLITANO MELISSA A. 
Published: November 2019

ABSTRACT

Introduction
There is a paucity of information on the clustering of cardiometabolic risk factors in young adults and how this clustering may vary based on whether or not they perform sufficient levels of physical activity.

Methods
We analyzed baseline data from 346 young adults (23.3 ± 4.4 yr) participating in the Healthy Body Healthy U clinical trial from 2015 to 2018. Cardiometabolic risk factors were measured according to standard procedures and moderate- to vigorous-intensity physical activity (MVPA) was determined by accelerometry. A cardiometabolic clustering score (ranging from 0 to 5) was created from five biomarkers according to whether or not a standard clinical risk cut point was exceeded (0, no; 1, yes): abdominal circumference (>102 cm (men) or >88 cm (women)), hemoglobin A1c (≥5.7%), HDL cholesterol (<40 mg·dL−1 (men) or <50 mg·dL−1 (women)), systolic blood pressure (≥130 mm Hg), and diastolic blood pressure (≥85 mm Hg). Cardiometabolic dysregulation (CD) was defined as a cardiometabolic clustering score ≥3. Multiple logistic regression determined the independent association between level of MVPA and CD, while adjusting for sex, race/ethnicity, sedentary time, and smoking.

Results
The prevalence of CD was 18% (22% in men, 17% in women). We observed a nonlinear graded association between MVPA and CD. Participants performing 150–300 min·wk−1 of MVPA significantly lowered their odds of CD by 66% (odds ratio, 0.34; 95% confidence interval, 0.16–0.75), whereas those exceeding 300 min·wk−1 lowered their odds by 61% (odds ratio, 0.39; 95% confidence interval, 0.18–0.86) compared with those performing <150 min·wk−1, independent of obesity and the other covariables.

Conclusion
Recommended levels of moderate-intensity physical activity is significantly associated with lower odds of CD and thus may prevent or diminish the need for expensive pharmaceutical treatment over the remainder of the life-span.
Preprints and Scholarly Communication: An Exploratory Qualitative Study of Adoption, Practices, Drivers and Barriers
Authors: Chiarelli Andrea , Johnson Rob , Pinfield Stephen , Richens Emma 
Published: November 2019

Background: Since 2013, there has been a dramatic increase in the number of preprint servers. Little is known about the position of researchers, funders, research performing organisations and other stakeholders with respect to this fast-paced landscape. In this article, we explore the perceived benefits and challenges of preprint posting, alongside issues including infrastructure and financial sustainability. We also discuss the definition of a ‘preprint’ in different communities, and the impact this has on uptake. Methods: This study is based on 38 semi-structured interviews of key stakeholders, based on a purposive heterogeneous sampling approach and undertaken between October 2018 and January 2019. Interviewees were primarily drawn from biology, chemistry and psychology, where use of preprints is growing. Interviews were recorded, transcribed and subjected to thematic analysis to identify trends. Interview questions were designed based on Innovation Diffusion Theory, which was also used to interpret our results. Results: Participants were conscious of the rising prominence of preprints and cited early and fast dissemination as their most appealing feature. Preprints were also considered to enable broader access to scientific literature and increased opportunities for informal commenting. The main concerns related to the lack of quality assurance and the ‘Ingelfinger rule’. We identified trust as an essential factor in preprint posting, and highlight the enabling role of Twitter in showcasing preprints. Conclusions: The preprints landscape is evolving fast, and disciplinary communities are at different stages in the innovation diffusion process. The landscape is characterised by experimentation, which leads to the conclusion that a one-size-fits-all approach to preprints is not feasible. Cooperation and active engagement between the stakeholders involved will play an important role going forward. We share questions for the further development of the preprints landscape, with the most important being whether preprint posting will develop as a publisher- or researcher-centric practice.