bluuebunny/crossref_metadata_2025_split huggingface dataset:
The clinical significance of gabapentin in combination with opioids in controlling outbreak of pain in cancer patients.
Authors: Zhang Xue , Jiang Da , Yan Qingyu , Huang Fang , Jin Hui , Fan Shaoshuang , Li Ying , Zhou Xinliang , Wang Zhe 
Published: May 2020

e24142 Background: This study compared the pain relief effects of opioids combined with gabapentin and opioids alone after an outbreak of pain in patients with opioid-tolerant cancer pain to explore better cancer pain management. Methods: A total of 60 patients with moderate and severe cancer pain from September 2016 to April 2017 in the Department of Oncology of the Fourth Hospital of Hebei Medical University. They were randomly divided into two groups when they experienced an outbreak of pain, only oxycodone hydrochloride sustained-release tablets group (A group) 30 cases and gabapentin capsule combined with oxycodone hydrochloride sustained-release tablets group (B group) 30 cases, The degree of pain relief before and after treatment, the consumption of oxycodone hydrochloride sustained-release tablets, quality of life scores and adverse reactions, and nighttime sleep time were compared between the two groups. Results: 1. The NRS score in group B after treatment was significantly lower than that in group A after treatment (1.83±0.46 vs. 2.30±0.75). There was a statistically significant difference (P < 0.05). 2. The consumption of oxycodone hydrochloride sustained-release tablet in group B was lower than that in group A (19.000±6.074 vs. 25.667±10.063). There was statistical significance (P = 0.003). 3. The quality score was higher than before, and the quality of life score in group B was higher than that in group A (P < 0.05). 4. The main adverse reactions in both groups were constipation, nausea, vomiting and dizziness. The incidence was 86.67% vs. 50.00%、33.33% vs. 23.33%, 20.00% vs. 16.67%, respectively, there was no significant difference (P > 0.05). The nighttime sleep time of both groups was higher than that before treatment (6.017±0.636 vs. 5.167±0.735, 6.433±0.583 vs. 5.167±0.661). 5. The nighttime sleep time of Group B was longer than that of Group A after treatment (6.433±0.583 vs. 6.017±0.636). The difference was statistically significant (P < 0.05). Conclusions: Opioids combined with gabapentin are superior to opioids alone in the treatment of cancer pain with analgesic efficacy, improved quality of life, reduced opioid consumption, adverse drug reactions, and effective night time sleep.
Cannabis use patterns and patient reported outcomes in oncology and hematology patients: An anonymous survey.
Authors: Subbiah Shanmuga , Presant Cary A. , Upadhyaya Gargi , Zheng Meizi 
Published: May 2020

e24143 Background: In a contemporary era of rapidly evolving social and regulatory changes, it is important to understand and characterize patient (pt) cannabis usage and response. Methods: In order to avoid responding bias, we performed the first ever anonymous survey in consecutive patients (pts) cared for in a City of Hope practice site in California. We analyzed demographic information, qualifying conditions, symptoms, and the cannabis product used. Pt reported outcomes of response to cannabis were collected. Improvement in control of symptoms was defined as pts choosing “total” or “a lot”. Results were tabulated and analyzed by the Chi-squared and Fisher’s Exact statistics. Results: 154 of 176 consecutive patients agreed to participate (87.5%). 72.7% had a malignancy (CA), 18.1% non-malignant hematologic disease (HEME), and 10.3% had other illnesses (OTHER). Age was < 45 in 10.3%, 45-64 in 37.0%, and > 64 in 52.6%. Older pts more frequently had CA (32.5% < 45, 70.2% 45-64, vs 81.5% > 64p = .0012). 41.8% were male. Cannabis use was reported in 24.7%. Surprisingly, this did not vary significantly by age (37.5% age < 45, 28.0% age 45-64, and 19.8% age > 64 p = .24), by disease (CA 22.9%, HEME 34.6%, OTHER 28.6% p = .41), nor by gender (male 21.9%, female 25.8% p = .57). Pts used cannabis to control their disease in 42.1%, GI symptoms (nausea, vomiting) in 28.9%, weight loss in 10.5%, fatigue in 42.1%, pain in 73.6%, and other symptoms in 36.8%. Cannabis product was marijuana (MJ) in 32%, CBD in 58% and THC in 8% and varied by age (p = .0006) but not by illness or gender. Improvement in disease was reported in 62.5%, GI symptoms in 63.6%, weight loss in 50%, fatigue in 50%, and pain in 60.7%. Symptom improvement trend was numerically higher with MJ or THC (71%) vs CBD (47%, p = .27). 73% of pts reported they would participate in a cannabis clinical trial. Conclusions: There is a high usage of cannabis. While cannabis use does not vary by age, preference for cannabis product however does vary by age. Pts reported high response rates for various symptoms, which can confound the effectiveness of anticancer or supportive medications. Clinical trials of anticancer agents should stratify by use of cannabis products to avoid misattribution of antitumor effects or side effects. Since cannabis access is expanding across the country, it provides an opportunity to perform randomized trials looking into benefits and risks of cannabis use, and dose and administration methods. Clinicians should screen for cannabis use and document it in social histories separate from the category of illegal drug use.
Evaluation of prescribing practices of denosumab and zoledronic acid in breast and prostate cancer patients at University of Chicago Medicine.
Authors: Yang Heng , Knoebel Randall W , Parsad Sandeep , Carroll Emma , Stadler Walter Michael 
Published: May 2020

e24144 Background: Zoledronic acid (ZA) and denosumab are both bone-modifying agents (BMAs) approved for use in patients with bone metastases with breast or prostate cancer as well as patients who are receiving aromatase inhibitors (breast cancer) or androgen deprivation therapy (prostate cancer). There are various frequencies of administration, doses, and duration of these agents depending on indication and extent of disease. Currently there is data to show that ZA can be given every 3 months in patients with metastatic breast and prostate cancer, however, there is no data that clearly indicates that denosumab every 3 months is non-inferior to every 28 days. This study aimed to analyze current prescribing patterns of ZA and denosumab in metastatic breast cancer and metastatic castration resistant prostate cancer patients at The University of Chicago Medicine (UCM). Methods: This was a retrospective study of 80 patients who received at least one dose of ZA or denosumab between July 1st 2018 to June 30th 2019 from UCM outpatient oncology clinic for the purpose of treating metastatic breast cancer or metastatic castration resistant prostate cancer in conjunction with standard antineoplastic therapy. All included patients must have bone metastases. Patients were divided into four groups by disease state (breast or prostate cancer) and BMA agent (ZA or denosumab). The primary outcome was BMA therapy adherence rate, which was defined by those who received greater than or equal to 80% of appropriately scheduled doses. Descriptive statistics were used for skeletal-related events (SREs) and BMA associated adverse effects. Results: Patients who received ZA achieved higher adherence rates (100% breast, 86% prostate) compared to patients that received denosumab (63% breast, 23% prostate). The most common reason for the lower adherence rate in denosumab groups was scheduling convenience. During the study period, there were 3, 0, 2 and 5 patients had SREs in the above four groups respectively. The predominant adverse event across all groups was hypocalcemia and two patients with prostate cancer on denosumab developed osteonecrosis of the jaw. The cost analysis showed using ZA as primary BMA agent might save up to 2.5 million dollars per year at UCM. Conclusions: The use ofZA was associated with higher adherence rates compared to denosumab. Implementing a pharmacy driven protocol for ZA use for patients with metastatic breast and prostate cancer may improve BMA regimen adherence rates and significantly reduce costs.
Real-world evidence highlights sizeable gap in adopting early palliative care referral in patients with advanced cancers.
Authors: Cole Suzanne , Storie Sarah , Owens Sonya , Gipson LaShanta , Hardy Michael , Turk Ashley , Subbiah Ishwaria Mohan 
Published: May 2020

e24147 Background: Early referral to palliative care (PC) for patients w/ adv cancer is supported by compelling evidence from large RCTs demonstrating a lower symptom burden, higher QOL, and increased OS. However, these studies reflect pts who have self-selected to accept a PC referral and attend a PC visit. WHO/NCCN/ASCO guidelines support early integration of PC. We sought to characterize the referral patterns in our heme/onc practice to identify and mitigate the barriers to early PC adoption in the community setting. We began a concerted effort to discuss early PC referral w/ pts recently diagnosed w/ adv cancer at the time systemic therapy was initiated. Methods: To ensure real-world applicability of this study, we identified a large satellite clinic of a major academic center w/ access to PC on the main campus (located 20 miles from the satellite clinic). We retrospectively reviewed new pts age 18y+ w/ adv cancer, characterized PC referrals and outcomes. Using qualitative methodology, we identified pt-reported barriers to accepting PC care. Results: 407 new pts were seen; 168 w/ benign heme, 145 w/ early cancers, 94 w/ adv cancers. Of the 94 pts w/ adv cancers, 25 pts had one-time 2ndopinion visits, and 16 pts were not candidates for, or did not desire cancer treatment and directly enrolled on hospice. Our analysis cohort consisted of 53 pts w/ adv cancer pursuing life prolonging therapy. At initiation of treatment, 57 % (n=30) were not offered a PC referral, 22% (n=12) received a PC referral and attended the appt, however 21% (n=11) received a PC referral but did not attend the appt. A qualitative analysis of the 11 patients referred to early PC who did not attend the appt revealed; 5 patients scheduled an appt but did not attend (3-unknown reason, 2-hospitalized during appt, 1-lack of transportation), 2 pts were unreachable, and 4 pts were contacted but declined to schedule stating: “I feel pressured” “I want to hear what other treatment options I have” “I want to be treated first and then see if I need it” "I am overwhelmed with too many new doctors and visits". Conclusions: Despite the benefit of early PC referral in pts w/ adv cancer, we identified a considerable gap in its adoption in our community practice despite access to proximate PC clinic. Further studies are under design to address institutional and pt-related factors to improve real-world adoption of this critical service.
A prospective cohort study of stability in preference for place of death among patients with stage IV cancer.
Authors: Koh Ling En , Malhotra Chetna , Finkelstein Eric ,   COMPASS Study Group
Published: May 2020

e24148 Background: Advanced care planning (ACP) involves discussion and documentation of patients’ care preferences including their preference for place of death. This process assumes that patients’ preference will not change over time; yet evidence for this is inconclusive. The primary aim of this study was to test whether patient preference for place of death changes over time and to identify factors associated with this change. We also assessed whether patients who do not change their preference for place of death during the study duration have greater congruence between actual and baseline preference for place of death. Methods: As part of an ongoing cohort study, we surveyed 466 advanced cancer patients every 6 months in Singapore for a period of two years. We asked patients their preference for place of death (home/ institution/ unclear). We assessed proportion of patients who changed their preference from baseline and at every time point. We ran univariable and multivariable multinomial logistic regression models to assess the association between change in preference for place of death and patient socio-demographics (gender, race, education, housing, marital status) as well as time varying variables (quality of life (Functional Assessment of Cancer Therapy- General), pain severity (Brief Pain Inventory), psychological distress (Hospital Anxiety and Depression Scale), any intervening hospitalization). We used a logistic regression model to assess if no change in preference during the study period was associated with congruence between actual and baseline preference for place of death. Results: More than a quarter of patients changed their preference for place of death every 6 months with 55% changing their preference at least once within 2 years. There was no clear trend in direction of change in preference. Patients who were psychologically distressed at the time of survey had a greater relative risk of changing their preferred place of death to home (Relative Risk Ratio (RRR) 1.81; 95% Confidence Interval (CI): 1.16-2.82) and to institution (RRR 2.00; 95% CI: 1.17-3.42) relative to no change in preference. Having no change in preference for place of death during the study period was not associated with congruence between actual and baseline preference for place of death. Conclusions: The study provides evidence of instability in advanced cancer patients’ preference for place of death. It calls into question the validity of patient preference for place of death recorded on ACP documents and suggests that we should regularly re-evaluate these documents.
The benefits of an open art studio for patients with cancer: A mixed methods study.
Authors: Brondfield Sam , Perlis Cynthia 
Published: May 2020

e24152 Background: Art therapy can improve quality of life (QOL) and symptoms in patients with cancer. However, prior studies have focused on time-limited interventions. At the University of California, San Francisco, the Art for Recovery Open Art Studio (OAS) allows patients with cancer to create art and discuss experiences as a group with an art therapist (C.P.) each week. Most patients participate weekly. Our research question was: What is the value of the OAS that keeps patients coming back? Methods: In April 2019, C.P. identified all 23 patients who had attended the OAS over the past three months. We excluded one due to cognitive impairment. We designed a one-time email survey with closed- and open-ended questions. We chose a survey rather than interviews to minimize burden to patients, minimize social desirability bias, and maximize time for reflection before responding. We drew upon S.B.’s formal training in survey design and C.P.’s decades of experience with the OAS for content validity. We conducted cognitive interviews with two patients for response process validity which did not result in changes. We reported closed-ended responses using descriptive statistics. We used a paired t-test to compare, retrospectively, mean QOL before attending the OAS to mean present QOL, on a five-point scale (poor to excellent). We felt a longer QOL survey could burden symptomatic patients. S.B. and C.P. independently coded open-ended responses and aligned codes through discussion. Results: Eighteen of 22 patients (82%) responded. Mean age was 54 (range 37-76). Mean duration of attendance was four years (range 10 months to 11 years), and median frequency was three times per month. All respondents found the OAS “very helpful,” and 17 of 18 (94%) felt the friendships from the OAS were “very valuable” (top of four-point scale). Mean QOL improved from 2.7 to 4.2 (p < 0.001). Coding revealed themes of self-reflection, emotional experience, artistic engagement, togetherness, and familiar surroundings as OAS benefits. Conclusions: Our study focuses on OAS elements that keep patients with cancer coming back for years. While our results align with prior studies showing improved QOL, our study additionally reveals the multifaceted benefits of experiencing the OAS longitudinally. Study limitations include small sample size, incomplete validity evidence for the survey, and social desirability bias in survey responses. Our study supports further exploration of longitudinal OAS experiences, which may provide benefits such as friendship and community that briefer art therapy interventions may lack.
Treatment in patients with cat receiving LMWH: Learnings from predicare, a non-interventional prospective cohort study.
Authors: Scotte Florian , Laporte Silvy , Chapelle Céline , Lamblin Anne , Meyer Guy 
Published: May 2020

e24154 Background: Venous thromboembolism (VTE) is a difficult to treat condition in cancer patients with a persisting risk of recurrent VTE (rVTE). We conducted a prospective multicenter observational cohort study in VTE cancer patients treated with tinzaparin for 6 months in order to validate the Ottawa score. The Ottawa score is composed of 5 items, female (+1), lung (+1), breast (-1), cancer stage I (-2) and previous VTE (+1). Methods: Adult cancer patients with recent diagnosis of documented VTE treated with tinzaparin for 6 months were included. The primary endpoint was the rVTE within the first 6 months. Other endpoints were symptomatic rVTE and major bleeding (MB). All events were adjudicated by a Central Adjudication Committee. To validate the Ottawa score, the area under the curve (AUC) and its 95% CI were calculated on receiver operating characteristic curve analysis. Results: 409 patients were included; median age: 68 years; pulmonary embolism: 60.4%; lung cancer: 31.3%; digestive cancer: 18.3%; stage IV cancers: 67.0%. According to Ottawa score, 58% were classified at high clinical probability of recurrence (score ≥ 1). Among all patients, during the 6 months treatment period, 7.3% and 3.7% had rVTE and MB, respectively. 9.1% had rVTE for patients with a score ≥ 1 compared to 5 % for other patients (score < 1). AUC of the Ottawa score was 0.60 (95% CI 0.55-0.65). Conclusions: This prospective cohort of patients with cancer receiving tinzaparin for VTE reported that the Ottawa score did not accurately predict rVTE. Clinical trial information: NCT03099031 .
The incidence, risk factors and outcomes of chemotherapy related acute kidney injury in China.
Authors: Li Lu , Nie Sheng , Ren Chen , Li Yanqin , Wu Dehua 
Published: May 2020

e24161 Background: Nephrotoxicity of chemotherapeutic agents remains a significant complication limiting the efficacy of the treatment. However, comprehensive data on the epidemiology and outcomes of chemotherapy related acute kidney Injury in China is lacking. Methods: We conducted a nationwide cohort study of hospitalized patients from 25 general and children’s hospitals in China during 2013-2015. Patient-level data were obtained from the electronic hospitalization information system, prescription database and laboratory databases of all cancer patients who received chemotherapy and had at least two serum creatinine tests within any 7-day window during the hospitalization. AKI was defined and staged according to Kidney Disease Improving Global Outcomes criteria. The incidence of AKI in patients with various type of cancer and chemotherapeutic agents was examined. The outcomes of AKI, including in-hospital mortality, death after discharge, kidney recovery, and length of stay, were also assessed. Results: A total of 23,232 cancer patients, including 3,120 children ( < 18 years old), 16,310 adult (19-65 years old) and 3,802 elderly patients ( > 65 years old), were analyzed. Platinum compounds and pyrimidine analogues were the most common used chemotherapy agents for cancer patients. The overall incidence of AKI was 4.9%. Patients with urinary system malignancy (12.3%), hematological malignancy (10.2%) and nerve motor system malignancy (4.1%) have the highest incidence of HA-AKI. The top three types of chemotherapy drugs with the highest incidence of AKI were Purine analogues (30.1%), folic acid analogues (15.3%) and combinations of antineoplastic agents (14.1%). The nephrotoxicity of chemotherapy drugs was different among age groups. AKI is associated with a higher risk of in-hospital mortality and death after discharge. Conclusions: The risk of AKI in cancer patients varied in different age group, type of cancer and chemotherapeutic agents.
Health-related values of newly-diagnosed cancer patients: Qualitative analysis of oncology nurse-led discussions.
Authors: Shin Paul , Okpako Molly , Lynch Kathleen , Romano Danielle R. , Bernal Camila , Desai Anjali V. , Epstein Andrew S. 
Published: May 2020

e24163 Background: A novel, patient-verified summary documenting nurse-led discussions assessing health-related values of newly-diagnosed cancer patients has been implemented in outpatient gastrointestinal (GI) oncology clinics, but the content of these discussions has not previously been analyzed. Methods: Three interdisciplinary coders met and reviewed values summaries for 40 patients. Phase One meetings consisted of identifying key domains to guide line-by-line coding with ATLAS.ti software, codebook generation, and quality assurance of codebook fidelity. Phase Two meetings consisted of independent review and code categorization, followed by three successive consensus meetings of coders to identify themes. Results: Content analysis of 40 patient values summary documents revealed 5 distinct themes: Family, friends, and faith as sources of strength; strong family ties predominate definitions of living well. Despite this, patients stated that communication with loved ones about values and goals was limited; 35% of patients had not discussed core values prior to nurse-led discussion. Patients emphasized information processing and communication preferences as important definitions of selfhood. Patients defined treatment goals as survival and maintenance or return to “normal life” for as long as possible. When asked about treatment preferences during potential future crisis, patients emphasized quality of life over survival. Conclusions: Early, nurse-led values discussions provide important and unique data that are informative and actionable by clinicians in the delivery of person-centered care. Thematic analysis reveals that while family and friends are important, patients often had not discussed core values or care preferences with them. Although patients desire to live longer, treatment preferences during crisis are also shaped by expected quality of life from interventions. Assessment and creation of patient values summaries captures nuanced data that can facilitate discussion with loved ones and play a key role in surrogate decision-making during moments of crisis. Further mixed-methods analysis of patient variables ( e.g., age, stage) modifying values and impact on patient-reported outcomes is warranted.