bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of medical cannabis in treating anorexia and nausea in elderly cancer patients.
Authors: Nathan Rachel Andrea , Mupamombe Charles Tonderai , Walter Michelle , Case Amy Allen , Hansen Eric 
Published: November 2019

124 Background: The use of medical cannabis (MC) in cancer symptom treatment has been increasing. Since its legalization is limited to select states, there are few clinical trials that have studied the effectiveness and safety of MC, and even fewer studies in the elderly patient population. Given this, we aimed to evaluate the effects of MC on nausea, appetite, and body mass index (BMI) of elderly cancer patients. Methods: We conducted a retrospective chart review of patients age 65 and older prescribed MC in the year 2018 in an outpatient palliative care clinic at a comprehensive cancer center. Nausea and appetite were measured by numerical rating (0-10) and BMI was recorded with data collected at consecutive clinic visits before and after MC use. Results: Eight-three patients aged 65 and over were included in our analysis. Half of patients were age 65-70, while 12% were age 76 or older. More than half were male (58%) and Caucasian (92%). For patients with anorexia or nausea, 58% had previously used cannabis. For nausea, 58% were prescribed ondansetron, 53% were prescribed prochlorperazine or metoclopramide, and 20% were prescribed olanzapine. For anorexia, 24% were prescribed mirtazapine, 6% were prescribed dronabinol, and 1% were prescribed megestrol. The majority of patients used oil (64%), with one-third using vape (33%) and fewer using pill (17%) and powder (5%). Patients primarily used high THC (50%) or equal THC:CBD (45%) formulations initially, with only 7% using high CBD products. The median nausea and anorexia trended towards improvement, though neither was significant (delta nausea = 0.1, p = 0.81) nor anorexia score (delta anorexia = 0.7, p = 0.69). BMI worsened despite MC use (delta BMI 1.9, p < 0.001). Conclusions: In this study of elderly patients with cancer prescribed MC, more than half had previously used cannabis. Two-thirds of patients with anorexia were using MC first-line for appetite stimulation. The majority of patients used oil, with vape next most commonly used, and the vast majority of patients using high THC or equal THC:CBD initially. Use of MC was not associated with a significant improvement in nausea nor anorexia, and BMI significantly decreased despite MC use.
Pharmacogenomics: Personalizing palliative pharmacotherapy.
Authors: Scheckel Caleb , Kekic Adrijana , Edwin Mark 
Published: November 2019

126 Background: Pharmacogenomics (PGx) is a developing field in individualized medicine concerned with understanding genetic polymorphisms that may explain inter-individual variation in drug efficacy and toxicity. Understanding these polymorphisms is a key tool in guiding clinician’s selection and dosing of specific medications to optimally manage patient symptoms. Common pharmacogenes that impact analgesic prescribing include: CYP2D6, OPRM1, and COMT; for mood disorders: CYP2C19. This cross-sectional study explored the activity of pharmacogenes of clinical significance in palliative medicine with either Level 1 or 2 evidence. Methods: We performed PGx testing on 50 new referrals to the palliative medicine clinic with an active malignancy. Each patient underwent PGx testing with clinical pharmacist review and interpretation prior to their initial office appointment. Results: In our cohort 54% were men and the mean age was 64.7 (24-87). The average number of medications, medication allergies, and creatinine clearance were 10.5 (1-22), 1.3 (0-13), and 78.4 (31-120), respectively. Among the pharmacogenes impacting opiate and antiemetic prescribing, 14% (7/50) of patients were poor metabolizers of CYP2D6 and 8% (4/50) were rapid or ultra-rapid metabolizers. Another 60% (30/50) showed intermediate metabolism which would impact initial dosing. Poor metabolism of COMT or OPRM1 was seen in 8% (4/50) with another 36% (18/50) demonstrating rapid metabolism. Activity for the pharmacogene CYP2C19, which impacts many psychotropics, revealed 32% (16/50) rapid or ultra-rapid metabolizers and no poor metabolizers. Overall, 66% (33/50) of patients had pharmacogene activity suggestive of significant clinical impact necessitating either drug avoidance due to toxicity risks or substantial dose adjustment to be efficacious. Conclusions: Polymorphisms impacting pharmacotherapy were common in our cohort. Patients with difficult-to-control symptoms or multiple medication toxicities can utilize PGx testing as a guide to symptom relief. As PGx technology becomes readily accessible and economical, opportunities for patients to have precision genomic information guide healthcare decisions is expected to increase.
Multimorbidity, cancer, and symptoms: Using electronic health record data to cluster patients in multimorbidity phenotypes.
Authors: Gilbertson-White Stephanie , Srivastava Sanvesh , Li Yunyi , Laures Elyse , Saeidzadeh Seyedehtanaz , Yeung Chi , Chae Sena 
Published: November 2019

130 Background: Cancer-related symptoms are associated with decreased quality of life, increased health care utilization, and shorter life expectancy. There is limited understanding of how multiple chronic conditions (MCC) contribute to variability in symptoms experienced in the context of cancer. Data mining the EHR will allow us to use real clinical data to identify multimorbidity phenotypes based on the clinical similarity of patients. Purpose of this study is to identify distinct subgroups of patients based on the MCC and cancer diagnoses and describe differences across these subgroups. Methods: EHR data was extracted from adult patients (n=2977) newly diagnosed with cancer in 2017 at one academic medical center. The SEER cancer site/histology list was used to group cancer diagnosis. MCC present for >6 months on the problem list or ICD-10 billing data were used. K-Means and K-Modes clustering procedures, with K equaling 7, were used to cluster patients based on MCC. Results: The sample consisted of 58% women, 93% white, with mean age of 62.4 (16.1) years. The most frequent cancers were GI (17%), gynecological (14%), and pulmonary (10%). The most frequent MCC were hypertension (33%), anemia (24%), and metabolic diseases (21%). Seven clusters correspond to following primary cancer sites: GI, pulmonary, urinary, gynecological, breast, endocrine, and skin. The MCC rates varied significantly across different primary sites with hypertension being present in call clusters, but anemia was present only in GI and urinary system cancers clusters. Conclusions: K-Means and K-Modes clustering procedures, with K equaling 7, produced similar clusters of cancer primary sites and MCCs, indicating our findings are stable and replicable. Our data extraction methods and clustering techniques worked well and can be expanded upon. Our next step is to repeat the data extraction and clustering analysis with the full data from the data warehouse (>30,000 records). The identified multimorbidity phenotypes will be used as inclusion criteria for prospective research with patients to explore the relationships among MCCs and symptoms in the context of cancer.
Prognostic value of the Memorial Sloan Kettering (MSK) prognostic score (MPS) in pancreatic ductal adenocarcinoma (PDAC).
Authors: Lebenthal Justin , Zheng Junting , Glare Paul A. , O'Reilly Eileen Mary , Epstein Andrew S. 
Published: November 2019

133 Background: The MPS, a composite of the Neutrophil-Lymphocyte Ratio (NLR) and albumin, is an alternative prognostic tool to the Glasgow Prognostic Score (C-reactive protein and albumin). A retrospective analysis (jco.2016.34.26_suppl.36) of patients with PDAC suggested that the MPS predicts survival. This did not control for clinically relevant factors such as performance status (PS), metastatic sites, or cancer therapies. More discriminating prognostic tools are needed. Methods: A retrospective chart review identified patients at MSK with pathology-confirmed stage IV PDAC diagnosed from 2011 to 2014. An MPS scale of 0-2 was utilized: MPS = 0 for albumin ≥ 4 g/dl and NLR ≤ 4 g/dl, MPS = 1 for either albumin < 4 g/dl or NLR > 4 g/dl, and MPS = 2 for albumin < 4 g/dl and NLR > 4 g/dl. PS (ECOG or KPS) was abstracted from outpatient visit notes. Metastatic sites at initial MSK visit were assessed from cross-sectional imaging. Cancer therapies were characterized as 5FU-based, gemcitabine-based, experimental, and radiation to primary or metastatic sites. Thromboembolic (TE) diagnoses were also noted. Time-dependent Cox regression analyses identified clinical variables associated with overall survival (OS). Univariately significant variables were utilized in a multivariable regression model to interrogate their effect on the association of MPS and OS. Results: Univariate analyses in n = 833 stage IV PDAC patients identified higher MPS score, higher CA19-9 at diagnosis (n = 737), chemo, radiation, liver metastases, TE, hospital admission, and lower PS (n = 727) as associated with worse OS (p < 0.05). A multivariate model (n = 727) controlling for radiation, liver metastases, TE, admission, and PS demonstrated that higher MPS scores at diagnosis remained associated with worse OS (p < 0.001). Median OS in patients with MPS 0, 1, and 2 were 14.5 (95%CI: 12.9-17), 10.2 (9-11.6), and 6.2 (5.1-8.1) months, respectively. Conclusions: The MPS is an objective prognostic tool associated with OS in advanced PDAC independent of PS, disease characteristics, and types of cancer therapies. Future directions include prospective evaluation and application of the MPS to other PDAC disease settings and other malignancies.
Relationship of spiritual constructs to mental health PROs in adolescents with cancer.
Authors: Lyon Maureen , Grossoehme Daniel H. , Baker Justin N. , Friebert Sarah , Cheng Yao , Chrastek Jody , Thompkins Jessica , Tweddle Matthew , Wang Jichuan , Needle Jennifer 
Published: November 2019

136 Background: Global beliefs and goals form a meaning system, which plays a role in adjusting to stressors like cancer. Spirituality (search for the sacred) is a meaning system that can play a role in adolescent coping, and psychosocial adjustment to chronic disease. When malignancies occur during adolescence, there are long-term consequences to adjustment, functioning, and disease self-management. Methods: Data were obtained from 126 adolescents diagnosed with cancer at various stages and 4 sites in a longitudinal pediatric advance care planning intervention trial. Scales used: demographic; 2 spiritual scales (Brief-MMRS and FACIT-Sp v4); and 2 emotional PROMIS items (anxiety and depression). Bivariate relationships were analyzed. Structural equation modeling examined the relationship between spiritual and PROMIS items. Bootstrap with 1000 resamples was applied to due to sample size. Results: Mean age was 16.9 years (range: 14-20), with a mean time since diagnosis of 77 months (range: 1-232); 21% were on active treatment. The majority were female (57%) and white (79%). Most identified as spiritual (89%) and religious (83%). When asked if they believed they will be spiritually healed from cancer by a miracle, 49% reported “yes.” Adolescents viewing cancer as God’s punishment were more likely to have high depression (p = 0.03). Very or moderately spiritual teens were more likely to have high anxiety and high depression (p = 0.02). Meaning/peace (FACIT-Sp subscale) mediated feeling God’s presence on anxiety (β = -3.5; 95% CI: -9.2, -0.48) and depression (β = -4.6; 95%CI: -10.7, -1.1); and mediated religious identification on anxiety (β = -3.1; 95%CI:-6.9, -0.6) and depression (β = -4.1; 95%CI:-9.3,-0.24). Conclusions: Our findings are consistent with adult literature and a single longitudinal study of teens with cancer: spiritual distress (cancer is God’s punishment) is associated with poorer mental health outcomes, and meaning with positive outcomes. Adolescent anxiety and depression were inversely related to feeling God’s presence, and to identifying as religious; this effect was mediated by their sense of meaning/peace. Meaning-making is a modifiable process, opening a novel focus for intervention development. Clinical trial information: NCT02693665.
Factors impacting fertility preservation in children, adolescents, and young adults.
Authors: Mobley Erin Michele , Ryan Ginny L. , Sparks Amy E. , Monga Varun , Terry William W. 
Published: November 2019

139 Background: Fertility preservation (FP) prior to therapy is underutilized for those diagnosed with cancer as a child, adolescent or young adult (AYA). This study describes the factors impacting utilization of FP consultations and procedures among childhood and AYA cancer patients at the University of Iowa Health Care (UIHC). Methods: Patients were identified by the oncology registry at UIHC. Disease site, histology, date of diagnosis, sex, race, ethnicity, insurance, and zip code were gathered by the registrars. Disease site and histology were categorized using International Classification of Diseases-Oncology-3 (ICD-O-3). UIHC’s electronic medical record (EMR, Epic) was queried for ICD codes for FP consultation. Data from UIHC’s Reproductive Endocrinology and Infertility clinical database were merged with the primary data set to capture information about those who underwent FP. Rural-Urban Commuting Area codes incorporated a measure of rurality. Descriptive statistics and multivariate linear probability models were used to predict the probability of FP consultation and procedure. Results: From 2008-2017, 3,605 children and AYAs were treated for an invasive malignancy. Of the 637 (18%) who received a FP consultation, 162 (25%) underwent a FP procedure. Multivariate analyses showed that those with public insurance or no insurance, a diagnosis of a CNS tumor, melanoma, or miscellaneous neoplasm, and age over 30 years at diagnosis had a lower probability of having a consultation. The probability of undergoing a procedure was lower for female patients, those with germ cell tumor, melanoma, or carcinoma, seen by a pediatric-based provider, and diagnosed between 15-25 years of age. Conclusions: This study has important implications for survivorship and late effects research. The combination of sample identification via cancer registrars and linkage with EMR data could be used by others. The use of federal data to incorporate rurality is frequently overlooked. The use of this type of publicly available data would help improve the robustness of survivorship and late effects research through the inclusion of measures of rurality, health service availability, and economic indicators at varying levels of geography.
Serious illness communication among patients with head and neck cancer.
Authors: Buen Floyd , Martin Emily J , Wenger Neil , Buen Kirsten , Walling Anne M. 
Published: November 2019

2 Background: Head and neck cancer is associated with significant morbidity and mortality, yet little is known about the frequency and content of discussions addressing patients’ values, goals of care, and treatment preferences. Methods: Using an institutional cancer registry, we conducted a retrospective analysis of 70 decedents who underwent surgical treatment for squamous cell carcinoma of the head and neck. We abstracted patients’ medical records using a standardized template. An independent reviewer re-abstracted 20% of the records. For abstracted data pertaining to documented values, goals of care, and/or treatment preferences our inter-rater reliability was greater than 93%. Results: The mean age at diagnosis was 66 years and 69% were male. An enduring advance directive, a completed Physician Order for Life Sustaining Treatment form, and a serious illness conversation documented in the medical record were noted in 27%, 4%, and 49% of the medical records, respectively. Half of the documented goals of care discussions were held in the inpatient setting, over 50% were held in the last month of life, and 25% were held in the last week of life. These conversations involved specialist palliative care providers (47%), hematologist/oncologists (41%), hospitalists (32%), head and neck surgeons (21%), radiation oncologists (19%), and intensivists (18%). None of these discussions involved patients’ primary care providers. Of those with a known location of death, 58% died in the hospital and 4 out of 5 of these patients died during attempted cardiopulmonary resuscitation. Conclusions: In this retrospective analysis, serious illness communication was documented in the minority of patients who died of head and neck cancer. These discussions occurred late in the trajectory of illness. The continuity relationships of teams treating head and neck cancer patients (e.g., head and neck surgeon, radiation/oncologist and hematologist/oncologist) situate these clinicians in the best position to enact serious illness conversations. These data suggest that opportunities to have these discussions upstream are often missed.
Chronic conditions among advanced cancer patients and their spouse caregivers.
Authors: Ketcher Dana , Otto Amy , Reblin Maija 
Published: November 2019

20 Background: Chronic conditions and multimorbidity have been recognized to have negative impacts on costs of healthcare, quality of care, and well-being. The interdependence of patients and caregivers has also been highlighted, in that patient factors can impact caregiver outcomes and vice versa. Yet little research has been conducted on how the number of other health conditions among spouse caregivers (CGs) and advanced cancer patients impact their own and their partners’ well-being. Methods: Data were gathered as part of a prospective observational study of couples coping with advanced cancer. Patients had to have a cohabiting spouse/partner who identified as providing some care and also agreed to participate. Results: Patients rated their overall health slightly worse (scale 1-5, M = 2.85, SD = 0.95) than CGs ( M = 2.27, SD = 0.75). Patients also reported more total conditions ( M = 2.59, SD = 1.42) than CGs ( M = 1.4, SD = 1.14). Most patients (81%) reported at least one chronic condition other than cancer (44% of patients reported at least two other conditions); the most common conditions among patients were hypertension (43%), lung disease (36%), arthritis, and diabetes (both 24%). About 23% of CGs reported having no chronic conditions; 36% reported at least one and 41% reported at least two. The most common conditions among CGs were arthritis (40%), hypertension (39%), and heart disease, diabetes, and cancer (13% each). A greater number of CG conditions predicted greater depression symptoms in the patient ( B = 0.60, p = .040), controlling for patient conditions. More conditions among patients was a significant predictor of less patient social support ( B = -0.67, p = .017) and a marginally-significant predictor of greater perceived stress among caregivers ( B = -0.27, p = .064). A history of CG cancer predicted greater depression symptoms in the patient ( B = 2.3, p = .02). Conclusions: Chronic conditions and multimorbidity can have significant psychological consequences for both patient and CG. Clinicians, in addition to making an active effort to incorporate CGs into medical decision making and treatment planning, should also be aware of patient and caregiver multiple chronic conditions in order to provide more holistic care for patients.
Patient perceptions of treatment benefit in advanced cancer.
Authors: Patell Rushad , Einstein David Johnson , Halleck Jennifer , Dodge Laura , Buss Mary K. 
Published: November 2019

25 Background: Informed consent assumes accurate perceptions of potential treatment benefits and risks, yet many patients receiving palliative cancer therapies misperceive the likelihood of cure. Patients’ understanding of treatment benefits/risks beyond cure is unknown. We aimed to further explore patient perceptions of benefits/risks of palliative treatment in the era of novel therapeutics. Methods: We surveyed patients with advanced solid cancers and their oncologists regarding benefits/risks of palliative therapies. We assessed perceived likelihood of tumor response, survival benefit, symptom palliation and side effects, as well as information-seeking behavior. We used log binomial regression to estimate risk ratios (RR) and 95% confidence intervals (CI) of the association between misperception (patient perception minus physician’s perception) and various demographic, disease and treatment characteristics. Results: Of 119 patients enrolled: median age was 65 years (range 59–73), 55% male and 56% had prior treatment. Treatments included chemotherapy (60%), immunotherapy (25%) and targeted therapy (16%). Median misperceptions are shown in Table. Factors associated with decreased misperception included male gender (RR=0.70, 95% CI: 0.55–0.89), graduate level education (RR=0.63, 95% CI: 0.41–0.98) and targeted therapy (RR=0.54, 95% CI: 0.30–0.98). There was no correlation between misperceptions of tumor response and curability (r=0.13, P=0.15) or self-education (r=-0.04, P=0.69). Conclusions: Compared with their oncologists, patients’ overestimate not only curability but also chances of tumor response, symptom palliation and survival benefit; though they accurately perceive likelihood of toxicity. There is no correlation between perception of curability and other goals of therapy such as response rate and symptom palliation. Improvements in communication should focus on the likelihood of different treatment goals rather than treatment risks. [Table: see text]
Assessing oncology patients’ perceptions of treatment goals.
Authors: Ngo Phuong , Souders Lisa , Mull Jetta , Powell Stephanie , Hegazi Mohamed M. , Redman Rebecca A. 
Published: November 2019

26 Background: Metastatic disease is generally treated with palliative intent. An individual patient’s understanding of his or her treatment goal is highly variable and dependent upon multiple factors. Our study evaluated patients’ understanding of whether their treatment was for curative or palliative purposes and sought to identify factors associated with perception of treatment intent. Methods: This was a prospective study of 65 consecutive patients with stage IV solid tumor malignancies at a single institution. Patients were given a questionnaire during a routine follow up visit. Requested information included primary site of malignancy, stage, duration of treatment, whether they think the treatment is curative, and whether they think the treatment will help them live longer and/or relieve cancer-related symptoms. Patients also provided basic demographic information such as age, gender, marital status, race and education level. Their answers regarding cancer type, stage and length of treatment were compared with their medical records. Results: Median age was 64 with 37% males and 63% females. Of the 65 patients, 50.8% had some college or higher education. The primary malignancies consisted of 40% lung, 18.5% breast, 20% colorectal, and 10.8% melanoma. Forty-nine percent of patients were metastatic at the time of diagnosis, and 55.4% of patients had received two or more lines of therapy for metastatic disease. Nine percent of patients could not identify their primary malignancy or did not know, and only 76.9% of patients knew their cancer is metastatic. Only 29.2% of patients knew their treatment was not curative while 30.8% thought it was, and 40% did not know. The majority of patients (86.2%) believed their treatment would help them live longer and 67.7% believed the treatment would alleviate their symptoms. Conclusions: In our study, less than one-third of patients receiving treatment with palliative intent reported understanding that the goal of his/her treatment was not curative. Factors influencing a patient’s perception of treatment goals are many and include those specific to patients, their cancers, and providers. Ongoing studies will focus on identifying factors most strongly associated with a patient’s perceived intent of treatment.